School epidemics: should we raise the alarm?

By Ana Espino | Published on September 2, 2025 | 3 min read

#Gastroenteritis #Infection #SchoolEpidemic  


Acute gastroenteritis ranks among the most common infections worldwide. It represents a major cause of absenteeism and morbidity in schools. Children, who are particularly vulnerable due to their still-developing immune systems and the close contact within educational settings, are at heightened risk of infection and transmission.

Despite their importance, the management and prevention of these outbreaks remain limited by several factors: frequent underreporting of cases, heterogeneity in surveillance protocols, and difficulties in controlling spread, among others.  

Recent data suggest that infectious etiology—bacterial, viral, or parasitic—plays a central role in the onset and severity of outbreaks. However, the relative weight of each agent and the dominant modes of transmission remain poorly characterized. A major challenge therefore lies in accurately identifying the infectious agents involved, understanding transmission dynamics within schools, and evaluating the effectiveness of preventive measures already in place. Against this background, this study was undertaken to analyze the characteristics of gastrointestinal outbreaks that have occurred in schools over the past decade, in order to identify more effective and context-appropriate preventive strategies.  

Dirty hands, water, or school canteens: where do the microbes come from?

A total of 121 documented outbreaks in schools worldwide were identified and analyzed. Results showed that 51% were bacterial in origin, 40% viral, and 7% parasitic—mainly due to Cryptosporidium. The most frequently implicated agents were norovirus, pathogenic E. coli, Shigella, Salmonella, and hepatitis A virus. Modes of transmission were dominated by foodborne spread (45%), followed by person-to-person contact (16%), contaminated water (12%), and animal contact (11%).  

In response to this diversity, control measures relied on several complementary approaches: rapid notification of health authorities, temporary exclusion of infected cases, reinforcement of hand hygiene, intensive disinfection of premises, and food safety training. Comparative analysis of interventions confirmed that supervised hand hygiene, targeted training for food handlers, vaccination against hepatitis A, and strict separation of food preparation and animal areas were among the most effective strategies to limit the scope of school outbreaks. These findings demonstrate that a combination of targeted, consistent measures constitutes the best approach to contain the rapid spread of such infections in the sensitive environment of schools.  

What if prevention began on the playground?

School-based gastrointestinal outbreaks represent a public health concern due to their frequency, their potential for community spread, and the hospitalizations they sometimes require. The challenge remains to adopt interventions tailored to the school context, where close contact and young age favor transmission. The aim of this study was to identify the most relevant prevention strategies. Findings confirmed the effectiveness of interventions targeting hand hygiene, food safety, and vaccination, but available studies remain limited by underreporting and methodological heterogeneity.  

Future research should include systematic surveillance of outbreaks, evaluation of long-term educational programs, and development of standardized crisis management protocols for school settings. This will help strengthen schools’ resilience to infectious threats and better protect children’s health.

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