title: A review of gastrointestinal outbreaks in schools: effective infection control interventions.
abstract: BACKGROUND
  The purpose of this study was to review documented outbreaks of gastrointestinal illness in schools, published in the last 10 years, to identify etiology, mode of transmission, the number of children affected, morbidity and mortality patterns, and interventions for control and prevention.
  
  
  METHODS
  Searches of electronic databases, public health publications, and federal, state, and provincial public health Web sites were completed.
  
  
  RESULTS
  Of the 121 outbreaks that met the inclusion criteria, 51% were bacterial, 40% viral, 7% were from Cryptosporidium, and 2% from multiple organisms. Transmission routes recorded in 101 reports included foodborne (45%), person-to-person (16%), waterborne (12%), and animal contact (11%). Actions to control outbreaks included alerting medical and public health authorities or the community to the outbreak (13%), treating cases (12%), enhancing hand washing (11%), and increased vigilance during food preparation (8%). Recommendations to prevent future outbreaks were compared with previously published studies that demonstrated effectiveness.
  
  
  CONCLUSIONS
  The risk of foodborne illness was reduced when food handlers practiced effective hand washing technique and received food safety training and certification. Student training programs on hand hygiene, enhanced cleaning and disinfection of the school, and hepatitis A vaccination were found effective. Children should be supervised on farm visits, hand washing strictly enforced, and food eaten in an area separated from the animals. Staff and students should have a positive, continuous communication with public health authorities including educational sessions and immediate reporting of possible outbreaks.
authors.affiliation: School of Occupational and Public Health, Ryerson University, 350 Victoria St., Toronto, Ontario, Canada N1E 3Y5. marilyn.lee@ryerson.ca
authors.forename: Marilyn B
authors.initials: MB
authors.lastname: Lee
authors.forename: Judy D
authors.initials: JD
authors.lastname: Greig
mesh_terms: D003140:Communicable Disease Control / Q000379:methods*; D004196:Disease Outbreaks / Q000517:prevention & control*; D005506:Food Contamination; D005511:Food Handling / Q000592:standards; D005516:Food Microbiology; D005517:Foodborne Diseases / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D005759:Gastroenteritis / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control*; D006235:Hand Disinfection; D006801:Humans; D012574:Schools