Sam's policy paper

Policy on the Reduction of Antibiotic Resistant Strains of Streptococcus Pneumoniae
Today Streptococcus pneumoniae is the primary cause of infectious disease and death in the United States (1). To date, Streptococcus pneumoniae is the deadliest bacteria, causing more deaths worldwide than any other bacteria (4). In addition, for the past two decades Streptococcus pneumoniae has become increasingly resistant to antibiotics (1, 2). As well, the infectious diseases caused by Streptococcus pneumoniae occur more often from birth to three years of age (1, 2). For children attending daycare, the risk of transmission of Streptococcus pneumoniae increases from around 40% to between 60-80% (2). With children being the largest carrier of antibiotic-resistant strains of Streptococcus pneumoniae, we, at the Iowa Department of Human Services, have assessed the best way we can help prevent further Streptococcus pneumoniae antibiotic resistance is to monitor our state-certified daycare facilities. Additionally, the Pneumococcal conjugate vaccine has been proven to be the best prevention by reducing the number of Streptococcus pneumoniae antibiotic-resistant strains (1, 2). In daycare facilities where children attending have received the Pneumococcal conjugate vaccine, the number of antibiotic-resistant Streptococcus pneumoniae has not only decreased among the children, but has significantly dropped in the adults that are employed in these facilities (2). Another issue that has been brought to our attention is the misuse of antibiotics themselves. Many children with viral respiratory tract infections are being prescribed antibiotics. In most cases, physicians that are unnecessarily prescribing antibiotics are doing so because the parents are demanding them (3, 5). Educating parents on understanding the correct use of antibiotics is too overwhelming at the physician’s level. Therefore, we are mandating that education begin in our state-certified daycares. The education materials and new policy requirements will be funded as part of the application process for state-certification and are as follows:
POLICY
I. Any daycare facility seeking state certification must provide documentation that all employees have received the Pneumococcal conjugate vaccine prior to applying for certification. All future employees must be vaccinated prior to employment and documentation must be reported to the Iowa Department of Human Services within 30 days of employment to maintain certification.
II. Any parent/ legal guardian placing a child in a state-certified daycare facility must provide vaccination records for that child including the four recommended doses of the Pneumococcal conjugate vaccine by the Centers for Disease Control and Prevention (1).
III. All state-certified daycare facilities must provide an orientation class for all new parents that will educate them on correct use of antibiotics, when they should be prescribed for their children, and how to talk with their physician accordingly.
The Iowa Department of Human Services urges all to address the matter of antibiotic resistance and determine how to prevent it in the future.
References
1. Centers for Disease Control and Prevention. 23 September 2008 <http://www.cdc.gov/narms/>.
2. Rosen, Frederick S., and Matthew W. Ryan. "The prevalence of colonization with drug-resistant pneumococci among adult workers in children's daycare." ENT: Ear, Nose & Throat Journal 86.1 (Jan. 2007): 38-44. Academic Search Premier. EBSCO. [Library name], [City], [State abbreviation]. 5 Oct. 2008 <http://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=23831722&site=ehost-live>.
3. Forssell, Gunnar, Anders Hakånsson, and Nils-Ove Månsson. "Risk factors for respiratory tract infections in children aged 2-5 years." Scandinavian Journal of Primary Health Care 19.2 (June 2001): 122-125. Academic Search Premier. EBSCO. [Library name], [City], [State abbreviation]. 5 Oct. 2008 <http://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=4645319&site=ehost-live>.
4. Mangione-Smith, R., Elliott, M. N., Stivers, T., McDonald, L. L., and Heritage, J.
“Ruling out the need for antibiotics: are we sending the right message?”
Arch Pediatr Adolesc Med, September 1, 2006; 160(9): 945 - 952.
5. Sá-Leão, Raquel, Tomasz, Alexander, Santos Sanches, Ilda, Brito-Avô, António, Vilhelmsson, Sigurdur E., Kristinsson, Karl G. and de Lencastre, Hermínia. “Carriage of Internationally Spread Clones of Streptococcus pneumoniae with Unusual Drug Resistance Patterns in Children Attending Day Care Centers in Lisbon, Portugal. The Journal of Infectious Diseases 2000 182:4, 1153-1160.

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