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E. coli Blog

Surveillance & Analysis on E. coli News & Outbreaks

E. coli O157:H7 Warning in South Royalton Vermont Worthy Burger

E.-coli1Update:  5 confirmed, 2 probable E. coli cases.

Matt Hongoltz-Hetling and Jordan Cuddemi of the New Hampshire Valley News report that Vermont Health officials are investigating a cluster of E. coli O157:H7 cases and warning physicians to watch for more cases.

According to Hongoltz-Hetling, Vermont health officials are warning clinicians to be on the lookout for signs of E. coli, after at least five Vermont residents contracted infections caused by the food-borne bacteria. The locations of the five laboratory-confirmed cases, and a sixth case listed as “probable,” were not divulged by the Vermont Department of Health, which asked doctors to report instances of patients with diarrhea, nausea, stomach cramps and vomiting to state health officials immediately.

According to Cuddemi, a South Royalton, Vermont restaurant voluntarily closed for several days recently and switched food vendors after being contacted by state officials who are investigating an E. coli “cluster” that has sickened at least five people.

Jason Merrill, executive chef at Worthy Burger, said the Vermont Department of Health approached the restaurant’s leadership team last week and asked them to consider changing some of their food vendors out of precaution.

Hamburger Recalled Over non-O157 Shiga toxin-producing E. coli

Schrader Farms Meat Market, a Romulus, N.Y., establishment, is recalling approximately 20 pounds of ground beef product that may be contaminated with non-O157 Shiga toxin-producing E. coli, the U.S. Department of Agriculture’s Food Safety and Inspection Service (FSIS) announced today.

The ground beef item was produced on September 2, 2015. The following product is subject to recall: [View Labels (PDF only)]

  • 1-lb. packages containing of “SCHRADER FARMS Meat Market Ground Beef” or “SCHRADER FARMS Meat Market GROUND BEEF, BULK” with a pack date of September 2, 2015.

The products subject to recall bear the establishment number “Est. 44950” inside the USDA mark of inspection. These products were sold at the Schrader Farms retail store in Seneca County, New York.

The problem was discovered during routine establishment testing, however this establishment released product into commerce prematurely (Review of Testing Results). FSIS and the company have received no reports of adverse reactions due to consumption of these products.

Many clinical laboratories do not test for non-O157 Shiga toxin-producing E. coli (STEC), such as STEC O26, O103, O45, O111, O121 or O145 because it is harder to identify than STEC O157. People can become ill from STECs 2–8 days (average of 3–4 days) after consuming the organism. Most people infected with non-STEC E. coli develop diarrhea (often bloody), and vomiting. Some illnesses last longer and can be more severe. Infection is usually diagnosed by testing of a stool sample. Vigorous rehydration and other supportive care is the usual treatment; antibiotic treatment is generally not recommended.

Most people recover within a week, but, rarely, some develop a more severe infection. Hemolytic uremic syndrome (HUS) is uncommon with STEC O26, O103, O45, O111, O121 or O145 infection. HUS can occur in people of any age but is most common in children under 5 years old, older adults and persons with weakened immune systems. It is marked by easy bruising, pallor, and decreased urine output. Persons who experience these symptoms should seek emergency medical care immediately

FSIS and the company are concerned that some product may be frozen and in consumers’ freezers.

10 with E. coli Linked to Los Chilangos

From Seattle/King County Department of Health:

The investigation team is continuing to figure out where the E. coli O157 came from. We expected to find additional people who were exposed to the E. coli O157 linked to Los Chilangos before we closed them. To this point, we are able to say that there are four more people impacted by this outbreak, bringing the total to ten. These are not people who are newly ill, but rather people who were unable to be reached during our initial interview process or people who did not recall eating at Los Chilangos at the time of their interview. None of these nine people became sick after August 21.

