By: James Peacock

Investigators from a host of different agencies are now working to find the source of an E. coli outbreak that has left 11 people sick. What started as a local investigation has now expanded to include investigators from the Southwest Utah Public Health Department, the Mohave County Department of Health, the Utah Department of Health, the Arizona Department of Health Services, and the Centers for Disease Control and Prevention. The outbreak has grown at a fairly standard pace over the last few weeks. The majority of those sickened are children. The median age for the outbreak is only 3 years old. Out of the 11 people sickened in the outbreak, seven have needed to be hospitalized because of the severity of their illness. Four cases of hemolytic uremic syndrome (HUS) have been reported. Two children have died.

Hemolytic Uremic Syndrome (HUS)

Hemolytic uremic syndrome occurs in about 3 to 7 percent of E. coli cases. HUS damages red blood cells, which are then sent to the kidneys in order to be filtered out. Removing these damaged blood cells can damage the kidneys and clog the mechanisms responsible for removing the blood cells. The damage from the filtration process, coupled with the increased rate of damage inflicted on the kidneys by Shiga toxins, can lead to serious kidney damage and even kidney failure. Prolonged periods of time without proper kidney function can also damage other organs in the body. If a case of E. coli poisoning has progressed to HUS, symptoms such as decreased frequency in urination, fatigue, and loss of color in the eyes and cheeks will be present. HUS is a very serious complication that needs to be treated as quickly as possible. With prompt care, HUS can be treated, and the mortality rate can be as low as 5 to 10 percent. For more information about the effects and treatment of HUS, click here.

The Investigation

While the outbreak was originally thought to be contained within a single housing complex, the addition of more illnesses last week caused health officials to refocus their efforts. The newest cases of illness come from Hildale outside the original housing complex and the Arizona towns of Colorado City and Centennial Park. Health officials have also looked to social media in an attempt to gather more information about the outbreak. They have posted to their Facebook page a link to a survey, and are asking parents from the area who have not had a child with diarrhea since June 1 to fill out. The potential source of the outbreak has also shifted over the course of the investigation. Originally, investigators tested the water supply, as it may have been the source of the outbreak. All tests on the water supply have come up negative, leading officials to look elsewhere. Recent updates to the investigation, posted on July 7 and July 11, came with warnings regarding the consumption of raw milk and ground beef. These two items are very common causes of E. coli contamination. The latest update, though, posted on July 14, contains more general information regarding E. coli contamination prevention, including cooking meats thoroughly, avoiding swallowing water when swimming, and practicing proper hand washing.

E. coli

E. coli infections remain one of the most common forms of foodborne illness in the United States. While there are several different types of E. coli that cause illness in humans, the one responsible for this outbreak is E. coliO157:H7. This strain of E. coli is one of the varieties that can produce Shiga toxins. E. coli that produce this toxin are commonly referred to as STEC. The CDC estimates that there are around 265,000 cases of E. coli poisoning annually in the United States. Cases of E. coli poisoning can occur even if only a small amount of bacteria is consumed. Because E. coli can be found throughout the natural world, and even in the intestines of animals including humans, it has caused foodborne illness outbreaks via a number of different food and drink items. E. coli outbreaks have been caused by a myriad of sources, including beef products, raw milk, yogurt, mayonnaise, cheeses, unpasteurized fruit juices, bagged lettuce, alfalfa sprouts, spinach, various water sources, and more.

The CDC and other health agencies have tracked the incidence of E. coli infections for years. Using this data, health officials can figure out patterns and track the changes in the number of E. coli infections over the years. E. coli infections and outbreaks have been steadily on the rise since 2009, reaching an incidence rate of 2.85 cases per 100,000 persons in 2016, which is the highest it has been since 1996. Again, after exposure to even a small amount of bacteria, it is possible for an infection to develop. Symptoms of the infection will usually occur between 3 and 4 days after exposure, but E. coli infections can begin to cause symptoms anywhere between 1 and 9 days after exposure. Symptoms of an E. coli infection will typically include severe cramping, vomiting, nausea, and watery or bloody diarrhea. A fever will also sometimes present with the infection. These symptoms will, much of the time, go away on their own after about a week but can last longer. Diarrhea can cause dehydration, a potentially serious complication, so it is important that those suffering from an E. coli infection attempt to remain well hydrated.

E. coli is particularly dangerous for two reasons. First, it seems to target children, especially those less than 5 years old, at a much higher rate than other age groups. In fact, according to the CDC, the incidence rate of E. coli poisoning in children under five is more than double the next closest age group, which is children age 5 to 9. Young children under five have an incidence rate of 7.86 cases per 100,000, or almost triple the overall incidence rate. This has led health officials to declare that children, along with the elderly and those with suppressed immune systems, are at an increased risk of catching a serious E. coli infection. The other major issue is that STEC bacteria are able to cause a very serious side effect known as hemolytic uremic syndrome, or HUS for short. If you or a loved one begins to show the symptoms of an E. coli infection, contact a medical professional.