Vaccine-preventable disease outbreaks in schools, part 2: pertussis, meningococcal disease, diphtheria, poliomyelitis, hepatitis A, and rotavirus infection.

Schools are essential elements during childhood and adolescence, not only for providing education, but also for promoting the personal development and socialization of students. School attendance almost always takes place in classrooms and in close proximity for several hours daily. Students also interact with students from other classrooms and schools through participation in sports and extracurricular activities. These characteristics render the schools ideal environments for the transmission of vaccine-preventable diseases. We reviewed 57 articles published from 2000 to June 2, 2025, presenting original data on pertussis, meningococcal disease, hepatitis A, rotavirus, diphtheria, and poliomyelitis outbreaks in schools. The published outbreaks occurred almost exclusively in high-income and upper-middle income countries. Among all outbreaks, pertussis has caused most outbreaks, and by far the largest in terms of duration, number of cases, and attack rates. Rotavirus also caused significant outbreaks, mainly in primary schools. Hepatitis A outbreaks were often waterborne or foodborne and part of community outbreaks. Diphtheria and poliomyelitis outbreaks were extremely rare. Fatalities were reported exclusively in meningococcal and diphtheria outbreaks, with high case fatality rates among students. On several occasions, school activities were disrupted. In conclusion, it is likely that school outbreaks are underreported, particularly in low-income countries. Considering the decline in vaccination coverage in recent years in many countries worldwide, the risk of school outbreaks is rising. Strengthening vaccination services, surveillance, and diagnostic capacity are needed to prevent and contain them.