E. coli in Seattle

CN2mSrKVEAAQZu9Seattle King County Public Health is currently investigating an outbreak of E. coli O157:H7 – one of the most serious foodborne illnesses you can contract. Our thoughts are with the families affected by this outbreak, and we appreciate the support of the community as we work to protect the health of the public.

A person can get an E. coli O157 infection from many different sources: by eating or drinking something contaminated with animal or human fecal matter, through animal contact, or through contact with another person who has an E. coli infection. One of our responsibilities at Public Health is to track down these sources. When there are illnesses associated with any one of the more than 12,000 food establishments in the county, we search for contaminated products, ill food workers, or improper food handling.

We follow specific steps to find clues that help us pinpoint the source(s) that may be linked to illness. Here are key steps of this current investigation.

  • We interviewed people who got sick.

At this time, we know that six people have been infected with the same strain of E. coli (three have been hospitalized). When Public Health determines that anyone is sick from a serious foodborne illness like E. coli, we interview them to determine what may have caused their illness. We do this to find the source of the outbreak and prevent others from getting infected. In this instance, through a few initial interviews with ill people, we determined that everyone who became sick had something in common – they ate food prepared by a local food vendor called Los Chilangos. Public Health took swift action and required Los Chilangos to cease operations.

  • We investigated a food business that was associated with the people who got sick.

But we didn’t stop there. Los Chilangos serves food at seven farmers markets in King and Snohomish Counties, operates two food trucks, and also caters events. Los Chilangos utilizes a shared kitchen space, called a commissary kitchen. The kitchen that they use is Eastside Commercial Kitchen, where they share space and equipment with about a dozen other food businesses.

  • We intervened at the specific site and operation.

The condition of the commissary and the potential for cross contamination were deemed an imminent health hazard, and the health officer issued a cease and desist order to the commissary on Thursday, August 27. Additionally, all of the food vendors permitted by Public Health that use this kitchen were also told to cease operations. Recognizing that this lapse in operation hurts business, our team has worked diligently with these vendors to find new places for them to resume their work and remind them about important food safety measures.

  • Next steps: tracing the source

As of today, the investigation isn’t over. We are still investigating the source of the E. coli.  If we determine that a food contained the E. coli bacteria, we will try to trace it back to stores, suppliers, and even farms to address the root of the problem with corrective actions, if possible.

But, it’s possible that the source of E. coli may never be determined. E coli is often linked to beef, but it can also be linked to produce, such as spinach and sprouts, along with a variety of other foods such as unpasteurized juices, raw milk, game meats, and other common foods.

For outbreaks such as this one, we continue to monitor the situation and look for other common factors among ill people. While we know Los Chilangos is linked, they may not be the only ones involved. For instance, the source of E. coli could be served by other vendors.

We are currently working with all of the businesses connected to this outbreak to make sure that they are not using any products that may have become contaminated and that they have food safety measures in place. This includes having the businesses address needed repairs to their equipment, providing education to their staff, and ensuring their operations are safe to open.

KIRO’s Amy Clancy reports that Los Chilangos is a link to at least six E. coli cases in King and Snohomish Counties. Los Chilangos serves food at seven farmers markets in King and Snohomish counties, operates two food trucks, and also caters events. Los Chilangos uses Eastside Commercial Kitchen, where they share space and equipment with about a dozen other food businesses.

King County Public Health is investigating six E. coli cases that appear to be linked to a food truck that visited farmers markets.

  • 6 sickened
  • 3 hospitalized
  • Food trucks operated at 7 farmers markets in King, Snohomish counties
  • Los Chilangos food trucks shut down

“Through a few initial interviews with ill people, we determined that everyone who became sick had something in common – they ate food prepared by, a local food vendor called Los Chilangos,” King County Public Health staff said in a statement.

The department required the food truck to stop selling food.

A 4-year-old girl is one of those affected, and her mother said her daughter became sick after eating at Los Chilangos around August 8.

