6 children sick: E. coli cases confirmed in Missouri

The Columbia/Boone County Department of Public Health and Human Services has confirmed four cases of Shiga toxin-producing E. coli O157:H7 , and two probable cases in Boone County preschool and school-aged children.

sorenne-hi-mommyPublic Health officials are reviewing laboratory analyses and conducting case interviews to determine the possible cause(s) of the outbreak. Currently, the source of the infection has not yet been determined.  

E. coli strikes in Missouri

Every time I go to Buffalo I want to barf.

Buffalo, Missouri, that is, and it’s next door to where Amy’s father lives and the roads are, um, adventurous.

5yrold-jpgThe Dallas County Health Department is investigating an E. coli outbreak, and the family of the affected children say they want to spread the word about the bacteria’s harmful effects.

“It was heartbreaking, I didn’t think my son to come through it,” says Sierra Sanford.

Sanford says her one-year-old son got sick from E. coli in early September. She says the bacteria led to hemolytic uremic syndrome, or HUS, which is a condition that caused his kidneys to fail. She says he was taken to a hospital in Springfield and then airlifted to a hospital in Saint Louis.

Angela Sanford, the child’s grandmother, says, “When we first saw him, it was horrible, my daughter had to literally set him up, lay him down, he couldn’t move.”

Angela Sanford says her five-year-old granddaughter got sick roughly a week after her grandson was sent to the hospital. She says E. coli made her sick, she contracted HUS, and her kidneys failed as well. The young girl is still in a Saint Louis hospital and Sanford says she has a long road to recovery, but she’s stable. Angela Sanford says her mother, the children’s great grandmother, also got sick from E. coli.

“I think the word needs to be out, people need to take precaution,” she says.

We went to the Dallas County Health Department and spoke with Administrator Cheryl Eversole.

She says, “We believe that this is a closed case, meaning this is a contained incident. We do not believe that this is anything that is going to affect a majority of the public. We feel that this may be just a localized incident within a family unit.”

Gettin’ shiggy wit it: There’s a lot of Shigella being shared at child care centers in Missouri

Unfortunately no one in the public knows exactly where though.

According to the Columbia Tribune reported cases of shigellosis is more than 4 times the expected rate in the Columbia area, and most illnesses are linked to child care settings.

The Columbia/Boone County Department of Public Health and Human Services reports 25 cases of shigellosis, also called shigella, occurring in the past two weeks. Spokeswoman Andrea Waner said the department has averaged six cases a year for the past five years.dirty-hands-medium-new

Waner said most of the cases involve children attending day care. The Missouri Code of State Regulations prohibits her from identifying the locations, she said.

Michelle Baumstark, spokeswoman for Columbia Public Schools, said the district had only one case, several weeks ago. The student was the sibling of a child who was in day care at a location where shigella was reported.

She said because school-age children are toilet trained there isn’t a big concern about the illness spreading in the schools.

A couple of years ago I collaborated with Clemson’s Angie Fraser on a set of USDA NIFA funded food safety and infection factsheets for childcare facilities including using exclusion of ill staff and children as an outbreak control measure. The sheets can be downloaded here and hereAngie just published a bunch of the observation work that led to the the factsheets in the American Journal of Infection Control (abstract below). The work provides some insight on how pathogens might move around a center.

An observational study of frequency of provider hand contacts in child care facilities in North Carolina and South Carolina

jan.15

American Journal of Infection Control 43 (2015) 107-11

Angela Fraser, Kelly Wohlgenant, Sheryl Cates, Xi Chen, Lee-Ann Jaykus, You Li, Benjamin Chapman

Background: Children enrolled in child care are 2.3-3.5 times more likely to experience acute gastrointestinal illness than children cared for in their own homes. The purpose of this study was to determine the frequency surfaces were touched by child care providers to identify surfaces that should be cleaned and sanitized.

Methods: Observation data from a convenience sample of 37 child care facilities in North Carolina and South Carolina were analyzed. Trained data collectors used iPods (Apple, Cupertino, CA) to record hand touch events of 1 child care provider for 45 minutes in up to 2 classrooms in each facility.

Results: Across the 37 facilities, 10,134 hand contacts were observed in 51 classrooms. Most (4,536) were contacts with porous surfaces, with an average of 88.9 events per classroom observation. The most frequently touched porous surface was children’s clothing. The most frequently touched nonporous surface was food contact surfaces (18.6 contacts/observation). Surfaces commonly identified as high- touch surfaces (ie, light switches, handrails, doorknobs) were touched the least.

