The Hawaii Department of Health’s COVID-19 cluster report this week focuses on outbreaks found in child care settings, particularly home-based ones.

Health officials in June investigated three clusters associated with child care settings on Maui.

The first included 10 cases that were associated with a home-based setting with one caregiver and eight children ranging in age from 8 months to 5 years old.

After one child tested positive for the virus, the caregiver and four more children at the home exhibited symptoms of COVID-19. Four secondary cases were also identified among their close contacts.

No one was hospitalized.

>> RELATED: Hawaii records one new coronavirus-related death, 49 additional infections

However, there was no policy or protocol for sick children to stay home, officials said Also, masks were not worn by either the caregiver – who was vaccinated — nor children older than 2 as recommended.

The Centers for Disease Control and Prevention, in its guidance for operating child care programs during COVID-19, recommends that everyone ages 2 and older wear a mask covering their mouth and nose when around people who do not live in their household, except when eating and sleeping.

Also, the symptoms in the children with the coronavirus were initially attributed to teething rather than COVID-19, which prolonged exposure.

The business remained closed until the caregiver and all children were cleared from isolation and quarantine.

Health officials said the second COVID-19 cluster was also associated with a home-based setting with one caregiver and six children ages 1 to 9.

Both the caregiver and two children tested positive for the coronavirus, which then spread to two household members. No one was hospitalized.

But the three adult cases in this cluster were not vaccinated.

The third cluster, which resulted in nine cases, was associated with a child care program within a congregate setting.

Four out of seven children in the program ranging from 2 months old to almost 2 years old, four out of 12 adult residents, and one of 21 staff members tested positive for the coronavirus. There were no secondary cases identified. No one in this cluster was hospitalized.

But none of the residents and only half of the staff were fully vaccinated when the cases emerged.

Health officials said child care workers were prioritized for COVID-19 vaccination as frontline essential workers early in the state’s rollout.

“Vaccination of parents, guardians, and caregivers can help protect young children who are not eligible for vaccination and can’t wear masks,” according to the report.

In addition, CDC recommends layering prevention strategies to reduce the risk of COVID-19 spread in child care and early education settings — from staff vaccinations to encouraging children and staff to stay home when sick, ensuring the correct and consistent wearing of masks, frequent handwashing, regular and consistent cleaning and disinfecting, and improved ventilation.

The report, published today, reflects clusters under investigation for the past two weeks. Last week, the report focused on clusters in places of worship.

Health officials are currently investigating 12 clusters across all four counties:

>> On Oahu, officials are investigating three clusters from social gatherings that resulted in 31 cases, one cluster at a place of worship that resulted in 11 cases, and two clusters in the “other” category that resulted in nine cases. The “other” category includes other occupational settings such as offices, retail establishments and first responders.

>> On Maui County, officials are investigating one cluster in an educational setting resulting in six cases, and one cluster in a place of worship that resulted in eight cases.

>> On Hawaii County, officials are investigating an ongoing cluster at a correctional facility – reported as the Hawaii Community Correctional Center in Hilo — with a total of 271 cases. Officials are also investigating a gym cluster that resulted in 13 cases.

>> On Kauai County, officials are investigating a cluster at a restaurant that resulted in 17 cases, as well as a cluster at a place of worship that resulted in 12 cases.