The food truck visited the Issaquah and Sammamish farmers markets. Deanna Buder said her 4-year-old daughter started experiencing pain and swelling in her abdomen, and stopped eating. Tuesday is her seventh day at Seattle Children’s Hospital.

Fulton, Wabash, and Marshall Counties Investigating E. coli Outbreak

The six cases currently being investigated include one death.

The Indiana State Department of Health has confirmed E. coli O157:H7 infection in three individuals as part of an investigation into reports of diarrheal illness in three northern Indiana counties. The cases are among a total of six illnesses currently being investigated.

ISDH is working with public health officials in Fulton, Wabash, and Marshall counties to determine the cause of illness in the three other individuals, and to monitor for diarrheal illness in family members or others who may have been in contact with all six individuals who became ill.

Indiana Day Link in Another E. coli Outbreak

The Fulton County Health Department, Wabash County Health Department and Indiana State Department of Health announced that they are investigating cases of E. coli O157 among children who attend a local daycare. Currently, all confirmed cases being investigated with this outbreak are associated with this daycare.

E. coli O157 is a contagious diarrheal illness that causes symptoms such as abdominal cramping, diarrhea, vomiting, and sometimes bloody stool. Symptoms usually begin three to four days after exposure but can appear from one to eight days after exposure. Symptoms typically last five to 10 days. While most people resolve infection on their own, about 3 percent to 7 percent of people will develop severe complications that require hospitalization. Some people may have no symptoms but can still spread the infection to others. For this reason, careful and frequent hand washing is important.

Ill children who attend school or daycare should be excluded until they are symptom-free and have two negative stool tests to prevent other children from getting sick. Parents and caretakers of ill individuals also are at risk of contracting E. coli O157 and should limit contact with others as much as possible and see a health care provider if symptoms develop. Adults infected with E. coli O157 who work in food service or health care settings should not attend work while ill.

E. coli O157 is normally found in animals, such as cattle, but not found in humans. People become infected by having contact with contaminated food or water or through contact with animals or infected people. Once infected, people shed the bacteria in their stool.

Hand washing is the single best defense against E. coli O157. Hands should be washed after using the restroom, before eating or preparing food, and after contact with animals. Adults should supervise children to make sure they are washing their hands properly for at least 20 seconds while using soap and warm water. Children under 5 years of age should avoid direct contact with farm animals (such as from petting zoos or county fairs).

E. coli Cluster in Sacramento

e_coli-300x300Likely E. coli O157:H7 cases are being investigated by the Sacramento County Department of Health and Human Services.

Department spokesperson Laura McCasland told Food Safety News that four of the seven who tested positive for E. coli first exhibited symptoms for the pathogen.

McCasland said department investigators do not believe they are dealing with an ongoing outbreak. While the source has not yet been identified, they have no evidence that any retail grocery store is involved.

Food Safety News first learned of the Sacramento County outbreak from a reader who claims to have two children among the infected individuals. That source said that there are three hemolytic uremic syndrome, or HUS, cases among the seven individuals.

Nevada Prison Linked to E. coli Outbreak

Besides the confirmed case at the prison about 100 miles northeast of Reno, there are two suspected cases of E. coli being examined, the department said in a news release.

Corrections officials contacted the state’s Division of Public and Behavioral Health to investigate the cause and sent samples to the Centers for Disease Control and Prevention for testing, the release said.

“No other inmates or anyone in the general public have been reported as showing symptoms of or have been suspected of having E. coli in Nevada,” the release said.

E. coli Outbreak: Red River Valley Fair

The North Dakota Department of Health is investigating a possible cluster of Shiga toxin-producing E. coli (STEC) infections in eastern North Dakota.

Three cases have been reported, all are less than 18 years of age and all reported attending the Red River Valley Fair in West Fargo which was held July 7 through 12.

One of the cases has been diagnosed with hemolytic uremic syndrome (HUS), a severe complication of STEC infections, in which red blood cells are damaged and can cause kidney damage and kidney failure.