Conclusion: General cleaning and sanitizing guidelines should include detailed procedures for cleaning and sanitizing high-touch surfaces (ie, clothes, furniture, soft toys). Guidelines are available for nonporous surfaces but not for porous surfaces (eg, clothing, carpeting). Additional research is needed to inform the development of evidence-based practices to effectively treat porous surfaces.

Of course it came from Missouri; trichinellosis caused by consumption of wild boar meat — Illinois, 2013

It sounds like something Amy would have eaten when she was a kid. Maybe that’s why she’s still attracted to me – there’s a parasitic worm affecting her cognitive abilities.

The U.S. Centers for Disease Control reports that on March 6, 2013, the Cook County Department of Public Health (Chicago, Illinois) contacted the Illinois Department of Public Health regarding a diagnosis of trichinellosis in a patient who had consumed wild boar and deer meat obtained by hunting at a Missouri ranch January 16–18. Trichinellosis is a parasitic infection caused by consumption of undercooked infected meat, most commonly from carnivorous or omnivorous animals (1).

he_WildBoarThe Cook County and Illinois health departments and the Missouri Department of Health and Senior Services queried the Illinois and Missouri electronic reportable disease registries and interviewed patients to identify additional cases and describe patients’ clinical characteristics. CDC performed immunoglobulin G enzyme-linked immunosorbent assay testing of patient serum and microscopically examined the meat for evidence of Trichinella larvae.

Patient interviews revealed that the index patient had ground the wild boar and deer meat into sausage and served it to three family members who had participated in the hunt. The sausage was shared with a friend and the friend’s four family members, none of whom had participated in the hunt. A case was defined as illness in a person who consumed the implicated meat and had positive serology or myalgias. Nine cases were identified. All nine persons had consumed the implicated sausage during January 20–February 16 and experienced illness compatible with trichinellosis during February 13–March 4; three of six tested had a positive serologic test for antibodies specific to Trichinella within 7 days of symptom onset. No one else consumed the sausage, and no additional cases were identified from electronic disease registries.

Among the nine cases, five occurred among men (median age = 35 years; range = 20–54 years), and the median incubation period was 16 days (range = 4–24 days). All patients reported myalgias, eight had periorbital edema, and seven had both fever and eosinophilia. Trichinella spiralis larvae were identified microscopically in the sausage but not in the deer meat, indicating that the boar meat was the likely source. All patients were treated solely with albendazole and recovered without complications.

Trichinellosis cases remain infrequent in the United States because of state and federal laws preventing feeding of uncooked swill to commercial swine and public awareness of the danger of eating raw or undercooked game meat. The Missouri Department of Health and Senior Services provided additional education to employees of the ranch about the risk for Trichinella ingestion and the need to inform hunting patrons. The Illinois Department of Public Health recommends posting advisories at hunting ranches that inform hunters of the importance of cooking game meat to the cooking temperature of 71°C (160°F) recommended by the U.S. Department of Agriculture and CDC before consuming it (2).

Stress relief? Couldn’t uni kids just have sex? Who decided a bear cub that bit students should be part of a university petting zoo?

Oh Missouri, how I do not miss you, and your petting zoos that feature a bear cub.

Former student and future veterinarian Gonzalo said next it will be petting zoos with skunks, raccoons and bats, because they are all cute.

bear.cub(There’s been a dead flying fox, or bat, decomposing on the road where daughter Sorenne and I walk every day and it has provided many a moment for us to discuss zoonoses.)

The Missouri take on this story is that a bear cub that nipped students at Washington University was not rabid and will not be euthanized, officials of the St. Louis school said Friday.

The 18 students who sustained skin-breaking bites have been notified they will not need rabies vaccinations.

The petting zoo had been allowed on campus as a stress reliever for students during finals week. Besides the small bear, named Boo Boo, it included a variety of animals, such as goats and a baby pig.

Several students held and cuddled the bear. It nipped at some of them, university spokeswoman Susan Killenberg McGinn said Friday.

The bear was born in the wild and was part of a petting zoo operated by Cindy’s Zoo in Moscow Mills, Missouri. A message left Friday with owner Cindy Farmer was not returned.

