Advisory from the Montana Health Alert Network

Subject: Multi-state outbreak of E. coli O157:H7 (STEC O157), including Montana.

Background: There has been an increase in reports of STEC O157 cases in Montana, with onset dates between 3/28 and 4/7. These cases are linked to a multi-state outbreak of STEC O157 sickening at least 29 individuals in 11 states.

This total includes three confirmed STEC O157 cases (2 in Missoula, 1 in Ravalli) with patterns matching the national outbreak strain. An additional five PCR positive cases are pending culture confirmation with the state laboratory (3 in Flathead, 1 in Lincoln, and 1 in Gallatin). Further analysis will be needed to determine if they part of the outbreak. Please see the information below for recommendations.

Information for Clinicians

Clinicians are encouraged to consider E. coli infection in clinically compatible patients and order appropriate laboratory testing. Laboratories are reminded to submit specimens, as required by state rules, for surveillance purposes to the Montana Public Health Laboratory. Advanced testing will be conducted at no expense to the provider/patient that will enable us to compare the isolate to others at the state and national level.

Local public health officials will interview cases or proxies to assess exposures and the potential for additional transmission using a standardized data collection tool. Prompt reporting to local public health officials is essential.

Reporting: Reporting of suspected and confirmed cases of STEC (O157 and others) is required by state reporting rules. Prompt reporting by clinicians is essential to break the disease transmission cycle and identify potential sources.

Local Health Authorities

  • Please interview the patient using the general STEC investigation tool and outbreak specific tools distributed through a separate email. We request that the tools be used on any locally confirmed cases and returned via confidential fax to the CD/Epi program for analysis.
  • Review the information in this HAN with key surveillance partners, particularly laboratories, who may be processing enteric samples.


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