Published Date: 2003-01-10 23:50:00
Subject: PRO/AH/EDR> E. coli O157, day care center - USA (California)
Archive Number: 20030110.0078
E. COLI O157, DAY CARE CENTER - USA (CALIFORNIA)
A ProMED-mail post
ProMED-mail is a program of the
International Society for Infectious Diseases
Date: Thu, 9 Jan 2003 18:26:50 -0000
From: A-Lan Banks <a-Lan.Banks@derwent.co.uk>
Source: San Francisco Chronicle [edited]
_E. coli_ strikes San Francisco day care center
One child hospitalized, 7 others made sick by potentially deadly bug
One child has been hospitalized and 7 others were made ill in an outbreak
of potentially deadly _E. coli_ bacteria at a popular San Francisco day
The illnesses occurred before the Christmas break at a private school in
the Mission District and were confined to infants and toddlers enrolled in
a program serving children between the ages of 3 months and 2 years, and to
a sibling of one of those children. Although the outbreak appears to have
ended and the affected children are recovering, the city Health Department
has barred the return of any of the infected children until they pass tests
showing they have completely cleared the bacteria from their systems. That
can take an average of 3 weeks.
"It looks like a person-to-person spread that took place over several weeks
in December," said Dr. Tomas Aragon, director of community health
epidemiology and disease control at the San Francisco Department of Public
Health. "It happened, and died out, before Christmas vacation." No other
cases of the illness at the day care center or anywhere else in the city
have been reported, he said.
Aragon confirmed that the children were apparently exposed to a strain of
the bacteria _E. coli_ O157:H7 that is particularly dangerous to
youngsters. However, only one child was made seriously ill by the bug. The
outbreak was reported on Christmas Eve after a girl who was hospitalized
tested positive for the bacteria, as did a second child who had a milder
illness. The unidentified girl is still hospitalized after a
life-threatening bout of hemolytic uremic syndrome, a form of kidney
failure that is the most serious complication of the infection.
Aragon said a city environmental health officer had been sent to inspect
the school, which has operated in the city for 27 years. "We couldn't see
anything that would cause concern," he said. "They run a pretty tight ship."
Although _E. coli_ has been traced to contaminated ground beef, juices, and
salads, investigators believe the bug in this case was picked up by a
family that had traveled to a farm, where the bacteria are shed by healthy
cattle. The germs were subsequently spread among the toddlers.
"It's hard to keep hygiene perfect in that group," Aragon said. "They are
not all potty trained."
During the Christmas break, the private school staffers contacted parents
of the 102 children who attend the day care center, starting with the 22
enrolled in the infants and toddlers program. City disease detectives found
that 13 of those children had diarrhea symptoms within the past
month. According to a letter sent to parents by the city, 7 of 10 infants
and toddlers who had diarrhea tested positive for _E. coli_ O157:H7,
although only 2 children became sick enough for their parents to seek
medical attention. One of the sick children's siblings, who did not attend
the day care center, also tested positive for _E. coli_.
Among another group of 62 older children enrolled in a daytime preschool
program, 10 reported having diarrhea symptoms in the past month, but none
tested positive for the dangerous pathogen.
[Byline: Sabin Russell, Chronicle Medical Writer]
[Although the transmission of this potentially lethal pathogen is
classically associated with the ingestion of undercooked ground beef, it is
clear that the organism can be acquired by direct contact with cattle (such
as at a petting zoo or farm) or even from contact with the cattle
surroundings without the animals present. As was reported in the above
outbreak, secondary person-to-person and especially sibling-to-sibling
transmission may occur.
Nosocomial transmission in hospitals and nursing homes can also occur. It
cannot be emphasized enough that adequate handwashing is the best deterrent
to acquisition if contact with cattle occurs. - Mod.LL]