Caring for Our Children (CFOC)

Chapter 7: Infectious Diseases

7.4 Enteric (Diarrheal) Infections and Hepatitis A Virus (HAV)

7.4.0 Disease Surveillance of Enteric (Diarrheal) and Hepatitis A Virus (HAV) Infections

The child care facility should cooperate with local health authorities in notifying all staff and parents/guardians of other children who attend the facility of possible exposure to hepatitis A, and diarrheal agents including Shiga toxin-producing E. coli (STEC), Shigella, Salmonella, Campylobacter, Giardia intestinalis, and Cryptosporidium.
Intestinal organisms, including hepatitis A virus (HAV), cause disease in children, caregivers/teachers, and others in the household including close family members (1-7). Disease has occurred in outbreaks within centers and as sporadic episodes. Although many intestinal agents can cause diarrhea in children in child care, rotavirus, other enteric viruses, Giardia intestinalis, Shigella, and Cryptosporidium have been the main organisms implicated in outbreaks.

Caregivers/teachers should observe children for signs of disease to permit early detection and implementation of control measures. Facilities should consult the local health department to determine whether the increased frequency of diarrheal illness requires public health intervention.

Children who have completed the immunization series for rotavirus and HAV are likely to be protected against infections with these pathogens (1,2).

Sample letters of notification to parents/guardians that their child may have been exposed to an infectious disease can be found in the current publication of the American Academy of Pediatrics' (AAP's) Managing Infectious Diseases in Child Care and Schools. For additional information, consult the current edition of the Red Book from the American Academy of Pediatrics (AAP).

Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home
RELATED STANDARDS Inclusion/Exclusion/Dismissal of Children
  1. Centers for Disease Control and Prevention. 2006. Prevention of hepatitis A through active or passive immunization. MMWR 55 (RR07).
  2. American Academy of Pediatrics, Committee on Infectious Diseases. 2007. Policy statement: Hepatitis A vaccine recommendations. Pediatrics 120:189-99.
  3. Shane, A. L., L. K. Pickering. 2008. Infections associated with group child care. In Principles and practice of pediatric infectious diseases, eds. S. S. Long, L. K. Pickering, C. G. Prober. 3rd ed. Philadelphia: Churchill Livingstone.
  4. Pickering, L. K., D. G. Evans, H. L. Dupont, et al. 1981. Diarrhea caused by Shigella, rotavirus and Giardia in day care centers; prospective study. J Pediatr 99:51-56.
  5. Hadler, S. C., H. M. Webster, J. J. Erben, et al. 1980. Hepatitis A in day care centers: A community-wide assessment. N Engl J Med 302:1222-27.
  6. Centers for Disease Control and Prevention. 2009. Prevention of rotavirus gastroenteritis among infants and children. MMWR 58 (RR02).
  7. Bartlett, A. V., B. A. Jarvis, V. Ross, et al. 1988. Diarrheal illness among infants and toddlers in day care centers: Effects of active surveillance and staff training without subsequent monitoring. Am J Epidemiol 127:808-17.