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Risk factors associated with outbreaks of seasonal infectious disease in school settings, England, UK

Lookup NU author(s): Professor Sarah O'Brien



This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


Children are important transmitters of infection. Within schools they encounter large numbers of contacts and infections can spread easily causing outbreaks. However, not all schools are affected equally. We conducted a retrospective analysis of school outbreaks to identify factors associated with the risk of gastroenteritis, influenza, rash or other outbreaks. Data on reported school outbreaks in England were obtained from Public Health England and linked with data from the Department for Education and the Office for Standards in Education, Children's Services and Skills (Ofsted). Primary and all-through schools were found to be at increased risk of outbreaks, compared with secondary schools (odds ratio (OR) 5.82, 95% confidence interval (CI) 4.50–7.58 and OR 4.66, 95% CI 3.27–6.61, respectively). School size was also significantly associated with the risk of outbreaks, with higher odds associated with larger schools. Attack rates were higher in gastroenteritis and influenza outbreaks, with lower attack rates associated with rashes (relative risk 0.17, 95% CI 0.15–0.20). Deprivation and Ofsted rating were not associated with either outbreak occurrence or the subsequent attack rate. This study identifies primary and all-through schools as key settings for health protection interventions. Public health teams need to work closely with these schools to encourage early identification and reporting of outbreaks.

Publication metadata

Author(s): Donaldson AL, Harris JP, Vivancos R, O'Brien SJ

Publication type: Article

Publication status: Published

Journal: Epidemiology & Infection

Year: 2020

Volume: 148

Online publication date: 18/11/2020

Acceptance date: 12/11/2020

Date deposited: 21/06/2021

ISSN (print): 0950-2688

ISSN (electronic): 1469-4409

Publisher: Cambridge University Press


DOI: 10.1017/S0950268820002824

PubMed id: 3320349


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Funder referenceFunder name
NIHR HPRU 2012-10038