title: Duration of shedding of Verocytotoxin-producing Escherichia coli in children and risk of transmission in childcare facilities in England.
abstract: Exclusion of children with presumptive Verocytotoxin-producing Escherichia coli (VTEC) from childcare facilities until negative stool specimens are obtained is routine practice that disrupts families. We estimated the shedding and exclusion duration and transmission risk in such facilities. The study population comprised 225 children aged <6 years attending 201 childcare facilities in England with microbiologically confirmed VTEC in 2010-2011. We estimated the interval from onset to first negative specimen, and identified transmission events with secondary cases linked to facilities. The median duration of shedding was 31 days, and median period of exclusion was 39·5 days. Cases attending facilities while shedding VTEC did so for a median of 2 days before exclusion. Secondary cases occurred in 6/83 facilities (7%) attended by infectious cases. Despite evidence of VTEC shedding at facilities, transmission is relatively low. Revised control guidelines could consider supervised return for prolonged asymptomatic shedders.
authors.affiliation: Hampshire and Isle of Wight Health Protection Unit, Hampshire, UK.
authors.forename: G
authors.initials: G
authors.lastname: Dabke
authors.affiliation: Health Protection Agency, London and South East Regional Epidemiology Units, London, UK.
authors.forename: A
authors.initials: A
authors.lastname: Le Menach
authors.affiliation: Hampshire and Isle of Wight Health Protection Unit, Hampshire, UK.
authors.forename: A
authors.initials: A
authors.lastname: Black
authors.affiliation: Hampshire and Isle of Wight Health Protection Unit, Hampshire, UK.
authors.forename: J
authors.initials: J
authors.lastname: Gamblin
authors.affiliation: Hampshire and Isle of Wight Health Protection Unit, Hampshire, UK.
authors.forename: M
authors.initials: M
authors.lastname: Palmer
authors.affiliation: Health Protection Agency, London and South East Regional Epidemiology Units, London, UK.
authors.forename: N
authors.initials: N
authors.lastname: Boxall
authors.affiliation: Hampshire and Isle of Wight Health Protection Unit, Hampshire, UK.
authors.forename: L
authors.initials: L
authors.lastname: Booth
mesh_terms: D057138:Bacterial Shedding; D002656:Child Day Care Centers / Q000706:statistics & numerical data*; D002675:Child, Preschool; D004739:England / Q000453:epidemiology; D004927:Escherichia coli Infections / Q000453:epidemiology / Q000382:microbiology / Q000635:transmission*; D005260:Female; D006801:Humans; D008297:Male; D012307:Risk Factors; D054323:Shiga-Toxigenic Escherichia coli; D013997:Time Factors