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Health department: E. coli outbreak started at Stock Show

Jeffrey Wolf and Anastasiya Bolton, KUSA-TV

February 6, 2009

DENVER - The Colorado Health Department says it believes an outbreak of E. coli started at the National Western Stock Show and has spread to nearly a dozen children.

The Colorado Department of Health and Environment (CDPHE) says there are 12 confirmed cases of E. coli believed to be linked to the Stock Show and all but one of the cases is in a child. The cases are all in Front Range counties, from Boulder to El Paso County.

"We've had 20 cases of a very unusual type of E. coli. Of these 20 cases, 12 have been confirmed and 16 of the cases have a relationship with the National Western Stock Show," said Dr. Chris Urbina, the director of the Denver Public Health Department.

Urbina says the Denver area usually averages two cases in January.

"So having 20 cases is very unusual. This is an outbreak investigation," he said.

Several of the sick children go to day care and at least two of the cases appear to have happened after ill children came into contact with other sick children, according to the CDPHE.

The CDPHE says there is a potential there will be several more cases because so many schools and child care centers organized trips to the Stock Show.

Doris Roque's 4-year-old daughter, Anastasia, became ill and then Doris got sick as well.

"It's hard when you see your child go through something like that because it's like you know you're a sitting duck. You can't do nothing but watch them go through it. It's a very painful thing to have," said Doris Roque.

It is unclear how the E. coli first spread at the Stock Show.

"There are signs advising visitors to wash their hands after the children or the adults have contact with the animals and there are multiple signs especially in those areas where there are adults and children with animals," said Pat Grant, president and CEO of the National Western Stock Show.

The CDPHE says it is concerned because E. coli can spread easily among children and can be very serious. In some case there can be a complication that can cause kidney failure in young children.

"If you've had contact with the Stock Show or you've had contact with somebody who's been to the Stock Show, you have bloody diarrhea, you should see your health provider to get tested," Urbina said.

Grant says he hopes this outbreak will not leave a lasting image with the public.

"The National Western is all about people, it's all about animals, it's all about kids and we want to do anything and everything we can to ensure a healthful, fun, enjoyable but educational experience. If nothing else, we would like the outcome to be a better understanding of animals and what animals mean to society and what animals mean to us as individuals and families," Grant said.

The CDPHE is recommending the following tips:

For child care centers:

• Report any cases of bloody diarrhea (even if there is only one) to your local public health agency or to CDPHE at 303-692-2700 immediately.

• Report any increase in the number of children or staff with diarrhea who attend your facility to your local health department or to CDPHE at 303-692-2700 immediately.

• Children or staff must not attend child care while ill with diarrhea.

o If it is known that a child/staff member with diarrhea attended the stock show, or if the facility took a trip to the stock show, the child/staff member should be referred to his/her health care provider for follow up and stool testing before returning to class. That stool test must be negative and the diarrhea must have resolved before the child/staff member can return to child care.

o Any child/staff member with bloody diarrhea, regardless of whether he/she went to the stock show should be referred to his/her health care provider for follow up and stool testing before returning to class. That stool test must be negative and the diarrhea must have resolved before the child/staff member can return to child care.

o If a child/staff member has diarrhea that is not bloody and did not attend the stock show, then the child/staff member is not required to provide a negative stool specimen, however diarrhea must be resolved before returning to child care.

• Children and staff who are diagnosed with E. coli O157 must have two stool specimens that are negative for E. coli O157 or shiga toxin before returning to child care.

For schools:

• Report any cases of bloody diarrhea (even if there is only one) to your local public health agency or to CDPHE at 303-692-2700 immediately.

• Report any increase in the number of children or staff with diarrhea who attend you facility to your local health department or to CDPHE at immediately.

• Children should not attend school while ill with diarrhea.

o If it is known that a child with diarrhea has attended the stock show, or if the child has bloody diarrhea, we strongly recommend the child be referred to his/her provider for follow up and stool testing.

• Because transmission of E. coli O157 from one person to another is rare in school settings, children who are diagnosed with E. coli O157 are not required to have negative stool specimens before returning to school. They should, however, be free of diarrhea before returning to class.

• School staff who are diagnosed with E. coli O157 are also not required to have negative stool specimens before returning to work, unless the staff member handles food as part of his/her job.

General control measures:

• Regular agents that are used for sanitizing and disinfection, such as sodium hypochlorite and quaternary ammonia based solutions, are effective against E. coli. No special disinfectants are necessary to kill E. coli.

• Consider increasing cleaning frequency of sanitizing and/or disinfection, particularly in restrooms and diaper changing areas.

• Meticulous hand hygiene following diaper changing is extremely important in controlling the spread of many pathogens. Both the child's and caregiver's hands should be washed immediately following diaper changing and toileting.

• Handwashing is also extremely important for food handlers and before eating meals. Caregivers should supervise children during handwashing to ensure that the process is adequate.

• Again, staff responsible for preparing meals in child care facilities and in schools should not handle food if they have diarrhea or have been diagnosed with E coli. Food handlers with diarrhea should not return to work until their diarrhea has resolved and should be encouraged to visit a physician to have their stool tested. Food handlers diagnosed with E coli, should not return to work until they have had two negative stool samples.

For your information, CDPHE has provided the following advice for health care providers:

• Please obtain stool specimens from children presenting with bloody diarrhea. Please ensure the laboratory will test for E. coli O157 or for shiga toxin, as not all laboratories do this routinely.

• Consider obtaining stool specimens from children with non-bloody diarrhea if diarrhea has persisted for more than 2 days, or is accompanied by fever, severe abdominal cramping or other symptoms.

• Report cases of bloody diarrhea in children to CDPHE at 303-692-2700 until further notice.

• Children should not attend child care while they have diarrhea. Children who are diagnosed with E. coli O157 must have two stool specimens that are negative for E. coli O157 or shiga toxin before returning to child care. Please explain these exclusion policies to parents of children who are ill and who attend child care.

• Antibiotics are generally not recommended for E. coli O157 infection and may be associated with development of hemolytic uremic syndrome (HUS).

If outbreaks or ill children are identified in your facility, your local public health agency will work with you to determine if additional control measures are necessary.

Please maintain this enhanced vigilance for illness and the extra screening measures for some children with diarrhea from now to Feb. 16.

For disease reporting or other questions please contact the CDPHE Communicable Disease program at 303-692-2700.

More on this outbreak: National Western Stock Show E. coli Outbreak

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