Tennessee outbreak over; 1 child still in hospital

A Tennessee outbreak of 15 E. coli infections – all among children – has been declared over by the Knox County Health Department (KCHD), which also concluded that the illnesses came from two different sources.

One child remains hospitalized, in fair condition, at East Tennessee Children’s Hospital in Knoxville.

The KCHD announced that two different strains of E. coli O157 sickened the 15 children, nine of whom were hospitalized. In addition, seven of the nine developed hemolytic uremic syndrome (HUS), a severe form of kidney disease that occurs in about 10 percent of infected people, the majority of whom are children.

Although there has been one new case of E. coli infection reported in an adult, who contracted it from one of the ill children, the outbreak appears to be over, KCHD director Dr. Martha Buchanan said.

“While it is rare, it appears we had two sets of children sickened by two different strains of E. coli O157 at the same time,” Buchanan said. “The epidemiological evidence overwhelmingly supported the two-source theory: consumption of raw milk and some type of contact, most likely indirect, with ruminant animals.

“The investigation revealed no definitive connections between the two sources or the two groups of ill children. And this is now supported by the state’s lab results confirming it was two different strains of E. coli O157.”

(ruminant: an even-toed, ungulate mammal that chews the cud regurgitated from its rumen. Ruminants comprise cattle, sheep, antelopes, deer, giraffes, and their relatives.)

A Tennessee outbreak of 15 E. coli infections from two sources – raw milk and goats – has been declared over by the Knox County Health Department.

Tennessee outbreak: raw milk

Ten of the children had one commonality: They consumed raw milk from French Broad Farm in East Knox County. State lab results confirmed the children had the same strain of E. coli O157, and confirmed that the strain is a DNA match to E. coli O157 found in cow manure samples collected from French Broad Farm.

Although the lab did not find E. coli O157 in samples of the French Broad Farm raw milk, Buchanan said that doesn’t mean the milk the children drank was not contaminated. E. coli do not distribute uniformly in milk, meaning a portion of even the same glass of milk can be contaminated while another portion is not. Buchanan said that is why raw milk’s safety cannot be guaranteed, even if a dairy takes precautions, including testing the milk.

“We pasteurize milk for a reason,” Buchanan said. “The heating process is what kills the bacteria that can be in milk — E coli is just one of them. When you think about raw milk practices, the udders and the feces are in close proximity to one another, so it’s easy for contamination to happen. … It’s not the fault of the dairy operator. Raw milk is just inherently unsafe.”

A Tennessee outbreak of 15 E. coli infections from two sources – raw milk and goats – has been declared over by the Knox County Health Department.

Tennessee outbreak: goats

The only common link among the other five ill children was that they all attended Kids Place, Inc., a child-care facility in Mascot where goats are present.

The KCHD’s lab results confirmed the five Kids Place children had the same strain of E. coli O157. Lab results also showed the strain was a DNA match to the E. coli O157 found in the goat fecal samples and one hay sample collected from Kids Place.

The lab did not find E. coli O157 in the other environmental samples from inside the facility. This is not uncommon, and one reason testing environmental samples is merely one part of the investigation process.

Tennessee outbreak: E. coli

E. coli bacteria (Escherichia coli) is one of the most common causes of foodborne illness. E. coli are normally found in the intestines of mammals, and most strains are benign. However, some strains can cause serious illness, primarily by eating contaminated food.

Anyone can become infected by ingesting food contaminated with E. coli. People with the highest risk of developing HUS include young children, the elderly, and people with suppressed immune systems.

E. coli symptoms
Symptoms of an E. coli illness are similar to those of other foodborne pathogens, and include:

• nausea and vomiting
• severe abdominal cramping
• diarrhea, often bloody
• fever and fatigue
• loss of appetite
• decreased urination.

Hemolytic uremic syndrome (HUS)
HUS can be life-threatening, especially for children. The overwhelming majority of HUS cases involve children younger than 5, and the disease is the No. 1 cause of acute kidney failure for that age group.

HUS typically develops after a long bout with E. coli-produced diarrhea. The disease damages red blood cells, which can clog the kidney’s filtering, thus resulting in kidney failure. In severe cases, a kidney transplant might be necessary to avoid death.