Day-care and meningococcal disease in young children

Abstract

The Republic of Ireland has the highest incidence of meningococcal disease in Europe with 40% of all cases occurring in children under the age of 5 years. Attending day-care increases the risk of certain infections, including Haemophilus influenzae type b (Hib) meningitis. The risk of meningococcal disease associated with day-care is not known. We conducted a case-control study among pre-school children with 130 laboratory-confirmed cases and 390 controls, matched on age, gender and place of residence, to determine if day-care attendance was a risk factor for meningococcal disease. Multivariate analysis showed that day-care attenders had a lower risk of disease than non-attenders (OR 0.3, 95% CI 0.1-0.7) whereas the number of adults in a household, and household crowding were independent risk factors for disease. Asymptomatic carriers of Neisseria meningitidis are the main source of transmission and these carriers are usually adults. Regular day-care attendance may reduce this risk by removing children from close and prolonged contact with adults.

What is the evidence for giving chemoprophylaxis to children or students attending the same preschool, school or college as a case of meningococcal disease?

“…The risk assessment should take into account duration and closeness of contact, as the risk of further cases is likely to be higher in settings similar to households, where risk of exposure to respiratory droplets would be more likely. Some studies found a higher risk for IMD in more crowded household settings [51,[83][84][85] and crowded conditions were described in several day-care-associated outbreaks in the USA [13,14]. Thus children in the same group as the index case who have spent long periods in the same room (e.g.…”

Effectiveness of Serogroup C Meningococcal Polysaccharide Vaccine: Results from a Case‐Control Study in Quebec

“…However, it is difficult to disentangle the independent effects of socioeconomic and demographic variables that are highly correlated. For families with a large number of children and crowded living conditions, an increased risk of invasive meningococcal disease has already been noted elsewhere [28][29][30][31]. The association with socioeconomic status is not surprising, [32,33], but knowing what biological mechanisms are involved is difficult.…”

Risk factors for invasive meningococcal disease in southern Queensland, 2000−2001

“…20 Other studies have suggested that attendance at childcare centres is not associated with a risk of meningococcal disease and might reduce the risk of IMD by removing young children from close and prolonged contact with adults (carriers). 21,22 Australian guidelines limit chemoprophylaxis in childcare settings to children and staff in the same room group attended by a single index case. 23 This is on the basis of same room ('household') contact for a period of more than 4 h in the 7-day period preceding onset of IMD in the case.…”