ABSTRACT
AIM OF THE STUDY: Dental group prophylaxis in day-care centers with teeth brushing as one of its components is intended to reduce caries incidence and promote dental health. However, various barriers can hinder implementation of this preventive measure. One concern relates to an increased risk of transmission of acute respiratory infections (ARI) in day-care centers. The ZINFEKT study aimed at determining whether and to what extent there are differences in the occurrence of ARI between day-care centers that implement vs. those that do not implement teeth brushing. METHODS: In an ecological study, 2013-2018 data from the ARI surveillance of the Public Health Agency of Lower Saxony were merged with information from the Dental Services on teeth brushing for n=33 day-care facilities from the urban municipality of Braunschweig, the region of Hannover, and the administrative district of Osnabrück (all Lower Saxony, Germany). Following the concept of patient days from hospital infection surveillance, "ill child weeks" were specified as observational units, defined as weeks for which an ARI had been reported for a registered child. Besides cross-tabulations, relative risks for ill child weeks by teeth brushing and Breslow-Day Tests for interactions with area, size of day-care center, ARI season and time slot with ARI seasons were computed. RESULTS: Overall, the ARI-rate, defined at the proportion of ill child weeks, was 4.6% higher in day-care centers in which teeth brushing took place, vs. centers in which this measure was not implemented (17.9 vs. 13.3%, p<0.0001). In analyses stratified by the geographic and temporal co-variables, the direction of this difference did not change (with one exception: day-care centers with 50 or less registered children) . CONCLUSION: The assumption that regular teeth brushing is associated with higher ARI rates in day-care centers does seem to have an empirical basis. However, despite the study's limitations (primarily its ecological design and possibly limited representativeness of the day-care centers), the identified difference - due both to its magnitude and possibly improvable hygiene compliance - to our assessment does not speak against brushing teeth as a component of dental group prophylaxis in day-care centers.
Subject(s)
Day Care, Medical , Respiratory Tract Infections , Child , Child Day Care Centers , Germany/epidemiology , Humans , Incidence , Respiratory Tract Infections/epidemiology , Respiratory Tract Infections/prevention & controlABSTRACT
In May 2011 one of the worldwide largest outbreaks of haemolytic uraemic syndrome (HUS) and bloody diarrhoea caused by Shiga toxin-producing Escherichia coli (STEC) serotype O104:H4 occurred in Germany. One of the most affected federal states was Lower Saxony. We present the investigation of a cluster of STEC and HUS cases within this outbreak by means of a retrospective cohort study. After a 70th birthday celebration which took place on 7th of May 2011 among 72 attendants seven confirmed cases and four probable cases were identified, two of them developed HUS. Median incubation period was 10 days. Only 35 persons (48.6%) definitely answered the question whether they had eaten the sprouts that were used for garnishing the salad. Univariable analysis revealed different food items, depending on the case definition, with Odds Ratio (OR)>1 indicating an association with STEC infection, but multivariable logistic regression showed no increased risk for STEC infection for any food item and any case definition. Sprouts as the source for the infection had to be assumed based on the results of a tracing back of the delivery ways from the catering company to the sprouts producer who was finally identified as the source of the entire German outbreak. In this large outbreak several case-control studies failed to identify the source of infection.
