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In the United States in 2006, approximately 54% of the 23.7 million children younger than 5 years of age attended a child-care facility, and 55 million children attended school from kindergarten through 12th grade. (1)(2) Children cared for in child-care settings have an increased rate of infectious diseases. (3)(4) Prevention and control of infectious diseases among children in out-of-home group settings is a concern for families, staff, health-care practitioners, and the community.

Several factors influence the risks for introduction and spread of infections in child-care settings. These factors include the personal hygiene and health status of the caregivers and the children (as well as their ages) and the condition of the facility (eg, environmental sanitation, space and quality, food-handling practices, policies for attendance, and ratio of children to caregivers). The characteristics of the...

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