TRANSMISSION DYNAMICS OF ENTERIC BACTERIA IN DAY-CARE CENTERS

Abstract

Ekanem, E. E., H. L. DuPont (U. of Texas Medical School at Houston, Houston, TX 77030), L. K. Pickering, B. J. Selwyn and C. M. Hawkins. Transmission dynamics of enteric bacteria in day-care centers. Am J Epidemiol 1983;118:562–72. The role of fomites in the transmission of diarrhea in day-care centers was evaluated. During a nine-month period (December 1980–August 1981), inanimate objects and hands of children and staff in five Houston day-care centers were cultured monthly and again during outbreaks of diarrhea. Air was sampled from the classrooms and bathrooms using a single-stage sieve sampler. When a diarrhea outbreak occurred, stool specimens were collected from III and well children and from staff in the affected rooms. Multiple pathogens accounted for 3 of 11 outbreaks. The rates of isolation of fecal coliforms from hands and classroom objects on routine sampling were 17% (22/131) and 13% (8/64), respectively. During outbreaks of diarrhea, fecal conforms were recovered with significantly greater frequency from hands (32%; p < 0.005) and from classroom objects (36%; p < 0.005). There was no difference in the level of fecal contamination in the toilet areas during outbreak and nonoutbreak periods. Shigella was not isolated in the study; salmonella was Isolated on one occasion from a table during an outbreak of salmonellosis. Contamination of hands, communal toys and other classroom objects appeared to play a role in the transmission of enteropathogens in day-care center diarrhea outbreaks and helped to explain the presence of multiple pathogens among those affected.