Published Date: 2011-10-18 11:52:03
Subject: PRO/AH/EDR> E. coli VTEC non-O157 - Ireland: (LK) day care, O26
Archive Number: 20111018.3115
E. COLI VTEC NON-O157 - IRELAND: (LIMERICK) DAY CARE, O26
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A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org
Date: Mon 17 Oct 2011
Source: Raidio Teilifis Eireann (RTE) News [edited]
http://www.rte.ie/news/2011/1017/ecoli.html
A creche [day care center - Mod.LL] in Limerick has been asked to
close by the public health department of the Health Service Executive
[HSE] as a result of an outbreak of _Escherichia coli_ infection.
The strain has been identified as _E. coli_ O26, a toxin-producing
strain. Fewer than 10 children have been infected; a number of linked
cases have been identified. The closure is to enable all staff and
children attending the creche to be screened.
The HSE said it was satisfied that the creche was fully compliant with
preschool standards. However, children from this creche will not be
able to attend other child care facilities until they have been
cleared of infection.
--
communicated by:
ProMED-mail
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[Outbreaks of enterohemorrhagic _E. coli_ infection are not uncommon
in day care centers as, especially with young children, there is ample
opportunity for child-to-child transmission related to less than ideal
hygiene. It is possible that the origin of the outbreak could be a
food vehicle at the day care center or a child introducing the strain
into the center after acquiring it at home. Secondary spread in the
center is also likely to occur since, as noted by Mod.DK in a previous
posting, toddlers are marvelous sharers of toys as well as fecally
contaminated hands.
In analyzing the genetic and phenotypic profiles of non-O157 groups,
it has been found that they belong to their own lineages and have
unique profiles of virulence traits different from O157 (1). The
serogroups appearing to be most prominent are O26, O111, O128, and
O103 (2), the former serotype being the implicated strain in this
outbreak.
If a laboratory is using sorbitol-MacConkey (sMAC) plates to identify
VTEC by virtue of O157's inability to ferment sorbitol, the non-O157
strains will be missed. In a 3-year pediatric study from the
University of Washington, USA (3), 1851 stool samples were processed
for sorbitol fermentation as well as toxin production by EIA (enzyme
immunoassay), and 28 strains of O157 were found along with O103 (4
strains), O118 (2 strains), O111 (2 strains), and 3 other strains.
Clinically, the O157 infections had a higher frequency of bloody
stools, fecal leukocytes, and abdominal pain with shorter symptom
duration. 5 (18 per cent) of O157 infections developed hemolytic
uremic syndrome (HUS); none of the non-O157 strains did. Since toxin
assay did not identify all O157 strains found on sMAC plates, the
investigators did not advocate performing toxin assay alone. Non-O157
can produce HUS, as demonstrated by a cluster of O121 cases associated
with a lake in Connecticut, USA (4).
Since toxin assays are not uniformly performed in many areas, and most
cases do not produce HUS, it is likely that cases due to non-O157
strains are being missed. How frequent this phenomenon will become
over time is unclear.
References
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1. Schmidt H, Geitz C, Tarr PI, et al. Non-O157:H7 pathogenic
Shiga-toxin producing _Escherichia coli_: phenotypic and genetic
profiling of virulence traits and evidence for clonality. J Infect Dis
1999; 179(1): 115-23; available at
http://www.journals.uchicago.edu/doi/full/10.1086/314537.
2. Bettelheim KA. Role of non-O157 VTEC. Symp Ser Soc Appl Microbiol
2000; (29): 38S-50S; abstract available at
http://www.ncbi.nlm.nih.gov/pubmed/10880178.
3. Klein EJ, Stapp JR, Calusen CR, et al. Shiga toxin-producing
_Escherichia coli_ in children with diarrhea: a prospective
point-of-care study. J Pediatr 2002; 141(2): 172-7; available at
http://www.ncbi.nlm.nih.gov/pubmed/12183710.
4. McCarthy TA, Barrett NL, Hadler JL, et al: Hemolytic-uremic
syndrome and _Escherichia coli_ O121 at a lake in Connecticut, 1999.
Pediatrics 2001; 108(4): E59; available at
http://pediatrics.aappublications.org/cgi/content/full/108/4/e59. -
Mod.LL
Limerick, in the Mid-West Region of Ireland can be located via the
HealthMap/ProMED-mail interactive map at
http://healthmap.org/r/1lDg. - Sr.Tech.Ed.MJ]
See Also
E. coli O157 - UK (03): leeks, potatoes 20111001.2965E. coli O157 - UK (02): (England) day care 20110824.2576
E. coli O157 - UK: (Wales) kebabs 20110816.2479
E. coli VTEC non-O157 - USA: (ID) O26, camp 20110704.2023
E. coli O104 - EU (27): update, fenugreek seed susp. 20110629.1979
E. coli VTEC - Germany: RFI 20110523.1566
2010
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E. coli VTEC non-O157 - USA (07): O26, ground beef, alert, recall
20100831.3097
E. coli O157 - UK: (England) day care 20100209.0442
2009
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E. coli O157 - UK (07): ex Spain (VC) alert, RFI 20091130.4092
E. coli O157 - UK (04): England, children's farm 20090913.3224
E. coli O157 - UK (03): Wales dance camp 20090823.2969
E. coli O157 - UK (02): Wales, HUS cluster 20090817.2916
E. coli O157 - UK: Wales dance camp, alert 20090817.2915
2007
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E. coli O157, tourist area - Ireland (Sligo) 20070829.2841
E. coli O157 - UK (Scotland): sliced meat susp. (04) 20070824.2785
E. coli O157 - UK (Scotland): sliced meat susp 20070814.2655
E. coli O157 - UK (Scotland) ex Turkey: alert 20070813.2644
E. coli O157, prepackaged food - UK (England) (02) 20070722.2351
E. coli O157, prepackaged food - UK (England) 20070721.2348
2006
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E. coli O157, day care - USA (TN) 20060701.1823
E. coli O157, day care - UK (Scotland)(02): background 20060512.1356
E. coli O157, day care - UK (Scotland) 20060511.1346
2005
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E. coli O157, preschoolers - Ireland (Midwest) 20051228.3698
E. coli O26, unpasteurized cheese - UK ex France: recall
20051222.3662
E. coli O157, schools - UK (Wales)(05) 20051007.2929
E. coli O157, schools - UK (Wales) 20050922.2799
E. coli O157, school - UK (Northern Ireland) 20050608.1590
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