On June 7, 2021, the Pennsylvania Department of Health (PADOH) received multiple complaints of gastrointestinal illness from patrons of a community swimming pool. Two patrons reported positive Shiga toxin-producing Escherichia coli (STEC) and Clostridioides difficile from stool specimens. PADOH issued pool closure orders and initiated an outbreak response to identify a source and prevent additional illnesses.

Confirmed cases were defined as isolation of E. coli O157:H7 or detection of Shiga toxin or Shiga toxin genes from stool specimens of persons who visited the pool during May 31–June 7, 2021. Probable cases were defined as three or more loose stools in 24 hours with nausea, vomiting, fever, or cramps in persons who visited the pool during the same time frame. C. difficile results were deemed incidental upon consultation with experts (LC McDonald, MD, CDC, personal communication, June 2021) and were not included in the case definition.

Fifteen cases (nine confirmed, six probable) in persons aged 4–14 years were identified; 10 patients were male. All persons reported swimming at the pool on May 31, 2021, the seasonal opening date, and had no other common exposures. The total number of pool visitors on this date is unknown. Symptom onsets occurred during June 2–June 4, 2021. Thirteen patients sought medical evaluation, and six were hospitalized. Four received antibiotics for C. difficile. None developed hemolytic uremic syndrome.

Early findings suggested an unusual association between exposure to a chlorinated swimming pool and infections caused by two pathogens susceptible to chlorine. Pool inspection revealed an automatic chlorinator malfunction. Record-keeping was inconsistent with local requirements, and the few available records demonstrated at least one instance of no detectable chlorine. The pool reopened following chlorinator repair, after which no additional cases were identified.

The investigation highlighted three important points regarding evaluation of outbreaks of childhood diarrheal disease. First, C. difficile testing is only recommended for children aged ≥2 years with prolonged or worsening diarrhea and risk factors, including immunocompromising conditions or relevant exposures (e.g., recent health care visits or antibiotics). Reported prevalence of asymptomatic C. difficile colonization might vary by study population, laboratory detection method, and environmental setting. One study of children aged 1 month–12 years with diarrhea identified C. difficile toxin B in 3% of outpatients, 5% of inpatients, and 7% of asymptomatic controls). Recent studies using molecular techniques reported rates up to 25% in asymptomatic children aged 1–5 years and 24% in persons aged 1–18 years without diarrhea. In the current outbreak, all children were previously healthy and considered to be at low risk for C. difficile infection. Thus, C. difficile testing was not indicated and provided no relevant clinical or epidemiologic data. Second, laboratory reports should include age-based interpretive suggestions for colonization versus infection and reminders that clinical symptoms are required for a diagnosis of C. difficile infection. Provider interpretations should include clinical and epidemiologic information. Finally, antibiotics are usually not required for treatment of diarrheal illnesses. In this STEC outbreak, no adverse outcomes were reported among the children receiving antibiotics. However, among STEC-infected persons, current guidance recommends against antibiotic use because of the risk for hemolytic uremic syndrome.

Enteric disease outbreaks caused by multiple pathogens rarely occur. Coinfections with C. difficile and other pathogens are unusual, but possible. Full investigation revealed that this outbreak was likely the result of STEC infections among children, some of whom were colonized with C. difficile. Recreational waters should be properly treated and maintained, and persons experiencing diarrhea should abstain from swimming.

The Loudoun County Health Department is notifying the public of the exposure to a specific type of bacterium, called Shiga Toxin Producing E. coli (STEC), by several people who came in contact with goats at Georges Mill Farm in Lovettsville between March 6 and April 20, 2022. Several individuals experienced diarrhea and other symptoms of illness. The bacterium was isolated and identified by the Virginia Division of Consolidated Laboratory Services.

