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A cluster of E. coli O157 cases from two different sources

E. COLI EHEC - USA (21): (TENNESSEE) O157, 2 CLUSTERS, 2 SOURCES

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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: Fri 6 Jul 2018 2:00 p.m. ET
Source: Knox News [edited] <https://www.knoxnews.com/story/news/health/2018/07/06/knoxville-e-coli-outbreak-tennessee/763625002/>


A cluster of 15 _E. coli_ infection cases in June 2018, all among children, came from 2 different sources, Knox County Health Department investigators have concluded: a somewhat unusual outcome.

The health department announced Fri 6 Jul 2018 that 2 different strains of _E. coli_ O157 sickened the children, 9 of whom were hospitalized and 7 of whom developed hemolytic uremic syndrome, a severe complication that affects the kidneys and occurs in 5-10 percent of infected people. One child remains hospitalized, now in fair condition, at East Tennessee Children's Hospital. The outbreak appears to be over, as no new transmissions are occurring, health officials said.

"While it is rare, it appears we had 2 sets of children sickened by 2 different strains of _E. coli_ O157 at the same time," said health department director Dr. Martha Buchanan. "The epidemiological evidence overwhelmingly supported the 2-source theory: consumption of raw milk and some type of contact, most likely indirect, with ruminant animals. The investigation revealed no definitive connections between the 2 sources or the 2 groups of ill children. And this is now supported by the state's lab results confirming it was 2 different strains of _E. coli_ O157."

Ten of the 15 ill children had a common link: they consumed raw milk from French Broad Farm in East Knox county. State lab results confirmed these children had the same strain of _E. coli_ O157 and that this strain is a DNA fingerprint match to the _E. coli_ O157 found in cow manure samples collected from French Broad Farm.

Though the lab did not find _E. coli_ O157 in the raw milk samples, that is not uncommon and doesn't mean the milk the children drank was not contaminated, Buchanan said. _E. coli_ bacteria do not distribute themselves uniformly in milk, meaning a portion of even the same glass of milk can be contaminated while another portion is not. That's why raw milk's safety can't be guaranteed, even if a dairy takes precautions, including testing the milk. Based on the dates when the children started showing symptoms of infection, and allowing time for the milk to be distributed and time for incubation of the illness, officials believe the contamination event occurred in mid-May 2018.

The other 5 ill children had only one common link: attending the same child-care facility, Kids Place Inc. in Mascot, [TN], where goats are present. State lab results confirmed these 5 children had the same strain of _E. coli_ O157 and that it was a DNA match to the _E. coli_ O157 found in goat fecal samples and one hay sample collected from the child-care center. The lab did not find _E. coli_ O157 in other environmental samples from inside the facility.

_E. coli_ O157 is naturally found in the intestinal tracts of certain types of farm animals, including healthy cattle, sheep, and goats, which can then shed it in their stool without appearing unhealthy. _E. coli_ can contaminate the animals' skin, fur, and the areas where they live and roam.

[Byline: Kristi L. Nelson]

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Communicated by: ProMED-mail <promed@promedmail.org>

[This is an example of 2 separate clusters of EHEC O157 occurring in parallel, one associated with unpasteurized cow's milk and one at a daycare associated with goat exposure. - Mod.LL

HealthMap/ProMED-mail maps:
Tennessee, United States: <http://healthmap.org/promed/p/244>
Mascot, Tennessee, United States: <http://healthmap.org/promed/p/36150>]

[See Also:
E. coli EHEC - USA (20): O157, romaine lettuce, water sourcehttp://promedmail.org/post/20180702.5882323
E. coli EHEC - USA (19): (UT, AZ) O157, 2017 http://promedmail.org/post/20180616.5858104
E. coli EHEC - USA (18): (TN) raw milk, more cases http://promedmail.org/post/20180614.5856110
E. coli EHEC - USA (17): (OR) O111, daycare center http://promedmail.org/post/20180613.5854733
E. coli EHEC - USA (16): (TN) raw milk http://promedmail.org/post/20180607.5844304
E. coli EHEC - USA (15): O157, romaine lettuce, more cases, fatal http://promedmail.org/post/20180604.5837662
E. coli EHEC - USA (14): (WA) sandwich shops http://promedmail.org/post/20180527.5820803
E. coli EHEC - USA (13): O157, romaine lettuce, increasing cases, fatality http://promedmail.org/post/20180517.5799620
E. coli EHEC - USA (12): O157, romaine lettuce, increasing cases, fatality http://promedmail.org/post/20180510.5791677
E. coli EHEC - USA (11): (OK) day care center http://promedmail.org/post/20180502.5780250
E. coli EHEC - USA (10): O157, romaine lettuce, fatality http://promedmail.org/post/20180502.5780249
E. coli EHEC - USA (09): O157, romaine lettuce http://promedmail.org/post/20180427.5771229
E. coli EHEC - USA (08): (CA) military outbreak, undercooked beef, 2017 http://promedmail.org/post/20180425.5769489
E. coli EHEC - USA (07): O157, romaine lettuce http://promedmail.org/post/20180425.5769488
E. coli EHEC - USA (06): O157, romaine lettuce http://promedmail.org/post/20180421.5761217
E. coli EHEC - USA (05): O157, romaine lettuce http://promedmail.org/post/20180418.5756056
E. coli EHEC - USA (04): O157, romaine lettuce http://promedmail.org/post/20180413.5745944
E. coli EHEC - USA (03): O157, expansion of NJ outbreak http://promedmail.org/post/20180411.5738813
E. coli EHEC - USA (02): (NJ) poss. restaurant chain link, RFI http://promedmail.org/post/20180405.5728398
E. coli EHEC - USA: O157, leafy greens http://promedmail.org/post/20180110.5550773

