By: James Peacock

The E. coli outbreak that has sickened a dozen people in Hildale, Utah and Colorado City, Arizona has continued to be investigated by health officials. The majority of those sickened in the outbreak have been children, and the outbreak has led to the deaths of two children in Hildale already. In the beginning of the investigation, which was first announced on July 3, the Southwest Utah Public Health Department was looking at a single housing complex as the source of the illnesses. Since then, as the outbreak has doubled in size, the surrounding areas have been included in the outbreak, and there are now officials from 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 working to investigate the outbreak.

The supposed source of the E. coli contamination and outbreak has shifted several times over the course of the investigation. At first, the water supply was suspected. However, after numerous tests, it became clear that there were no E. coli bacteria in the water supply. People sickened in the outbreak in the beginning of the investigation also reported dirty diapers as a potential source of the outbreak. When the outbreak expanded beyond a single housing complex, the dirty diaper theory was laced on the back burner. In back to back updates, the health department issued warnings for both ground beef and raw milk. Since these are both very likely sources for E. coli contaminations, they are almost always looked at in the instance of E. coli outbreaks. Further outbreak investigation updates expanded the warnings, with more recent updates including general advice for avoiding getting an E. coli infection. On an update issued on July 21, the most recent for this outbreak, tips such as avoiding raw milk, avoiding swallowing water while swimming, thoroughly cooking foods, and proper hand washing are all included. Another update, though, came with a statement that ground beef is no longer being considered as the potential source of the outbreak. The original warning from July 11 regarding purchasing ground beef no longer applies, though health officials still caution the thorough cooking of meats. A source has not been confirmed as of the last update, and the case count still rests at 12. The health department has asked people who live in the area to fill out a survey in an effort to help narrow down the source of the outbreak and track other potential cases of illness.

After weeks of mystery, the Utah health authorities confirmed that livestock was the source of an E. coli outbreak. According to the announcement on the Southwest Utah Public Health Department website:

“The investigation of the E. coli outbreak in the Hildale/Colorado City area is drawing to a close. It has been determined that the likely source of the disease was infected animals, followed by person-to-person contact. Several livestock tested positive for the E. coli strain involved in this outbreak. Their owners have been contacted and given guidance to prevent further spread. Tests on water systems, springs, ground beef, produce, and dairy products were negative.There have been no new confirmed cases linked to this outbreak since July 9th, although public health agencies will continue to monitor disease activity in the community. ”

E. coli

E. coli bacteria are one of the most common causes 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. coliO157H7. This strain of E. coliis one of the several varieties that can produce Shiga toxins. E. coli that produce this toxin are commonly referred to as Shiga toxin-producing E. coli (STEC). The CDC estimates that there are around 265,000 cases of E. coli poisoning each year in the United States, though this estimate varies from year to year because in some instance someone with E. coli poisoning may not need to receive medical care. 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, it has caused foodborne illness outbreaks through a wide variety of different food and drink items. E. coli outbreaks have been caused by beef products, raw milk, yogurt, cheeses, unpasteurized fruit juices, bagged lettuce, mayonnaise, alfalfa sprouts, spinach, various water sources, and more. 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. This is the highest the incidence rate 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 typically 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 to the bacteria. Symptoms of an E. coli infection will typically include severe cramping, vomiting, nausea, and watery or bloody diarrhea. There is sometimes a low-grade fever associated with the infection as well. These symptoms, in many cases, will go away on their own after about a week. There is a chance that the infection lasts longer, though. Diarrhea can cause dehydration, a potentially serious complication, so it is important that those suffering from an E. coli infection attempt to stay well hydrated.

E. coli is particularly dangerous for two reasons. First, it seems to target children 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. This is almost triple the overall average incidence rate. This has led health officials to declare that the elderly, along with children and those with suppressed or otherwise compromised immune systems are at an increased risk of developing a serious E. coli infection. The other major issue is that STEC are able to cause a very serious side effect known as hemolytic uremic syndrome (HUS). Hemolytic uremic syndrome occurs in about 3 to 7 percent of E. coli infections. HUS damages red blood cells, which are then sent to the kidneys in order to be filtered out of the bloodstream. Removing these damaged blood cells can damage the kidneys and clog the mechanisms responsible for removing the blood cells. The damage done to the filtration mechanisms, coupled with the increased rate of damage inflicted on the kidneys by Shiga toxins, can lead to serious kidney damage and even kidney failure. HUS can also damage the nervous system and other organs in the body, making it especially dangerous. 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. If you or a loved one begins to show the symptoms of E. coli poisoning, contact a medical professional.

Sources:

http://swuhealth.org/ecoli/

https://wwwn.cdc.gov/foodnetfast/

https://www.cdc.gov/ecoli/

http://swuhealth.org/outbreak-updates-2017/