Coming into direct contact with animals, particularly livestock, presents a risk for illnesses. People should remember that, while animal interactions can be fun and educational, it’s always important to practice healthy habits around pets and other animals, such as washing your hands after being in contact with animals. The Loudoun County Health Department is communicating directly with those who are known to have come in contact with goats at Georges Mill Farm. Anyone who had contact with these goats during this time frame and has not yet communicated with the Health Department should:

Monitor for illness and seek medical attention if you become ill. Let your healthcare provider know of your possible exposure to assist in your diagnosis and treatment.

E. Coli Symptoms

Symptoms of E. coli illness usually start two to four days after exposure, but can occur as late as 12 hours later, or as long as 10 days after exposure. Symptoms of STEC may include:

  • Diarrhea with stomach cramps
  • Blood may also be present in the stool
  • Vomiting
  • Fever
  • Chills

In a very small percentage of cases (approximately 2% to 7%) particularly higher risk groups such as children under the age of 5, the immunocompromised, and the elderly, a more severe complication known as HUS (Hemolytic Uremic Syndrome) may occur. That complication includes kidney failure and anemia, and often results in prolonged hospitalization. However, the large majority of people exposed to STEC do not develop HUS and recover completely from their diarrhea within 5 to 10 days. More specific information on E. coli, including STEC, is available from the Centers for Disease Control and Prevention here.

Prevention

Health officials remind everyone that there are steps they can take to help prevent contracting illnesses from animals, which sometimes carry germs that can make people sick. Animals that look clean and healthy can carry harmful germs, and even areas where animals live, or roam can contain germs that can make people sick. Having contact with the animals’ environment can also be a risk factor for illness. Every year, many people get sick after visiting animal exhibits, such as petting zoos, aquariums, farms, or fairs. Preventive steps to take include:

  • Wash your hands right after touching animals or anything in the areas where they live, roam or eat. Even if you didn’t touch the animals or wore gloves, wash your hands when you leave animal areas.
  • Running water and soap are best, but if they are not available, use an alcohol-based hand sanitizer that contains at least 60% alcohol and wash your hands with soap and running water as soon as you can.
  • Don’t eat or drink around animals and keep food and drinks away from animal areas.
  • Children 5 years of age and younger, people with weakened immune systems and adults over 65 years of age are more likely to get sick from the germs animals can carry and should take extra precautions at animal exhibits.

Take these extra precautions for children:

  • Always supervise children around animals.
  • Leave items such as strollers, pacifiers, cups, or toys outside the exhibit.
  • Don’t let children put their thumbs, fingers, or objects such as pacifiers in their mouths when they’re around animals or in an animal area.
  • Don’t let children sit or play on the ground in animal areas.
  • Teach children to approach animals with caution and follow the rules provided on signs or verbally by the staff.
  • Children 5 years of age and younger should not have contact with reptiles, amphibians, or live poultry because these animals are more likely to make them sick. Parents of children in this age group should also consider not letting the children have direct contact with other types of livestock.

See also www.fair-safety.com

The Alabama Department of Public Health (ADPH) is investigating four cases of E. coli O157:H7 and two cases of Rotavirus in younger children in Northeastern Alabama. ADPH regularly investigates clusters and outbreaks of communicable diseases as required by Notifiable Disease Rules in Alabama.

In 2021, ADPH investigated 113 cases of E. coli, shiga toxin-producing illness (includes O157:H7). People of any age can become infected with this germ, but very young children and the elderly are more likely to develop severe illness and kidney problems than others.

The symptoms of E. coli O157 and similar E. coli infections can vary. Symptoms frequently include severe stomach cramps, diarrhea (often bloody) and vomiting. Fever up to 101 degrees F may occur, but is not the most common symptom. While most people improve in 5-7 days of illness, it is important that persons who have symptoms talk to their healthcare provider, especially if the persons are having bloody diarrhea or are very young or elderly.

