CRYPTOSPORIDIOSIS IN THE CHILD-CARE SETTING

Cryptosporidiosis is an infectious diarrheal disease caused by the Cryptosporidium parasite. Cryptosporidiosis is a common cause of diarrhea in children, especially those in child-care settings. Symptoms usually include watery diarrhea and stomach ache but can also include nausea and vomiting, general ill feeling and fever. Healthy people who contract cryptosporidiosis almost always get better without any specific treatment. Symptoms can come and go for up to 30 days but usually subside in less. However, cryptosporidiosis can cause severe illness in persons with compromised immune systems, such as those with HIV infection or those taking drugs that suppress the immune system. Cryptosporidiosis is spread through fecal-oral transmission by feces of an infected person or an object that has been contaminated with the infected person's feces. Infection can also occur if someone ingests food or water contaminated with the parasite.

Cryptosporidiosis outbreaks in child-care settings are most common during late summer/early fall (August/September) but may occur at any time. The spread of cryptosporidiosis is highest among children who are not toilet-trained and higher among toddlers than infants, probably due to the toddlers' increased movement and interaction among other children. For child-care providers, the risk is greatest for those who change diapers.

Cryptosporidium is tougher to kill than most disease-causing organisms. The usual disinfectants, including most commonly used bleach solutions, have little effect on the Cryptosporidium parasite. An application of a 3 percent concentration of hydrogen peroxide or a 1 percent concentration of ammonia seem to be the best choices for disinfection during an outbreak of cryptosporidiosis. However, because ammonia has a strong odor and produces hazardous gas when mixed with bleach or other chlorinated solutions, hydrogen peroxide is probably the best choice in the child-care setting.

If an outbreak of cryptosporidiosis occurs in the child-care setting:

· Contact your state or local health department. Health officials may require negative stool cultures from the infected child before allowing return to the child-care setting.

· Exclude any child or adult with diarrhea until the diarrhea has ceased. Children who are infected with cryptosporidium but do not have diarrhea may be allowed to return.

· Make sure that everyone in the child-care setting practices good hand-washing technique, using disposable towels. Wash your hands after using the toilet, after helping a child use the toilet, after diapering a child, and before preparing or serving food. (Note: In larger facilities, when staffing permits, people who change diapers should not prepare or serve food.) Have children wash their hands upon arrival at your child care facility, after using the toilet, after having their diapers changed (an adult should wash an infant's or small child's hands), and before eating snacks or meals.

· Disinfect toys, bathrooms and food preparation surfaces daily.

· Notify parents of children who have been in direct contact with a child who has diarrhea. Parents should contact the child's physician if their child develops diarrhea.

· Make sure children wear clothing over their diapers to reduce the opportunity for diarrheal leakage.

· Instead of a bleach solution, use a 3 percent concentration of hydrogen peroxide to soak possibly contaminated surfaces for 10 minutes to disinfect them. (This is not a routine measure but may be necessary if an outbreak - usually two or more cases in the same child-care group - occurs.)

· Notify any child-care provider, the parents of any children, or any household contacts of a person known to have an impaired immune system. They should consult their physicians.