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Secondary Haemophilus influenzae Type b in Day-care FacilitiesRisk Factors and Prevention
David W. Fleming, MD;
Mark H. Leibenhaut, MD;
Demetrius Albanes, MD;
Stephen L. Cochi, MD;
Allen W. Hightower, MS;
Sue Makintubee, RN;
Steven D. Helgerson, MD, MPH;
Claire V. Broome, MD;
the Contributing Group
JAMA. 1985;254(4):509-514.
Abstract
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The risk factors for acquisition of secondary day-care—associated Haemophilus influenzae type b disease were evaluated in a cohort of children in Seattle—King County, Washington; Atlanta; and the state of Oklahoma. During the study period, 129 primary cases were identified in children less than 5 years old who attended day-care facilities. In ten instances (8%), a secondary case occurred between one and 60 days after a primary case in the same classroom. Risk of secondary disease in classroom contacts was strongly age related: 2.4% in children 0 to 11 months old, 1.2% in children 12 to 23 months old, and 0.0% in children 24 to 59 months old. Controlling for age, children attending day-care more hours per week were more likely to transmit or acquire secondary disease. Risk of secondary disease for children in other classrooms at a center where a case had occurred was not significantly greater than risk of primary disease. Administration of rifampin to classroom contacts of a child with invasive H influenzae was effective in preventing secondary cases (95% confidence interval for rifampin efficacy, 47% to 100%). For children 0 to 23 months old not treated with rifampin, risk of secondary disease was 2.7% (95% confidence interval, 1.1% to 4.3%), a risk approaching that reported in household contacts.
(JAMA 1985;254:509-514)
Author Affiliations
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From the Respiratory and Special Pathogens Epidemiology Branch (Drs Fleming, Cochi, and Broome) and the Statistical Services Activity (Mr Hightower), Division of Bacterial Diseases, Centers for Disease Control, Atlanta; the Columbia University College of Physicians and Surgeons, New York (Dr Leibenhaut); the National Cancer Institute, National Institutes of Health, Bethesda, Md (Dr Albanes); the Office of Epidemiology, Georgia Department of Human Resources, Atlanta (Dr Cochi); the Oklahoma State Department of Health, Oklahoma City (Ms Makintubee); and the Seattle-King County (Washington) Department of Public Health, Seattle (Dr Helgerson).; Members of the Contributing Group were as follows: Janice C. Boase, RN, MS, and Kathleen E. Johnson, RN, MPH, Seattle-King County (Washington) Department of Public Health, Seattle; Harold Heijbel, MD, Division of Field Services, Epidemiology Program Office, located at the Oklahoma State Department of Health, Oklahoma City; Gregory R. Istre, MD, Oklahoma State Department of Health; Gail A. Bosley, MS, and George M. Carlone, PhD, Respiratory and Special Pathogens Laboratory Branch, Division of Bacterial Diseases, Centers for Disease Control, Atlanta; and J. David Smith and R. Keith Sikes, DVM, MPH, Office of Epidemiology, Georgia Department of Human Resources, Atlanta.
Footnotes
Reprint requests to the Respiratory and Special Pathogens Epidemiology Branch, Division of Bacterial Diseases, Centers for Disease Control, 1600 Clifton Rd NE, Atlanta, GA 30333 (Dr Fleming).
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