2017
---
E. coli EHEC - USA (39): relatedness to Canada isolates http://promedmail.org/post/20171229.5527271
E. coli EHEC - Canada (14): O157, lettuce, fatal http://promedmail.org/post/20171222.5518867
E. coli EHEC - Canada (13): O157, lettuce, fatal http://promedmail.org/post/20171215.5506384
E. coli EHEC - Canada (12) : O157, lettuce http://promedmail.org/post/20171212.5497097
E. coli EHEC - USA (38): (CA) http://promedmail.org/post/20171212.5498214
E. coli EHEC - USA (37): raw dough, FDA alert http://promedmail.org/post/20171202.5479176
E. coli EHEC - USA (36): (CA) military outbreak, O157 http://promedmail.org/post/20171111.5436982
E. coli EHEC - USA (35): (CA) military outbreak, O157 http://promedmail.org/post/20171104.5424631
E. coli EHEC - USA (34): (CA) military outbreak, O157 http://promedmail.org/post/20171103.5422415
E. coli EHEC - USA (33): (CA) military outbreak, O157 http://promedmail.org/post/20171102.5421203
E. coli EHEC - USA (32): (CA) military outbreak, revised case numbers http://promedmail.org/post/20171102.5420166
E. coli EHEC - USA (31): (CA) military outbreak http://promedmail.org/post/20171101.5417972
E. coli EHEC - USA (30): (CA) military outbreak, RFI http://promedmail.org/post/20171031.5416569
E. coli EHEC - USA (29): (MI) farm animal exposures, RFI http://promedmail.org/post/20171030.5410350
E. coli EHEC - USA (28): (VT) O157, ground beef, alert, recall http://promedmail.org/post/20171014.5381117
E. coli EHEC - USA (27): (WI) O157, RFI http://promedmail.org/post/20170921.5330484
E. coli EHEC - USA (26): (MI) O157, antimicrobial resistance http://promedmail.org/post/20170824.5272308
E. coli EHEC - USA (25): (CA) O157, recreational water http://promedmail.org/post/20170818.5258783
E. coli EHEC - USA (24): (CO) county fair, RFI http://promedmail.org/post/20170811.5243577
E. coli EHEC - USA (23): (CA) recreational water http://promedmail.org/post/20170810.5240983
E. coli EHEC - USA (22): (CA) recreational water http://promedmail.org/post/20170804.5227891
E. coli EHEC - USA (21): (CA) recreational water http://promedmail.org/post/20170802.5220799
E. coli EHEC - USA (20): (CA) recreational water, RFI http://promedmail.org/post/20170731.5217061
E. coli EHEC - USA (19): (UT, AZ) O157, fatalities, susp. livestock exposure http://promedmail.org/post/20170730.5215421
E. coli EHEC - USA (18): (UT, AZ) O157, fatalities http://promedmail.org/post/20170727.5206988
E. coli EHEC - USA (17): (OH) summer camp, RFI http://promedmail.org/post/20170724.5198725
E. coli EHEC - USA (16) : (MN) fatality http://promedmail.org/post/20170721.5195217
E. coli EHEC - USA (15): (UT) O157, fatalities http://promedmail.org/post/20170711.5167176
E. coli EHEC - USA (14): (UT) O157, fatalities http://promedmail.org/post/20170705.5152059
E. coli, EHEC - USA (13): (UT) fatalities, susp EHEC, RFI http://promedmail.org/post/20170703.5147181
E. coli EHEC - USA (12): (TX) http://promedmail.org/post/20170621.5121066
E. coli EHEC - USA (11): O157, deer droppings, water exposure, 2016 http://promedmail.org/post/20170511.5028649
E. coli EHEC - USA (10): O157, soynut butter http://promedmail.org/post/20170505.5014128
E. coli EHEC - USA (09): (AR) fatality, unrelated cases http://promedmail.org/post/20170422.4988037
E. coli EHEC - USA (08): (AR) fatality, RFI http://promedmail.org/post/20170421.4984124
E. coli EHEC - USA (07): (MA) O157, restaurant chain, RFI http://promedmail.org/post/20170414.4970974
E. coli EHEC - USA (06): O157, soynut butter http://promedmail.org/post/20170405.4949992
E. coli EHEC - USA (05): O157, soynut butter, CDC update http://promedmail.org/post/20170401.4941247
E. coli EHEC - USA (04): (OR) O157, soynut butter, preschool http://promedmail.org/post/20170315.4902827
E. coli EHEC - USA (03): O157, soynut butter, more cases, recall http://promedmail.org/post/20170308.4887992
E. coli EHEC - USA (02): O157, soynut butter http://promedmail.org/post/20170307.4883675
E. coli EHEC - USA http://promedmail.org/post/20170302.4875298]

Published 27-09-2017 in Focus on , last update 10-07-2018

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