Habaneros E. coli Outbreak – In late August of 2003, staff in the Communicable Disease (CD) section at the St. Clair County Health Department (SCCHD) received a report that four Illinois residents who had recently traveled to the St. Clair area were experiencing bloody diarrhea and had gone to emergency rooms in their respective hometowns for treatment. Laboratory tests were being conducted to determine the pathogen causing illness, and results were pending. CD staff notified the SCCHD Environmental Health section.
On Tuesday, September 2, SCCHD was notified that E. coli O157:H7 had been isolated from at least one of the four people’s stool specimens. The four had shared only two meals: one at a wedding reception and one at Habaneros Mexican Restaurant located in the St. Clair Square Mall. As no one else who had attended the wedding was reporting symptoms, they suspected the food at Habaneros was the source of their illness.
At the same time, the SCCHD began receiving other reports of diarrheal illness in patients seen by local physicians. Preliminary interviews of ill persons revealed that all had eaten at Habaneros prior to the onset of diarrhea.
SCCHD conducted a foodborne outbreak investigation and found that of 64 persons, including seven employees, who had eaten at Habaneros between August 15, 2003 and September 5, 2003, thirty (47%) reported having diarrheal symptoms; ten sought medical care. An extensive food consumption history was obtained from each person interviewed, but no specific food-item was statistically associated with illness.
Five individuals were laboratory-confirmed with E. coli O157:H7. All five ate at Habaneros on either August 23 or August 24. Pulsed field gel electrophoresis (PFGE) analysis of the five isolates obtained from culture-confirmed patients revealed that all five had an indistinguishable PFGE pattern, indicating that they were infected with the same strain of E. coli O157:H7.
On September 2, upon hearing that there was a laboratory-confirmed case of E. coli O157:H7 with a possible connection to Habaneros restaurant, the SCCHD EH staff conducted an on-site environmental investigation. A second on-site inspection occurred on September 4. EH staff noted improper cooling procedures for cooked ground beef on both occasions. On September 5, the restaurant agreed to voluntarily cease operations while the E. coli outbreak investigation was underway.
On September 18, IDPH received a report that E. coli O157:H7 had been cultured from a sample of pico de gallo obtained from Habaneros. In a final report, the public health agencies investigating the outbreak noted that pico de gallo could not be confirmed as the source of the outbreak, but that the outbreak had originated at Habaneros.
Herb Depot & Autumn Olives Farm Raw Milk E. coli Outbreak In early May of 2008, the Lawrence County, Missouri, Health Department (LCHD) learned that a child had been hospitalized with hemolytic uremic syndrome (HUS) secondary to E. coli O157:H7 infection. The health care provider who reported the child’s illness reported that the child had consumed raw goat’s milk purchased at the Herb Depot in Barry County, Missouri.
Shortly thereafter, LCHD learned that another Barry County child had tested positive for E. coli O157:H7 infection and that the child had also consumed raw goat’s milk from Herb Depot.
LCHD conducted epidemiological and environmental investigations, and determined that the raw milk consumed by both children suffering from E. coli infections had been produced at Autumn Olives Farm. In addition, LCHD announced that two additional cases had been connected to the outbreak. Each of the cases were from different counties in Southwest Missouri, and shared a common exposure to Autumn Olives Farm.
All cases that cultured positive for E. coli O157:H7 during the outbreak shared a common, indistinguishable strain of E. coli O157:H7 that had never before been reported in Missouri. LCHD reported that “no other plausible sources of exposure common to all four cases were identified [other than the milk.]” LCHD ultimately concluded that “the epidemiological findings strongly suggest the unpasteurized goat’s milk from Farm A [Autumn Olives] was the likely source of infection for each of the cases associated with this outbreak.”
Kid’s Korner Daycare E. coli Outbreak 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.