Mysterious illness sickens coroner’s conference attendees in Missouri

How gruesome is this:  dozens attending a coroner’s conference at the Truman Hotel & Conference Center became ill after dinner Wednesday night.

Capital Region Medical Center confirmed seeing a few people that night and Thursday in the emergency department. One person was hospitalized, six-feet-under-everything1but a hospital spokesperson said the patient had a pre-existing condition that was aggravated by the sudden illness.

The wife of Randolph County coroner Gerald Lundsford told connect midmissouri that, as of Thursday evening, her husband was still feeling awful.

No word on exactly how many people were affected. The source of the illness is also unknown at this time.

Missouri boy’s death linked to E. coli

The Columbia Daily Tribune is reporting a 2-year-old Howard County boy died yesterday as a result of E. coli poisoning.

The Boone County Medical Examiner’s Office confirmed this morning the victim was Coy Boley of the New Franklin area, and it also confirmed the boy’s death was linked to E. coli. An autopsy had not yet been conducted.

The boy died around 7 a.m. yesterday at Women’s and Children’s Hospital in Columbia.

The New Franklin Police Department said the boy’s home was not within city limits, and the Howard County Sheriff’s Department could not be reached for comment to confirm whether it is conducting a death investigation.

66 sick with Salmonella in another chick outbreak

Media doesn’t tell people what to think; but it does tell people what to think about.

And that includes doctors, epidemiologists and other mere mortals.

So the numerous previous chick-related Salmonella outbreaks mean people of all professions may be more attuned to the chick link.

The outbreak is the fourth linked to mail-order chicks and ducklings since 2011.

The U.S. Centers for Disease Control reports at least 66 persons have been infected with the outbreak strain of Salmonella Montevideo in 20 states; 16 ill persons have been hospitalized. One death was reported in Missouri, but Salmonella infection was not considered a contributing factor in this person’s death.

35% of ill persons are children 10 years of age or younger.

Epidemiologic, laboratory, and traceback findings have linked this outbreak of human Salmonella infections to contact with chicks, ducklings, and other live baby poultry from Estes Hatchery in Springfield, Missouri.

CDC, why didn’t you say Hatchery A, or Hatchery A in Missouri? What are the guidelines on publicly fingering sources of food- or chick-related illness?

9 sick in Missouri, 2 kids in hospital, but raw milk faithful rally to the cause

Food to many is an evangelical calling.

Some find faith in monotheism, some in nature, some in the sports shrine (I prefer ice hockey, especially now that the playoffs have started and the cathedral once known as Maple-Leaf-Gardens-whatever-the-corporate-home-of-Toronto’s-disgrace-is-now is out of the theological debate), and some in the kitchen.

For some faiths, like creationism, biology don’t matter much.

So the headline in today’s St. Louis Post-Dispatch, harking to centuries of food hucksterism, is not surprising: “Illnesses don’t dissuade raw milk fans.”

“Raw milk enthusiasts say an E. coli outbreak in Missouri won’t change their preference for unpasteurized dairy products.

“At least nine people in five counties in central and western Missouri have been sickened by E. coli since late March. Health officials have pointed to raw milk as a possible cause in at least four of the cases, including a 2-year-old from Columbia who remains hospitalized with severe complications.

“MooGrass Farms near Collinsville sells about 200 gallons of raw cow, goat and sheep milk each week, mostly to families from the St. Louis area, said the farm’s manager, Kevin Kosiek.

“His customers appreciate the taste of whole raw milk as well as the lack of heat processing that kills some of the nutrients.

"This is not a fad," Kosiek said. "People are going back to where people used to get their food, and that’s farmers doing natural, organic things."

“Kosiek and several other raw milk distributors said they doubt the E. coli outbreak will be ultimately linked to unpasteurized dairy products.”

Faith and biology don’t have to conflict. Facts are important, but never enough. It’s a religious thing.

A table of raw milk related outbreaks is available at: http://bites.ksu.edu/rawmilk.

7 now sick from E. coli linked to raw milk in Missouri

Two more cases of E. coli in central Missouri were confirmed Tuesday, bringing the total to seven people in the area who have recently been sickened by the same bacterial strain, state health officials said.

The patients include a 2-year-old from Boone County who is hospitalized with complications from the infection; a 17-month-old has also developed life-threatening complications affecting the kidneys. The other patients are all adults, health officials said.