Re: Ireland - Limerick creche to close after E coli outbreak
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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Date: Mon 17 Oct 2011
Source: Raidio Teilifis Eireann (RTE) News [edited]
http://www.rte.ie/news/2011/1017/ecoli.htmlA creche [day care center - Mod.LL] in Limerick has been asked toclose 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-producingstrain. Fewer than 10 children have been infected; a number of linkedcases have been identified. The closure is to enable all staff andchildren attending the creche to be screened.The HSE said it was satisfied that the creche was fully compliant withpreschool standards. However, children from this creche will not beable to attend other child care facilities until they have beencleared of infection.--
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[Outbreaks of enterohemorrhagic _E. coli_ infection are not uncommonin day care centers as, especially with young children, there is ampleopportunity for child-to-child transmission related to less than idealhygiene. It is possible that the origin of the outbreak could be afood vehicle at the day care center or a child introducing the straininto the center after acquiring it at home. Secondary spread in thecenter is also likely to occur since, as noted by Mod.DK in a previousposting, toddlers are marvelous sharers of toys as well as fecallycontaminated hands.In analyzing the genetic and phenotypic profiles of non-O157 groups,it has been found that they belong to their own lineages and haveunique profiles of virulence traits different from O157 (1). Theserogroups appearing to be most prominent are O26, O111, O128, andO103 (2), the former serotype being the implicated strain in thisoutbreak.If a laboratory is using sorbitol-MacConkey (sMAC) plates to identifyVTEC by virtue of O157's inability to ferment sorbitol, the non-O157strains will be missed. In a 3-year pediatric study from theUniversity of Washington, USA (3), 1851 stool samples were processedfor sorbitol fermentation as well as toxin production by EIA (enzymeimmunoassay), and 28 strains of O157 were found along with O103 (4strains), O118 (2 strains), O111 (2 strains), and 3 other strains.Clinically, the O157 infections had a higher frequency of bloodystools, fecal leukocytes, and abdominal pain with shorter symptomduration. 5 (18 per cent) of O157 infections developed hemolyticuremic syndrome (HUS); none of the non-O157 strains did. Since toxinassay did not identify all O157 strains found on sMAC plates, theinvestigators did not advocate performing toxin assay alone. Non-O157can produce HUS, as demonstrated by a cluster of O121 cases associatedwith a lake in Connecticut, USA (4).Since toxin assays are not uniformly performed in many areas, and mostcases do not produce HUS, it is likely that cases due to non-O157strains are being missed. How frequent this phenomenon will becomeover time is unclear....
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