Hepatitis Infections in the Day-Care Setting

The hepatitis session reviewed current knowledge of the epidemiology and public health importance of hepatitis A (HAV) and hepatitis B virus (HBV) in day care centers (DCCs), current recommendations and prevention measures, areas that need additional research, and the potential for new preventive measures. HEPATITIS A The clinical characteristics, modes of transmission, risk factors for day-care-related outbreaks, and characteristics of hepatitis A virus outbreaks have been well described previously.1 Within the day-care setting, HAV is transmitted via the fecal-oral route, either person to person (between children and staff); via contaminated food (often in association with individuals who prepare food and care for diapered children); or possibly via fomites on contaminated surfaces or toys. In young children, in contrast to adults, hepatitis A may be difficult to recognize, as clinical illness is frequently nonspecific and mild, consisting primarily of malaise, nausea, fever, and diarrhea. Fewer than 5% of children under 3 years of age and only about 10% of those 4 to 6 years of age develop jaundice and are thus easily recognized as having hepatitis. Consequently, recognition of hepatitis A outbreaks in the day-care setting is often dependent upon recognizing hepatitis A in adults (parents or staff) who have had contact with day-care centers (DCCs). The initial recognition of DCCs as important sources of hepatitis A virus transmission both within the centers and in the communities they serve occurred in the mid-1970s.2,3 Early studies focused on describing the characteristics of DCCs in which hepatitis A outbreaks occurred, including DCCs with large numbers (≥50) of children in diapers and centers that are open more than 15 hours per day.2