Epidemiology and Infection

Original Papers

Gastroenteritis and outbreaks

Duration of shedding of Verocytotoxin-producing Escherichia coli in children and risk of transmission in childcare facilities in England

G. DABKEa1 , A. LE MENACHa2a3 , A. BLACKa1, J. GAMBLINa1, M. PALMERa1, N. BOXALLa2 and L. BOOTHa1 c1

a1 Hampshire and Isle of Wight Health Protection Unit, Hampshire, UK

a2 Health Protection Agency, London and South East Regional Epidemiology Units, London, UK

a3 European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Control and Prevention, Tomtebodavägen, Solna, Stockholm, Sweden


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.

(Received October 24 2012)

(Revised March 28 2013)

(Accepted April 17 2013)

(Online publication May 15 2013)

Key words

  • Carriage;
  • child day-care centres;
  • disease outbreaks;
  • England;
  • shiga-toxigenic Escherichia coli ;
  • transmission


c1 Author for correspondence: Dr L. Booth, Wessex PHEC, Unit 8 Fulcrum 2, Solent Way, Whiteley, Hampshire PO15 7FN, UK. (Email: linda.booth@phe.gov.uk)


  These authors contributed equally to this work