Published Date: 2005-12-28 23:50:00
Subject: PRO/AH/EDR> E. coli O157, preschoolers - Ireland (Midwest)
Archive Number: 20051228.3698
E. COLI O157, PRESCHOOLERS - IRELAND (MIDWEST)
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Date: Thu 22 Dec 2005
From: ProMED-mail <promed@promedmail.org>
Source: Eurosurveillance [edited]
<http://www.eurosurveillance.org/ew/2005/051222.asp#3>
Large _E. coli_ O157 outbreak in Ireland, October - November 2005
-----------------------------------------------
Between 15 Oct and 30 Nov 2005, 18 cases of _Escherichia coli_ O157,
phage type 32, verotoxin 2 positive were identified in a small rural
area of midwest Ireland. No further cases have been reported, and the
outbreak control team has concluded that the outbreak has ended.
Verocytotoxin-producing _E. coli_ (VTEC) O157 is the most commonly
reported VTEC in Ireland. This is the largest outbreak of VTEC
infection ever recorded in Ireland, and it is unusual, because half
the cases detected were asymptomatic. 2 children were hospitalized
with hemolytic uremic syndrome, and a child required peritoneal
dialysis. In recent years, between 6 and 10 VTEC cases have occurred
annually in this region (Mid-Western Area), which has a population of
340 000.
9 of the 18 cases of VTEC O157 were in preschool children attending 2
local creches, both of which were unregistered. In Ireland, a creche
is a childcare facility that may be based in the home of the creche
owner, and Irish legislation requires that creche owners who care for
more than 3 children in their own homes be registered with local
preschool services. There have been 5 family clusters, including 3 in
sets of siblings. Contact tracing in 2 schools, one playgroup
(childcare facility providing part-time activities for 3 to 4 year
olds) and families have yielded negative results in 152 people.
Epidemiological investigations included the use of a trawling
questionnaire for investigation of possible exposures to sources of
_E. coli_ O157. Each case and relevant water supplies were mapped.
Several cases had apparent exposure to a vulnerable private group
water scheme (GWS). GWSs are formed by a number of households coming
together to provide their own common water supply. 6 percent of
households in Ireland are supplied by GWSs that are not connected to
a public water supply. Preliminary results from the investigation
support the hypothesis that creche attendance and drinking water from
a local GWS were risk exposures. Transmission appeared to be confined
to childcare and household settings, and there was significant
person-to-person transmission.
The local GWS implicated in this outbreak draws water from an
agricultural hinterland with close proximity to cattle and slurry
spreading. Data from veterinary sources showed the presence of _E.
coli_ O157 verotoxin 2 organisms in one herd in the area. Further
characterization of these organisms is underway.
Control measures included the voluntary closure of the 2 creches
where cases were identified, exclusion of all cases in "at risk"
groups, hygiene advice to all close contacts and family contacts of
cases, and placement of a "boil water notice" on the vulnerable GWS.
This outbreak has highlighted the importance of maintaining water
quality standards in private GWSs and the need for parents to be
aware of how childcare facilities are regulated. Registered creches
are subject to basic minimum hygiene requirements and are regularly
inspected by local authorities who give hygiene advice. The outbreak
also demonstrates the potential that vulnerable water supplies in
agricultural communities have for producing a large scale VTEC
outbreak with significant morbidity.
[Prepared by Mai Mannix <mai.mannix1@mailh.hse.ie> on behalf of the
Outbreak Control Team]
--
ProMED-mail
<promed@promedmail.org>
[Asymptomatic infection with _E. coli_ O157:H7 has been described
previously, although a detailed description of the length of the
carriage, risk of secondary spread from such patients and other
bacteriological or clinical features is needed.
The below abstract from Bielaszewska M, Janda J, Blahova K, et al:
Human _Escherichia coli_ O157:H7 infection associated with the
consumption of unpasteurized goat's milk. Epidemiol Infect 1997;
119:299-305 mentions 4 such cases:
"A cluster of 4 cases of hemolytic uremic syndrome in children
occurred in Northern Bohemia, Czech Republic, between 15 Jun and 7
Jul 1995. All the cases had significantly elevated titers of
anti-O157 lipopolysaccharide (LPS) antibodies as detected by the
indirect hemagglutination assay. All but one of them had drunk
unpasteurized goat's milk from the same farm within the week before
the disease. Evidence of _E. coli_ O157 infection was subsequently
found in 5 of 15 regular drinkers of the farm's raw goat's milk; 4 of
them were asymptomatic; one had mild diarrhea at the end of June
1995. Verocytotoxin 2-producing _E. coli_ O157:H7 strains of phage
type 2 and of identical pulsed-field gel electrophoresis patterns
were isolated from one of 2 farm goats and from one of the
asymptomatic goat's milk drinkers. The frequency of anti-O157 LPS
antibodies found among regular drinkers of the farm's raw goat's milk
(33 percent; 5 of 15) was significantly higher than that found in the
control population (0 percent; none of 45) (P = 0.0005; Fisher's
exact test). Our findings indicate that goats may be a reservoir of
_E. coli_ O157:H7 and a source of the infection for humans; raw
goat's milk may serve as a vehicle of the pathogen transmission." -
Mod.LL]
See Also
E. coli O157, schools - UK (Wales)(05) 20051007.2929E. coli O157, schools - UK (Wales) 20050922.2799
E. coli O157, tourists - UK (Scotland) ex Turkey 20050818.2429
E. coli O157, water contamination - Switzerland (02): corr 20050805.2282
E. coli O157, water contamination - Switzerland (Black Forest) 20050804.2269
E. coli O157, school - UK (Northern Ireland) 20050608.1590
E. coli O157, farm - UK (England) 20050521.1401
2004
----
E. coli O157, butcher shop - UK (Durham)(02) 20040723.2015
E. coli O157, butcher shop - UK (Durham) 20040706.1809
2003
----
E. coli O157, day care - UK (N Ireland) (03) 20030918.2366
E. coli O157, day care - UK (N Ireland) 20030916.2347
E. coli, VTEC non-O157 - UK (Scotland) 20030825.2144
E. coli O157 - UK (Scotland): background 20030430.1074
E. coli O157 - UK (Scotland) 20030429.1051
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