By: Heather Williams

The small town of Hildale, Utah mourns the loss of 2 children with several other residents still sickened over the past 2 weeks due to E coli infection. The second child passed Friday, June 30, 2017 following the death of an unrelated 3-year-old boy earlier that week.  The second child first became ill June 22, 2017 and was taken to the hospital three times before the illness took her life.  The child’s parents have come forward, claiming that dirty diapers from other residents could be to blame for her illness.

The source of the outbreak is still being investigated by the health department.  The water supply has been tested repeatedly coming back clean each time, said David Heaton, Southwest Utah Public Health Department Public Information Officer.  A news release issued July 3, 2017 says that “the outbreak appears to be confined to a limited area of Hildale and risk to the larger community is not considered to be significant at this time.” Investigators are focusing on animals or tainted food as a possible cause of the outbreak.

Four other cases confirmed by the Southwest Utah Public Health Department are currently being treated from the small area of Hildale. Heaton did provide additional information that the other four cases are a combination of children and adults and appear to be less serious than those of the children who died.  He further noted that some of the victims are still being treated, though none of their conditions have been released at this time.

What is E. coli?

Escherichia coli, also known as E. coli is a diverse group of bacteria.  Several forms of E. coli exist, causing a range of symptoms from mild to serious.  Some simply cause diarrhea, while other may cause urinary tract infections, respiratory illness and pneumonia, and other illnesses.  Some may even cause hemolytic uremic syndrome (HUS) a very serious illness affecting the kidneys. The most common form of E. coli causing illness in the United States is E. coli O157:H7.  This form of E. coli can produce a harmful substance call Shiga toxin.  E. coli that produces Shiga toxin are known as STEC, or Shiga toxin E. coli.

STEC Infections

 While the very young and the very old are most susceptible to serious illness from STEC infections, even healthy adults and older children can become ill.  Symptoms vary from person to person with varying degrees of severity, but often include stomach cramps, vomiting, and diarrhea (bloody).  A mild fever is sometimes present, generally less than 101 ⁰F.  Symptoms usually appear within 3 to 4 days of exposure, often lasting between 5 and 7 days.  If HUS develops, symptoms will begin an average 7 days after initial symptoms (after diarrhea symptoms begin improving).

Hemolytic Uremic Syndrome (HUS)

 Of those diagnosed with STEC infection, 5 to 10% develop a potentially life-threatening complication known as HUS.  While most people recover from E. coli infection or even STEC infections without medical attention. They simply treat the symptoms to make the person feel more comfortable and drinking plenty of fluids to keep from being dehydrated.  Those presenting symptoms of HUS must seek medical attention quickly.  Symptoms include decreased frequency of urination, paleness of the cheeks and lower eyelids, and feeling very tired or loss of energy.  HUS may cause kidney and other organ failure if not treated appropriately.  Those treated for HUS usually recover within a few weeks, but some may suffer some form of permanent damage or in severe or untreated cases, it could be fatal.

How is E. coli Infection Spread?

 In terms of transmission, E. coli is transmitted through fecal-oral route.  Yes, it is as gross as you are probably imagining.  Though most infection is spread by very small amounts of the viral, so you generally cannot see the fecal matter.  It is as simple as touching something that has been contaminated with E. coli and then touching your mouth or food.  Other ways include: exposure to contaminated food such as unpasteurized raw milk, water that has not been properly disinfected, contact with cattle or other animals, or contact with the feces of infected people.  The CDC explains that some foods are at a higher risk for carrying E. coli O157 and particularly those with compromised immune systems should avoid them.  These foods include: unpasteurized raw milk, unpasteurized apple cider, and soft cheeses made from raw milk.

Outbreaks

 Statistically, only 20% of E. coli infections are formally linked as part of a recognized outbreak.  If this is the case, the health department may be able to help identify a source.  Historically, several agencies have been making steps to prevent outbreaks from occurring.  For example, in 1998 the Hazard Analysis and Critical Control Points program (HACCP) began to require meat processing plants to establish critical checkpoints to prevent pathogens from contaminating meat.  In 1999, the USDA approved an irradiation process of meat to use beams of high-speed electrons to kill E. coli and other bacteria that might make it into the meat during the processing of the carcass – with Huisken Meats of Sauk Rapids, Minnesota being the first meat processor to use this this method in May 2000.  In June 2009, a new cow vaccine that reduces E. coli transmission between cows and humans began, licensed by a veterinary pharmaceutical company called Epitopix, LLC.  These prevention mechanisms were put in place in response to outbreaks throughout the years.

Between 1992 and 1993, the Bill Clinton administration prompted random testing for E. coli in ground meat.  The meat packing industry sued the USDA to remove the requirement, but the USDA won.  In 1997, 25 million pounds of meat from Hudson Foods plant in Columbus Nebraska is recalled causing 15 people to become ill.  The company closed after their largest customer, Burger King, stopped purchasing from them.  Many other outbreaks have occurred over the years with sources ranging from green onions, cheese, spinach, and flour.  The most recent outbreak occurred due to a soynut butter that affected 32 people and was reported in 12 different states.

In the case of the children in Utah, the cause is still undetermined, but investigators are narrowing in on the source, citing that both children who have died from the illness were cleaning up trash and debris around their complex.  The children came in contact with dogs who had been around disposed dirty diapers.  Further investigation is underway.

 How to Protect Yourself and Your Family

 Frequent hand-washing and safe cooking practices are the best way to protect yourself and your family.  Wash hands after handling trash or touching animals.  Be sure to wash hands before preparing foods or eating and after using the restroom or changing diapers to avoid spread of the bacteria.  Cook food to appropriate internal temperatures to kill any bacteria that might be contaminating the raw food.

 

Sources:

http://www.cedarcityutah.com/news/archive/2017/07/03/jcw-2-hildale-children-die-following-e-coli-outbreak/#.WV0piulOmUk

http://www.webmd.com/a-to-z-guides/tc/e-coli-infection-topic-overview#1

http://www.cnn.com/2013/06/28/health/e-coli-outbreaks-fast-facts/index.html

https://www.cdc.gov/ecoli/general/index.html

http://www.foxnews.com/health/2017/07/03/girl-who-died-after-contracting-e-coli-was-cleaning-dirty-yard-family-says.html