An epidemiological perspective on gastroenteritis in child day care centers: Assessment of impact and risk

The impact of gastroenteritis related to Dutch DCCs is substantial, particularly among the very young attendees. Attending a DCC roughly doubles a child’s probability of experiencing an episode of gastroenteritis that requires a visit to a general practitioner or hospital. A child might experience a lower risk of hospitalization for gastroenteritis after 12 months of attendance compared to a child that never attends day care, but only if it started attending day care before the age of one. In addition, the protective effect extended throughout, but not after the preschool years. The impact of DCC-related gastroenteritis might be even more substantial if further research can prove that asymptomatic day care-attendees contribute to the transmission of enteropathogens both within and beyond the borders of the DCC. The transmission potential of asymptomatic DCC children is currently under investigation. A significant proportion of gastroenteritis could be attributed to the circulation of five enteropathogens in the DCC. Improved implementation of existing DCC practices that proved to be associated with circulation rates of these and other enteropathogens would theoretically not only reduce the disease burden of DCC-related gastroenteritis, but also generate substantial cost savings from a societal point of view. Therefore, future research might focus on designing intervention studies that determine whether improved implementation of DCC risk factors as identified in this thesis is effective and feasible in the Dutch DCC setting. Efforts are currently ongoing amongst stakeholders to determine whether increased control of DCC-related infectious diseases is desirable in the Netherlands.