Sept. 20, 2007 (Chicago) -- Day care centers -- often thought of as giant petri dishes of pathogens -- are safer than ever, thanks to improved vaccination of toddlers against a host of common childhood diseases, experts say.
"Are day care centers safer in the era of vaccines? Absolutely they are," says Larry Pickering, MD, a specialist in infectious diseases at the CDC in Atlanta.
About 11 to 12 million kids go to child care centers nationwide each day, he says. There, the children are exposed to numerous illnesses as they mix and mingle, trading bugs and bringing them home.
The fact that the youngsters' immune systems are not fully developed, that they often have poor hand washing habits, and that many day care centers themselves are not hygienic doesn't help matters, he adds.
While kids in care are still more likely to get sick than those who play at home, "I'd be a lot more comfortable having my child in care than in the pre-vaccine era," Pickering tells WebMD.
At a meeting of the American Society for Microbiology this week, Pickering and other experts discussed the impact that vaccines against meningitis, chickenpox, the flu, and other disorders have had on the health of day care's young charges -- and that of their families as well.
Before the varicella vaccine was introduced, chickenpox was a rite of passage, with 4 million cases each year, says the CDC's Jane Seward, MD.
And it wasn't always harmless: about 11,500 kids were hospitalized each year, and 100 to 150 died, she says.
Since the U.S. started a varicella surveillance program in 1995, the number of cases overall in the U.S. has dropped 90%.
Among the under-5 set, cases dropped by up to 95%, she tells WebMD.
"Varicella has virtually disappeared from day care centers," Seward says.
There has also been an 80% decrease in cases among infants too young to be immunized who typically catch the disease from their siblings, she says.
(What have your experiences with day care been like? Share with us on WebMD's Parenting message boards: 3-6 Months, 6-9 Months, 9-12 Months, and 2-Year-Olds.)
The influenza vaccine is 54% to 87% effective in day-care-aged kids, says Janet Englund, MD, associate professor of pediatrics at the University of Washington in Seattle.
Researchers haven't tracked how that translates into reductions in disease. But in one day care center that she studied, Englund says the overall incidence of disease is now five cases per 100 child-years, "which is lower than in the past."
Vaccinating your child protects not only the youngsters' health, but also that of other family members as well, she says.
In one study of kids aged 5 to 12, for example, doctor visits for the flu by family members dropped nearly 40% after the kids got their shots.
Englund tells WebMD that anecdotal evidence suggests that vaccinating your toddler will have just as robust an effect on the family's health.
And with the FluMist nasal spray vaccine winning FDA approval for healthy children as young as 2, vaccination rates may further increase, experts say. Previously, the vaccine was only approved for those aged 5 and older.
Since the Haemophilus influenzae type b (Hib) meningitis vaccination was developed, rates of invasive disease among children under 5 have declined by more than 95%, according to the CDC.
Pickering adds that overall, there were 20,000 cases per year in the pre-vaccine era. Now there are only a few hundred, he says.
Licensed in the mid-1990s, the hepatitis A vaccine has had "a remarkable effect in lowering disease rates, particularly among kids in day care," Pickering says.
An Israeli study showed that there had been no outbreaks in day care centers since the vaccine was introduced, he says.
In the U.S., the CDC has not tracked trends specifically among the day care set. But overall, a survey of 11 Western states showed there were 20 cases per 100,000 Americans in the pre-vaccine era, he says. Now the figure stands at 1.5 cases per 100,000 people.
Affected kids also bring the bug home, where 15% of family members get sick, on average, he says.
Since the RotaTeq rotavirus vaccine was only licensed last year, there are no good surveillance figures yet, according to Pickering. "But I expect we'll see a significant drop in infections," he says.
Since the 2000 introduction of a pneumococcal vaccine to prevent ear infections in children under 2, cases have dropped by at least 20%, studies show.
Researchers reported earlier this week that the vaccine has had a worrisome side effect, spurring the development of a superbug resistant to all the antibiotics used to treat ear infection.
"Nevertheless, there's no doubt day care is safer than ever thanks to the vaccine," says Robert Cohen, MD, professor of pediatrics at the Hospital of Cretiel in Saint Maur, France.
He says parents should continue to have their toddlers immunized as the vaccine prevents serious illness and even saves lives.
Tips for Choosing a Safe Day Care Center
While day care is safer than ever, your kid can, and probably will, still catch a cold, flu, or other infection at some point. But you can minimize the risk of illness by putting some time into choosing a child care center, Pickering says.
Among the experts' tips:
- Make sure that all people at the day care have been properly immunized and that there's a notification process when kids get ill.
- Make sure the day care has proper hand-washing arrangements, with plenty of sinks and soap.
- Make sure kids aren't kept in the same room all the time.
"We are doing a good job at keeping day care safe, but we need to be vigilant," Pickering says.