The state Department of Health investigated three COVID-19 clusters associated with childcare settings on Maui in June.

The DOH said on Thursday in is weekly cluster report that two clusters were associated with home-based child care and the third cluster was associated with a childcare program. In all, there were a total of 24 cases associated with the clusters.

The first cluster of 10 COVID-19 cases was associated with a home-based setting with one caregiver and eight children ranging in age from 8 months to 5 years. One child tested positive. The caregiver and four more children had COVID-19 symptoms and were epidemiologically linked to the case. In addition, four secondary cases were identified as close contacts. No one was hospitalized.

The caregiver and one secondary case were vaccinated; the secondary case was asymptomatic.

There was no policy or protocol for sick children to stay home, and masks were not worn by the caregiver or children older than 2 years.

The symptoms in children were initially attributed to teething rather than COVID-19, which prolonged exposure. The childcare business was closed until the caregiver and all children were cleared from isolation and quarantine.

The second cluster of five COVID-19 cases was also associated with a home-based setting with one caregiver and six children. The children ranged in age from 1 to 9 years old. The caregiver and two children tested positive. Two secondary household contacts were also identified. No one was hospitalized. The three adults who tested positive were not vaccinated.

The third cluster of nine COVID-19 cases was associated with a childcare program within a congregate setting. Four of seven children ranging from two to 20 months; four of 12 adult residents and one of 21 staff members tested positive.

No secondary cases were identified and no one was hospitalized.

None of the residents and only half of the staff were fully vaccinated when the cases were reported.

The DOH said that vaccination of parents, guardians and caregivers can help protect young children who are not eligible for vaccination and cannot wear masks, which are not recommended for children younger than 2.

Childcare providers should implement preventative strategies to “provide safe and health environments for children and prevent the spread of COVID-19,” the DOH said.

In addition to vaccination, encouraging sick children and staff to stay home, requiring all staff and children older than 2 to wear masks correctly and consistently indoors and improving ventilation can help prevent COVID-19 cases and clusters in childcare settings, according to a news release.

In this week’s cluster report, the DOH said that it was investigating one COVID-19 cluster in an educational setting in Maui County that had six cases. It was also investigating a cluster in places of worship that had eight cases.