The points raised by Dr Holmes are well taken. The works of Capps and colleagues in the 1950s not only served as models for recent studies of hepatitis A in day-care centers but helped to inspire initiation of these studies.1 The lessons in both postexposure treatment and preexposure prevention have not been lost to those persons who deal with this problem.Certainly the cornerstone of disease control in a day-care setting must be educational programs aimed at maximizing hygienic standards in day-care centers. Such programs must be broadly conceived to be applicable not only for hepatitis A but also for the other enteric diseases—shigellosis and rotavirus, Giardia, and Campylobacter infections—that have been recognized as disease threats in day-care centers.2 Such programs should be primarily for day-care employees and directors who are directly responsible for establishing and implementing appropriate hygienic practices in a day-care setting. But to
Hadler SC. Prevention of Hepatitis in Day-Care Centers-Reply. JAMA. 1983;250(14):1842. doi:10.1001/jama.1983.03340140017014
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