Published online April 1, 2005
PEDIATRICS Vol. 115 No. 4 April 2005, pp. 852-860 (doi:10.1542/peds.2004-0856)
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Illness Transmission in the Home: A Possible Role for Alcohol-Based Hand Gels

Grace M. Lee, MD, MPH*,{ddagger}, Joshua A. Salomon, PhD§, Jennifer F. Friedman, MD, MPH||, Patricia L. Hibberd, MD, PhD, Dennis Ross-Degnan, ScD*, Eva Zasloff, BA{ddagger}, Sitso Bediako, BA{ddagger} and Donald A. Goldmann, MD{ddagger}

* Center for Child Health Care Studies, Department of Ambulatory Care and Prevention, Harvard Pilgrim Health Care and Harvard Medical School, Boston, Massachusetts
{ddagger} Division of Infectious Diseases, Children's Hospital Boston, Boston, Massachusetts
§ Department of Population and International Health, Harvard Center for Population and Development Studies, Harvard School of Public Health, Boston, Massachusetts
|| International Health Institute and Department of Pediatrics, Brown University, Providence, Rhode Island
Clinical Research Institute, Tufts–New England Medical Center, Boston, Massachusetts

Objectives. The widespread use of child care has altered the epidemiology of respiratory and gastrointestinal (GI) infection in the community. Our primary objective was to measure transmission of respiratory and GI illnesses among families with children enrolled in child care. We also sought to examine potential predictors of reduced illness transmission in the home in a secondary analysis.

Methods. We performed an observational, prospective cohort study to determine transmission rates for respiratory and GI illnesses within families with at least 1 child between 6 months and 5 years of age enrolled in child care. A survey about family beliefs and practices was mailed at the beginning of the study. Symptom diaries were provided for families to record the timing and duration of respiratory and GI illnesses. To ensure the accuracy of symptom diaries, biweekly telephone calls were performed to review illnesses recorded by participants. Families with ≥4 weeks of data recorded were included in the analysis. Families were recruited from 5 pediatric practices in the metropolitan Boston area. Of 261 families who agreed to participate in the study, 208 were available for analysis. Secondary transmission rates for respiratory and GI illnesses were measured as illnesses per susceptible person-month.

Results. We observed 1545 respiratory and 360 GI illnesses in 208 families from November 2000 to May 2001. Of these, 1099 (71%) respiratory and 297 (83%) GI illnesses were considered primary illnesses introduced into the home. The secondary transmission rates for respiratory and GI illnesses were 0.63 and 0.35 illnesses per susceptible person-month, respectively. Only two thirds of respondents correctly believed that contact transmission was important in the spread of colds, and fewer than half believed that it was important in the spread of stomach flus. Twenty-two percent of respondents reported use of alcohol-based hand gels all, most, or some of the time; 33% reported always washing their hands after blowing or wiping a nose. In multivariate models, use of alcohol-based hand gels had a protective effect against respiratory illness transmission in the home.

Conclusions. In homes with young children enrolled in child care, illness transmission to family members occurs frequently. Alcohol-based hand gel use was associated with reduced respiratory illness transmission in the home.

Key Words: child care • illness transmission • respiratory • gastrointestinal • alcohol-based hand gels

Abbreviations: GI, gastrointestinal

Accepted Aug 19, 2004.


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