title: School outbreak of Escherichia coli O157 with high levels of transmission, Staffordshire, England, February 2012.
abstract: Verocytotoxin-producing Escherichia coli (VTEC) are bacteria that cause infectious gastroenteritis and in certain settings can cause widespread infection due to secondary transmission. We describe the findings of an investigation of a school-based outbreak of VTEC in Staffordshire, England.
  
  
  
  Outbreak investigation at a school in February 2012 after two children were diagnosed with VTEC infection. Cases were defined as pupils and staff (or their household contacts) with gastrointestinal symptoms or asymptomatic screened persons, with laboratory confirmed VTEC O157 infection (phage type 32, verocytotoxin 2) occurring on or after 1 February 2012. Microbiological tests of food and faecal samples plus screening of asymptomatic contacts were undertaken. Epidemiological and clinical data were descriptively analysed.
  
  
  
  Thirty-eight cases were detected. Nineteen were asymptomatic and identified via screening of 191 pupils. Infection was introduced into the school from an earlier household cluster, followed by extensive person-to-person transmission within the nursery/infant group with limited spread to the wider school population.
  
  
  
  Control measures included several interventions, in particular, universal screening of pupils and staff. Screening during school outbreaks is not underpinned by guidance but proved to be a key control measure. Screening of asymptomatic contacts should be considered in similar outbreaks.
authors.affiliation: Field Epidemiology Service, Public Health England, Birmingham, UK.
authors.forename: Laura
authors.initials: L
authors.lastname: Bayliss
authors.affiliation: Health Protection Team North, Public Health England Centre West Midlands, Public Health England, Birmingham, UK.
authors.forename: Robert
authors.initials: R
authors.lastname: Carr
authors.affiliation: Field Epidemiology Service, Public Health England, Birmingham, UK.
authors.forename: Obaghe
authors.initials: O
authors.lastname: Edeghere
authors.affiliation: Health Protection Team North, Public Health England Centre West Midlands, Public Health England, Birmingham, UK.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Knapper
authors.affiliation: Public Health Laboratory Birmingham, Public Health England, Birmingham, UK.
authors.forename: Kathy
authors.initials: K
authors.lastname: Nye
authors.affiliation: Environmental Health Department, Newcastle-under-Lyme Borough Council, Stoke-on-Trent, UK.
authors.forename: Gareth
authors.initials: G
authors.lastname: Harvey
authors.affiliation: Gastrointestinal Emerging and Zoonotic Infections, Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK.
authors.forename: Goutam
authors.initials: G
authors.lastname: Adak
authors.affiliation: Health Protection Team North, Public Health England Centre West Midlands, Public Health England, Birmingham, UK.
authors.forename: Harsh
authors.initials: H
authors.lastname: Duggal
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks / Q000517:prevention & control / Q000706:statistics & numerical data*; D004739:England / Q000453:epidemiology; D004927:Escherichia coli Infections / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control / Q000635:transmission; D019453:Escherichia coli O157 / Q000472:pathogenicity*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D012572:School Health Services; D012574:Schools / Q000706:statistics & numerical data; D055815:Young Adult
keywords: communicable diseases; epidemiology; public health