Schoolzone: e-Bug – making hygiene child's play

01 May 2011


Why teach children about microbes and antibiotics?

In many European countries, antibiotic prescription rates are highest in children. Teaching children about the different types of microbes, the activity of antibiotics against them and the increasing problems of antibiotic resistance with unnecessary use should raise awareness of prudent antibiotic use in children who are our future generation of users. Within schools, infections are a major cause of absenteeism with poor respiratory and hand hygiene contributing to increased spread. School hygiene campaigns can reduce rates of infection in school children, staff and their families; this in turn may reduce antibiotic use.

The development of e-Bug

Advice from teachers

Before developing the e-Bug resource it was essential to discuss classroom needs with teachers. Meetings of individual focus groups of junior and senior school teachers were carried out in England and France to address key learning, classroom and teacher needs. The main points from the focus groups included:

  • terminology must be relevant for each particular age group;
  • large blocks of text should be avoided;
  • activity sheets should be available in Microsoft Word format to allow modification of lessons, if required, to suit their students' needs and learning abilities;
  • 'teacher refresher' sections are always welcome;
  • activities should have a 'fun' element;
  • the use of a variety of media (photographs, slides, Microsoft PowerPoint, animation) is beneficial.

It was also highlighted that each child is unique and, as such, may approach learning in different ways. As it is generally accepted that children’s learning styles change as a child develops and that learning styles are not mutually exclusive, we have developed the resource with a variety of activities taking into consideration different learning styles.

Advice from students

Ultimately, the e-Bug pack is to help educate children. Therefore, we felt it necessary to involve students in the development of the pack and website artwork. Both junior and senior school students took part in a series of artwork development questionnaires to develop the appearance of the human and microbe characters. Artists drew a range of characters and gave them to the students for comment. After a series of redrafts, the e-Bug characters were born. The junior school students preferred a more cartoon look and feel to the characters, whereas the senior school students, although wanting a graphical representation, preferred their characters to have a more realistic look and feel.

e-Bug resources

e-Bug for teachers

The teacher pages on the e-Bug website ( contain detailed interactive lesson plans covering each of the topics below. You can also find school competitions, films of each of the activities, PowerPoint presentations and animations to help teach some of the more difficult topics, as well as some alternative activities to those found in the pack.


Introduction – Students learn about the different types, shapes and sizes of microbes – bacteria, viruses and fungi – and where microbes are found.
Useful microbes – Students find out that microbes can be beneficial through a yeast or yogurt-making experiment.
Harmful microbes – Examination of various illnesses illustrates how and where bad microbes cause disease.

Spread of infection

Hand hygiene – Through a classroom experiment students learn how microbes can spread from one persion to another through touch and why it is important to wash hands properly.
Respiratory hygiene – Students recreatea a giant sneeze to learn how easily microbes can be spread through coughs and sneezes.
Food hygiene – Junior school children make a chicken salad for their classmates and observe just how far they have spread bad microbes.
Sexual transmission – Senior school students carry out a chemical experiment to observe how easily many people can become infected unknowingly by unprotected sexual intercourse.

Prevention of infection

Natural immunity – Presentations and animations are used to show how the body fights harmful microbes on a daily basis.
Vaccinations – Students use their reading comprehension and creative skills to answer questions on and act out the discovery of vaccinations. In the senior pack, students play a card game and discover how vaccination can protect them against certain infections.

Treatment of infection

Antibiotic use – Through teacher-led discussion and debate, and experiments in senior schools, students learn the importance of using antibiotics and other medicines appropriately.

Evaluation of the pack and teacher site

We have measured the effectiveness of the e-Bug pack in improving children’s knowledge on the topics outlined above when used within the National Curriculum in England, France and the Czech Republic.

The junior pack demonstrated a significant improvement in all pack-teaching areas over time with most students enjoying all lessons. The vaccines and antibiotic sections of the pack were the least preferred. All English and Czech teachers said that they will use the junior e-Bug pack in the future with 3/11 French teachers stating they would not, mainly because there was no IT for students.

The senior pack results varied in terms of knowledge improvement in all areas observed in Ostrava (Czech Republic) and Gloucester (England). Student knowledge before teaching the section ‘Spread of Infection’ was very high, resulting in only 3 of the 6 regions demonstrating knowledge improvement. All English and Czech teachers said that they will use the junior e-Bug pack in the future with only one French teacher stating they would not.

