Toddlers hit by 'E.coli outbreak' (Fife, Scotland)

[ukcz]

Toddlers hit by 'E.coli outbreak'
BBC, Tuesday, 9 May 2006

A suspected outbreak of the E.coli 0157 infection has left three children in a serious condition.

The two-year-olds, who are being treated for kidney failure at Glasgow's Yorkhill Hospital, all attend the Careshare nursery in Dunfermline, Fife.

The nursery is based at Lauder College and looks after about 100 children.

The source of the suspected outbreak has not been identified but the nursery has closed voluntarily while the premises are inspected by officials.

Lauder College principal Bill McIntosh named two of the children affected as Lorna Balfour and Abigail Young. They are both children of students at the college.

Professor McIntosh added that initial reports suggested that the infection had been brought into the nursery from elsewhere.

He said: "Lauder is aware of the current situation regarding the suspected cases of E.coli 1057 which concerns three children who attended the state of the art nursery located within the grounds here at Halbeath and run by Care Share."

A spokesman for NHS Fife confirmed that the first child became ill on Friday evening.

When a second child linked to the nursery fell ill on Monday, an E.coli outbreak team was mobilised.

A third child was taken to hospital on Tuesday morning and the nursery was closed.

Nursery inspected

The incubation period for E.coli 0157 is usually between one and 14 days. Symptoms can include diarrhoea, feeling sick, vomiting, stomach pain and fever.

A spokeswoman at the nursery said: "We reported the illness immediately to the authorities who have inspected the nursery and our hygiene procedures, and have confirmed that they are satisfied.

"Although there is no evidence that the nursery is the source, we have decided to close the nursery for the time being to prevent any spread.

"We are of course taking advice from environmental health and health officials."

Dr Charles Saunders, consultant in public health medicine at NHS Fife, said: "The source of these infections is not yet known.

"We are writing to all parents and staff at the nursery with advice on E.coli 0157 infection and offering screening for E.coli 0157 infection.

"We have not so far been able to exclude possible food or water sources. We are working with Fife Council's environmental services department.

"It is certainly possible that other children who attend the nursery may be affected."

Ten years ago an outbreak of the same strain of E.coli resulted in the death of 21 elderly people in Lanarkshire.

It was the country's worst outbreak of E.coli and centred on a butcher's shop in Wishaw.

Afterwards new hygiene regulations for the preparation and sale of raw and cooked meats were introduced.

http://news.bbc.co.uk/1/hi/scotland/edinburgh_and_east/4754483.stm

[pinkfrost]

Re: Toddlers hit by 'E.coli outbreak' (Fife, Scotland)

Well, it's not bird flu!

Sounds like the children have HUS (haemolytic uraemic syndrome) which can cause irreversible kidney damage. A toxin released by the E Coli damages the kidney. Usually associated with poorly stored or cooked meat.

[KC]

Re: Toddlers hit by 'E.coli outbreak' (Fife, Scotland)

> from the CDC: http://www.cdc.gov/ncidod/dbmd/disea...chiacoli_g.htm

Escherichia coli O157:H7

Disease Listing | General Information | Technical Information | Additional Information

Frequently Asked Questions

What is Escherichia coli O157:H7?
How is E. coli O157:H7 spread?
What illness does E.coli O157:H7 cause?
How is E. coli O157:H7 infection diagnosed?
How is the illness treated?
What are the long term consequences of infection?
What can be done to prevent the infection?
What can you do to prevent E. coli O157:H7 infection?

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Escherichia coli O157:H7 is an emerging cause of foodborne illness. An estimated 73,000 cases of infection and 61 deaths occur in the United States each year. Infection often leads to bloody diarrhea, and occasionally to kidney failure. Most illness has been associated with eating undercooked, contaminated ground beef. Person-to-person contact in families and child care centers is also an important mode of transmission. Infection can also occur after drinking raw milk and after swimming in or drinking sewage-contaminated water.

Consumers can prevent E. coli O157:H7 infection by thoroughly cooking ground beef, avoiding unpasteurized milk, and washing hands carefully.
Because the organism lives in the intestines of healthy cattle, preventive measures on cattle farms and during meat processing are being investigated.


--------------------------------------------------------------------------------

What is Escherichia coli O157:H7?

E. coli O157:H7 is one of hundreds of strains of the bacterium Escherichia coli. Although most strains are harmless and live in the intestines of healthy humans and animals, this strain produces a powerful toxin and can cause severe illness.

