Systematic review on the incubation and infectiousness/shedding period of communicable diseases in children

Evidence assessment
​Illnesses caused by infectious diseases are common in children in schools or other childcare settings. Currently there is no common EU approach to the control of communicable diseases in schools or other childcare settings, and existing information is uncertain.

Executive Summary

ECDC undertook a systematic review that looked into the incubation period and period of infectiousness/duration of shedding for 30 of the most common infectious diseases in children. It also looked into the exclusion period for children in schools and other childcare settings. The findings may provide evidence essential for public health action, such as the minimum school leave period for an infected child/teenager. Evidence from the scientific literature can also provide the basis for a guidance on the exclusion-making process and for other control strategies to prevent the spread of the most frequent infectious diseases in schools and other childcare settings. 

The review covered selected infections in children aged 1 month to 18 years. The outcomes were subdivided in the following disease groups:

  • Vaccine preventable diseases (measles; meningococcal disease; mumps; pertussis; rubella; varicella);
  • Food and waterborne diseases (enterovirus infections; viral gastroenteritis by adenovirus, astrovirus, noro-/calici-/sapovirus, rotavirus; hepatitis A; campylobacteriosis; Escherichia coli infections; Salmonella infections (non-typhoid, typhoid, paratyphoid); shigellosis; giardiasis):
  • Airborne diseases (influenza; infectious mononucleosis; respiratory syncytial virus infections; streptococcal infections (scarlet fever, streptococcal pharyngitis, impetigo);
  • Other transmissible diseases of interest in paediatrics (roseola infantum, erythema infectiosum, staphylococcal impetigo, hospital colonisation by resistant pathogens and MRSA infections).
Publication file

Systematic review on the incubation and infectiousness/shedding period of communicable diseases in children

English (1.12 MB - PDF)

Related diseases

Measles virus particles, TEM. © Science Photo Library

Measles is a highly contagious viral disease that can be contracted at any age, and that can spread widely.

Meningitis bacteria, SEM. © Science Photo Library

Meningococcal disease is caused by Neisseria meningitidis, a bacterium with human carriers as the only reservoir. It is carried in the nose, where it can remain for long periods without producing symptoms.

Mumps virus. © Science Photo Library

Mumps is an acute illness caused by the mumps virus. It is characterised by fever and swelling of one or more salivary glands (mumps is the only cause of epidemic infectious parotitis).

TEM of Rubella viruses. © Science Photo Library

Rubella is a mild febrile rash illness caused by rubella virus. It is transmitted from person to person via droplets (the virus is present in throat secretions). It affects mainly, but not only, children and when pregnant women are infected, it may result in malformation of the foetus. Humans are the only reservoir of infection.

Varicella-zoster virus. Credit: NIAID

Varicella (chickenpox) is caused by the varicella-zoster virus (VZV), which also causes shingles. The virus spreads through the body into the skin causing rashes to appear.

Flu viruses in the throat, artwork. © Science Photo Library

Seasonal influenza is a preventable infectious disease with mostly respiratory symptoms. It is caused by influenza virus and is easily transmitted, predominantly via the droplet and contact routes and by indirect spread from respiratory secretions on hands etc.

Morphologic traits of the Coxsackie B4 virus virions. Credit: CDC

Enteroviruses are a group of viruses that cause a number of infectious illnesses which are usually mild. However if they infect the central nervous system, they can cause serious illness. The two most common ones are echovirus and coxsackievirus, but there are several others.

Rotavirus. Credit: CDC/ Jessica A. Allen

Rotavirus infection is an acute infectious disease mainly affecting children. The main symptoms are fever, vomiting and diarrhoea and many affected children suffer from extensive fluid loss in need of medical attention. The incubation period is 1-2 days.

3D graphical representation of a single Norovirus virion. Credit: CDC/ Jessica A. Allen

Norovirus cause gastrointestinal illness to humans. Norovirus infection can cause vomiting, diarrhoea, and stomach pain.

Hepatitis A virus particles, TEM. © Science Photo Library

Hepatitis A is an acute infectious disease of the liver caused by the hepatitis A virus, a small, non-enveloped hepatotropic virus classified in the genus Hepatovirus within the family Picornaviridae.

Helicobacter pylori bacteria, SEM. © Science Photo Library

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Salmonella typhimurium bacteria. © Science Photo Library

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