Although the draft packs can be viewed as a success, there was a need to modify various sections of both resources to make them more appealing. Sections particularly disliked by both junior and senior school students consisted of activities which were based on independent research and had no ‘hands-on’ practical element. Teacher criticism included not enough multimedia support, some activities were too time-consuming and too much photocopying was required. Based on these comments and the evaluation, we modified the e-Bug pack with the following changes:

  • slight modifications made to some sections of the junior pack and major changes to various activities in the senior pack;
  • films of each of the activities included on the teacher website;
  • more alternative activities to the teacher website provided;
  • animations and presentations created to help teach the topics;
  • student games included on the website;
  • handouts merged to reduce the amount of photocopying required.

The final resource was launched in London on 3/4 September 2009 and the e-Bug packs were sent to all schools in England during September 2010.

e-Bug for students

Evaluation results highlighted that both teachers and students wanted more online resources for students. Throughout  2010 we carried out focus  group meetings with junior and senior students to find out exactly what they wanted and how they wanted this to look. The new-look e-Bug student  website was launched in September 2010. The colourful and fun website splash and landing page encourage children of all ages (and adults) to venture further into the website to play the interactive games and access further materials. Throughout 2010, the children’s website has been upgraded with help from junior and senior school students and now has a lot more fun features which include:

Microbe of the week – Facts on and a picture of a new microbe ever week, some useful, some harmful, but all interesting.
Fact of the week – Some quirky, some fun, some disgusting and outright weird, but all true microbe facts. Did you know that we produce around 2 pints of snot a day, most of which we swallow?
Revision guides – For students who want to learn a little bit more or to be used in the classroom.
Disease fact files – Fact files on important infectious diseases both new and old, relative to children and young people, such as measles, influenza, holiday infections and much more.
Quizzes – Students can test themselves with fun quizzes, a true or false quiz for juniors and a multiple choice quiz for seniors.
Hall of Fame – Here students canvisit a lab or hang out in an art gallery hall of fame to learn about those ‘boring old' scientists who have made important contributions to microbiology and medicine.
Home science – A series of experiments to do in the home.
Interactive games – Fun games designed to highlight key learning points in the pack. How long can you survive the sneeze? Will you get your vaccine before the holiday bugs get you? Can you beat the computer with your microbe knowledge in our fun card game?
Downloads – Photos of microbes, animated characters and backgrounds are all available here to download and to use in any school projects or just for fun.

Have a look at the website today and enter our schools competition to celebrate European Antibiotic Awareness day and win a chance for the e-Bug team to come to your school to provide a fun interactive day of microbe-based activities.

Due to the success of the e-Bug evaluation, the European Centre for Disease Prevention and Control (ECDC) have translated all of the e-Bug resources, the pack and websites into all remaining EU languages and these will be available from September 2011.

Donna Lecky is the e-Bug Project Manager

Health Protection Agency Primary Care Unit, Microbiology Department, Gloucester Royal Hospital, Great Western Road, Gloucester  GL1 3NN (tel. 08454 225062; email [email protected])

Further reading

Lecky, D.M., McNulty, C.A.M., Touboul, P., Herotova, T.K., Beneš, J., Dellamonica, P., Verlander, N.Q., Kostkova, P. & Weinberg, J. (2010). Evaluation of e-Bug, an educational pack, teaching about prudent antibiotic use and hygiene, in the Czech Republic, France and England. J Antimicrob Chemother 65, 2674–2684.
Lecky, D.M., McNulty, C.A.M., Adriaenssens,  N. & others (2011). Development of an educational resource on microbes, hygiene and prudent antibiotic use for junior and senior school children. J Antimicrob Chemother (in press).
Lennell, A. & Fredlund, H. (2008). Use of hand disinfection reduces absenteeism from day care centres. Eur Surveill: Eur Commun Dis Bull 13, 1560.
Reid, J.M. (1975). The learning style preferences of ESL school children TESOL Q 21, 87–111.
Sandora, T.J., Shih, M.C. & Goldmann, D.A. (2008). Reducing absenteeism from gastrointestinal and respiratory illness in elementary school students: a randomized, controlled trial of an infection-control intervention. Pediatrics 121, 1555–1562.
World Health Organization (2000). WHO Annual Report on Infectious Diseases. Overcoming Antimicrobial Resistance. (accessed 26 November 2008).