Each of the five nurseries which were closed as a safety precaution during an E-coli outbreak in East Lothian have now been given the green light to re-open.
The Musselburgh Private Nursery chain has become the latest to welcome back staff and children, following final checks and inspection visits by East Lothian Council environmental health team, the Care Inspectorate and NHS Lothian Public Health team.
The Stoneybank nursery opened today (wed) while it’s sister company in Bridge Street is gearing up to re-open as soon as tomorrow (thurs).
Testing and the stringent E.coli clearance process has also been completed in both nurseries.
Dr Josie Murray, Consultant in Public Health Medicine and Chair of the multi-agency Incident Management Team (IMT), said: “We are really encouraged to see all of the nurseries open their doors once again and welcome back their staff and pupils.
“We know it has been a really difficult time for everyone involved, especially in accepting some of the control measures which were vital in containing the infection and stopping its spread within the community.
“On behalf of the IMT, I would like to thank everyone for working with us throughout this rapidly evolving and complex outbreak.”
Work is still continuing behind the scenes by the health care scientists in epidemiology and microbiology to try and identify the source of the infection.
Letters providing the most up to date information have been issued to families directly in some circumstances and via the nurseries distribution systems.
Church Street Pear Tree Nursery was originally closed on August 2 after a number of children fell ill and went on to test positive for E-coli.
The sister nursery Meadowpark Pear Tree Nursery was closed next, as well as West Road Pear Tree Nursery, Musselburgh Private Nursery, Bridge Street and Musselburgh Private Nursery, Stoneybank,.
In total, there have been 56 confirmed cases of E.coli. The infection was not confirmed at West Road Pear Tree Nursery.
The complex outbreak has evolved rapidly and a set of FAQs were developed to help answer questions from concerned families and carers and can be found on NHS Lothian’s website:
A list of the most frequently asked questions has been prepared to help give families in East Lothian more information around E-coli following a cluster of cases linked to local nurseries.
If, after reading this list, you still have questions or concerns about your own family circumstances, please get in touch.
A general information line on 0800 22 44 88 has been created through NHS24 to help families answer many of the questions they may be facing.
Background:
A cluster of cases of E-coli has been linked to nurseries in East Lothian. Four nurseries remain closed.
Cases of E-coli have been identified in Church Street Pear Tree Nursery and Meadowpark Pear Tree Nursery. Families have been informed of the actions they need to take.
Two other nurseries – West Road Pear Tree and Musselburgh Bridge Street Private Nursery – remain closed as a precaution after symptoms of a sickness bug were reported. Families have been informed and asked to provide samples if their child has had any symptoms to rule out the presence of E-coli.
There are currently in excess of 34 confirmed cases.
All children and staff from both Pear Tree Nursery at Church Street Pear Tree Nursery and Meadowpark Pear Tree Nursery have been formally excluded under the Public Health Act and need to go through the clearance process.
Children and staff attending the Pear Tree Nursery at West Road and Musselburgh Bridge Street Private Nursery have been advised to hand in samples if they have had Gastrointestinal symptoms.
Information last updated 22nd August 2022
General Questions
Q. What are the main symptoms of E.coli?
A. E.coli can cause:
Nausea
Vomiting
Stomach pains
Diarrhoea
Bloody diarrhoea
Fever
Q. Why is E.coli so serious?
A. Infection with this bug can have a range of effects from mild diarrhoea, to bloody diarrhoea and in a small proportion of cases it can cause serious complications such as kidney failure. Complications are more common in children aged under five or the elderly.
Q. Where does E.coli infection come from?
A.This bug is carried by a proportion of healthy animals such as cattle. It can be picked up from contact with animal faeces in the environment.
People can also become infected through eating contaminated food for example meat which has not been adequately cooked, or contaminated fruit or vegetables which have not been adequately washed. Unpasturised milk or contaminated water can also cause infection.
E.coli can also be passed on from someone who is infected with the bacteria.
Q. How is E.coli spread?
A. The infection can be spread person to person in families, nurseries or other institutions when contaminated faeces from an infected person are somehow ingested by another person (faecal-oral route). It can also be spread through contaminated food, water or from environmental contamination, including animal parks and gardens.
