Antibiotic resistance is an increasing community problem and is related to antibiotic use. If antibiotic use could be reduced, the tide of increasing resistance could be stemmed. e-Bug is a European project involving 18 European countries, partly funded by The Directorate-General for Health and Consumers (DG SANCO) of the European Commission. It aims to develop and disseminate across Europe a junior and senior school teaching pack and web site (hosting the lesson plans and complementary games) that teach young people about prudent antibiotic use, microbes, transmission of infection, hygiene and vaccines. The aim of e-Bug is to increase young people's understanding, through enjoyable activities, of why it is so important to use antibiotics correctly in order to control antibiotic resistance, and to have good hand and respiratory hygiene to help reduce the spread of infection. Within the senior school pack the sexual transmission of infections has also been included, as the peak age of chlamydial infection is in 16-24 year olds. Teachers, young people and the consortium of 18 countries were closely involved with agreeing learning outcomes and developing the resource activities. Young people helped create the characters and microbe artwork. The resources have been translated, adapted for and disseminated to schools across 10 countries in Europe, and endorsed by the relevant government departments of health and education. The web site has been accessed from >200 countries. The resources will be translated into all European Union languages, and have been used to promote European Antibiotic Awareness Day and better hand and respiratory hygiene during the influenza pandemic in 2009.

Handwashing, respiratory hygiene and antibiotic resistance remain major public health concerns. In order to facilitate an effective outcome when teaching the basic principles of hand and respiratory hygiene, educational interventions should first target school children. As computer games are ubiquitous in most children's lives, e-Bug developed computer games targeted at teaching children handwashing, respiratory hygiene and antibiotic resistance. The games were designed for two target audiences: junior school children (9-12 year olds); and senior school children (13-15 year olds). Between May and August 2009, the finalized junior game underwent an evaluation in three UK schools (in Glasgow, Gloucester and London), involving 62 children in the schools and ∼ 1700 players accessing the junior game online. The e-Bug junior game consists of a number of levels of play, each of which promotes a set of learning outcomes (LOs). These LOs, complementary to those in the e-Bug packs, are expressed through the game mechanics (the rules of the game) rather than through story or dialogue. Although the junior game's evaluation demonstrated a statistically significant change in the knowledge for only a small number of given LOs, because many children had the required knowledge already before playing the game, this is e-Bug's first statistical study on the junior game and the first comprehensive evaluation of its kind. Future work includes a re-examination of the quiz-style questionnaires utilized in this study and an exploration of the potential knowledge change acquired strictly through engagement.

As a complement to the e-Bug teaching pack, two e-Bug games were developed to provide content that aimed to entertain as well as to educate. A set of agreed learning outcomes (LOs) were provided by the scientific partners of the e-Bug Project and the games were developed using user-centred design techniques (the needs, wants and limitations of the potential game players were assessed at each stage of the design process). The e-Bug games were designed for two age groups: Junior (9-12 year olds); and Senior (13-15 year olds). A study using focus groups was done to gain an understanding as to the types of games enjoyed by the target users. According to the preliminary study, the Junior Game was developed as a platform game and the Senior Game was developed as a story-based detective game. The Junior Game consists of five levels, each associated with a set of LOs. Similarly, the Senior Game consists of four missions, each comprising five stages using problem-based learning techniques and LOs. In this paper, the process of development for each game is described in detail and an illustration is provided of how each game level or mission addresses the target LOs. Development of the games used feedback acquired from children in four schools across the UK (Glasgow, London and two in Gloucester). The children were selected according to their willingness to participate. European Partners of the e-Bug Project also provided further support, translation and requests for modifications. The knowledge gained of LOs and further evaluation of the games is continuing, and preliminary results are in press. The final versions of the games, translated into 11 European languages, are available online via www.e-bug.eu.

Playing computer games is widely popular among children and teenagers as an entertainment activity; meanwhile, playing computer games also provides a learning opportunity. For example, the rules of the game have to be learned by the player in order to improve his/her performance. Based on that principle, the City eHealth Research Centre (CeRC) developed a web game for 13-15 year olds, whereby the player becomes an investigator who attends the scene of an incident that involves microbes. There are four missions in total, each involving a mystery that the player needs to solve and learning objectives that need to be taught - such as antibiotic resistance and the importance of hygiene. This paper presents the results from a game evaluation that took place between July of 2009, in four UK schools (Glasgow, Gloucester, London), with 129 students; whereby 98% of the students commented positively about playing the game. Subsequently, CeRC has improved the game and developed an interactive educational games portal (www.edugames4all.com) for different age groups of web game enthusiasts.