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Associate Professor of Sociology, University of Virginia 

More Daycare Disease

Bryce J. Christensen and Robert W. Patterson

How do young children contract Streptococcus pneumonia, a pathogen that can cause not only pneumonia but also acute sinusitis, otitis media (an ear infection), bacterial meningitis, bacteremia, and sepsis? It seems one prime way infants and toddlers catch this germ is by spending time in a daycare center. The role of daycare in spreading this worrisome microbe receives detailed attention in a study by health researchers at the National Institute for Health and Welfare in Helsinki, Finland.

By studying the children attending three daycare centers in or near Tampere, Finland, the authors were able to analyze just how Streptococcus pneumonia spreads. Through careful medical diagnoses and subsequent statistical analysis, the researchers establish that “65% of acquisitions [of Streptococcus pneumonia] in day care attendees were from fellow day care attendees, 25% from the community, and only 10% from family members.”

After further investigation, the researchers calculate that an “average [of] 2.7 new outbreaks of pneumococcal carriage initiate in a day care cohort each month. While 39% of outbreaks [involved only a single child], the mean [or average] outbreak size was 7.6 individuals and the mean length of an outbreak was 2.8 months.”

The researchers regard these “micro-epidemics” within daycare centers as a key to transmission of Streptococcus pneumonia in the general population. “Transmission within day care centres,” they assert, “is the driving force of pneumococcal transmission in a [general] population. In particular, outbreaks of pneumococcal carriage in day care centres cause an amplifying effect that contributes in maintaining circulation of pneumococci in the population.”

In contrast, the new analysis concludes: “The role of families in creating and maintaining micro-epidemics is minimal. This is due to the smaller size of families in comparison to day care centres and to the significantly lower susceptibility of adults compared to children.”

Given the current political sensitivities surrounding any issue linked to maternal employment, it is perhaps entirely predictable that the authors would conclude by stressing the importance of vaccinations for children. But this study may prompt other thoughts among those who care most about protecting young children—and the broader community—from disease. Perhaps it is time to think not about how to vaccinate more children but how to get them out of daycare and into maternal homecare.

(Fabian Hoti et al., “Outbreaks of Streptococcus Pneumoniae Carriage in Day Care Cohorts in Finland: Implications for Elimination of Transmission,” BMC Infectious Diseases 9:102, June 27, 2009, emphasis added.)