Q. How can E.coli be prevented?
A. Firstly, thorough hand washing with soap in running water after going to the toilet, before preparing food and after contact with animals or farm environments. Handwashing after nappy changing is very important as is environmental cleaning. Secondly, good food hygiene is essential, for example cooking all meat products thoroughly, washing all salads, fruits and vegetables before consumption and keeping raw and cooked food separate with separate utensils.
Q. My child does not attend any of the above named nurseries, but has diarrhoea, do they have E.coli and what should I do?
A. There are many causes of diarrhoea particularly in children and in most cases it is due to a virus such as norovirus or rotavirus. We would recommend that you take your child to the GP for assessment if their symptoms do not settle down after 24 hours or you are concerned about your child. All children with symptoms of diarrhea should remain off school or nursery until at least 48 hours after their last symptoms. This also means that children should not attend any other settings or clubs where there are children under the age of 10. They should also not be allowed to play with their friends until they have fully recovered.
Q. My child has no contact with any of the above named nurseries, but had diarrhoea 2 weeks ago and is better, what should I do?
A. If your child had a bout of diarrhoea or vomiting which has resolved and they have had no contact with the named nurseries it is highly unlikely that they have an E-coli infection. If you are concerned about your child or their symptoms return please speak to your GP.
Q. My child has no contact with the above named nurseries but has bloody diarrhoea, what should I do?
A. If your child develops bloody diarrhoea, you should contact your GP for an immediate medical assessment taking a stool sample from your child to your GP. Your child may have an E.coli infection that is not linked to the nurseries.
Q. Should I take any special cleaning precautions at home as I have young children?
A. The main preventative action to prevent the spread of diarrhoeal illness is good hand washing with soap under running water, after using the toilet, nappy changing and before eating.
Wipes can be used to remove faecal matter from your hands after changing a nappy but may not act as an anti- bacterial and hand washing is also needed. Alcohol gels should only be used if soap and running water is not available and are only effective on hands that are already visibly clean.
Surfaces should be cleaned using warm water and detergent for surfaces followed by drying with a paper towel. Bleach, or other household disinfectants may be used on appropriate surfaces depending on manufacturer’s recommendations.
Q. My child does not attend the above nurseries and has symptoms – none of which are listed at Q1, but I’m worried about E.coli .
A. It is unlikely that your child has E coli infection. Seek advice from your GP or Health Visitor in the usual way if you are concerned about their health and follow the precautions mentioned above.
Q. Can an E.coli infection be treated with antibiotics?
A. Antibiotics are not routinely recommended for E.coli infection, and in some cases may make the illness more severe. Anti-motility drugs, such as Imodium are also not recommended for diarrhoea caused by E.coli.
Children who are diagnosed with an E.coli infection in their poo will be seen by the pediatricians at the Royal Hospital for Children and Young People. They will give advice to parents on what treatment the child will receive while they have E.coli infection.
Q. My child was at a party/other group where a child from the above nurseries attended, what should I do?
A. There is a very low risk of spread of infection if the other child from the nursery had no symptoms at the time. E.coli is more likely to be passed on when a child has active diarrheal symptoms. If your child does develop symptoms of E.coli you should take them to your GP.
Q. My child started P1 last week and was in a class with a pupil who has since been excluded from Meadowpark Pear Tree Nursery, should I be worried?
A. There is no need for concern. The IMT acts in line with Public Health Scotland guidance which states that people should be excluded from work or school once there is a confirmed presence of E-coli.
In this case, there were only reports of general sickness symptoms. As a precaution, the nursery was closed on August 12, children and staff asked to stay home and report any sickness symptoms over coming days which included the start of the new school term on August 17.
E-coli went on to be detected in a small number of cases on August 19. None of the children who were starting P1 had symptoms of any infection and therefore the risk to others was extremely low.
They have only now been excluded as a precautionary measure to rule out infection as possible contacts within the nurseries with confirmed E.coli and can return to school when negative samples have been received.
Q. My child has been playing with a child who attends the Pear Tree Nursery in Meadowpark or the Pear Tree Nursery Church Street, should they continue to do this?
A No, at this time children who are excluded from nursery should not play or socialise with anyone outwith those who normally live within their household until they have been contacted directly by the Health Protection Team and advised that they can do so.
