Days before deaths in meningitis case, inspectors found problems at daycare center

Two days before the first of two children at a downtown Miami childcare center died of suspected meningitis, state inspectors made an ominous finding: The daycare had no place to isolate sick children from healthy ones.

The Department of Children & Families gave the daycare, the YWCA Carol Glassman Donaldson Childcare Center, 30 days to correct the deficiency. But on Dec. 3, a 22-month-old boy died from an illness that was initially thought to be pneumonia. A second child, a 2-year-old boy, died a week later — after also being first diagnosed with pneumonia.

Florida health officials confirmed Wednesday that one of the two children tested positive for pneumococcal meningitis, an infectious disease caused by a common bacteria that spreads through sneezing, coughing and direct contact with the saliva or mucus of infected persons.

The second child also is suspected of having contracted meningitis. But because the child died outside of the country, said Mara Gambineri, a spokeswoman for the Florida Department of Health, state officials have been unable to confirm with laboratory testing whether the second child also had meningitis.

“We’re in the midst of that investigation at this point,” said Gambineri, who added that the daycare’s administrators had asked the agency and the Department of Children & Families, which regulates child daycare centers, to inspect the facility and provide feedback.

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The main entrance to the YWCA Carol Glassman Donaldson Center Day Care next to the Stephen P Clark Government Center, 111 NW First St. on Wednesday, Dec. 13, 2017. Two children who attended the daycare center died of suspected meningitis, state health officials said this week. Inspectors found a slew of problems at the facility, according to reports from the Department of Children and Families, including a failure to keep an isolation area for sick children, evidence of rodent or vermin infestation, and a lack of training for some of the staff.

Jose A. Iglesias jiglesias@elnuevoherald.com

State health officials did not identify the children or say which one tested positive for pneumococcal meningitis. Sources familiar with the case said one of the boys died in Belize.

The YWCA closed the Donaldson center on Tuesday, and state and county regulators said the daycare will not reopen until state health administrators have declared it safe. Kerry-Ann Royes, director of YWCA Miami, said she decided to close the center as a precaution and that state officials had not advised the non-profit to shut down after the suspected death from meningitis.

“At the time, the health department did not advise us we had to close,” she said.

In a letter dated Dec. 7 and addressed to parents of children at the Donaldson center, state officials said “a child” who attends the Donaldson center had been diagnosed with pneumococcal meningitis, which is caused by “a very common bacterium called Streptococcus pneumoniae, which causes ear infections, pneumonia, and rarely meningitis.”

The letter explained the symptoms of meningitis, which include fever, severe headache, stiff neck, drowsiness or confusion, nausea and vomiting. And it said the bacteria that causes it spreads from person to person by sneezing, coughing, and direct contact with the saliva or nasal mucus of infected people.

The letter advised parents of children with sickle-cell anemia, HIV, no spleen, kidney disease or compromised immune systems to contact their family doctor.

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Dr. Ivan Gonzalez, a pediatric infectious disease specialist with the University of Miami Health System, said pneumococcal meningitis is rare among children in the United States because they are routinely vaccinated by the age of 15 months.

“It’s not something that we would normally see a lot of times,” he said. “But if we were to see it, it would be in someone who really wasn’t vaccinated or didn’t respond well to the vaccine.”

Gonzalez said it’s also possible that the children contracted a strain or serotype of pneumococcal bacteria that is not covered by current vaccines.

There are more than 90 types of pneumococcal bacteria, according to the U.S. Department of Health and Human Services. The two most common pneumococcal vaccines protect against 13 and 23 different types of the bacteria.

But regardless of the type of pneumococcal bacteria that caused meningitis in one of the two boys who died, isolating children with meningitis usually won’t do much good, Gonzalez said.

“By the time that you see any symptoms, you’re already kind of sick,” he said. “So isolating a kid that’s sick, I don’t know how that would really work in this scenario.”

Florida rules require children in licensed daycare centers to have a pneumococcal vaccine, as well as vaccinations against other diseases, such as polio, mumps and measles. Dr. Reynald Jean, the head of epidemiology for the state health department’s office in Miami-Dade, said Tuesday the boys had all of their immunizations.

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This is the playground at the YWCA Carol Glassman Donaldson Center Day Care at the Stephen P. Clark Government Center in Miami. Two children who died of suspected meningitis in December attended the daycare center.

Douglas Hanks dhanks@miamiherald.com

The Donaldson center, at 112 NW Third St. , has a licensed capacity of 122 children, records show. It is listed as a provider under Florida’s Voluntary Pre-Kindergarten program, which offers subsidized tuition for all 4-year-olds as a way to improve school readiness for the state’s youngsters. The state’s last inspection of the facility was on Dec. 1; a report on the visit said there were 45 youngsters present that day.

The seven-page inspection report identified a slew of problems at the daycare center, including evidence of rodent or vermin infestation, a broken bathroom sink, an improper diaper-changing surface, and a faulty rubber surface “that can cause children to fall.” The report also said two child-care workers had failed to complete annual training.

Inspections on April 7 and Dec. 14, 2016, Aug. 10, 2016, and June 20, 2016, turned up no deficiencies. An April 26, 2016, inspection found other deficiencies, including incomplete immunization records for one or more children.

“We’re just devastated by this,” Royes continued. “These are our babies.”

The YWCA rents space from Miami-Dade at the Stephen P. Clark Government Center at 111 NW First St.

In a statement, Miami-Dade’s Internal Services Department, which oversees building operations, said it worked with the YWCA “to ensure that every step has been taken … to notify parents and follow all recommendations.”

In a statement, DCF wrote: “We are devastated by the death of two small children who attended this child-care facility and we continue to grieve with their families and loved ones.” The agency said the center will remain closed until the state clears it for reopening after an investigation.