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How long should children in childcare with E. coli stay home? This was the subject of a recent study in England. These researchers were determining if current exclusion guidance was sufficient, or if it should be modified to a longer or shorter time period.
The current exclusion guidance in England is that children with Shiga toxin-producing Escherichia coli (STEC) should be kept at home until they are completely microbiologically clear of the pathogen. This means that the child must have two consecutive negative fecal specimens, taken at least 24 hours apart.
The current exclusion guidance for children with STEC is to be kept out of childcare until microbiologically clear of the pathogen.
This information is achieved through specialized laboratory testing.
In families that rely on childcare so that parents can work, this extended exclusion can not only disrupt earnings and family schedules, but also the child’s education. This can be stressful for a family.
The study was designed to determine if the timelines for this guidance need to be updated.
What exactly is STEC? Shiga toxin-producing E. coli are strains of E. coli bacteria that produce a toxin harmful to the human body.
Shiga toxin-producing E. coli are strains of E. coli bacteria that produce a toxin harmful to the human body.
Not all E. coli bacteria are bad. In fact, some strains are a normal part of our digestive system.
Others, on the other hand, can cause serious illness. STEC is one of those.
The most famous of the STEC strains is STEC O157. But other non-O157 STEC strains can be just as harmful.
People become infected with STEC infections in a few different ways. The most common include consuming contaminated food or drinks, contact with carrier animals, and person-to-person transmission.
Person-to-person transmission is the biggest concern when it comes to children in childcare with E. coli
It is the person-to-person transmission that is the biggest concern when it comes to children in childcare with E. coli infections. Children are not always aware of potential hazards of putting things in their mouths and poor handwashing. One case of STEC can quickly spread in a childcare setting.
The Centers for Disease Control and Prevention (CDC) estimates that there are around 265,000 STEC infections in the United States each year. STEC O157 accounting for around 36% of them. However, the CDC expects that a significant number of non-O157 cases go undiagnosed and under reported.
In many cases, milder cases do not require medical attention, and therefore no testing is performed. Additionally, certain non-O157 strains are not reliably detected on current screening protocols.
STEC symptoms can vary from mild to very serious. However, most symptoms include some combination of severe stomach cramps, diarrhea (often bloody), and vomiting. Fever, if present, is usually not very high. It is usually under 101 °F.
Symptoms usually begin around 3 to 4 days after exposure. Most people feel better within 5 to 7 days, though some may experience more serious illness or complications from the infection.
In fact, children are more likely to experience a type of kidney complication known as hemolytic uremic syndrome.
Hemolytic uremic syndrome, or HUS, is a type of kidney complication that develops in around 5 to 10% of those diagnosed with STEC infections.
While most people may recover from an STEC infection on their own and do not need medical intervention, those with STEC require hospitalization to recover.
The toxin produced by the harmful E. coli strain can break down red blood cells. These damaged blood cells can block the filtering pathways in the kidneys, causing them to fail. Symptoms usually begin around 7 days after initial diarrheal symptoms begin (just as it is improving).
Symptoms of HUS:
With appropriate care, most people with HUS will recover within a few weeks. However, in some cases, HUS can cause permanent damage or become fatal.
Young children, the elderly, and those with a weakened immune system are at higher risk of becoming sick if exposed to STEC and experiencing more serious illness when infected.
This leaves children in childcare more vulnerable, as it can quickly spread and cause serious illness throughout the entire group.
This is the reason for the study.
The study analyzed how long children shed the harmful bacteria and transmission risk to determine how long they should be excluded from childcare settings.
Data was collected from historical information between 2018 and 2022 where cases of children in childcare with E. coli were analyzed. Additional information, such as screening among children at the facility were also analyzed to get an idea of transmission rates.
Investigators discovered that the majority of cases had a shedding duration of about 32 days. This was on par with previous studies that showed a shedding duration of about 31 days.
Rates of transmission seemed to be lower among case reporting bloody diarrhea, however an overall data analysis showed a transmission rate of about 13% among close contacts.
“Findings do not warrant guidance changes regarding exclusion and supervised return of prolonged shedders.”
Study findings show no wiggle room in changes for exclusion guidance for children in childcare with E. coli.
Sharing is not always caring. Particularly when it comes to communicable illness. Children pass illnesses back and forth as easily as they share toys. This is why illness protocols are so important in a childcare setting.
As developmentally appropriate, it is important to help instill protective measures and hand hygiene practices in young children to help arm them against infections.
If your child has become seriously ill from an outbreak in a childcare setting, you have a lot to deal with. The E. coli lawyers at The Lange Law Firm, PLLC have experience helping families through these difficult times. If you have questions about a recent outbreak in a childcare setting, call (833) 330-3663 for a free consultation or click here for more information.
If you’d like to know more about food safety topics in the news, like New Study on Children in Childcare with E. coli Exclusion Guidance, check out the Make Food Safe Blog. We regularly update trending topics, foodborne infections in the news, recalls, and more! Stay tuned for quality information to help keep your family safe, while The Lange Law Firm, PLLC strives to Make Food Safe!
By: Heather Van Tassell (contributing writer, non-lawyer)
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