E. coli O157:H7 was first recognized as a cause of illness in 1982 during an outbreak of severe bloody diarrhea; the outbreak was traced to contaminated hamburgers. Since then, most infections have come from eating undercooked ground beef.

The combination of letters and numbers in the name of the bacterium refers to the specific markers found on its surface and distinguishes it from other types of E. coli.


How is E. coli O157:H7 spread?

The organism can be found on a small number of cattle farms and can live in the intestines of healthy cattle. Meat can become contaminated during slaughter, and organisms can be thoroughly mixed into beef when it is ground. Bacteria present on the cow's udders or on equipment may get into raw milk.

Eating meat, especially ground beef, that has not been cooked sufficiently to kill E. coli O157:H7 can cause infection. Contaminated meat looks and smells normal. Although the number of organisms required to cause disease is not known, it is suspected to be very small.

Among other known sources of infection are consumption of sprouts, lettuce, salami, unpasteurized milk and juice, and swimming in or drinking sewage-contaminated water.

Bacteria in diarrheal stools of infected persons can be passed from one person to another if hygiene or handwashing habits are inadequate.
This is particularly likely among toddlers who are not toilet trained. Family members and playmates of these children are at high risk of becoming infected.

Young children typically shed the organism in their feces for a week or two after their illness resolves. Older children rarely carry the organism without symptoms.


What illness does E. coli O157:H7 cause?

E. coli O157:H7 infection often causes severe bloody diarrhea and abdominal cramps; sometimes the infection causes nonbloody diarrhea or no symptoms. Usually little or no fever is present, and the illness resolves in 5 to 10 days.

In some persons, particularly children under 5 years of age and the elderly, the infection can also cause a complication called hemolytic uremic syndrome, in which the red blood cells are destroyed and the kidneys fail. About 2%-7% of infections lead to this complication. In the United States, hemolytic uremic syndrome is the principal cause of acute kidney failure in children, and most cases of hemolytic uremic syndrome are caused by E. coli O157:H7.


How is E. coli O157:H7 infection diagnosed?

Infection with E. coli O157:H7 is diagnosed by detecting the bacterium in the stool. Most laboratories that culture stool do not test for E. coli O157:H7, so it is important to request that the stool specimen be tested on sorbitol-MacConkey (SMAC) agar for this organism. All persons who suddenly have diarrhea with blood should get their stool tested for E. coli O157:H7.


How is the illness treated?

Most persons recover without antibiotics or other specific treatment in 5-10 days. There is no evidence that antibiotics improve the course of disease, and it is thought that treatment with some antibiotics may precipitate kidney complications. Antidiarrheal agents, such as loperamide (Imodium), should also be avoided.

Hemolytic uremic syndrome is a life-threatening condition usually treated in an intensive care unit. Blood transfusions and kidney dialysis are often required. With intensive care, the death rate for hemolytic uremic syndrome is 3%-5%.


What are the long-term consequences of infection?

Persons who only have diarrhea usually recover completely.

About one-third of persons with hemolytic uremic syndrome have abnormal kidney function many years later, and a few require long-term dialysis. Another 8% of persons with hemolytic uremic syndrome have other lifelong complications, such as high blood pressure, seizures, blindness, paralysis, and the effects of having part of their bowel removed.


What can be done to prevent the infection?

E. coli O157:H7 will continue to be an important public health concern as long as it contaminates meat. Preventive measures may reduce the number of cattle that carry it and the contamination of meat during slaughter and grinding. Research into such prevention measures is just beginning.


What can you do to prevent E. coli O157:H7 infection?

Cook all ground beef and hamburger thoroughly. Because ground beef can turn brown before disease-causing bacteria are killed, use a digital instant-read meat thermometer to ensure thorough cooking. Ground beef should be cooked until a thermometer inserted into several parts of the patty, including the thickest part, reads at least 160º F. Persons who cook ground beef without using a thermometer can decrease their risk of illness by not eating ground beef patties that are still pink in the middle.

If you are served an undercooked hamburger or other ground beef product in a restaurant, send it back for further cooking. You may want to ask for a new bun and a clean plate, too.

Avoid spreading harmful bacteria in your kitchen. Keep raw meat separate from ready-to-eat foods. Wash hands, counters, and utensils with hot soapy water after they touch raw meat. Never place cooked hamburgers or ground beef on the unwashed plate that held raw patties. Wash meat thermometers in between tests of patties that require further cooking.

Drink only pasteurized milk, juice, or cider. Commercial juice with an extended shelf-life that is sold at room temperature (e.g. juice in cardboard boxes, vacuum sealed juice in glass containers) has been pasteurized, although this is generally not indicated on the label. Juice concentrates are also heated sufficiently to kill pathogens.

