Childhood Upper Respiratory Tract Infections: To What Degree Is Incidence Affected by Day-Care Attendance?

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Abstract
Risk factors for acute upper respiratory tract disease in childhood were evaluated in a population-based sample of the Atlanta metropolitan area. Mothers from 449 households containing 575 children less than 5 years of age were selected by random-digit dialing and questioned about upper respiratory tract infection and ear infection occurring in their children during the preceding 2 weeks. Household demographic and socioeconomic characteristics, maternal smoking history and child day-care attendance and breast-feeding information were also obtained. For children less than 5 years of age, the reported incidence of upper respiratory tract infection was 24%, and of ear infection, 6%. Controlling for the other variables measured, day-care attendance was associated with a significantly increased risk of both illnesses. For upper respiratory tract infection, increased risk was present for all children attending day care (P = .02, odds ratio = 1.6), whereas for ear infection, risk could be demonstrated only for full-time attendees (P = .005, odds ratio = 3.8). Maternal smoking was a second independent risk factor for a child's having upper respiratory tract infection (odds ratio = 1.7, P = .01). Thirty-one percent of all upper respiratory tract infection among day-care attendees and 66% of all ear infections among full-time day-care attendees were attributable to day-care attendance. Given the proportion of children in day care, 9% to 14% of the total burden of upper respiratory tract disease in this population was day care related. As use of child day-care facilities has increased, this specific exposure has become a major factor contributing to transmission of acute upper respiratory tract disease in childhood.