Occupational risks for child-care providers and teachers

Article Abstract:

The results of previous studies indicate that the risk of contracting a number of infectious diseases is increased by exposure to large numbers of children in child-care facilities. Increases in otitis media (ear infection), bacterial meningitis, and intestinal and respiratory infections have been documented. Although both children and adults in these environments are at increased risk, research has largely concentrated on children. A study by Gillespie and colleagues published in the April 18, 1990 issue of The Journal of the American Medical Association identified some epidemiologic features of parvovirus B19 infection which concern adults. This infection, which causes erythema infectiosum, is an occupational risk for adults who work with children. During an outbreak of erythema infectiosum, adults were tested for current or previous infection with parvovirus B19. Nineteen percent of susceptible adults were infected during this outbreak and 35 percent of those infected had symptoms. The most common manifestation of this virus is a contagious skin rash; other complications include acute arthritis in adults and chronic anemia in immunocompromized individuals. In pregnant women the infection can cause a condition known as fetal hydrops or fetal death. However, less than one percent of pregnant teachers would be expected to experience a bad fetal outcome during an erythema infectiosum outbreak, and the incidence in pregnant women not working in a child-care facility would be even lower. Serologic screening of women of child-bearing age is not warranted from a public health point of view. If pregnancy occurs and it is determined that the woman has no immunity, then appropriate precautions concerning occupational exposure should be taken. It is hoped that additional information will be forthcoming concerning prevention of parvovirus B19 infection. (Consumer Summary produced by Reliance Medical Information, Inc.)

Risk factors, Environmental aspects, Occupational diseases, Parvoviruses, editorial, Erythema infectiosum

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The effect of diaper type and overclothing on fecal contamination in day-care centers

Article Abstract:

Babies and toddlers are more likely to develop intestinal infections than any other age group, especially if they attend day-care centers. Fecal contamination on hands, toys, and other objects is more common when children have diarrhea, and increases the spread of infection. Precautions against contamination of the environment, including good handwashing practices, cleaning surfaces of furniture and toys, and removing children with infectious diarrhea, reduce intestinal infections among babies and toddlers. The extent of fecal contamination also varies with the type of diaper and clothing worn by the children. Recent state proposals promote or require the use of cloth diapers, but this may increase fecal contamination. To test the effects of the type of diaper worn, 141 children in 10 rooms in 4 day-care centers were assigned to wear cloth or disposable diapers, and 2,946 fecal samples were analyzed. It was found that there was substantial fecal coliform contamination of the environment during outbreaks of diarrhea. In addition, greater contamination occurred when children did not wear outer clothing over their diapers. When high absorbency paper diapers were used, contamination was significantly lower than when cloth diapers were used. The problems of solid waste management and closing landfills will not go away, and approximately two percent of the garbage by weight is paper diapers. Many states are looking into banning disposable diapers in day-care centers, but the gains in waste management must be weighed against greater contamination and the spread of infectious diseases among small children. The use of paper diapers and overclothes is the best way to minimize fecal contamination and reduce the incidence of intestinal infections among infants and children attending day-care. (Consumer Summary produced by Reliance Medical Information, Inc.)

Infection, Infants, Clothing, Day care centers, Baby clothing, Diapers, Gastrointestinal system

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The Case for Conservative Management of Early HIV Disease

Article Abstract:

Early treatment of HIV infection may not be appropriate for all patients. Experts recommend early treatment to prevent viral mutation and immune system damage. Combination drug therapy in HIV infection requires adherence to complex dosing instructions, and failure to comply with prescribed therapy contributes to the development of drug-resistant infection. Antiviral therapy can cause significant, debilitating adverse effects. Physicians should evaluate the likelihood of patient compliance, and balance potential risks and benefits of aggressive treatment in each HIV patient.

Complications and side effects, HIV infection, Drug therapy, HIV infections, Patient compliance, Drug therapy, Combination, Combination drug therapy

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