Pickering L K, Bartlett A V, Woodward W E
Rev Infect Dis. 1986 Jul-Aug;8(4):539-47. doi: 10.1093/clinids/8.4.539.
The incidence of diarrhea among children in day care centers is highest for those under three years of age. Limited studies indicate that diarrhea occurs more frequently among children enrolled at these centers than among age-matched children cared for at home or in family day care. Most reported outbreaks have been caused by rotavirus, Giardia, Shigella, or combinations of these organisms. Children in day care centers commonly excrete enteropathogens in the absence of symptoms; the significance of this phenomenon in transmission is unknown. An association between higher rates of diarrhea and selected characteristics of centers--the most important of which is the presence of non-toilet-trained children--has been shown. The contamination of hands, communal toys, and other classroom objects as well as a lack of infection control measures play a role in the transmission of enteropathogens in outbreaks of diarrhea in day care centers. Spread of infection from non-toilet-trained children in centers to their families is common. Potential ways of dealing with this situation include education; development, implementation, and enforcement of regulations; and use of infection control measures. However, the effectiveness of specific control measures has not been systematically evaluated.
日托中心三岁以下儿童腹泻的发生率最高。有限的研究表明，与在家中或家庭日托中接受照料的年龄匹配儿童相比，日托中心登记在册的儿童腹泻发生得更频繁。大多数报告的疫情是由轮状病毒、贾第虫、志贺氏菌或这些病原体的组合引起的。日托中心的儿童通常在没有症状的情况下排出肠道病原体；这种现象在传播中的意义尚不清楚。腹泻发生率较高与日托中心的某些特征之间存在关联，其中最重要的是有未接受如厕训练的儿童。手、公共玩具和其他教室物品的污染以及缺乏感染控制措施在日托中心腹泻疫情中肠道病原体的传播中起作用。日托中心未接受如厕训练的儿童将感染传播给其家人的情况很常见。应对这种情况的潜在方法包括教育；制定、实施和执行相关规定；以及使用感染控制措施。然而，具体控制措施的有效性尚未得到系统评估。
