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)
† These authors contributed equally to this work