UK Health Security Agency, London, England, UK.
UK Field Epidemiology Training Programme, UK Health Security Agency, London, England, UK.
BMC Public Health. 2024 Aug 21;24(1):2272. doi: 10.1186/s12889-024-19580-w.
Shiga toxin-producing Escherichia coli (STEC) infections are a significant public health concern as they can cause serious illness and outbreaks. In England, STEC incidence is highest among children and guidance recommends that children under six diagnosed with STEC are excluded from childcare until two consecutive stool cultures are negative. We aimed to describe the barriers and facilitators to implementing exclusion and the impact of exclusion policies on young children and their families.
Individual level data was obtained from a wider study focusing on shedding duration among STEC cases aged < 6 years between March 2018 - March 2022. Data was extracted from England's public health case management system. The case management system includes notes on telephone conversations, email correspondence and meeting minutes relating to the case. Collected data consisted of free text in three forms: (1) quotes from parents, either direct or indirect, (2) direct quotes from the case record by health protection practitioners or environmental health officers, and (3) summaries by the data collector after reviewing the entire case record. We analysed free text comments linked to 136 cases using thematic analysis with a framework approach.
The median age of included cases was 3 years (IQR 1.5-5), with males accounting for 49%. Nine key themes were identified. Five themes focused on barriers to managing exclusion, including (i) financial losses, (ii) challenges with communication, engagement and collaboration, (iii) issues with sampling, processing, and results, (iv) adverse impact on children and their families and (v) conflicting exclusion advice. Four themes related to facilitators to exclusion, including (i) good communication with parents and childcare settings, (ii) support with childcare, (iii) improvements to sampling, testing, and reporting of results, and (iv) provision of supervised control measures.
Qualitative analysis of public health case records can provide evidence-based insights around complex health protection issues to inform public health guidelines. Our analysis highlights the importance of considering wider social and economic consequences of exclusion when developing policies and practices for the management of STEC in children.
产志贺毒素大肠杆菌（STEC）感染是一个严重的公共卫生问题，因为它们会导致严重疾病和疫情。在英国，STEC 的发病率在儿童中最高，指南建议，确诊 STEC 的 6 岁以下儿童在连续两次粪便培养阴性之前不得进入托儿所。我们旨在描述实施隔离的障碍和促进因素，以及隔离政策对幼儿及其家庭的影响。
从 2018 年 3 月至 2022 年 3 月期间，一项针对年龄<6 岁的 STEC 病例的粪便持续时间的更广泛研究中获取了个体水平数据。数据从英格兰公共卫生病例管理系统中提取。病例管理系统包括与病例相关的电话交谈、电子邮件往来和会议记录的说明。收集的数据由三种形式的自由文本组成：（1）父母的直接或间接引述，（2）卫生保护从业人员或环境卫生官员从病例记录中直接引述，以及（3）数据收集者在审查整个病例记录后进行的总结。我们使用框架方法的主题分析对与 136 例相关的自由文本评论进行了分析。
纳入病例的中位年龄为 3 岁（IQR 1.5-5），男性占 49%。确定了 9 个关键主题。五个主题侧重于管理隔离的障碍，包括（i）经济损失，（ii）沟通、参与和合作方面的挑战，（iii）采样、处理和结果方面的问题，（iv）对儿童及其家庭的不利影响，以及（v）相互冲突的隔离建议。四个主题与隔离的促进因素有关，包括（i）与父母和儿童保育场所的良好沟通，（ii）儿童保育支持，（iii）采样、检测和结果报告的改进，以及（iv）提供监督控制措施。
对公共卫生病例记录的定性分析可以为复杂的卫生保护问题提供循证见解，为制定儿童 STEC 管理政策和实践提供信息。我们的分析强调了在制定 STEC 儿童管理政策和实践时，考虑隔离的更广泛的社会和经济后果的重要性。
