"We don’t see a whole lot of this but it can occur," said Dr. Alan Melnick, Clark County’s public health officer. He said the health department investigates an average of 8 cases of E. coli O157:H7 infection in Clark County each year.
In the current outbreak, Melnick said the health department learned of the first hospitalization on March 19. Soon after, three other children required hospitalization. Melnick said investigators tested stool samples from 22 children and four adult caregivers at the day care and found six carrying the O157:H7 strain but not showing symptoms.
To reduce the risk of further spread, Melnick said the health department decided to close the day care on April 2. One of the four sick children remains hospitalized, Melnick said. So far, none of the other day-care children or staff have become sick. Symptoms can take up to 10 days to appear after exposure, Melnick said, so the health department each day is checking with staff and the families of the children who attended the day care, which is state-licensed.
The day care will remain closed until the affected staff show no presence of the bacteria on two consecutive tests conducted at least a day apart, Melnick said. Children who tested positive have to meet the same criteria before being allowed to attend any daycare or school.
It is not clear whether any of the children developed hemolytic uremic syndrome. E. coli O157:H7, and other frequent foodborne pathogens, are a recognized risk in daycare, as well as foodservice, settings. It is a risk that needs to be addressed and controlled for by chld care workers.
Frequently, though certainly not always, it is not the food that ends of causing illness in daycares, but the general sanitation of the facility that serves as the vector by which bacteria passes to children or staff. In May 2010, this is exactly what happened in Joplin, Missouri at Kids Korner Daycare.
On May 10, 2004, the Jasper County Health Department (JCHD) received a report from St. Johns Regional Medical Center that two 2-year-old children had been hospitalized with hemolytic uremic syndrome (HUS) at Children’s Mercy Hospital in Kansas City, Missouri. The children, one boy and one girl, were residents of Carthage Missouri. Five of the girl’s family members soon developed symptoms of E. coli infection, and one later tested positive for E. coli O157:H7.
JCHD began investigating the apparent E. coli outbreak, and learned that the hospitalized girl and one of her siblings attended daycare at Kid’s Korner daycare in Joplin, Missouri. JCHD investigators visited the daycare facility on May 11. They did not note any major hand washing or diapering violations, and discussed the importance of excluding children with diarrheal illness from the daycare with daycare operators and employees.
On May 24, JCHD was notified that a 4-year-old girl who attended daycare at Kid’s Korner had become ill with symptoms of E. coli infection on May 14 and was being transferred from a Joplin hospital to Children’s Mercy in Kansas City with HUS.
JCHD inspectors returned to Kid’s Korner on May 25, and instructed the daycare to distribute a letter explaining the incidence of E. coli at the daycare and the signs and symptoms of illness to parents. During this inspection, JCHD investigators noted deficiencies conducive to the spread of disease and instructed Kid’s Korner employees on methods of hygiene and sanitation effective to prevent the further spread of E. coli.
By May 26, JCHD had received two additional reports of illness in children who attended Kid’s Korner. One of the children had had bloody diarrhea on May 11; the child’s sibling fell ill on May 26 and was later hospitalized with HUS. Despite their earlier assurances that no children at the daycare had been symptomatic during the month of May, Kid’s Korner then produced a list of nine children who had exhibited symptoms of E. coli infection to JCHD investigators.
On May 27, JCHD inspectors returned to the daycare center and noted handwashing lapses. They also learned that Kid’s Korner had failed to distribute the May 25 letter regarding possible E. coli exposure and symptoms to 32 percent of the families with children in attendance at Kid’s Korner.
Marler Clark represented the family of a two-year-old boy and his eight-month-old sister who both attended Kids’ Korner and became ill with E. coli infections. The two-year-old boy developed HUS and was hospitalized for nearly three weeks. He endured a full week of dialysis, seven transfusions, three surgeries, and a severe case of pancreatitis. The family’s claim was resolved in 2006.