“We are in the early stages of this investigation and are asking people who became sick with diarrhea or bloody diarrhea for more than 24 hours within ten days of attending the fair to let us know,” said Michelle Feist, a health department epidemiologist. “Although the cases reported having contact with animals while at the fair, we are looking into other possible exposures as well.”

STEC is a bacterial infection that can cause abdominal cramping, nausea, vomiting, diarrhea and bloody diarrhea. Symptoms can be severe resulting in dehydration and electrolyte imbalances. People usually get sick within 3 to 4 days from the time of infection, but it can take as long as 10 days for symptoms to appear.

People who have symptoms of STEC should consult with their health care provider.

STEC is shed in the stool of infected animals and people. STEC infections can result from eating contaminated food, drinking contaminated water, coming into contact with animals that are carrying STEC and can be spread from person to person through inadequate hygiene. Undercooked meats, especially ground beef, contaminated produce or sprouts and attending petting zoos have all been implicated in STEC outbreaks in the U.S. Animals may be infected and not have symptoms but can shed the bacteria.

First, see www.fair-safety.com – this is nothing new.

Day Care’s Can Be E. coli Friendly and Dangerous to Kids

The South Carolina Department of Health and Environmental Control (DHEC) has provided the following update to a E. coli investigation at Learning Vine Daycare in Greenwood County:

  • At this time, DHEC has confirmed eleven (11) cases of Shiga toxin-producing E. coli (STEC) in Greenwood County. The cases involve individuals at The Learning Vine childcare facility and their family members.
  • As of today, 186 test results are negative for STEC. The three new laboratory-confirmed cases are in individuals who either previously had symptoms of diarrheal illness or were asymptomatic, but who are all now symptom-free.
  • There is no evidence of ongoing transmission related to this investigation, and there has been no new onset of illness in students or staff of the daycare since June 1, 2015.
  • DHEC is continuing to collect and test samples for laboratory analysis. Information resulting from this investigation will be provided as it is confirmed, and in accordance with state and federal law.

As part of this ongoing investigation, DHEC today continued to:

  • Collect and test samples for laboratory analysis
  • Notify individuals of their test results and answer any questions of those affected
  • Provide updated guidance to individuals affected by the investigation
  • Operate a hotline (1-800-868-0404) to provide assistance to those affected
  • Scheduled a private, one-on-one informational session for those affected
  • Work with the CDC, FDA and the childcare facility to investigate the mode of transmission in an effort to stop the spread of the infection
  • DHEC to hold information forum in Greenwood 6/13/15

Learning Vine on Overland Drive in Greenwood shut down voluntarily on Monday.  The closure followed the death of 2-year-old Myles Mayfield, of Greenwood, who died from hemolytic uremic syndrome, a condition associated with E. coli that can lead to kidney failure.

Site reviews conducted by the state Department of Social Services’ Division of Early Care and Education June 4 found 12 violations at Learning Vine, according to results posted on the DSS website.

The violation areas pending correction are:

– Diaper changing, 24-month and younger room (x2)

– Improper medication practices

– Sanitation violations (x3)

– Facility restrooms (x2)

– Feeding, 24-month and younger room

– Food safety/menu

– Posted information

– Other health and safety

Learning Vine has a “C” in the DSS Division of Early Care and Education ABC Quality voluntary rating and improvement program, meaning it meets basic requirement, but C is the lowest of grades in the rating program.

A few prior examples of Daycare E. coli Outbreaks:

In August of 2000, the Kindercare facility located on Lexington Drive in Folsom, California, was traced as the source of an E. coli O157:H7 outbreak. Health department officials who investigated the outbreak determined that the probable “index case” – a child who unknowingly brought the bacteria into the facility – experienced “explosive diarrhea at the daycare on the afternoon of 8-3-00.” Shortly thereafter, four other children became infected with E. coli O157:H7 on successive days, the 6th, 7th, 8th and 9th of August, 2000. All of the children were in the same day care group. In addition to the illnesses of the children, the mother of one child, and another child’s sibling became ill and tested positive for E. coli. Another toddler also became ill.