To reduce the risk of E. coli O157:H7 and other gastrointestinal illnesses, the Centers for Disease Control and Prevention (CDC) recommends:

  • WASH YOUR HANDS thoroughly after using the bathroom or changing diapers, and before preparing or eating food.
  • WASH YOUR HANDS after contact with animals or their environments (at farms, petting zoos, fairs, even your own back yard).
  • COOK meats thoroughly. Ground beef and meat that has been needle-tenderized should be cooked to a temperature of at least 160 degrees F/70 degrees C. It is best to use a thermometer as color is not a very reliable indicator of “doneness.”
  • AVOID raw milk, unpasteurized dairy products and unpasteurized juices (like fresh apple cider).
  • AVOID swallowing water when swimming or playing in lakes, ponds, streams, swimming pools and backyard “kiddie” pools.
  • PREVENT cross contamination in food preparation areas by thoroughly washing hands, counters, cutting boards and utensils after they touch raw meat.

French health officials have confirmed 50 cases of E. coli linked to a type of Nestlé frozen pizza.

Of these infections, 48 were caused by E. coli O26 and two by E. coli O103, according to Santé publique France, the French public health agency.

Another 25 cases of hemolytic uremic syndrome (HUS) and Shiga toxin-producing E. coli (STEC) infections are still being investigated. HUS is a type of kidney failure associated with E. coli infections that can result in lifelong, serious health problems and death.

Buitoni brand Fraîch’Up pizzas sold since June 2021 were withdrawn and recalled in mid-March after Nestlé was warned about the potential presence of E. coli O26 in dough used to make them.

Of the 50 patients, 48 are children and two are adults. They fell ill between Jan. 18 and March 14. The two adults are older than 90, with one having developed HUS.

Sick children are between 1 and 17 years old with a median age of 7. Twenty are females and 28 are males. Two youngsters died but it is not known if they ate the pizzas and their deaths are under investigation.

Eleven patients live in Hauts-de-France, eight in Nouvelle Aquitaine, seven in Pays de la Loire, six in Bretagne and Ile-de-France, three in Auvergne-Rhône-Alpes, two each in Bourgogne Franche-Comté, Grand Est, Occitanie and Provence-Alpes-Côte d’Azur and one in Centre Val-de-Loire.

Viiworks Blog tells the story:

Little Marceau, 4 and a half years old, came close to death. The child, poisoned by the E.coli bacterium after having eaten a contaminated pizza, was finally able to be treated by doctors at the Lille hospital. Extremely shocked, her mother testifies to La Dépêche of the days of anguish that the family has spent.

Marceau returned to school just ten days ago with strict recommendations: not to eat salty foods. And, if he hurts himself, do not take anti-inflammatories. “He will never be able to get stung in the arm again either, breathes his mother, still tested by the seven weeks she has just spent. We must keep his veins intact for a transfusion in case he has another kidney problem. .” All that for having eaten a piece of Fraîch’up pizza without knowing that it was contaminated with E. coli bacteria, the weekend of February 12…

Coralie is determined to file a complaint against Buitoni so that all responsibilities are established concerning the ordeal experienced by her family. “And again, it could have been worse,” sighs this 8 and a half month pregnant mother, who remembers her reaction when her partner told her that the doctors did not know if Marceau was going to live or die. “When I arrived at Lille hospital, he greeted me, telling me that the next 72 hours were going to be decisive. That the bacteria was attacking the heart, the kidneys and the brain. I was devastated.”

According to French health authorities, as part of the investigations carried out on the cases of serious haemolytic and uraemic syndromes (HUS) reported since January 1, 2022, the analyzes (epidemiological, microbiological and traceability) carried out suggest, at this stage, a possible link with the consumption of frozen pizzas from the Fraîch’Up range of the Buitoni brand. Investigations are continuing to determine the origin of the contamination, including for other products, as well as epidemiological investigations in order to establish potential links with all the cases detected in the territory since the beginning of January 2022.

Consequently, as a precautionary measure, and pending additional analyses, the company is proceeding today with the withdrawal-recall of all the pizzas in the Fraîch’Up range, of the Buitoni brand, marketed on this day.

