Escherichia Coli O157:H7 and Hemolytic uremic syndrome (HUS) Escherichia coli (E. coli) O157:H7 can cause an infection of the intestines. These bacteria are found in the digestive tract of some beef and dairy cattle, where they can get into milk, or into meat during the slaughtering process. In humans, the bacteria produce a toxin, which can cause diarrhea. In rare cases, people can also develop HUS, which is a serious complication of E. coli O157:H7 infection. HUS is more common in children than adults. CAUSES: E. coli O157:H7 bacteria SYMPTOMS: People infected with E. coli O157:H7 can have no symptoms at all, or they can be ill with watery or severe bloody diarrhea, abdominal cramps and low-grade fever In some cases, people infected with these bacteria can develop HUS, a serious disease that affects the kidneys and blood clotting system. People with HUS usually need to be hospitalized; dialysis (artificial kidney) and transfusions are often needed SPREAD: By eating meat (especially ground beef) that is not thoroughly cooked, or by drinking unpasteurized milk or fruit juices. These bacteria can also easily spread from person to person, especially from children in diapers. E. coli O157:H7 leaves the body through the stool of an infected person and enters another person when hands, food, or objects (such as toys) contaminated with stool, are placed in the mouth. Spread can occur when a person does not wash his/her hands after using the toilet or changing diapers. Cases have occurred after visits to sites with animals (petting zoos, pet stores, farms) INCUBATION: It takes from two to eight days, usually about three to four days, from the time a person is exposed until symptoms develop CONTAGIOUS PERIOD: The bacteria can be found in the stool for about one week, possibly as long as two to eight weeks, after the start of symptoms EXCLUSION: Until two consecutive stool cultures, 24 hours apart and at least 48 hours after treatment is completed, are negative and child is asymptomatic Page 45 -----or----Until symptoms are resolved and two consecutive stool cultures, obtained at least one day apart, have tested negative for E. coli 0157:H7 if no treatment given REPORTABLE Provider: This disease is reportable to the local or state health department Parents/guardians: Inform your childcare provider if your child has this illness PREVENTION/CONTROL: 1. Thoroughly cook all hamburger or ground beef until it is brown, not pink, inside. Internal temperature of 160 degrees kills bacteria. Do not drink unpasteurized milk or fruit juice. 2. Wash hands thoroughly with soap and running water after using the toilet, changing diapers, and before preparing or eating food. Thorough handwashing is the best way to prevent spread of infectious diseases found in the intestinal tract. 3. Clean and disinfect contaminated areas (diapering area, toilets, potty chairs) and toys at least daily and when soiled. DISINFECTING SOLUTION: • To disinfect clean, non-food surfaces: Use a solution of household bleach and water -- ¼ cup bleach in a gallon of water. (to make smaller amount in a spray bottle, use 1-½ teaspoons bleach in a pint of water.) Saturate area with solution. Do not rinse. Air dry. • To disinfect mouthed toys or eating utensils: Boil, use a commercial dishwasher, or soak clean items for 2 minutes in a weak bleach solution -- 1 tablespoon bleach added to one gallon of water (or a teaspoon in a quart). Do not rinse. Air dry. This solution can also be used to disinfect clean kitchen surfaces. • Prepare solution fresh daily because it loses its ability to kill germs with time. Page 46 DIAGNOSIS/TREATMENT: Discuss this letter with your physician if you or your child has symptoms of E. coli O157:H7, HUS, or tests positive for shigatoxin. There is a lab test to look for E. coli O157:H7 in the stool. HUS cannot be diagnosed with a single laboratory test. Doctors use the results of tests for kidney function, blood clotting factors, and blood counts to decide if a person has HUS. As with all types of diarrhea, it is important to drink plenty of fluids to help prevent dehydration. For more information, please call Epidemiology Services at the Northern Kentucky Health Department at 859.363.2070. Revised August 2003 Revised June 2005 Page 47 If you are visiting an animal exhibit: Hand-washing stations • Find out where hand-washing stations are located • Always wash your hands after petting animals or touching the animal enclosure, especially before eating and drinking. • Running water and soap are best. Use hand gels if running water and soap are not available. Food and drinks • Keep food and drinks out of animal areas. • Do not share your food with animals. • Do not eat or drink raw (unpasteurized) dairy products. Children • Children younger than 5 years old need supervision. • Never allow children to put their hands or objects (For example: pacifiers) in their mouth while interacting with animals. • Hand washing should be supervised. Copied from: CDC(2004). Stay Healthy at Animal Exhibits this Summer. Healthy Pets Healthy People. Retrieved June 7, 2005 from: http://www.cdc.gov/healthypets/spotlightanexhbts.htm Page 48