Hepatitis A in day-care centers in Jefferson and Orleans parishes of Louisiana
Description
Statement of the Problem. The Epidemiology Unit of the Louisiana Department of Health and Human Resources had determined previously, through a systematic investigation, that children with subclinical hepatitis A infections in day-care centers (DCC) were transmitting the virus to parents and to other family members The secondary spread of hepatitis from DCC children to adult family members is known to be costly in terms of morbidity and economics. A cost of illness survey was conducted by this investigator and associates on 17 households affiliated with an outbreak center in 1977. The estimated minimum cost, including lost wages, was $1,952 per household The purpose of this study was to describe factors associated with hepatitis A outbreaks in DCC of Jefferson and Orleans Parishes and to determine which factors would differentiate outbreak from non-outbreak centers. Nine (9) research questions were addressed. Is there a difference between outbreak and non-outbreak DCC in relation to: (1) handwashing practices? (2) diapering practices? (3) employee characteristics and policies? (4) child characteristics? (5) water usage? (6) sanitarian review index? (7) demographic characteristics? (8) cleaning procedures? (9) hours of day-care operation? Methods and Material. Three (3) instruments were developed to collect data for this study: an Interview Schedule, an Observation Guide, and a Sanitarian's Inspection Schedule for Day-Care Centers. The Interview Schedule was designed to record information on 43 study variables from interviews with center directors. The purpose of the Observation Guide was to record observations on some of these same variables during on-site visits to DCC. The third tool, Sanitarian's Inspection Schedule for Day-Care Centers, was constructed from a standardized form routinely used by Louisiana Department of Health sanitarians for recording conditions in DCC Between July and November 1980, letters were written to day-care center directors informing them of the study. Appointments were then scheduled to conduct interviews and to perform observations and sanitarians' inspections of the centers The study sample consisted of 8 DCC which experienced hepatitis outbreaks in 1979 and a stratified random sample of 28 non-outbreak centers Data from coded questionnaires were key punched to computer cards and cross tabulation tables with raw scores and percentages were developed on study variables by outbreak status. Chi square tests were performed on all nominal level data and the t test was used on interval level data. The SPSS computer program was used for the data analysis Findings and Conclusions. Statistical analyses revealed that 5 of the 43 study variables selected for examination were significantly different (p < .05) between outbreak and non-outbreak DCC: (1) handwashing supervision after bathroom use, (2) a specific area designated for diapering, (3) employees who served food and changed diapers, (4) the number of children in diapers, and (5) the number of operation hours per day These findings suggest that a stringent program of personal hygiene for center children and employees, adherence to specific rules regarding diapering, restriction of the number of non-toilet trained children admitted, and restriction to an average of 10 or less hours of daily operation may decrease the risk of hepatitis A outbreaks in DCC Since the results of this study cannot be generalized to all DCC, it is recommended that similar studies be conducted in other communities and in other care facilities Certain factors identified in this study appeared to contribute to the transmission of hepatitis in DCC. Based on these findings, the investigator plans to develop a handbook that will assist DCC directors in formulating policies necessary for the prevention and/or control of hepatitis A in their centers