Abstract
During a 2009 nationwide outbreak of sorbitolfermenting Escherichia coli O157 in Norway, the Norwegian Institute of Public Health was notified of diarrhoea outbreaks in two nurseries. A link to the nationwide outbreak was suspected and investigated, including retrospective cohort studies. Both nurseries had recently visited farms. Faecal specimens were obtained from symptomatic children as well as from the farm animals and tested for Campylobacter, Salmonella, Yersinia, Shigella and pathogenic E. coli, and isolates were further characterised. Nursery A had 12 symptomatic children, and we found the same strain of C. jejuni in faeces from children and lambs. Nursery B had nine symptomatic children, including one child with bloody diarrhoea carrying enterohaemorrhagic E. coli (EHEC) O26. EHEC O26 with a similar multiple-locus variable number tandem repeat analysis (MLVA)-profile was found in sheep. Five children had enteropathogenic E. coli (EPEC) O76. Animals were not tested for EPEC O76. We found no significant association between illness and risk factors for either nursery. The isolated pathogens differed from the one involved in the nationwide outbreak. In each nursery outbreak, the pathogens isolated from children matched those found in farm animals, implicating animal faeces as the source. Hygiene messages are important to prevent similar outbreaks.
Highlights
There are several reports from around the world of sporadic cases as well as outbreaks of zoonoses, especially among children, after farm visits [1,2]
Enterohaemorrhagic E. coli (EHEC) are known to cause infections that can lead to serious complications such as haemolytic-uraemic syndrome (HUS), especially in children, immuno-compromised persons and the elderly
Our aims were to decide whether they were associated with the concomitant national outbreak of EHEC SF O157, and to identify the source or sources of infection in order to stop the current outbreaks and prevent similar outbreaks in the future
Summary
There are several reports from around the world of sporadic cases as well as outbreaks of zoonoses, especially among children, after farm visits [1,2]. Enterohaemorrhagic E. coli (EHEC) are known to cause infections that can lead to serious complications such as haemolytic-uraemic syndrome (HUS), especially in children, immuno-compromised persons and the elderly. The proportion of patients diagnosed with EHEC who develop HUS is around 10% [14,15], but varies by host factors and type of EHEC. In Europe, more than 50% of patients diagnosed with sorbitol-fermenting (SF) EHEC O157 (SF O157) develop HUS [14,16]. In the spring of 2009 there was a national outbreak of SF EHEC O157 in Norway, affecting 13 children, including nine HUS cases of whom one died [17,18]. This outbreak attracted a lot of media attention, reinforced by the public’s memory of the first large EHEC outbreak in Norway in 2006, that affected 17 children including 10 HUS cases of whom one died [19]
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