As of March 17, 2022, 27 cases of HUS or serious infection, linked to E. coli bacteria with similar characteristics, have been identified, and 31 additional cases are under investigation. These 58 cases occurred in 12 regions of metropolitan France: Hauts-de-France (13 cases), New Aquitaine (9 cases), Pays de la Loire (9 cases), Brittany (6 cases), Ile-de-France ( 6 cases), Grand Est (5 cases), Auvergne-Rhône-Alpes (3 cases), Bourgogne Franche-Comté (2 cases), Center Val-de-Loire (2 cases) Normandy (1 case), Occitanie (1 case ) and Provence-Alpes-Côte d’Azur (1 case). The sick children, aged 1 to 18 years with a median age of 5 ½ years, presented symptoms between 10/01/2022 and 10/03/2022. Two children died.

Public Health France, in conjunction with the National Reference Centers for E. coli, the General Directorate for Food, the General Directorate for Competition, Consumption and the Repression of Fraud, and in coordination with the General Directorate for Health, is continuing to investigate all cases of pediatric HUS reported since January 1, 2022.

As of February 7, there have been 14 laboratory-confirmed cases of E.coli O157 illness linked to this outbreak in the following provinces: Alberta (13) and Saskatchewan (1).

Individuals became sick between early December 2021 and early January 2022. No deaths or hospitalizations have been reported. Individuals who became ill are between 0 and 61 years of age. The majority of cases (64%) are female.

The CFIA issued food recall warnings on January 28, 2022 and February 6, 2022 for Hankook (Korean characters only) brand Original Kimchi products. The recalled products were distributed in British Columbia, Alberta, Saskatchewan, and Manitoba.

The CFIA is continuing its food safety investigation, which may lead to the recall of other products. If other products are recalled, the CFIA will notify the public through updated food recall warnings.

Federal officials are reporting that an outbreak of E. coli O121:H9 infections linked to romaine lettuce has ended.

Four illnesses were confirmed in the outbreak. Little other information was available from the Food and Drug Administration.

“The information collected over the course of this investigation indicated that romaine lettuce was the likely source of this outbreak; however, it appears that this outbreak is over, and there is no actionable advice for consumers,” according to FDA officials.

“FDA has been conducting a traceback investigation and other activities in an effort to learn more about possible sources or routes of contamination.”

The FDA first reported the outbreak two weeks ago but has not shared any information about patient demographics or what states are involved. The agency did not report when the first illness was reported or when the last one was logged by public health officials.

As of Jan. 26, the Centers for Disease Control and Prevention had not posted any information about the outbreak. That is generally standing procedure for the agency if a specific product is not identified.

As of December 29, 2021, 13 people infected with the outbreak strain of E. coli O157:H7 have been reported from six states – Washington – 7, Alaska – 2, California – 1, Mississippi – 1, Ohio – 1, Oregon – 1. Illnesses started on dates ranging from November 27, 2021, to December 9, 2021.

Sick people range in age from 4 to 79 years, with a median age of 54, and 92% are female. Of 12 people with information available, four have been hospitalized and one person developed a type of kidney failure called hemolytic uremic syndrome (HUS). No deaths have been reported.

State and local public health officials are interviewing people about the foods they ate in the week before they got sick. Of 12 people interviewed, all reported eating packaged salads. Of 10 people who provided brand information, 6 ate or bought Simple Truth Organic Power Greens and 1 ate Nature’s Basket Organic Power Greens. Both Organic Power Greens salads have the same mix of leafy greens: organic spinach, mizuna, kale, and chard. Several sick people reported using these salads in smoothies.

Public health investigators are using the PulseNet system to identify illnesses that may be part of this outbreak. CDC PulseNet manages a national database of DNA fingerprints of bacteria that cause foodborne illnesses. DNA fingerprinting is performed on bacteria using a method called whole genome sequencing (WGS).

WGS showed that bacteria from sick people’s samples are closely related genetically. This suggests that people in this outbreak got sick from the same food.

CDC is advising not to eat Simple Truth Organic Power Greens and Nature’s Basket Organic Power Greens with “best if used by” dates through December 20, 2021. Investigators are working to determine if additional products may be contaminated.