Wash fruits and vegetables thoroughly, especially those that will not be cooked. Children under 5 years of age, immunocompromised persons, and the elderly should avoid eating alfalfa sprouts until their safety can be assured. Methods to decontaminate alfalfa seeds and sprouts are being investigated.

Drink municipal water that has been treated with chlorine or other effective disinfectants.

Avoid swallowing lake or pool water while swimming. See more information about this.

Make sure that persons with diarrhea, especially children, wash their hands carefully with soap after bowel movements to reduce the risk of spreading infection, and that persons wash hands after changing soiled diapers. Anyone with a diarrheal illness should avoid swimming in public pools or lakes, sharing baths with others, and preparing food for others.

For more information about reducing your risk of foodborne illness, visit the US Department of Agriculture’s Food Safety and Inspection Service website at: http://www.fsis.usda.gov or the Partnership for Food Safety Education at: For more advice on cooking ground beef, visit the U.S. Department of Agriculture web site at: http://www.fsis.usda.gov/OA/topics/gb.htm

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A guestion to the virologists and bacteriologists out there.....

What is the significance of the H7 at the end of the bacterias definition? I don't know.... H7 AI has been recently found in the United Kingdom. Is this a cause for concern or does the H7 mean something else when you are describing a bacteria?

[KC]

Re: Toddlers hit by 'E.coli outbreak' (Fife, Scotland)

Also from the CDC: http://www.cdc.gov/ncidod/dbmd/disea...chiacoli_t.htm

"Transmission - Major source is ground beef; other sources include consumption of unpasteurized milk and juice, sprouts, lettuce, and salami, and contact with cattle. Waterborne transmission occurs through swimming in contaminated lakes, pools, or drinking inadequately chlorinated water. Organism is easily transmitted from person to person and has been difficult to control in child day-care centers."

[KC]

Re: Toddlers hit by 'E.coli outbreak' (Fife, Scotland)

This is the limit of my research ability. I need a virologist or a bacteriologist to answer my question above. This question scares me. Does the H7 have any significance in the e-coli outbreak (Both were in Fife, Scotland)?

H7 in the "Escherichia coli O157:H7" refers to the Flaggelar antigen in a bacteria.

H7 refers to the Hemagglutinin antigen in a virus.

I then find out that " http://www.pubmedcentral.gov/picrend...3&blobtype=pdf " uses the term "Flagellar or Hemagglutinin" interchangeably to describe the bacteria Vibrio cholerae... aka known as cholera.

[Sally Furniss]

Re: Toddlers hit by 'E.coli outbreak' (Fife, Scotland)

Fourth victim of suspected E.coli

Press Association
Thursday May 11, 2006 3:08 AM

A fourth child is seriously ill in hospital following a suspected outbreak of E.coli O157 in Fife, NHS officials have confirmed.

The 22-month-old child, who attended Careshare Nursery in Dunfermline, Fife, is being treated for kidney failure at Glasgow's Yorkhill Hospital.

Three toddlers who went to the same nursery remain in a serious condition at the hospital, one day after news of the suspected outbreak emerged.

Health officials confirmed that other possible cases of E.coli in two young children were also being investigated. It is not yet clear whether these children are linked to the nursery.

In a statement, Dr Charles Saunders, consultant in public health medicine, said: "As of 10am this morning, there are now four children confirmed as having kidney failure in the suspected E.coli O157 outbreak in children attending Careshare Nursery, Lauder, Dunfermline.

"The fourth child is 22-months old and is being treated in the Royal Hospital for Sick Children in Glasgow. All of these children are in hospital and their conditions have been described as serious.

"We are also aware of a further two possible cases in young children which are being investigated. These two children are at home.

"The investigation into the possible cause of the outbreak continues."

The nursery is based in the grounds of Lauder College in the Halbeath area of the town. It has been closed while health chiefs look into the cause of the outbreak.

Experts believe the children have been struck with the O157 strain, the same as the one which killed 21 people in Wishaw, Lanarkshire, in 1996. An outbreak control team of officials from NHS Fife and the local authority was meeting to discuss the matter.

http://www.guardian.co.uk/uklatest/story/0,,-5814040,00.html?gusrc=ticker-103704

[KC]

Re: Toddlers hit by 'E.coli outbreak' (Fife, Scotland)

This is a bad piece of legislation. It totally overlooks the fact that e-coli also spreads human to human. It doesn't consider the fact that if someone gets it from undercooked meat, they could then spread the disease to their families, friends, co-workers, and community.
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Beefed-up bill in hot seat
Lawmakers to decide whether rare meat is OK
BY PETER HULL, The Island Packet
Published Friday, May 12, 2006

http://www.islandpacket.com/news/business/story/5732696p-5130953c.html

Bills related to tourism and the hospitality industry are common during the state legislative session, but one of this year's bills is, well, rare.

