How can I prevent gastroenteritis in my child who attends daycare?

Preventing Gastroenteritis in Daycare-Attending Children

Ensure your child receives the rotavirus vaccine according to the recommended schedule—this is the single most effective intervention to prevent severe gastroenteritis in young children, and stopping daycare is neither necessary nor recommended. 1, 2

Rotavirus Vaccination: The Primary Prevention Strategy

The Advisory Committee on Immunization Practices (ACIP) recommends routine rotavirus vaccination for all U.S. infants, with the vaccine administered orally at ages 2,4, and 6 months. 1 This recommendation is based on the substantial disease burden rotavirus causes:

• Before vaccination became routine, rotavirus caused approximately 55,000-70,000 hospitalizations, 205,000-272,000 emergency department visits, and 410,000 physician visits annually among U.S. children under 5 years. 1
• Rotavirus is transmitted efficiently in daycare settings through the fecal-oral route, close person-to-person contact, and contaminated surfaces (fomites). 1
• Virtually all children become infected with rotavirus by age 5 years, with severe disease occurring primarily in children aged 3-35 months. 1

Vaccine Effectiveness

Rotavirus vaccination is highly effective, with recent data showing 78% effectiveness against rotavirus-associated emergency department visits or hospitalizations, and 94% effectiveness against very severe disease. 3 The vaccine prevents:

• Two-thirds of hospitalizations and deaths related to rotavirus 4
• Most physician visits for rotavirus gastroenteritis 1
• 94-97% of severe rotavirus cases requiring hospitalization 5, 3

Critical Timing Considerations

The first dose must be administered between 6-12 weeks of age, with all three doses completed by 32 weeks (approximately 8 months) of age. 1, 2 This strict age restriction exists because:

• The risk of intussusception increases with age at vaccination, particularly after 60 days of age 2
• If your child has missed this window, vaccination is no longer an option, but natural immunity will develop through exposure 2

Why Stopping Daycare Is Not Recommended

Withdrawing from daycare is impractical and unnecessary because:

• Rotavirus exposure is nearly universal—virtually all children will be infected by age 5 years regardless of daycare attendance 1, 2
• Natural infection provides immunity similar to vaccination, though the first infection may cause severe disease 2
• By age 5 years, 4 out of 5 children will develop rotavirus diarrhea whether or not they attend daycare 2

Additional Protective Measures Beyond Vaccination

While vaccination is the cornerstone, these supportive strategies reduce complications:

Home Preparedness

• Keep oral rehydration solutions readily available at home and use them at the first signs of gastroenteritis 2
• Learn to recognize signs of dehydration requiring immediate medical attention (decreased urination, lethargy, dry mucous membranes, sunken eyes) 2, 6

Hygiene Practices

• Handwashing and proper hygiene reduce the incidence of acute gastroenteritis in young children 6
• Note that even with excellent hygiene, rotavirus is highly contagious and difficult to prevent without vaccination 1

Understanding the Current Landscape

In vaccinated children, norovirus has now replaced rotavirus as the leading cause of gastroenteritis, accounting for 58% of all gastroenteritis illnesses. 4, 7 This epidemiologic shift demonstrates the success of rotavirus vaccination programs. However:

• No vaccine currently exists for norovirus 4
• Treatment remains supportive with rehydration regardless of the causative pathogen 4
• Norovirus illness is typically shorter (12-72 hours) compared to rotavirus (3-8 days) 4

Common Pitfalls to Avoid

• Do not delay vaccination hoping to avoid daycare exposure—the vaccine must be started by 14 weeks and 6 days of age 2
• Do not assume good hygiene alone will prevent rotavirus—the virus is shed in extremely high concentrations and is highly transmissible 1
• Do not confuse all gastroenteritis with vaccine-preventable disease—only rotavirus is vaccine-preventable among common viral causes 4