According to the Facility Evaluation Report by the Department of Social Services dated November 7, 2000, “[t]he cause of the [E. coli O157:H7] outbreak [at the Lexington Drive Kindercare] was due to a sponge being used simultaneously for wiping down a changing table and wiping down a table used for serving meals.”

In June of 2002, the Disease Control Section of the Tarrant County Public Health Department (TCPHD) in Fort Worth, Texas, was notified that a 2-year old child had been hospitalized with hemolytic uremic syndrome, or HUS, a complication of E. coli O157:H7 infection. In the following days, TCPHD received several additional reports of E. coli O157:H7 illness, including five culture-positive cases. During its investigation into the outbreak, TCPHD learned that all of the victims were associated with the CCC Alternative Learning Program Daycare in Fort Worth, Texas; 12 children who attended the daycare, one daycare staff member, and one parent of a daycare attendee had all fallen ill with E. coli infections.  TCPDH’s inspection of the daycare revealed “several breaches in food preparation and procedures at the daycare facility.”  In its investigation report, TCPDH noted:

  • The daycare had not obtained a city permit to prepare and serve food, but was providing food for the children attending the daycare.
  • Appropriate sources of drinking water were not available in the building housing the smaller children; water jugs were filled using the bathroom sink.
  • A swimming pool at the facility was in use with murky water prior to chlorination and the daycare had not obtained a city permit.

Perhaps the most important finding during TCPHD’s investigation was that staff, parents and children reported frequently eating portable lunches on the daycare grounds by a pond.  The pond collected run-off from a pasture that held grazing cattle.  TCPDH reported that several samples of pond water confirmed a heavy concentration of E. coli O157:H7.

On May 10, 2004, the Jasper County Health Department (JCHD) received a report from St. Johns Regional Medical Center that two 2-year-old children had been hospitalized with hemolytic uremic syndrome (HUS) at Children’s Mercy Hospital in Kansas City, Missouri.  The children, one boy and one girl, were residents of Carthage Missouri.  Five of the girl’s family members soon developed symptoms of E. coli infection, and one later tested positive for E. coli O157:H7. JCHD began investigating the apparent E. coli outbreak, and learned that the hospitalized girl and one of her siblings attended daycare at Kid’s Korner daycare in Joplin, Missouri. JCHD investigators visited the daycare facility on May 11.  They did not note any major hand washing or diapering violations, and discussed the importance of excluding children with diarrheal illness from the daycare with daycare operators and employees.

On May 24, JCHD was notified that a 4-year-old girl who attended daycare at Kid’s Korner had become ill with symptoms of E. coli infection on May 14 and was being transferred from a Joplin hospital to Children’s Mercy in Kansas City with HUS.  JCHD inspectors returned to Kid’s Korner on May 25, and instructed the daycare to distribute a letter explaining the incidence of E. coli at the daycare and the signs and symptoms of illness to parents.  During this inspection, JCHD investigators noted deficiencies conducive to the spread of disease and instructed Kid’s Korner employees on methods of hygiene and sanitation effective to prevent the further spread of E. coli.

By May 26, JCHD had received two additional reports of illness in children who attended Kid’s Korner.  One of the children had had bloody diarrhea on May 11; the child’s sibling fell ill on May 26 and was later hospitalized with HUS.  Despite their earlier assurances that no children at the daycare had been symptomatic during the month of May, Kid’s Korner then produced a list of nine children who had exhibited symptoms of E. coli infection to JCHD investigators.

On May 27, JCHD inspectors returned to the daycare center and noted handwashing lapses.  They also learned that Kid’s Korner had failed to distribute the May 25 letter regarding possible E. coli exposure and symptoms to 32 percent of the families with children in attendance at Kid’s Korner.