Q. My child has been playing with a child who attends the Pear Tree Nursery in West Road or the Musselburgh Bridge Street Private Nursery, should they continue to do this?
A As long as the child from either of these nurseries has been asymptomatic or symptom free from at least 48 they can continue to play and socialise. This is because there are currently no confirmed cases of E.coli in these nurseries.
Q. When can we expect to get further updates on the situation
A. The situation is changing regularly, and as new information comes to light the Health Protection Team will update parents. Information will be sent to the nursery management team to distribute to parents.
The Health Protection Team are working with Environmental Health, the Care Inspectorate and the Nursery management to ensure that the nurseries open as soon as possible and it is safe to do so.
Q. When will the Nurseries re-open?
A We are unable to answer that at present. This will depend partly upon when individual staff and children have been notified that they are able to return to pre-school establishments, and the nurseries meeting required standards for safety and care and standards for the control of infections.
The investigation into the outbreak is ongoing and as new cases emerge it is difficult to predict when each nursery will reopen. The nurseries may reopen at different times and we will communicate this to parents as more information becomes available.
We understand that this is a very difficult time for parents and once the Health Protection Team, Environmental Health Team and the Care Inspectorate are satisfied that the nurseries are safe, your children will be allowed to return.
Q. I am a Parent/Headteacher/Nursery Manager and we have a sibling of a child from the Pear Tree Nursery at Church Street or the Pear Tree Nursery at Meadowpark.
A If the child from Pear Tree Nursery at Church Street or Pear Tree at Meadowpark is symptomatic or confirmed to have E.coli infection, and their sibling is aged 10 years or under, the Health Protection Team will risk assess and likely exclude the child as a contact.
This means that the sibling cannot attend nursery or school until they have been contacted directly by the Health Protection Team and are advised they can do so.
Q. I am a Parent/Headteacher/Nursery Manager and we have a sibling of a child from the Pear Tree Nursery at West Road or Musselburgh Bridge Street Private Nursery.
A As long as the nursery sibling has no symptoms, this is fine. If the nursery child develops symptoms medical advice should be sought for that child and the situation would be reviewed. All schools and nurseries should enforce the rule that children with diarrhoea or vomiting should remain off until 48 hours after their last symptoms.
Q. I am a nursery manager in another nursery, how will I know when a child who also attends one of the affected nurseries can return to my establishment?
A For children attending the Pear Tree Nursery at Church Street or the Pear Tree Nursery at Meadowpark, all parents of these children will receive a letter from the Health Protection Team indicating that their child’s results are negative and that they can return to preschool groups.
They cannot return to any preschool group until they are notified directly by the Health Protection Team. If the Health Protection Team have been made aware that a child attends another nursery, that nursery will receive a formal exclusion letter for the child and will also receive a clearance letter from the Health Protection Team once the child is cleared to return.
For children attending the Pear Tree Nursery at West Road or Musselburgh Bridge Street Private Nursery, the children can continue to attend as long as they have not had symptoms or have been symptom free for at least 48 hours.
Questions for those Families or Staff with links to Pear Tree Nurseries in Meadowpark or Church Street
Q. My child is due to start Primary School but attended the Pear Tree Nursery in Meadowpark or the Pear Tree Nursery Church Street
A. All children who have attended these nurseries from the 15th July 2022 have been formally excluded under the Public Health Act. This is because both of these nurseries have confirmed cases of E.coli infection.
Your child needs to submit 2 stool samples at least 24 hours apart to their GP. The Health Protection Team will check that those samples are clear for E.coli infection.
Once the laboratories have reported the negative results, the Health Protection Team will contact you directly and lift the Public Health exclusion allowing your child to return to school.
Q. Why are two samples needed for clearance?
A Two samples are needed in line national guidance. The stool samples should be taken a minimum of 24 hours apart to ensure the results are robust.
Q. Where do I take the samples?
A Sample pots should be obtained from your GP surgery. Samples should be handed into your GP, not taken direct to the laboratory.
Please ensure that samples are collected at least 24 hours apart and that the label is completed with all the relevant information. Your GP should let you know the best times to drop off the samples as occasionally they are unable to store them overnight and they are unlikely to accept them at weekends.
