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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.

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.

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.