Reduction of acute respiratory infections in day-care by non-pharmaceutical interventions: a narrative review

Lars Andrup; Karen A Krogfelt; Lene Stephansen; Kristian Schultz Hansen; Brian Krogh Graversen; Peder Wolkoff; Anne Mette Madsen

doi:10.3389/fpubh.2024.1332078

Reduction of acute respiratory infections in day-care by non-pharmaceutical interventions: a narrative review

Front Public Health. 2024 Feb 14:12:1332078. doi: 10.3389/fpubh.2024.1332078. eCollection 2024.

Authors

Lars Andrup¹, Karen A Krogfelt², Lene Stephansen³, Kristian Schultz Hansen¹, Brian Krogh Graversen¹, Peder Wolkoff¹, Anne Mette Madsen¹

Affiliations

¹ The National Research Centre for the Working Environment, Copenhagen, Denmark.
² Department of Science and Environment, Molecular and Medical Biology, PandemiX Center, Roskilde University, Roskilde, Denmark.
³ Gladsaxe Municipality, Social and Health Department, Gladsaxe, Denmark.

Abstract

Objective: Children who start in day-care have 2-4 times as many respiratory infections compared to children who are cared for at home, and day-care staff are among the employees with the highest absenteeism. The extensive new knowledge that has been generated in the COVID-19 era should be used in the prevention measures we prioritize. The purpose of this narrative review is to answer the questions: Which respiratory viruses are the most significant in day-care centers and similar indoor environments? What do we know about the transmission route of these viruses? What evidence is there for the effectiveness of different non-pharmaceutical prevention measures?

Design: Literature searches with different terms related to respiratory infections in humans, mitigation strategies, viral transmission mechanisms, and with special focus on day-care, kindergarten or child nurseries, were conducted in PubMed database and Web of Science. Searches with each of the main viruses in combination with transmission, infectivity, and infectious spread were conducted separately supplemented through the references of articles that were retrieved.

Results: Five viruses were found to be responsible for ≈95% of respiratory infections: rhinovirus, (RV), influenza virus (IV), respiratory syncytial virus (RSV), coronavirus (CoV), and adenovirus (AdV). Novel research, emerged during the COVID-19 pandemic, suggests that most respiratory viruses are primarily transmitted in an airborne manner carried by aerosols (microdroplets).

Conclusion: Since airborne transmission is dominant for the most common respiratory viruses, the most important preventive measures consist of better indoor air quality that reduces viral concentrations and viability by appropriate ventilation strategies. Furthermore, control of the relative humidity and temperature, which ensures optimal respiratory functionality and, together with low resident density (or mask use) and increased time outdoors, can reduce the occurrence of respiratory infections.

Keywords: COVID-19; aerosols; common cold; indoor air quality; infectious transmission prevention; influenza; primary prevention; respiratory syncytial viruses.

Publication types

Review

MeSH terms

Adenoviridae
COVID-19* / epidemiology
COVID-19* / prevention & control
Child
Humans
Pandemics
Respiratory Aerosols and Droplets
Respiratory Tract Infections* / epidemiology
Respiratory Tract Infections* / prevention & control

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This work was supported by a grant from the Danish Government to develop a research program on Working Environment Economics, and a grant from Helsefonden, Copenhagen, Denmark.