Until you have been notified directly by the Health Protection Team about the results of the samples, your child must not attend any pre-school groups such as crèches, playgroups, toddler groups, sports groups or other nurseries.
Q. How do I store a poo sample before I take it to the GP?
A. Once the sample has been taken it can be double bagged and stored at room temperature for several days if required. Please do not store in the refrigerator.
Q. When will the screening test results be available?
A We expect results to be available within 2 weeks. The majority of samples have to be processed at the E coli reference lab in Edinburgh. At this time, our labs are using extra capacity but the samples have to be carefully processed.
You will be notified by telephone of the results. Please do not call the Health Protection Team for results. The Health Protection Team will contact you as soon as both results are available. The Laboratories are processing in excess of 500 tests so there may be delays in getting results to staff and parents.
Your child must not attend any pre-school groups such as crèches, playgroups, toddler groups, sports groups or other nurseries until you are contacted directly by the Health Protection Team to advise that they can do so. This precaution is needed to prevent any chance that the infection could be spread any further.
Q. My child attends the Pear Tree Nursery in Meadowpark or the Pear Tree Nursery Church Street as well as another nursery or playgroup, can they attend the other nursery?
A Your child should not attend any pre-school group such as crèches, playgroups, toddler groups, sports groups or other nurseries until the Health Protection Team have advised you they are able to do so. This is to ensure that there is no further spread of the infection.
Q. My child attends the Pear Tree Nursery in Meadowpark or the Pear Tree Nursery Church Street, can they go to a birthday party, children’s sports, swimming or soft play area?
A All children who have attended these nurseries from the 15th July 2022 have been formally excluded under the Public Health Act. This is because both of these nurseries have confirmed cases of E.coli infection.
Your child has been formally excluded they should not mix with other children until the Health Protection Team have advised you they are able to do so. This is to ensure that there is no further spread of the infection.
Q. My child attends the Pear Tree Nursery in Meadowpark or the Pear Tree Nursery Church Street but has had no diarrhoea can they go to another nursery?
A No. All children must not attend any other pre-school group such as crèches, playgroups, toddler groups, sports groups or other nurseries until they are advised by the Health Protection Team that they can do so. This is because occasionally people can carry the infection without having symptoms and it is essential that we minimise any chance of further spread.
Q. My child attends the Pear Tree Nursery in Meadowpark or the Pear Tree Nursery Church Street and has diarrhoea, what should I do?
A You should attend your GP for assessment and submit a stool sample.
Q. My child attends the Pear Tree Nursery in Meadowpark or the Pear Tree Nursery Church Street and has bloody diarrhoea, what should I do?
A You should seek immediate medical attention via your GP and submit a stool sample.
Q. I am a staff member from the Pear Tree Nursery in Meadowpark or the Pear Tree Nursery Church Street, can I work at another nursery?
A No, you must not work in any pre-school establishment, caring for children, or handling food until you have been notified directly by the Health Protection Team that you are clear to do so.
This is to ensure that any chance of further spread is minimised as occasionally people can carry the infection without having symptoms.
You may be eligible for compensation for loss of earnings, from the Health Protection Team if you have been formally excluded under the Public Health Act. A compensation form will be attached to your exclusion letter.
Q. I visited one of the Pear Tree Nursery branches: Church Street, Meadowpark or West Road since 15th July 2022, do I need to be checked for infection?
or
I visited the Musselburgh Bridge Street Private Nursery since 09th August 2022, do I need to be checked for infection?
A If this was a short visit where you did not eat food or use the toilet facilities within the nursery, the risk of infection is low, however, please be vigilant for any signs of infection such as those listed at the beginning of this document and contact your GP if symptoms do present.
Q. I have worked in the Pear Tree Nursery at Church Street or the Pear Tree Nursery at Meadowpark since 15th July or my child has attended one of these nurseries since 15th July and have not received any letters from public health, should I have?
A Yes, the Health Protection Team have sent inform and advise information out to all the staff and parents via the Nursery Management Team’ The Health Protection Team have sent out or are in the process of sending out formal exclusion letters to all staff and children who’s details have been supplied by the Nursery Management Team.
