Abstract
The objective of this study was to determine sources of Shiga toxin-producing Escherichia coli O157 (STEC O157) infection among visitors to Farm X and develop public health recommendations. A case-control study was conducted. Case-patients were defined as the first ill child (aged <18 years) in the household with laboratory-confirmed STEC O157, or physician-diagnosed hemolytic uremic syndrome with laboratory confirmation by serology, who visited Farm X in the 10 days prior to illness. Controls were selected from Farm X visitors aged <18 years, without symptoms during the same time period as case-patients. Environment and animal fecal samples collected from Farm X were cultured; isolates from Farm X were compared with patient isolates using whole genome sequencing (WGS). Case-patients were more likely than controls to have sat on hay bales at the doe barn (adjusted odds ratio: 4.55; 95% confidence interval: 1.41–16.13). No handwashing stations were available; limited hand sanitizer was provided. Overall, 37% (29 of 78) of animal and environmental samples collected were positive for STEC; of these, 62% (18 of 29) yielded STEC O157 highly related by WGS to patient isolates. STEC O157 environmental contamination and fecal shedding by goats at Farm X was extensive. Farms should provide handwashing stations with soap, running water, and disposable towels. Access to animal areas, including animal pens and enclosures, should be limited for young children who are at risk for severe outcomes from STEC O157 infection. National recommendations should be adopted to reduce disease transmission.
Highlights
Escherichia coli O157:H7 causes an estimated 95,000 illnesses and 30 deaths annually in the United States [1, 2]
The asymptomatic patient, who did not visit the farm, was detected because household contacts of a Shiga-toxin producing Escherichia coli (STEC) patient are recommended to be tested before returning to daycare in Connecticut
It was recommended that Farm X restrict access to areas more likely to be contaminated with manure or birthing by-products, and not allow food, beverages, or strollers to enter any of the animal areas. This investigation provided epidemiologic and laboratory evidence for an outbreak of STEC O157 infections resulting from exposure to goats and an animal environment that demonstrated widespread contamination caused by animals actively shedding E. coli
Summary
Escherichia coli O157:H7 causes an estimated 95,000 illnesses and 30 deaths annually in the United States [1, 2]. Zoonotic transmission of Shiga-toxin producing Escherichia coli (STEC) causes an estimated 5,960 annual US infections [3]. Some people with STEC infections, young children, can develop hemolytic uremic syndrome (HUS), a severe complication that can lead to extended hospitalizations, kidney failure, thrombocytopenia, and death [5, 6]. Non-specific supportive therapy, including hydration, is important in treating STEC infections [5]. Antibiotics are not recommended to treat infections, since there is no evidence that treatment with antibiotics is helpful and taking antibiotics might increase the risk of HUS [6, 7]. Antidiarrheal agents might increase that risk [8]
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