Le domaine des collectivités

Communities

Three steps are required for the transmission of an infectious disease from one individual to another:

The pathogen must be excreted by the person who is ill or the asymptomatic carrier (by decreasing frequency order: nose, oral cavity, stools, skin, urine)
The pathogen should be communicated to the healthy person (by order to frequency: aerosol, direct or indirect contact through objects or another person)
The pathogen must reach a susceptible site (oral cavity, nose, eye)

Communities of children (school, nurseries and infant day care, drop-ins), resulting in close contacts between a number of children in a relatively limited space promote the transmission of infectious agents.

The transmission of viruses, bacteria, and parasites from sick subjects or asymptomatic carriers to healthy subjects occurs through nasal and oral secretions (sputters), stools, urine or skin (direct or indirect contact with objects or another person).

Day care nurseries are particularly concerned because of:

Promiscuity and gregariousness of this type of child care
The immature immune defence systems of infants with a longer and more frequent carriage of pathogens
Factors specific to early childhood (incontinence, suction of hands and objects, dependence to adults providing multiple care)

Immunity immaturity is now well understood:

There is hardly any immunological history (immunological innocence) from birth to six months; infants progressively lose maternal transmitted antibodies, especially IgG2 antibodies
Their capacity in developing IgG2 type antibodies against polysaccharides (thymus-independent antigens) that form the capsule of many bacteria, is limited.
Lastly, secretory IgA antibody synthesis appears to be limited

Probably related to their immunological immaturity, the carriage of potentially pathogenic germs (S. pneumoniae, H. influenzae, M. catarrhalis) is more frequent and prolonged in infants. Every child carries viruses, bacteria, and parasites, which can be passed to the other children of the nursery, and also to staff and members of their own families.

A number of factors related to early childhood (incontinence, suction of hands and objects, dependence to adults providing multiple care) also promote the transmission of infectious diseases.

All this explains why the incidence of respiratory infectious diseases is higher in children living in nurseries.

Schools, nurseries and infant day care, drop-ins

Going to the nursery is probably a main factor in the epidemiology of many infectious diseases, as the nurseries are a unique place for the transmission of infections. Indeed, adding to the promiscuity and gregariousness inherent to this type of child care, are the very specific characteristics of the target population, susceptible to be hit by any infection. Therefore, it is essential to control the infectious risk.

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Public/municipal catering

Surfaces in contact with hands or food, major carriers of cross contamination, collect and disseminate all types of germs. The surfaces in contact with hands and food are: cutting boards, counters, refrigerators, kitchenware... In order to minimize infection risks, it is important to regularly disinfect anything in contact with food.