Questions for those Families or Staff with links to Pear Tree Nurseries in West Road
Q. My child is due to start Primary School but attended the above nursery
A. If your child has had no symptoms or has been clear of any symptoms for at least 48 hours, they can return to school. This is because there are currently no confirmed cases of E.coli at these nurseries, they are being investigated due to outbreaks of gastrointestinal illness which may or may not be due to E.coli. If E.coli is identified from any samples there will be further Public Health actions and the Health Protection Team will give further advice.
Q. My child attends the Pear Tree Nursery in Westroad, can they go to a birthday party, children’s sports, swimming or soft play area?
A. If your child has had no symptoms or has been clear of any symptoms for at least 48 hours, they can attend events and locations outlined above.
This is because there are currently no confirmed cases of E.coli at these nurseries, they are being investigated due to outbreaks of gastrointestinal illness could be due to a number of infections, including E.coli.
If E.coli is identified from any samples there will be further Public Health actions and the Health Protection Team will give further advice.
Q. Where do I take the samples if my child develops symptoms?
A Sample pots should be obtained from your GP surgery. Samples should be handed into your GP, not taken direct to the laboratory. Please ensure that the label is completed with all the relevant information.
Your GP should let you know the best times to drop off the samples as occasionally they are unable to store them overnight and they are unlikely to accept them at weekends. Your child must not attend any pre-school groups such as crèches, playgroups, toddler groups, sports groups or other nurseries until they are at least 48 hours clear of symptoms or until they have the result of their sample.
Q. How do I store a poo sample before I take it to the GP?
A. Once the sample has been taken it can be double bagged and stored at room temperature for several days if required. Please do not store in the refrigerator.
Q. I have worked in the Pear Tree Nursery at West Road since 15th July or my child has attended this nursery since 15th July and have not received any letters from public health, should I have?
A. You should have received what we call an ‘inform and advise letter’ from the Health Protection Team. This would have been sent to you by the Nursery Management Team. We have not sent out individual letters to parents or staff.
Questions for those Families or Staff with links to Musselburgh Bridge Street Private Nursery
Q. My child is due to start Primary School but attended the above nursery
A. If your child has had no symptoms or has been clear of any symptoms for at least 48 hours, they can return to school. This is because there are currently no confirmed cases of E.coli at these nurseries, they are being investigated due to outbreaks of gastrointestinal illness which may or may not be due to E.coli.
If E.coli is identified from any samples there will be further Public Health actions and the Health Protection Team will give further advice.
Q. My child attends the Musselburgh Bridge Street Private Nursery, can they go to a birthday party, children’s sports, swimming or soft play area?
A. If your child has had no symptoms or has been clear of any symptoms for at least 48 hours, they can attend events and locations outlined above.
This is because there are currently no confirmed cases of E.coli at these nurseries, they are being investigated due to outbreaks of gastrointestinal illness which could be due to a number of infections, including E.coli.
If E.coli is identified from any samples there will be further Public Health actions and the Health Protection Team will give further advice.
Q. I have worked in the Musselburgh Bridge Street Private Nursery since 9th August 2022 or my child has attended this nursery since 9th August 2022 and have not received any letters from public health, should I have?
A. You should have received what we call an ‘inform and advise letter’ from the Health Protection Team. This would have been sent to you by the Nursery Management Team. We have not sent out individual letters to parents or staff.
Q. Where do I take the samples if my child develops symptoms?
A Sample pots should be obtained from your GP surgery. Samples should be handed into your GP, not taken direct to the laboratory. Please ensure that the label is completed with all the relevant information.
Your GP should let you know the best times to drop off the samples as occasionally they are unable to store them overnight and they are unlikely to accept them at weekends. Your child must not attend any pre-school groups such as crèches, playgroups, toddler groups, sports groups or other nurseries until they are at least 48 hours clear of symptoms or until they have the result of their sample.
Q. How do I store a poo sample before I take it to the GP?
A. Once the sample has been taken it can be double bagged and stored at room temperature for several days if required. Please do not store in the refrigerator.
For cases who have confirmed E coli infection
Q. My child has confirmed E coli infection, will they get better and when?
A. Before your child can go back to a nursery or a pre-school establishment they need to be completely free of infection. In some cases, this can be several weeks after the initial illness, and repeat stool samples are needed. It is extremely important that your child does not attend any pre-school establishments until they are notified directly by the Health Protection Team that they are free of infection.
