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Screening Policies for Daycare Attendees

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submitted on 2024-06-06, 06:06 and posted on 2024-06-06, 06:07 authored by Mark Gilbert, Curt Monk, Hsiu-Li Wang, Ken Diplock, Lisa Landry


Control measures for enteric outbreaks in child care settings frequently include screening by stool cultures from symptomatic children only. We present evidence from an investigation of Escherichia coli (E. coli) O157:H7 in a daycare in Waterloo, Ontario to support implementation of a mandatory screening policy for all children during an outbreak.


In addition to routine outbreak control measures employed by the health unit, stool samples from all children and staff were collected, with positive E. coli cultures typed by pulsed field gel electrophoresis (PFGE). We conducted a cohort study, using data from the environmental investigation and questionnaires administered to parents and staff, to look for risk factors for infection and to survey parent/staff knowledge regarding appropriate management of diarrhea.


Overall 11 E. coli O157:H7 cases were identified (7 lab-confirmed); 9 were children. No common source of infection was identified. Factors identified as possibly contributing to person-to-person transmission within the daycare included: i) the underreporting and possible attendance of symptomatic children despite alerting parents to the outbreak and requirements to keep symptomatic children at home, ii) possible transmission from an asymptomatic infected child, and iii) inconsistent understanding among parents and staff regarding diarrhea and appropriate management of a child with diarrhea.


This investigation reveals that in child care settings, E. coli O157:H7 outbreak screening policies based on reported symptoms only may be insufficient. We recommend that such policies be amended to include the collection of at least one stool culture from all children in attendance, regardless of symptom history.

Other Information

Published in: Canadian Journal of Public Health
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The University of Doha for Science and Technology replaced the now-former College of the North Atlantic-Qatar after an Amiri decision in 2022. UDST has become and first national applied University in Qatar; it is also second national University in the country.


Open Access funding provided by the Qatar National Library.



  • English


Springer Nature

Publication Year

  • 2008

License statement

This Item is licensed under the Creative Commons Attribution 4.0 International License

Institution affiliated with

  • College of the North Atlantic - Qatar (-2022)
  • University of Doha for Science and Technology
  • College of Health Sciences - UDST

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