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HVAC design to reduce risk of communicable disease in child care center infant and toddler rooms.

Children in childcare programs have a greater incidence of upper
respiratory infections (Fleming et al. 1987, Hurwitz et al. 1991,
Kamper-Jorgensen et al. 2006, and Wald et al. 1991) and increased rates
of invasive streptococcus pnuemoniae infections compared to children
cared for at home,. (Takala et al. 1995, Gessner et al. 1995). Studies
have found that child care groups with less than 6 children have lower
rates of respiratory infections than groups with 6 or more children
(Bradley, 2003) and that day care cohorts have an amplifying effect that
enhances the spread of pneumococcal serotypes within the population
(Hoti et al. 2009). Young children are prolific disseminators of
influenza viruses - they are more frequently responsible than adults for
secondary transmission within households, usually shed more virus, and
do so for longer periods of time than adults (World Health Organization
Writing Group. 2006). Greater opportunities for exposure to more
children of the same age and other environmental aspects of CCCs may
boost susceptibility hvac and exposure to viruses and bacteria.

Increased risks of infectious diseases in CCCs are not limited to
respiratory diseases nor to children. Other serious infectious diseases
including meningitis (Mohle-Boetani et al. 1999), and hepatitis A
(Venczel et al. 2001) and cytomegalovirus have been linked to CCC
environments. The most important infections acquired by adults working
in CCCs are those with the potential for significant clinical morbidity,
such as hepatitis A, or those that generate concern, such as
cytomegalovirus (CMV) and parvovirus B19, because of their potential to
produce congenital infections in pregnant women. (Reves. 1992). CMV is a
leading cause of deafness and an important contributor to learning
disabilities (Raynor. 1993). Women in day care work are at greater risk
of acquiring a primary CMV infection during pregnancy than other women
(DeMello et al. 1996, Murph et al. 1991). A recent seroprevalence study
in the Netherlands showed that female care givers have more than a
two-fold increased risk of a primary CMV infection (Stelma et al. 2009).

Current infectious disease prevention and control efforts inchildcare programs involve a combination of immunization, exclusion ofsymptomatic individuals, and hygienic interventions (Stevenson et al.2009). State licensing agencies have extensive administrative controlrequirements that address infectious hazard risks including minimumstaffing levels, requirements for vaccinations (for staff and children),personal protective equipment such as gloves, and uniform precautionssuch as hand washing, in standard operating procedures to protectchildren and staff from endemic infections. In contrast toadministrative controls, by and large, state and local governments havenot developed regulations to mitigate potential infection risks throughHVAC code requirements. The extreme diversity in CCC programs andfacilities makes this difficult.

CCCs range in size from small "faith-based" organizations
in church basements to large free-standing buildings with hundreds of
children. There is no single definition of what constitutes a CCC,
according to the US Census Bureau, "organized care facilities"
(including day care centers, nursery schools and head start programs),
cared for nearly one-fourth of pre-school hvac website children in 2005 (Laughlin.
2005) Day care centers (which cared for about 14% of pre-school
children) were more commonly used than nursery or pre-schools; most
provide full-time care for children ages 6 weeks to 5 years; many also
provide after school care for older children. Many large organizations
sponsor/subsidize large day care centers - frequently these are
co-located on governmental, institutional (e.g., medical center),
organization and corporate properties (e.g., university campuses, office
and apartment community complexes, and military bases).

Large day care centers typically contain 2-10 child activity rooms,
each with 2-4 care givers and 10-20 children in age-limited cohorts. The
children take breakfast, lunch and snacks, naps, and engage in play
activities (e.g., singing, dancing, etc.) together for 7-9 hours per
day. Child diapering, toileting and hand washing are accomplished in an
open area where child minders can monitor other children when helping

Stevenson et al. (2009) have called attention to the need to
consider CCC children and staffs in preparations for influenza
pandemic(s). The 2009-2010 H1N1 pandemic disproportionately affected
pregnant women (they were at much higher risk of complications) and
children (ages 1-4 years had by far the click here highest incidence of
hospitalization) than other population groups (Creanga. 2010, Jhung.
2010). Moreover, more than 95% of child care center workers are women
(BLS. 200 cool . Influenza pandemics may cause closures of CCCs that could
disrupt critical organizations (such as hospitals, government agencies,
major companies and the military) and threaten the continued viability
of CCCs.


Wald, E.R., Guerra, N.N., and C.C. Byers. 1991. Frequency and
severity of infections in day care: three-year follow-up. Journal of
Pediatrics, 118: 509-514.

World Health Organization Writing Group. 2006. Nonpharmaceutical
interventions for pandemic influenza, international measures. Emerging
Infectious Disease, http://www.cdc.gov/ncidod/EID/vol12no01/05-1370.htm.

NOTE: The opinions expressed in this manuscript are the
authors' and do not represent official policy of the US Department
of Defense, U.S. Army, or Walter Reed Army Medical Center.



Larry Dlugosz is Chief of Industrial Hygiene Service in the
Department of Department of Preventive Medicine, Walter Reed Amy Medical
Center, Washington, DC. Wei Sun is Principal, Director of Engineering at
Engsysco Inc., Ann Arbor MI.

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