A cross-sectional national investigation of COVID-19 outbreaks in nurseries during rapid spread of the Alpha (B.1.1.7) variant of SARS-CoV-2 in England

Felicity Aiano, Kelsey McOwat, Chinelo Obi, Annabel A. Powell, Jessica Flood, Shivraj Bhardwaj, Kelly Stoker, Donna Haskins, Brian Wong, Marta Bertran, Maria Zavala, Johanna Bosowski, Samuel E.I. Jones, Zahin Amin-Chowdhury, Laura Coughlan, Mary Sinnathamby, Asad Zaidi, Rachel Merrick, Hongxin Zhao, Sharif IsmailMary E. Ramsay, Shamez N. Ladhani*, Vanessa Saliba

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Background: In England, the emergence the more transmissible SARS-CoV-2 variant Alpha (B.1.1.7) led to a third national lockdown from December 2020, including restricted attendance at schools. Nurseries, however, remained fully open. COVID-19 outbreaks (≥ 2 laboratory-confirmed cases within 14 days) in nurseries were investigated to assess the risk of SARS-CoV-2 infection and cumulative incidence in staff and children over a three-month period when community SARS-CoV-2 infections rates were high and the Alpha variant was spreading rapidly across England. Methods: This was a cross-sectional national investigation of COVID-19 outbreaks in nurseries across England. Nurseries reporting a COVID-19 outbreak to PHE between November 2020 and January 2021 were requested to complete a questionnaire about their outbreak. Results: Three hundred and twenty-four nurseries, comprising 1% (324/32,852) of nurseries in England, reported a COVID-19 outbreak. Of the 315 (97%) nurseries contacted, 173 (55%) reported 1,657 SARS-CoV-2 cases, including 510 (31%) children and 1,147 (69%) staff. A child was the index case in 45 outbreaks (26%) and staff in 125 (72%) outbreaks. Overall, children had an incidence rate of 3.50% (95%CI, 3.21–3.81%) and was similar irrespective of whether the index case was a child (3.55%; 95%CI, 3.01–4.19%) or staff (3.44%; 95%CI, 3.10–3.82%). Among staff, cumulative incidence was lower if the index case was a child (26.28%; 95%CI, 23.54–29.21%%) compared to a staff member (32.98%; 95%CI, 31.19–34.82%), with the highest cumulative incidence when the index case was also a staff member (37.52%; 95%CI, 35.39–39.70%). Compared to November 2020, outbreak sizes and cumulative incidence was higher in January 2021, when the Alpha variant predominated. Nationally, SARS-CoV-2 infection rates in < 5 year-olds remained low and followed trends in older age-groups, increasing during December 2020 and declining thereafter. Conclusions: In this cross-sectional study of COVID-19 outbreaks in nurseries, one in three staff were affected compared to one in thirty children. There was some evidence of increased transmissibility and higher cumulative incidence associated with the Alpha variant, highlighting the importance of maintaining a low level of community infections.

Original languageEnglish
Article number1845
JournalBMC Public Health
Issue number1
Publication statusPublished - Dec 2022
Externally publishedYes

Bibliographical note

Funding Information:
This surveillance was internally funded by PHE and did not receive any specific grant funding from agencies in the public, commercial or not-for-profit sectors. All authors had access to the data; the first and final authors verified the data and had final responsibility for the decision to submit for publication.

Publisher Copyright:
© 2022, The Author(s).


  • Children
  • Educational settings
  • Epidemiology
  • Nurseries
  • SARS-CoV-2


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