Outbreak of Shiga toxin-producing E. coli O157:H7 infections among King County residents from East African communities

Actions requested

• Be aware of an outbreak of Shiga toxin-producing E. coli (STEC) O157:H7 infections among King County residents, currently all from East African Communities. At least three children have developed hemolytic uremic syndrome (HUS).
  
• Consider STEC infection in people of all ages, particularly from East African Communities, who have bloody diarrhea and in people with any diarrhea and a history of any of the following within the 10 days prior to onset of symptoms:
  • Consumption of high risk foods (e.g., raw or undercooked meats, raw produce, unpasteurized dairy or juice products)
  • Animal contact (particularly farm animals – cows, goats, sheep, etc.)
  • Known exposure to someone else with STEC
  • Social event or gathering
• Obtain a stool specimen in patients with compatible symptoms and request E. coli testing by culture and Shiga toxin.
  • If bloody diarrhea is present, laboratory evaluation should include a complete blood count, blood smear, serum electrolyte panel, BUN, and creatinine. 
  • Shiga toxin immunoassay or PCR should be obtained in addition to culture, but should not replace culture on sorbitol MacConkey agar plate.
• Obtain the following history about risk factors during the exposure period (1-10 days preceding symptom onset):
  • Group events with food or animals
  • Travel with dates and destinations
  • Other known ills
  • Attendance in a childcare center
• Counsel patients with suspected or confirmed STEC to stop working in or attending childcare or preschool, or working in food handling or healthcare until cleared by Public Health.
  
• Encourage patients to respond when Public Health contacts them directly to ask about potential sources of their infection and to provide further guidance as indicated.
  
• Report confirmed & suspected STEC cases to Public Health immediately at (206) 296-4774.