PROSPECTIVE-STUDY OF DIARRHEAL OUTBREAKS IN CHILD LONG-DAY-CARE CENTERS IN WESTERN SYDNEY

Objectives: To investigate outbreaks of diarrhoeal illness in children attending long-daycare centres (LDCs), to characterise parasitic, bac terial and viral isolates from the children's faeces and to identify i ndividual and LDC risk factors for diarrhoea. Design: Eleven-month pro spective case-control study of diarrhoeal outbreaks among children in LDCs. Subjects: 2368 children attending 35 LDCs in the western Sydney area. Main outcome measures: Frequency of diarrhoeal outbreaks, rate o f attack and spread to family members; pathogens isolated from stools; and individual and LDC risk factors. Results: The overall incidence o f diarrhoeal disease was low (0.28 outbreaks per centre per year and 0 .056 outbreak-associated cases per child-year). Attack rates during ou tbreaks varied widely (4%-55%; mean, 15%), as did secondary spread rat es to family members (1%-15%; mean, 9%). Pathogens were isolated from 7% of symptomatic children and 7% of controls; no outbreak was shown t o be caused by a recognised pathogen. Children with outbreak-associate d diarrhoeal illness were more likely to have suffered vomiting, poor appetite, lack of energy, fever and to have taken antibiotics in the p revious week than other children. Hygiene practices varied widely amon g centres. Conclusions: We found low incidence and morbidity from diar rhoeal illness in Australian urban LDCs. Diarrhoea in children in LDCs may be caused predominantly by non-infectious factors such as diet an d antibiotic exposure. Current hygiene measures in LDCs seem adequate to prevent and contain outbreaks of infectious diarrhoea.