The toll of exclusion from work or preschool due to toxin-producing Escherichia coli positivity in Dublin and South East Ireland, 2022/2023.

Abstract

Background: Ireland has one of the highest rates of Shiga toxin-producing Escherichia coli (STEC) infections in Europe. As part of the public health response, those from high-risk groups must be excluded from work or pre-school until microbiological clearance is achieved.

Methods: This study analysed STEC cases from Dublin and the South-East public health region in Ireland in 2022 and 2023, focusing on the duration of exclusion of patients in high-risk groups.

Results: There were 383 STEC cases notified during the study period. Ninety-seven (25.3%) were excluded from work or pre-school, 76 had a definitive, quantifiable duration of exclusion. Overall, the patients in this study were collectively excluded for 2532 days (6.9 person-years) over a 2-year period.

Conclusions: Exclusions cause significant stress to individuals and families. This demonstrates the potential need to risk-stratify STEC notifications for clearance, as in other European countries. Another approach might involve administering antibiotics, believed to shorten the duration of shedding. Despite concerns around an association with an increased risk of Haemolytic Uraemic Syndrome with antibiotic use, recent data in asymptomatic shedders have been reassuring in this regard. This study illustrates the magnitude of lost time while awaiting clearance. The public health management of STEC infection needs to evolve, to take account of an evolving evidence base.