Abstract
ObjectiveAn enterohaemorrhagic Escherichia coli (EHEC) outbreak at an institute with multiple facilities for children and adults with intellectual disabilities was investigated to characterize the cases and identify risk factors for infection.MethodsA case was defined as a resident, a staff member or a visitor at the institute from 16 May through 30 June 2005 testing positive for type 2 Vero toxin-producing EHEC O157:H7 (confirmed case) or exhibiting bloody diarrhoea for two or more days (probable case). We collected and analysed demographic, clinical, laboratory and individual behaviour data to identify possible risk factors for infection and infection routes.ResultsWe recorded 58 confirmed cases, of which 13 were symptomatic. One probable case was also found. The median age of the patients was 37 years (range: 6–59 years). Thirty-six patients (61%) were male. Thirteen patients (93%) had diarrhoea and six (43%) had abdominal pain. Two developed haemolytic-uraemic syndrome but recovered. All the patients were treated with antibiotics and tested negative after treatment. Some residents had problems with personal hygiene. The residents of one of the facilities who cleaned a particular restroom had 18.0 times higher odds of being infected with EHEC (95% confidence interval: 4.0–102.4) than those who did not.DiscussionThe source of the outbreak could not be identified; however, the infection may have spread through environmental sources contaminated with EHEC. We recommend that institutional settings, particularly those that accommodate people with intellectual disabilities, clean restrooms as often as possible to reduce possible infection from contact with infected surfaces.
Highlights
On 6 June 2005, a physician informed a local health office of Oita Prefecture in western Japan of two Escherichia coli (EHEC) cases at an institute for adults and children with intellectual disabilities
A case was defined as a resident, a staff member or a participant in the activities at the institute for at least one day from 16 May through 30 June 2005 who had a stool specimen that tested positive for Vero toxin type 2 (VT2)producing EHEC O157:H7 or exhibited bloody diarrhoea for two days or more, considering the long incubation period (1 to 9 days) of EHEC
We randomly selected half of the strains isolated from the confirmed cases which were further analysed with pulsed-field gel electrophoresis (PFGE).[11]
Summary
An enterohaemorrhagic Escherichia coli (EHEC) outbreak at an institute with multiple facilities for children and adults with intellectual disabilities was investigated to characterize the cases and identify risk factors for infection. Enterohaemorrhagic Escherichia coli (EHEC) was first reported in 1983 in the United States of America.[1] Infection can cause diarrhoea, haemorrhagic colitis and haemolytic-uraemic syndrome (HUS).[2] Outbreaks involving EHEC can be spread through infected food,[2] water,[3] direct contact with infected humans[4] or animals[5,6] or exposure to infected environments.[7] In Japan, EHEC is a reportable communicable disease; the largest outbreak to date was associated with consumption of white radish sprouts affecting about 8400 schoolchildren in 1997.8. The objectives of the study were to characterize the epidemiology of the cases and identify possible risk factors for EHEC infection in this outbreak
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