What does this research mean for the field?

Prolonged childcare exclusions for children with Shiga toxin-producing E. coli (STEC) infection cause significant unintended social and economic harms that disproportionately affect vulnerable families, including women, those with special needs children, and those lacking financial resources. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.ESTABLISHES_NEW_DIRECTION.

What question did this study set out to answer?

This study aims to explore the social and economic inequalities faced by families excluded from childcare due to Shiga toxin-producing E. coli infection.

May 17, 2026SSM - Qualitative Research in Health0 citationsOpen Access

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‘I was locked down by myself’: Understanding inequalities in the impact of exclusion from childcare for families of children with Shiga toxin-producing E. coli infection.

SRSuzanne RotheramUniversity of Liverpool DSD. SumiloUniversity of Warwick BBB. BarrNational Institute for Health Research

Key Points

This study aims to explore the social and economic inequalities faced by families excluded from childcare due to Shiga toxin-producing E. coli infection.
Conducted a narrative study with 16 parents of children aged 9 months to 5 years excluded from childcare.
Investigated exclusion durations ranging from 1 day to 5 months following STEC infection.
Analyzed the social and economic impacts based on different family circumstances.
Exclusion resulted in significant negative social consequences, particularly for families of children with additional needs and those living in small homes.
Lack of access to paid leave or nursery fees intensified the economic impacts on families.
Parents with resources were better able to navigate the health protection process, reducing some of the challenges faced.

Abstract

Public Health and Social Measures (PHSM) are used worldwide to prevent the spread of infectious disease. However, PHSMs can also lead to unintended harms, exacerbating health and social inequalities. For example, many countries ‘exclude’ children under six shedding Shiga toxin-producing E. coli (STEC) from childcare settings to reduce transmission, given that STEC infection causes serious illness, including renal failure. In England, children shed STEC for an average of 32 days, with 2% shedding for more than 100 days. Yet the unintended consequences of these prolonged exclusions remain largely invisible in guidelines and unaddressed in policy. This paper presents data from a narrative study with 16 parents of children aged 9 months to 5 years excluded for between 1 day to 5 months following STEC infection. It illuminates the unintended negative consequences of STEC exclusions and how they are shaped by social and economic conditions as well as the organisation and implementation of the health protection process. Our analysis shows inequalities in the social consequences of STEC exclusions and from navigating the health protection process. Women, families of children with additional needs, families with smaller homes, and families without access to paid leave or paid nursery fees all experienced greater impacts. Parents with resources could circumvent some challenges they experienced navigating the health protection process. Practitioners and policymakers must weigh the significant harms of STEC exclusions alongside infection control benefits. Including lived experience in the development of PHSM policies is crucial to minimise harms and address inequalities caused by unintended consequences. • First narrative study to investigate inequalities in STEC exclusions • Exclusion and its implementation led to negative social and economic consequences • Lack of access to paid leave or nursery fees worsened financial consequences • Children with SEND and families in small homes experienced worse social impacts • PHSMs should consider lived experience to minimise unintended consequences

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Cite This Study

Rotheram et al. (Fri,) studied this question.

synapsesocial.com/papers/6a095ba67880e6d24efe182b https://doi.org/https://doi.org/10.1016/j.ssmqr.2026.100756

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