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Investigation Summary:

The Whatcom County Health Department in Bellingham is investigating 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 are assisting with the investigation.

Disease investigators are now calculating case counts based on lab-confirmed infection with E. coli 0157:H7 and physician-diagnosed cases of hemolytic uremic syndrome (HUS). The official case count will be adjusted regularly as the investigation proceeds.

Twenty-five people are confirmed cases.  Nine of these confirmed cases are considered secondary cases (the ill person didn’t go to the event but had close contact with someone who did attend).

  • No one has died.
  • Ten people have been hospitalized.
  • Four people have developed hemolytic uremic syndrome (HUS).
  • Illnesses in several other people are under investigation.
  • Four of 10 areas sampled produced results that match (indistinguishable from) the E. coli O157:H7 outbreak strain.

All of the ill people attended the Milk Makers Fest between April 21 and 23 at the Northwest Fairgrounds in Lynden; helped with the event between April 20 and 24; or were close contacts of ill people associated with the event. Most of the ill people are children, including older children who helped with the event. More than 1,000 primary school children from all school districts in Whatcom County attended the event on these days.

Whatcom County Health Department is working with community health care providers to identify cases, and interviewing patients and their parents to investigate the source of the outbreak. The source investigation involves collecting information from interviews as well as from clinical and environmental laboratory tests. A common source or sources has not been determined. Health officials expect that it will take several weeks to collect and analyze the information. Even if a common source is not found, potential risk factors will be identified, which will provide information that may reduce the risk of an outbreak in the future.

Advice to the Public:

People who attended the Milk Makers Fest, or have close contact with someone ill who did, and have signs or symptoms of E. coli infection should see a doctor. People usually get sick from E. coli 2-8 days (average of 3-4 days) after swallowing the germ (organism). Only people who have symptoms should see a doctor in relation to this outbreak.

Most people infected with E. coli develop diarrhea (often bloody) and abdominal cramps, and most people recover within a week.
Some illnesses last longer and can be more severe, resulting in a type of kidney failure called hemolytic uremic syndrome (HUS).
HUS can occur in people of any age, but is most common in young children under five, older adults, and people with weakened immune systems.Symptoms of HUS can include fever; abdominal pain; pale skin tone; fatigue and irritability; small, unexplained bruises or bleeding from the nose and mouth; and decreased urination. People who have these symptoms should seek emergency medical care immediately. o Antibiotics and antidiarrheal medicines should not be given unless E. coli is ruled out, since they may increase the risk of HUS in people with E. coli infections.

The outbreak appears to be over; however, the investigation into the source of the infections is ongoing. Secondary cases (people who become ill after contact with a person with E. coli infection) may be reported.

The Whatcom County Health Department (WCHD) is investigating an outbreak of shiga toxin – producing E. coli O157 associated with the Milk Makers Fest that was held at the Northwest Fairgrounds in Lynden on 4/21 – 4/23/15. Over a thousand primary school children from all of the school districts in Whatcom County attended the event. Most of the cases involve children who attended the event. Several older children involved with the event and some adults and close contacts of cases have also become ill. WCHD is continuing to interview cases to determine if there was a common food or water source or activity, such as the petting zoo or other contact with livestock. Washington State Department of Health Communicable Disease Epidemiology is
assisting with the outbreak investigation.

Cumulative total: 22 cases* (7 cases have been hospitalized), 20 probable cases ** Change since last report of 5/2/15: no new cases, +1 probable cases, no new hospitalizations *Cases include those with positive labs (preliminary presumptive positive O157 and final confirmed positives), and clinical cases with close contact with a case with positive or presumptive positive labs. ** Probable cases are cases with clinical symptoms and were associated with the event, but lab results are not available or labs were not done.

E-COLI-300x200The Whatcom County Health Department (WCHD) is investigating an outbreak of shiga toxin-producing E. coli O157 associated with the Milk Makers Fest that was held at the Northwest Fairgrounds in Lynden on 4/21 –4/23/15.

Over a thousand primary school children from all of the school districts in Whatcom County attended the event. Most of the cases involve children who attended the event. Several older children involved with the event and some adults and close contacts of cases have also become ill.

