This is an official
CDC Health Alert

Distributed via Health Alert Network  September 14, 2006, 23:00 EDT (11:00 PM EDT) CDCHAN-00249-06-09-14-ALT-N

Multiple States Investigating a Large Outbreak of E. coli O157:H7 Infections

Public health officials in multiple states, with the assistance of the Centers for Disease Control and Prevention, are investigating a large outbreak of E. coli O157:H7 infections. Thus far, 50 cases with isolates demonstrating pulsed-field gel electrophoresis (PFGE) CDC PulseNet pattern number EXHX01.0124, as determined by Xba restriction enzyme DNA digestion, have been reported from CT (1), ID (3), IN (4), MI (3), OR (5), NM (2), UT (11), WI (20).  Eight patients developed the hemolytic uremic syndrome (HUS) and one patient died.  Most cases are recent: for those with known illness onset, the range of onset is 08/25/2006 to 09/03/2006.  The outbreak is likely ongoing.

Preliminary findings from case interviews indicate that pre-packaged spinach is the most likely source.  Additional investigation is necessary to determine the brand or brands of pre-packaged spinach involved.  State and CDC investigators are working with FDA to quickly gather information to take action to protect the public.  The FDA advises that consumers not eat bagged fresh spinach at this time.

The E. coli O157:H7 bacterium causes diarrhea that is often bloody and accompanied by abdominal cramps, but fever is absent or mild. The illness typically resolves within a week.  However, some people, especially young children and the elderly, develop the hemolytic uremic syndrome, or HUS.

For more information concerning E. coli O157 infection, please see the CDC internet website: http://www.cdc.gov/ncidod/diseases/submenus/sub_ecoli.htm.

E. coli O157:H7 cases should be reported rapidly to the appropriate local and state public health officials, and isolates should be forwarded to state public health laboratories for rapid PFGE analysis.  We request state officials report cases demonstrating the outbreak PFGE pattern to the Enteric Diseases Epidemiology Branch (Thai-An Nguyen (ten9@cdc.gov, 404-639-0776) ASAP. 

 Clinical Issues  

• Suspect a case in any individual presenting with acute onset of severe diarrhea, often bloody.    

• HUS is most likely to develop several days after the onset of gastrointestinal symptoms in young children and the elderly.  

•  Young children with severe diarrhea may appear euvolemic or “puffy” when in fact, they may be severely dehydrated. The puffiness or edema results from the severe protein loss from diarrhea.      

• Have a low threshold for admitting young children or the elderly for IV hydration who have presented with severe diarrhea (see attached article on nephroprotection in children).

Laboratory Issues        

• Use your usual clinical lab resource to send stool for culture. Specifically order testing for E. coli O157:H7.        

• Clinical labs will report positives based on EIA testing for shiga toxin production.        

• Clinical labs should send all shiga toxin positive samples to the State Lab for Public Health for culture isolation and genetic analysis.

Public Health Issues        

• By law, a suspected E. coli O157:H7 case must be reported within 24 hours to your local health department.        

• Report all suspect cases. Do not wait for laboratory confirmation.