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A COMMUNITY-BASED CASE-CONTROL STUDY OF THE ASSOCIATION BETWEEN THE ATTENDANDCE OF GROUP DAY CARE AND DISEASE DUE TO HAEMOPHILUS INFLUNZAE TYPE B (Hib)

In an ongoing case-control study to assess the association between the attendance of group day care and the occurrence of Hib disease, active surveillance was used to prospectively identify children ≤60 months of age who had cultures of the blood, CSF, or other normally sterile sites that were positive for Hib and who were seen at either of the two hospitals in New Haven (the cases). Children who were transferred from outside the community were excluded. For each case, two matched controls were selected from the birthlogs of the hospital. The controls were matched to the case by age (±1 month) and their regular pediatric practice. The parents of the subjects were interviewed by telephone. Attendance of group day care was defined as ≥4 hours/week of care within the preceding 3 weeks with one or more children from a different household.Thusfar, 39 cases with Hib disease and 78 matched controls have been enrolled in the study. Their ages ranged from 3 to 51 months (median: 13 months). Of the children, 54% attended private physicians, 23% attended an HMO and 23% attended public clinics. Over-all, 59% of the cases and 42% of the controls attended group day care. The matched odds ratio for this association was 2.9 (95% confidence interval: 1.1-8.1), X2M-H=4.2;P<0.05. The results were not substantially affected by controlling for gender, race, Hollingshead social class or the number of children in the day care group. There was a trend towards increased risk with increased time spent in group day care. The attendance of group day care does increase the risk of Hib disease.