WCHD is continuing to interview cases to determine if there was a common food or water source or activity, such as the petting zoo or other contact with livestock.

Washington State Department of Health Communicable Disease Epidemiology is assisting with the outbreak investigation.

Cumulative total: 22 cases* (7 cases have been hospitalized), 19 probable cases **

*Cases include those with positive labs (preliminary presumptive positive O157 and final confirmed positives), and clinical cases with close contact with a case with positive or presumptive positive labs. ** Probable cases are cases with clinical symptoms and were associated with the event, but lab results are not available or labs were not done.

ecoli-bacteria-300x208The Whatcom County Health Department (WCHD) is investigating an outbreak of shiga toxin – producing E. coli O157 associated with the Milk Makers Fest that was held at the Northwest Fairgrounds in Lynden on 4/21 –4/23/15.

WCHD is continuing to interview cases to determine if there was a common food or water source or activity, such as the petting zoo or other contact with livestock.

Washington State Department of Health Communicable Disease Epidemiology is assisting with the outbreak investigation. Cumulative total: 18 cases* (5 cases have been hospitalized), 18 probable cases ** Change since last report 4/30/15: +1 case, +3 probable cases, 1 new hospitalization.

*Cases include those with positive labs (preliminary presumptive positive O157 and final confirmed positives), and clinical cases with close contact with a case with positive or presumptive positive labs.

** Probable cases are cases with clinical symptoms and were associated with the event, but lab results are not available or labs were not done.

Clarification from previous reports: the state public health lab is testing confirmed E. coli O157 isolates for serogroup (to determine if O157:H7 or another related serogroup).

Preliminary positive O157 isolates are regrown and have further testing done at a commercial lab to confirm O157. We expect to get the first results of serogroup testing from the state public health lab early next week.

According to the Bellingham Herald – of the 32 cases traced to the festival:

  • 17 have been confirmed by the state’s public health lab or tested positive at local labs — or were people with E. coli symptoms who had been in close contact with someone in the first two groups.
  • 15 additional people had been at the festival and were sick but lab results, some of which were pending, weren’t available yet.
  • 4 have been hospitalized.

We have been retained by several of the families, including one child who has developed hemolytic uremic syndrome (HUS).

The Whatcom County Health Department (WCHD) continues to investigate an outbreak of shiga toxin-producing E. coli O157:H7 associated with the Milk Makers Fest that was held at the Northwest Fairgrounds in Lynden Washington on 4/21 – 4/23/15. WCHD is continuing to interview cases to determine if there was a common food or water source or activity, such as the petting zoo or other contact with livestock.

It is certainly not like we have not seen this before:

For more information on the risks of zoonotic exposures, see Fair Safety Dot Com.

Food Safety News reported yesterday that Louisiana’s Silliman Institute students may well be part of an E. coli outbreak. Silliman sent students home last Friday, March 27, resumed classes Monday, March 30, and then called it quits until Monday, April 6.

“There is an outbreak of STEC (Shiga toxin-producing Escherichia coli) in a school in Region 2 and it is being investigated,” Ashley Lewis, spokeswoman for Louisiana’s Department of Health and Hospitals, told Food Safety News.

“As the investigation progresses, the Department continues to take all necessary preventive measures to protect public health,” Lewis noted, adding, “Louisiana law prohibits the disclosure of the content of epidemiological investigations except to the institutions concerned. The Department would also clarify that any decisions related to facility closure have been made by the facilities themselves.”

The first child sickened in the Louisiana outbreak, a girl, was reportedly hospitalized with the kidney disease known as hemolytic-uremic syndrome, or HUS. The second child, also hospitalized but without HUS, was not being held in a pediatric intensive care unit and was likely going to avoid kidney dialysis.

Today the Department of Health and Hospitals told WBRZ as many as 18 students are exhibiting symptoms of diarrhea and vomiting. The department is testing the cases for E. coli or norovirus. At least one case has been tentatively identified as E. coli. Symptoms began Sunday and have hospitalized some of the ill students. The state is investigating what made them sick, but said it does not appear to be in the water or in the food at school.