Rare ground beef, that is.

Lawmakers want to wash that down with a change in how liquor sales are taxed. And for now, smokers still can enjoy a cigarette after a meal, thanks to legislative inaction.

House Bill 3640 would allow restaurant customers to order rare hamburgers cooked to a temperature below 155 degrees. The amendment would provide restaurants with immunity from liability if a customer becomes sick from eating the rare meat. Restaurants must provide written warnings to customers on menus or other signs that there may be health risks.

"You cannot buy a rare hamburger in this state," said Tom Sponseller, president of the Hospitality Association of South Carolina.

Sounds like bull?

The law stems in part from an E. coli bacteria outbreak in 1993 when 600 people got sick after eating undercooked hamburgers at Jack in the Box restaurants. The outbreak was traced to E. coli-contaminated beef sold at restaurants in several Western states.

The bacterium can cause diarrhea, abdominal pain and, in severe cases, kidney failure and death. Most of the victims in the Jack in the Box outbreak were children living in Washington state; four of them died.

Health officials determined that Jack in the Box had not properly cooked the hamburgers, as required by state law, to internal temperatures of 155 degrees, a temperature that kills E. coli bacteria.

This year's bill passed the South Carolina House, Sponseller said, and is now in the Senate, but may not make it through the Senate Medical Affairs subcommittee before the legislative session ends June 1.

[KC]

Re: Toddlers hit by 'E.coli outbreak' (Fife, Scotland)

E.Coli: Fifth child seriously ill
May 12 2006
http://icrenfrewshire.icnetwork.co.u...name_page.html

A fifth child has been confirmed as having kidney failure following an outbreak of the potentially deadly E.coli bug at a nursery, health officials have said.

The 21-month-old boy was in hospital in Glasgow overnight, along with the other four youngsters, as incident control chiefs continued efforts to identify the source of the outbreak.

NHS Fife said it looked "increasingly likely" that the original infection may have been brought into the Careshare Nursery in Dunfermline by an adult or child and others infected through person to person spread.

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Person to person = human to human without known preventative measures.

[ukcz]

Re: Toddlers hit by 'E.coli outbreak' (Fife, Scotland)

Letter sent to parents playing down E coli risk was optimistic - expert
MICHAEL HOWIE

PARENTS at a nursery linked to the E coli outbreak which has left five toddlers seriously ill were told by health chiefs their children were not likely to be at risk - even after the first clinically confirmed case.

Dr Mike Roworth, a consultant in public health with NHS Fife, sent a letter to the Lauder College Nursery in Dunfermline on 5 May alerting them that a child was thought to have contracted the potentially-deadly E coli 0157 bug.

The fax said parents should seek medical advice if their child was ill, but added it was not thought any other child was likely to be at risk from the infection.

The letter last night sparked questions about the way public health officials have handled the outbreak, as it emerged a fifth child has been diagnosed with clinically-confirmed E coli.

The 21-month-old boy was transferred from Victoria Hospital in Kirkcaldy to Glasgow's Yorkhill Hospital yesterday morning, where he was being treated for kidney failure.

Four other children also are receiving specialist treatment at the hospital, while doctors are monitoring eight other suspected cases.

The letter sent out by Dr Roworth - seen by The Scotsman, stated: "It is not thought that the infection came from the nursery or that anyone else at the nursery is likely to be at risk. As a precaution, however, I am writing to advise you to be aware of the symptoms of E coli 0157 infection in your child over the next seven days, and to seek prompt medical advice if he or she shows signs of infection."

Professor Hugh Pennington, a leading microbiologist, described the approach taken by public health officials after the first case emerged as "optimistic".

Asked to comment on the fact parents were told that their children were not believed to be at risk of contracting E coli, Prof Pennington said: "That's rather on the optimistic side, I would have said.

"Nurseries are well-known places where cases of E coli can get about among young kids. To be on the safe side, you wouldn't say this is a single sporadic case, even if you believe it is. It's a very difficult call, but you could say they should have been a bit more cautious."

He added: "I think on balance, believing it was a sporadic case was a reasonable call, but on the other hand it turned out to be wrong."

