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E. coli Blog

Surveillance & Analysis on E. coli News & Outbreaks

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.

South Carolina Learning Vine Daycare E. coli Link

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.

Since Myles’ death, the South Carolina Department of Health and Environmental Control confirmed that there are eight cases of E. coli connected to Learning Vine.  Health officials have not said if those with E. coli are children or adults.

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.

Elk with E. coli Recalled

tuleelk.bull.modcrop.2725Frontiere Natural Meats, LLC, a Denver, Colorado establishment, is recalling 1,640 pounds of ground elk meat that may be contaminated with Escherichia coli O157:H7 bacteria (E. Coli O157:H7). E. coli O157:H7 causes a diarrheal illness often with bloody stools. Although most healthy adults can recover completely within a week, some people can develop a form of kidney failure called Hemolytic Uremic Syndrome (HUS). HUS is most likely to occur in young children and the elderly. The condition can lead to serious kidney damage and even death.

The recalled ground elk was distributed to North Carolina, South Carolina and Virginia through retail stores. The recalled ground elk was packed in 205 eight pound cases containing 8 one pound packages; each identified with a label that states “DK Natural Meats All Natural Ground Elk” with a “Use or Freeze By 4-27-15” on the back of each package.

Frontiere Natural Meats, LLC has received no reports of illnesses associated with consumption of this product to date.

The potential contamination was noted after routine testing by the company detected the presence of E. coli O157:H7 in two of four sub lots of bulk ground elk. As all four lots came from the same original batch Frontiere is recalling all lots associated with the original.

Another E. coli Outbreak Linked to Animal Contact

The Whatcom County Health Department (WCHD) in Bellingham investigated an outbreak of Shiga toxin-producing E. coli O157:H7 infections. The Washington State Department of Health and the Centers for Disease Control and Prevention assisted with the investigation.

Environmental contamination with E. coli O157:H7 of the Dairy Barn at the Northwest Washington Fairgrounds was the likely source of this outbreak. All of the ill people either attended the Milk Makers Fest between April 21 and 23 at the Northwest Fairgrounds; helped with the event between April 20 and 24; or were close contacts of people associated with the event. Most of the ill people were children, including older children who helped with the event. More than 1,000 children from primary schools in Whatcom County attended the event on these days.

The investigation team greatly appreciates the time and support of many community stakeholders who made this work possible, including Whatcom County schools, teachers, parents, students, Whatcom County Dairy Women, Northwest Washington Fair, and clinical and lab providers.

Final Case Counts

Disease investigators calculated case counts based only on lab-confirmed infection with E. coli 0157:H7 or physician-diagnosed hemolytic uremic syndrome (HUS), a type of kidney failure.

•          25 people were confirmed cases.

–          9 of these cases were considered secondary cases (the ill person didn’t attend the event but had close contact with someone who did attend).

•          No one died.

•          10 people were hospitalized.

•          6 people developed HUS.

Final Environmental Sampling Results

Multiple samples from the environment where the event was held were collected on two different days (April 30 and May 13) and submitted for laboratory testing. The samples indicated that several areas of the north end of the Dairy Barn at the Northwest Washington Fairgrounds were contaminated with the same strain of E. coli that made people ill. Negative results do not rule out contamination in other parts of the barn.

The outbreak strain of E. coli O157:H7 was identified in the following areas of the Dairy Barn:

•          Manure bunker

•          Hay maze area

•          Bleachers by east wall

•          Bleachers by west wall

Contamination of the environment most likely occurred before the Milk Makers Fest. Any environment where animals have been kept, such as barns, should be considered contaminated. E.coli 0157 can survive in the environment up to 42 weeks (Varma, 2003 JAMA).

Epidemiologic Investigation Findings

As part of the investigation, officials interviewed many of the confirmed cases to find out what they did during the event before they got ill. Officials also interviewed “controls,” meaning people who attended the Milk Makers Fest but did not get ill to find out what they might have done differently.

The results of analyzing the data collected during the interviews are not final, but a few preliminary findings stand out:

•          Event attendees who reported washing or sanitizing their hands before eating lunch were less likely to become ill.

•          Children who reported always biting their nails were more likely to become ill.

•          Leaving animal areas without washing hands might have contributed to an increased risk of transmission.

•          Eating in animal areas might have contributed to an increased risk of transmission.

Recommendations for Event Organizers:

•          Evaluate and update plans for cleaning and disinfection before, during, and after events, particularly surfaces with high levels of hand contact (such as seats, door or fence handles, and hand railings).

•          Evaluate and update measures to restrict access to areas more likely to be contaminated with animal manure.

–          This is especially important for people at higher risk for severe illness. These people include young children, pregnant women, adults older than 65, and people with weakened immune systems.

•          Ensure access to hand washing facilities with soap, running water, and disposable towels.

•          Display signs and use other reminders to attendees to wash hands when leaving animal areas.

•          Store, prepare, or serve food and beverages only in non-animal areas.

Recommendations for the Public:

•          Consider any environment where animals have been kept, such as barns, to be contaminated with bacteria or viruses that can make people ill.

•          Hands should always be washed immediately when exiting animal areas, after removing dirty clothing or shoes, and before eating or drinking.

–         Hand washing with soap, running water, and disposable towels is the most effective method.

–         Adults should always supervise young children while they wash their hands.

•          Food and beverages should be consumed in non-animal areas and only after washing hands first.

•          Be aware that objects such as clothing, shoes, and stroller wheels can become soiled and serve as a source of germs after leaving an animal area.

•          Nine secondary cases were reported during this outbreak. It’s important for people infected with E. coli or those with a family member infected with E. coli to follow these precautions to prevent secondary infection:

–          Wash your hands thoroughly with soap and water immediately after using the restroom or changing a child’s diaper.

–          Wash your hands before and after preparing food for yourself and others.

–          Stay home from school or work while diarrhea persists; most people can return to work or school when they no longer have diarrhea. Special precautions are needed for food handlers, health care workers, and child care providers and attendees. Check with your employer before returning to work, and check with your child’s child care center before resuming child care.

Eight Tons of Hamburger Recalled Over E. coli Fears

Tyson Fresh Meats, a Dakota City, Neb., establishment, is recalling approximately 16,000 pounds of ground beef products that may be contaminated with E. coli O157:H7, the U.S. Department of Agriculture’s Food Safety and Inspection Service (FSIS) announced today.

The ground beef items were produced on May 16, 2015. The following products are subject to recall:

5 lb. chubs of “80% Lean Ground Beef.”

The products subject to recall bear the establishment number “EST. 245C” inside the USDA mark of inspection and a “best before or freeze by” date of June 5, 2015. These products were shipped to one distribution location in New York.

FSIS discovered the problem during a routine sampling program. Neither FSIS nor the company received any reports of illnesses associated with consumption of this product. FSIS and the company are concerned that some product may have been sold and stored in consumers’ refrigerators or freezers.

E. coli O157:H7 is a potentially deadly bacterium that can cause dehydration, bloody diarrhea and abdominal cramps 2–8 days (3–4 days, on average) after exposure the organism. While most people recover within a week, some develop a type of kidney failure called hemolytic uremic syndrome (HUS). This condition can occur among persons of any age but is most common in children under 5-years old and older adults. It is marked by easy bruising, pallor, and decreased urine output. Persons who experience these symptoms should seek emergency medical care immediately.