Cytomegalovirus as an occupational risk in daycare educators.

BACKGROUND: Cytomegalovirus (CMV) infection continues to be an important occupational risk in the daycare setting. A comprehensive update of scientific evidence is timely to inform and promote appropriate preventive measures. METHODS: A review of the literature was conducted to examine the evidence for an occupational risk of CMV infection in daycare educators. Sources included Medline, government documents and additional references from published bibliographies. The key words used for searches were 'child day care centres' or 'nurseries' and 'cytomegalovirus' or 'cytomegalovirus infection'. RESULTS: EIGHT CMV SEROPREVALENCE STUDIES ON DAYCARE EDUCATORS IN INDUSTRIALIZED COUNTRIES WERE FOUND: four in the United States, three in Canada and one in Italy. Risk factors for seropositivity were older age, nonwhite race, foreign birth, birth in a low- or middle-income country, diaper changing, having children at home, and a child to educator ratio greater than 6:1 in children 18 to 35 months of age. Risk factors for seroconversion were younger age and working with young children. These studies suggest that daycare centres may be a high-risk setting for CMV infection. DISCUSSION: Recommendations to prevent CMV infection in this setting include handwashing, selective serological screening, avoiding work with younger children if pregnant and, in some cases, preventive leave from work. Evaluation and expert opinion of the effectiveness of various preventive options for CMV acquisition are needed to ensure that recommendations are evidence-based.

Risk factors for cytomegalovirus seropositivity in a population of day care educators in Montréal, Canada.

BACKGROUND: Horizontal transmission of cytomegalovirus (CMV) is common in the day care setting. Day care educators appear to be at a high risk of infection; however, studies are limited. AIMS: To determine the proportion of CMV-seropositive female educators in the day care setting and to identify associated risk factors. METHODS: Educator- and day care-level risk factors for CMV seropositivity were obtained by questionnaires from day care educators and directors, respectively. Sera were collected from educators and analyzed by enzyme-linked immunosorbent assay. Significant independent risk factors for CMV seropositivity were determined using a multivariable logistic regression model which was fitted using the generalized estimating equation method. RESULTS: CMV seroprevalence in 473 female educators from 81 day care centers in Montréal, Canada, was 57%. Significant risk factors for CMV seropositivity were (i) increasing age (OR5-yr = 1.19; 95% CI = 1.05-1.35), (ii) low-income country of birth (OR = 10.23; 95% CI = 2.64-39.50) or middle-income country of birth (OR = 4.99; 95% CI = 2.39-10.40), (iii) having > or =2 children of their own (OR = 1.98; 95% CI = 1.19-3.31) and (iv) child-to-educator ratio >6 (18-35 months old) in a day care center (OR = 1.87; 95% CI = 1.25-2.81). CONCLUSIONS: Day care educators have risks for CMV infection related to their work in the day care setting, as well as personal risk factors. A review of current guidelines for the prevention of CMV infection in day care is needed to ensure that recommendations are evidence based.

Hepatitis A seroprevalence and risk factors among day-care educators.

BACKGROUND: Day-care centres play a role in the epidemiology of hepatitis A virus (HAV). Up-to-date documentation on its seroprevalence and potential risk factors among day-care educators, who may be at risk for significant HAV morbidity, is nevertheless lacking. The availability of a hepatitis A vaccine provides an additional opportunity for prevention in this population. To determine the seroprevalence of previous HAV infection among day-care educators and to identify potential risk factors, we undertook a survey. METHODS: Of 167 randomly selected centres, 81 centres participated. Directors and educators completed questionnaires on risk factors. Sera were collected during on-site visits from October through December 2001. RESULTS: Seroprevalence of previous HAV infection in 492 participating educators was 35.6%. Significant risk factors in multivariate analysis included birth in a high-versus moderate/low-income country (odds ratio [OR] 20.8; 95% confidence interval [CI] 9.4-46.0); self-reported HAV vaccination (OR 6.1, CI 2.9-13.0); travel to endemic areas (OR 2.4, CI 1.3-4.2); and age (5-yr OR 1.5, CI 1.3-1.7). When Canadian-born educators were analyzed separately, an association was found between seropositivity and the number of years worked in daycare centres (5-yr OR 1.3, CI 1.0-1.8). INTERPRETATION: This represents the first study in Canada designed to examine risk factors for previous HAV infection among adult day-care educators. As a group, their risk factors for seropositivity are similar to those in the general population. However, educators born in Canada (a low-endemicity area for hepatitis A) appear to be at additional risk by working in day-care centres. The benefits of HAV screening and routine vaccination of day-care educators need to be examined.