Victoria’s Chief Health Officer Dr Rosemary Lester has issued a warning about the dangers of drinking raw cow’s milk.

Her warning has been prompted by five cases of gastroenteritis illness in children who had drunk unpasteurised milk.

“There have been three cases of Haemolytic Uraemic Syndrome (HUS) and two cases of cryptosporidiosis.

“HUS is a rare but serious condition caused by bacteria that affects the kidneys and the bloodstream. Cryptosporidiosis is a parasitic infection that commonly presents as gastroenteritis with watery diarrhoea.

“Only a small number of these pathogens are needed to cause illness. The sale of unpasteurised milk for human consumption is illegal in Victoria,” Dr Lester said.

“However all five cases drank unpasteurised milk which was sold as ‘bath’ or ‘cosmetic’ milk.

“Unpasteurised milk is labelled and sold for cosmetic use only, but the packaging is often very similar to other milk products.

“Unpasteurised milk increases the risk of contracting gastrointestinal illness because it can contain pathogens such as Campylobacter, Cryptosporidium, shiga toxin-producing E. coli and Listeria monocytogenes.

“Since the 1940s it has been compulsory to pasteurise cow’s milk in Australia. Milk is heated for a very short period of time effectively destroying any disease-causing bacteria which may be present in raw milk.

“Everyone is vulnerable to illness caused by the pathogens present in raw milk, but the risks are even greater for young children and for the elderly, those with underlying health problems, immunocompromised or pregnant,” Dr Lester said.

No matter what precautions are taken by dairy farmers during milking, there can be no guarantee that the milk will be free from harmful bacteria, making pasteurisation essential.

 

According to a recently released report by the Minnesota Department of Health (MDOH), 57 individuals who met the case definition were deemed to be part of the outbreak linked to Jim-N-Joe’s Northland Katering.

Of those ill, 65% were women.  All cases reported diarrhea, 96% cramps, 61% bloody stool, 37% vomiting and 19% fever.  37% sought medical treatment with 16% hospitalized.

After an exhaustive investigation, MDOH concluded that the common server at the five events between July 1 and July 17 on the Fond du Lac Reservation was Jim-N-Joe’s Northland Katering.  MDOH also found that the most common food items were the celery and onions.  Potato Salad, which included celery and onions was found to be tainted with E. coli O157:H7.  Cases were also identified at events where potato salad was not served, but celery was.  The celery was traced back to a field adjacent to a defunct dairy operation near Gonzales, California.

See additional documents at Outbreak Database.

The Kentucky Department for Public Health is warning consumers about the dangers of consuming unpasteurized milk as well as other products that could lead to disease-producing E. coli infection, following a recent outbreak in North Central Kentucky and the hospitalization of four children.

DPH has been working with local health departments, hospital and the provider community to investigate the outbreak. Four of the five children associated with the cluster developed Hemolytic Uremic Syndrome (HUS), a disease caused by the most severe E. coli infections which may result in life-threatening kidney failure.

“At this time, we know that all of the children consumed unpasteurized milk, which is different from the milk and dairy products you purchase at the grocery store,” said DPH Commissioner Stephanie Mayfield, M.D. “Unpasteurized milk is dangerous and has not undergone a process to kill bacteria before it is consumed, meaning it could contain disease-causing agents such as E. coli. The health of anyone who drinks unpasteurized milk can be affected if they are exposed to E. coli or other bacteria that can cause very serious illness, but the risk is even greater for children.”

Five Kentucky children were being treated at Kosair Children’s Hospital on Friday for a potentially life-threatening syndrome usually caused by E. coli O157:H7 infection, and the state health department has launched an investigation into how they got sick.

“There is a cluster of children with” hemolytic uremic syndrome,” said Beth Fisher, a spokeswoman for the Kentucky Department for Public Health. “We don’t know the source at this point.”

Three of the sick children are from Hardin County, one is from Oldham County and one is from Boone County. Fisher did not know their ages, but said they are very young. All remained hospitalized Friday September 12..