NHS Fife last night admitted it was "arguable" that a tougher warning should have been sent out, but said they did not want to cause unnecessary panic when they believed the case was a one-off.

Dr Charles Saunders, a consultant in public health medicine at NHS Fife, defended the wording of the letter, but added the outbreak would be reviewed to see what lessons could be learned. "We try to draw a line between getting vital information to parents and frightening them unnecessarily and causing panic," he said.

"Most cases of E coli are sporadic, even in nurseries. We had to get information out to parents so they were aware of the situation. We also faxed GPs the same day. But sending letters which put the fear of God into people would, I think, be difficult to justify most of the time."

The nursery was closed on Tuesday morning after a further two children fell ill.

Dr Saunders admitted it was possible that other children were infected at the nursery after the letter was sent out.

He said closing the nursery earlier, while the chances were that the case was a one-off, "would have involved risk" with parents either having to miss work or hastily arrange child-care. "It's difficult to get it absolutely right," he said.

Meanwhile, NHS Fife said it looked "increasingly likely" that the original infection may have been brought into the nursery by an adult or child and others infected through person to person spread.

Conservative MP Michael Fallon, managing director of Just Learning Holdings whose subsidiary Careshare runs the nursery, last night spoke of his concern.

The Sevenoaks MP said: "I am desperately concerned for the parents and children involved.

"It is becoming increasingly clear that our nursery was not the source of this outbreak and that we have done our very best to contain it based on the advice we have been given," added Mr Fallon.

http://news.scotsman.com/scotland.cfm?id=714412006

[KC]

Re: Toddlers hit by 'E.coli outbreak' (Fife, Scotland)

Two further E coli cases confirmed
By Judith Duffy, Health Correspondent

http://www.sundayherald.com/55683

THE number of victims of an outbreak of E coli in Fife rose to seven yesterday, with two more children identified as having the potentially deadly infection.
Five other children are still being treated for kidney failure in hospital, and the number of possible cases being investigated has risen from eight to 18. All have links with the Careshare Nursery in Dunfermline.

Health officials now believe the E coli 0157 infection was brought in to the nursery from an outside source, and say it is likely it would have subsequently spread due to poor hygiene.

Earlier this week, it emerged that the nursery was criticised over its infection control procedures by government inspectors in October last year.

Dr Charles Saunders, consultant in public health medicine at NHS Fife, who is heading the team investigating the outbreak, said: ?We haven?t ruled anything in or out conclusively yet, but what does seem quite a high possibility is that either an adult or a child picked up the infection from outside the nursery.

?Then it spread within the nursery, and that could only arise if there hasn?t been adequate handwashing and hygiene.?

Five children ? three two-year-olds, one girl aged 22 months and a 21-month-old child ? are being treated in the Royal Hospital for Sick Children in Glasgow. Their condition was described as either ?stable? or ?improving?.

The two other children who have been diagnosed with the E coli 0157 bug were undergoing tests at Victoria Hospital in Kirkcaldy yesterday .

A further 18 possible cases ? also mainly children ? who have had symptoms of diarrhoea ? are being monitored at home while experts await test results.

Staff at the E coli reference laboratory in Edinburgh are testing a total of 192 stool specimens from children, parents and staff associated with the nursery.

Saunders said it was a possibility that more cases would yet emerge as it could take between 10 to 14 days to get final test results. ? All of these [specimens] are being looked at and it won?t be until we get the final results back that we will be able to say that these people definitely don?t have that infection.?

He also admitted it would be ?extremely difficult? to identify the source of the stomach bug, as the initial cases which emerged were close together. ?With this particular bug it is possible for some people who have the infection not to be ill, so it could well prove difficult to identify how it was brought in.?

The incident control team, involving NHS Fife, Health Protection Scotland, Fife Council and the Care Commission, met again today to continue their investigations into the cause of the outbreak.

Nobody was available for comment last night at Careshare, which runs the nursery based at Lauder College, Dunfermline. The nursery has been closed while health chiefs investigate the outbreak. Staff and children will only be allowed back once they have two negative test results at least 24 hours apart.

In 1996, the world?s worst recorded outbreak of E-coli poisoning occurred in Wishaw, Lanarkshire, when 21 elderly people died. Scotland has a higher incidence of the bug than the rest of the UK, but experts remain baffled as to why.

Dr John Cowden, a consultant epidemiologist at Health Protection Scotland, said: ? A lot of people are suggesting possible answers, and to my knowledge none of them has been supported by evidence. It is a mystery.?