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Shedding and exclusion from childcare in children with Shiga toxin-producing Escherichia coli, 2018-2022

Amoolya Vusirikala1,2, Sam Rowell1, Girija Dabke1

  • 1Health Protection Operations, UK Health Security Agency, London, UK.

Epidemiology and Infection
|February 25, 2024
PubMed

Insights

Shiga toxin-producing Escherichia coli (STEC) shedding duration in young children does not differ significantly between O157 and non-O157 serotypes. Current guidance for excluding STEC-infected children from childcare remains appropriate.

Area of Science:

  • Microbiology
  • Infectious Diseases
  • Public Health

Background:

  • Shiga toxin-producing Escherichia coli (STEC) infections in children attending childcare can cause significant family and economic disruption.
  • Increased detection of non-O157 STEC serotypes in England necessitates updated understanding of shedding dynamics.
  • Current exclusion policies for STEC-infected children require evidence-based review.

Purpose of the Study:

  • To determine the shedding duration of STEC by serotype in young children.
  • To estimate the transmission risk of STEC in childcare settings.
  • To inform public health guidance on the exclusion of STEC-infected children from childcare.

Main Methods:

  • Retrospective analysis of STEC cases aged <6 years in England (March 2018-March 2022).
  • Calculation of shedding duration from first positive specimen to earliest negative specimen.
  • Estimation of transmission risk based on secondary cases in childcare settings.

Main Results:

  • Median STEC shedding duration was 32 days, with no significant difference between O157 and non-O157 serotypes.
  • Bloody diarrhoea was associated with a 17% reduction in shedding duration.
  • A secondary transmission rate of 13% was observed in settings with infectious cases.

Conclusions:

  • STEC shedding duration and transmission risk in young children do not warrant changes to current exclusion guidance.
  • Supervised return of prolonged shedders can be considered despite serotype shifts.
  • Evidence supports maintaining existing public health recommendations for STEC management in childcare.

Keywords:
Shiga toxin-producing Escherichia colicarriagechildcare settingepidemiologytransmission

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