Health Dept: E. Coli Cases May Be
Linked To Stock Show
20 Confirmed
Cases Could Grow
February 5, 2009 A lab has confirmed 20 E. coli cases but the number is expected to
grow, said Chris Urbina with Denver Public Health. The strain E. coli O157 primarily affected children on the Front
Range, from
"While the investigation is ongoing, we suspect that these
infections are linked to attending the National Western Stock Show, which was
held in Denver from Jan. 10 to Jan. 25," the Colorado Department of
Public Health and Environment said in a news release. Although health officials haven't pinpointed the exact cause of the
E. coli, the common denominator in all the cases is the stock show, Urbina said. The National Western Stock show had 643,100 visitors over 16 days. It
was a 4.5 percent drop from last year but it's the 12th straight year that
attendance has topped the 600,000 mark. A call to the spokeswoman of National Western Stock Show has not been
returned. Many schools and child care centers organized trips to the stock
show, and many children attended with their families, so there is the
potential that the number of cases could jump, health officials said. CDPHE
said it is working with local public health agencies to fully investigate
cases as they are reported. Part of the problem is that it takes up to eight days for E. coli to
incubate and for those infected to show symptoms, and in that time, the
bacteria can spread very easily from one person to another, especially among
young children, Urbina said. Several of the affected children attend child care. At least two of
the children appear to have become ill from contact with other ill children
and one of these illnesses was transmitted in a child care center, the CDPHE
confirmed. Health officials say E. coli infections among child care center
attendees are very concerning because E. coli infections can be very serious
in young children. Urbina said this strain was particularly
toxic and if the toxins aren't properly filtered by the kidney it can cause
damage to the kidney. They can lead to hospitalization and in some cases a
complication called hemolytic uremic syndrome, or HUS, which can cause kidney
failure, CDPHE said. That is why on Wednesday, the CDPHE sent a letter to daycare centers
alerting them to the outbreak and asking the staff to take special
precautions. The public health notice sent to daycares is below: At this point, the CDPHE recommends the following: For child care centers: o
Report any cases of bloody diarrhea (even if
there is only one) to your local public health agency or to CDPHE
immediately. o
Report any increase in the number of children
or staff with diarrhea who attend your facility to your local health
department or to CDPHE immediately. o
Children or staff must not attend childcare
while ill with diarrhea. o
If it is known that a child/staff member with
diarrhea attended the stock show, or if the facility took a trip to the stock
show, the child/staff member should be referred to his/her health care
provider for follow up and stool testing before returning to class. That
stool test must be negative and the diarrhea must have resolved before the
child/staff member can return to child care. o
Any child/staff member with bloody diarrhea,
regardless of whether he/she went to the stock show should be referred to
his/her health care provider for follow up and stool testing before returning
to class. That stool test must be negative and the diarrhea must have
resolved before the child/staff member can return to child care. o
If a child/staff member has diarrhea that is
not bloody and did not attend the stock show, then the child/staff member is
not required to provide a negative stool specimen, however diarrhea must be
resolved before returning to child care. o
Children and staff who are diagnosed with E.
coli O157 must have two stool specimens that are negative for E. coli O157 or
shiga toxin before returning to child care. For schools: o
Report any cases of bloody diarrhea (even if
there is only one) to your local public health agency or to CDPHE (number
below) immediately. o
Report any increase in the number of children
or staff with diarrhea who attend you facility to your local health
department or to CDPHE (number below) immediately. o
Children should not attend school while ill
with diarrhea. o
If it is known that a child with diarrhea has
attended the stock show, or if the child has bloody diarrhea, we strongly
recommend the child be referred to his/her provider for follow up and stool
testing. o
Because transmission of E. coli O157 from one
person to another is rare in school settings, children who are diagnosed with
E. coli O157 are not required to have negative stool specimens before
returning to school. They should, however, be free of diarrhea before
returning to class. o
School staff who are
diagnosed with E. coli O157 are also not required to have negative stool
specimens before returning to work, unless the staff member handles food as
part of his/her job. General control measures: o
Regular agents that are used for sanitizing
and disinfection, such as sodium hypochlorite and quaternary ammonia based
solutions, are effective against E. coli. No special disinfectants are
necessary to kill E. coli. o
Consider increasing cleaning frequency of
sanitizing and/or disinfection, particularly in restrooms and diaper changing
areas. o
Meticulous hand hygiene following diaper
changing is extremely important in controlling the spread of many pathogens.
Both the child’s and caregiver’s hands should be washed immediately following
diaper changing and toileting. o
Handwashing is also
extremely important for food handlers and before eating meals. Caregivers
should supervise children during handwashing to
ensure that the process is adequate. o
Again, staff responsible for preparing meals
in child care facilities and in schools should not handle food if they have
diarrhea or have been diagnosed with E coli. Food handlers with diarrhea
should not return to work until their diarrhea has resolved and should be
encouraged to visit a physician to have their stool tested. Food handlers
diagnosed with E coli, should not return to work until they have had two
negative stool samples. CDPHE has asked health care providers to obtain stool specimens from
children presenting with bloody diarrhea. ·
Please ensure the laboratory will test for E.
coli O157 or for shiga toxin, as not all
laboratories do this routinely. ·
Consider obtaining stool specimens from
children with non-bloody diarrhea if diarrhea has persisted for more than 2
days, or is accompanied by fever, severe abdominal cramping or other
symptoms. ·
Report cases of bloody diarrhea in children to
CDPHE at 303-692-2700 until further notice. ·
Children should not attend child care while
they have diarrhea. Children who are diagnosed with E. coli O157 must have
two stool specimens that are negative for E. coli O157 or shiga
toxin before returning to child care. Please explain these exclusion policies
to parents of children who are ill and who attend child care. ·
Antibiotics are generally not recommended for
E. coli O157 infection and may be associated with development of hemolytic
uremic syndrome (HUS). If
outbreaks or ill children are identified in your facility, your local public
health agency will work with you to determine if additional control measures
are necessary. Please
maintain this enhanced vigilance for illness and the extra screening measures
for some children with diarrhea from now to Feb. 16, 2009. For
disease reporting or other questions please contact the CDPHE Communicable
Disease program at 303-692-2700. |
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