Page 13 - An epidemiological perspective on gastroenteritis in child day care centers • Assessment of impact and risk

General introduction
General introduction Introduction
Child Day Care Centres (DCCs) have been amongst us since 18401 and have become an increasingly prominent feature of modern child rearing in the industrialized world, including the Netherlands. Quintupled since 19892, half of the Dutch preschool population (350,000 children) currently spends an average of 2.5 days in one of the 6,000 DCCs active in the Netherlands, ranking our country second only to Denmark in the utilization of child day care services in Europe.3 Although the number of DCC facilities in the Netherlands has stabilized over the last years, it is unlikely that the Netherlands will stop relying on their services any time soon. The DCC is in fact an institution here to stay, and its presence poses unique challenges regarding infectious disease control.
‘[...] Ever since our children started attending day care, my wife and I, as well as my children, have been constantly ill. I developed polyposis nasi, my son multiple episodes of otitis, my daughter chronic blefaritis and my wife required multiple antibiotic treatments for persisting nasopharyngitis. These disease episodes have had a tremendous impact on our family. It cannot be normal to be sick so much, can it [...]?’
Actually, it can. In fact, the syndrome the concerned parent describes has a name: Daycaritis.4 Daycaritis refers to the phenomenon that healthy infants and toddlers in DCCs are at anincreasedriskfordevelopingcommonand, generally, mild childhood illnesses. Daycaritis includes a broad spectrum of syndromes affecting the respiratory and gastrointestinal tract (‘colds’, bronchiolitis, otitis media, conjunctivitis, pharyngitis, gastroenteritis, etc.) as well as exanthematous syndromes (dermatitis, pustulosis, etc.). Although DCCs have been around for more than 170 years and the intention has always been to support children’s (healthy) growth and the society as a whole,
Email from a concerned parent, 2013
the epidemiology and control of daycaritis have received relatively little attention by the scientific community. As a result, the majority of recommendations in current international DCC-guidelines for infection control are expert- rather than evidence-based.5, 6
The Netherlands would benefit from a scientific assessment that aims at improving our understanding of the epidemiology of daycaritis. This thesis contributes to that assessment. However, it is beyond the scope of this thesis to study the epidemiology of all major childhood diseases belonging to the daycaritis phenomena. This thesis, therefore, focusses on one of its
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1 Introduction