Family members may also need tests and may be excluded from some types of work such as food handling or health care professions.
In a small percentage of cases, complications arise including Haemolytic Uraemic Syndrome which can cause renal failure. These children will be monitored extremely carefully in hospital.
Q. What is Haemolytic Uraemic Syndrome?
A This develops in a small percentage of people with E.coli infection. It affects blood cells and can cause kidney failure, therefore it is a serious complication.
Q.My child has confirmed E.coli and I have been excluded from my own work, when can I go back?
A You have been formally excluded from your work because you are a contact of a case of E.coli and work in a risk group, you will need two negative specimens taken at least 24-hours apart before you can return to work. The Health Protection Team will advise you further on this.
It is extremely important that you do not go back to work until you receive direct communication from the Health Protection Team indicating that you can do so. This is to reduce the risk of any further spread. You may be eligible for compensation for loss of earnings, a compensation form should be included with your exclusion letter.
Q.My child has confirmed E.coli infection but is well and we are due to go on holiday, what should we do?
A It is not recommended that you go on holiday until all required tests have returned negative, and this has been directly communicated to you by the Health Protection Team. This is to avoid the possibility of further infections occurring or members of other families needing to be excluded from work or school.
Q. My child has been invited to a party, should they attend?
A. No, Your child must not attend any parties, pre-school groups such as crèches, playgroups, toddler groups, sports groups or other nurseries until you are contacted directly by the Health Protection Team to advise that they can do so. This precaution is needed to prevent any chance that the bug could be spread any further.
Q. Can my child socialise with with any other people or families?
A. No, Your child should not be socialising with other children or families outwith those who normally live in your household until you are contacted directly by the Health Protection Team to advise that they can do so. This precaution is needed to prevent any chance that the bug could be spread any further.
What does Exclusion Under the Public Health etc (Scotland) Act 2008 mean?
Q. Why is a person excluded?
A Exclusion or restriction from work, school or nursery under the Public Health etc (Scotland) Act 2008 is applied when an individual(s) has an infectious disease or has been in close contact with someone with an infectious disease and when there is considered to be a risk that this disease could be passed on to other people.
Exclusion under the Public Health Act is used to reduce the risk of spread of infectious diseases from person to person via the ‘faecal oral route’: when you put something in your mouth, which has been contaminated by the stools/faeces of someone with the bug.
Q. Who can be excluded?
A. Children under the age of 10 are excluded under the Public Health Act when they have been diagnosed with an infectious disease that could be spread to others. If a child under the age of 10 is in close contact (e.g. a sibling) of someone who has an infectious disease, they may also be excluded.
Q. Where/what is a person excluded from?
A. Children who are excluded under the Public Health Act should not attend nursery, school or childcare facilities for the duration of the exclusion. Your child’s nursery/school/childminder will receive a letter to inform them of the exclusion; this will not include specific details of your child’s diagnosis.
In addition to exclusion for nursery/school, there are other activities that may be linked to possible spread of infection to vulnerable groups of people and should therefore be avoided.
Examples of activities and places to avoid during exclusion are:
Swimming
Soft play facilities
Children’s parties /crèches / playgroups / toddler groups / nurseries / after school clubs
Sports clubs
Other gatherings of children
Contact with children under the age of 10 years who are not part of your household
Q. What happens next?
A. You may have initially been told about your child’s infectious disease by your GP, an Environmental Health Officer or a doctor at the hospital. Exclusion under the Public Health Act is the responsibility of a Consultant in Public Health. Should you need further advice or information please contact the Health Protection Team.
Your child’s exclusion can be lifted when they have been formally cleared of infection. Clearance requires testing of stool samples, which you give to your GP surgery. Your child’s first sample can be submitted 48 hours after their last episode of symptoms. Samples should be collected at least 24 hours apart, 2 consecutive negative samples are required to show that your child is free from infection.
Once the Health Protection Team has received the results of samples and confirmed that your child’s exclusion can be lifted, we will inform you by telephone and in writing. Your child’s nursery/school will also be informed.