Federal officials have opened an investigation into an outbreak of E. Coli O157:H7 infections suspected to be linked to ground beef.

Other than the fact there is an open investigation, no other published information is available from the USDA’s Food Safety and Inspection Service (FSIS). The FSIS has not indicated what producers or what brands of ground beef might be involved. The agency also has not revealed how many people have been infected or what states are involved.

The FSIS outbreak investigation table has a column for “Outcomes & References” but the column for the new outbreak was blank as of Dec. 10.

“During investigations, FSIS may respond by posting recalls of FSIS-regulated products linked to illness or by issuing public health alerts,” according to the FSIS outbreak investigation website. 

“The Outcomes & References column includes links to recall notices, public health alerts, and after-action review reports, as well as CDC outbreak notices for selected multi-state foodborne outbreaks, which provide additional information.”

The Centers for Disease Control and Prevention had not yet announced the outbreak as of Dec. 11. Consequently the FSIS cannot yet post links to any CDC references re alerts.


Anyone who has eaten ground beef and developed symptoms of E. coli infection should seek medical attention and tell their doctor about their possible exposure to the bacteria. Specific tests are required to diagnose the infections, which can mimic other illnesses.

The symptoms of E. coli infections vary for each person but often include severe stomach cramps and diarrhea, which is often bloody. Some patients may also have a fever. Most patients recover within five to seven days. Others can develop severe or life-threatening symptoms and complications, according to the Centers for Disease Control and Prevention.

About 5 percent to 10 percent of those who are diagnosed with E. coli infections develop a potentially life-threatening kidney failure complication, known as hemolytic uremic syndrome (HUS). Symptoms of HUS include fever, abdominal pain, feeling very tired, decreased frequency of urination, small unexplained bruises or bleeding, and pallor. 

Many people with HUS recover within a few weeks, but some suffer permanent injuries or die. This condition can occur among people of any age but is most common in children younger than 5 years old because of their immature immune systems; older adults because of deteriorating immune systems; and people with compromised immune systems such as cancer patients. 

People who experience HUS symptoms should seek emergency medical care immediately. People with HUS should be hospitalized because it can cause other serious and ongoing problems such as hypertension, chronic kidney disease, brain damage and neurologic problems.

Epidemiologic and laboratory data show that Josie’s Organics prepackaged baby spinach with a “best by” date of October 23, 2021, may be contaminated with E. coli and may be making people sick.

Since the last update on November 15, four more illnesses have been reported. As of December 3, 2021, a total of 14 people infected with the outbreak strain of E. coli O157:H7 have been reported from nine states. Illnesses started on dates ranging from October 13, 2021, to October 27, 2021.

Sick people range in age from 2 to 76 years, with a median age of 26, and 79% are female. Of 12 people with information available, 4 have been hospitalized and 3 developed a type of kidney failure called hemolytic uremic syndrome (HUS). No deaths have been reported.

The true number of sick people in an outbreak is likely much higher than the number reported, and the outbreak may not be limited to the states with known illnesses. This is because many people recover without medical care and are not tested for E. coli. In addition, recent illnesses may not yet be reported as it usually takes 3 to 4 weeks to determine if a sick person is part of an outbreak.

State and local public health officials are interviewing people about the foods they ate in the week before they got sick. Of the 12 people interviewed, 10 (83%) reported eating spinach in the week before they got sick. This percentage was significantly higher than the 46% of respondents who reported eating spinach in the previous week in the FoodNet Population Survey, a survey that helps estimate how often people eat various foods. This difference suggests that people in this outbreak got sick from eating spinach. Six people reported eating Josie’s Organics brand spinach.

On November 15, 2021, CDC reported that officials in Minnesota found E. coli O157:H7 in a package of leftover Josie’s Organics baby spinach collected from a sick person’s home. Whole genome sequencing (DNA fingerprinting for bacteria) showed that the E. coli O157:H7 in the leftover package of spinach is closely related to bacteria isolated from ill people. This means that the person likely got sick from eating the spinach.