Two Children With E.coli Possibly Exposed at Puyallup Fair.

OLYMPIA, Wash.--(BUSINESS WIRE)--Sept. 22, 1998--The state Department of Health announced today that two children infected with E.coli O157:H7 bacteria may have been exposed at the Western Washington Fair in Puyallup.

Both children attended the fair on Sept. 13 and became sick approximately four days later.

"Although we haven't found a definite source yet, our investigation indicates that the fair is the most likely source of exposure for these two children," said John Kobayashi, communicable disease epidemiologist at the state Department of Health. "We are continuing to work with fair officials to identify the exact source of the infection and prevent further illnesses from occurring."

One child, age nine, is a Federal Way resident who is being treated at Mary Bridge Hospital in Tacoma. The other, a 20-month-old Yelm child, is being treated at St. Peter Hospital in Olympia. Both are responding well to treatment.

"This is a difficult process because there are so many possible sources of exposure," Kobayashi said. "We are specifically looking at food-borne exposure, as well as possible contamination at the animal petting areas and on water rides."

State and local health officials have inspected all of the fair's hamburger facilities, and samples are being tested at the state public health laboratories in Seattle. Samples also have been taken from animals at the petting zoo and from water rides. Results of lab tests will be available next week.

Kobayashi said that health officials have checked with medical labs and hospital emergency rooms but found no other cases of E.coli O157:H7. "Today we notified physicians that this is going on and asked them to be on the lookout for E.coli-like symptoms," he said.

E. coli O157:H7 can cause severe diarrhea and abdominal cramps. More severe complications are most likely to occur in children up to age nine and in elderly people. If individuals have severe diarrhea they should see their health care provider immediately, Kobayashi said.

"The local health departments notified us of these cases very quickly, so we were able to begin an investigation and put disease control measures in place right away," Kobayashi said. "As a result, the fair is one of the most highly-inspected facilities around right now."

Washington was the first state in the nation to begin in 1987 requiring physicians to report E. coli O157:H7 to state health officials. Since that time, other states have developed similar surveillance and testing systems for E.coli outbreaks. Note to Editors: A fact sheet on E.coli is attached. WASHINGTON STATE DEPARTMENT OF HEALTH Public health fact sheet E.coli O157:H7

What is E. coli?

E. coli are bacteria that normally live in the intestines of humans and animals. Although, most strains of this bacteria are harmless, several are known to produce toxins that can cause diarrhea. One particular E. coli strain called O157:H7 can cause severe diarrhea and kidney damage.

Who gets E. coli O157:H7 infection?

Anyone of any age can become infected with E. coli O157:H7, but the very young and the elderly are more likely to develop serious complications.

How is it spread?

The bacteria can be acquired by eating food containing the bacteria. The bacteria live in the intestines of some healthy cattle and contamination of the meat may occur in the slaughtering process. Deer meat (venison) may also be infected with the organism. Eating meat that is rare or inadequately cooked is the most common way of getting the infection. Fresh vegetables, unpasteurized fruit juices and raw milk have also caused outbreaks. Any food product eaten raw can be contaminated by raw meat juices. Person-to-person transmission, especially in child care settings, can occur if infected people do not wash their hands after using the toilet or diapering children. Contaminated drinking water and swimming in contaminated shallow lakes may also cause infection.

What are the symptoms?

Some infected people have mild diarrhea or no symptoms at all. Most identified cases develop severe diarrhea and abdominal cramps. Blood is often seen in the stool. Usually little or no fever is present. Symptoms generally appear 3-4 days after exposure, but can take as long as 9 days to appear. Persons experiencing these symptoms should contact their physician.

How is E. coli O157:H7 infection diagnosed?

Infection with E. coli O157:H7 can only be diagnosed by a special stool culture that is not performed in all laboratories. Public health authorities advise doctors and laboratories to consider performing a special stool culture test for E. coli O157:H7, particularly in people with bloody or severe diarrhea.

What is the treatment?

Symptoms generally go away without antibiotics or other specific treatment in five to 10 days.

Studies have not yet been conducted to determine if antibiotics are useful or harmful in the treatment of E. coli O157:H7 infection. It is recommended that antibiotics and diarrhea medicines not be given.

What serious complications can result from E. coli O157:H7 infection?

In some people, particularly children under five years of age, the infection can cause a complication called hemolytic uremic syndrome (HUS). This is a serious disease in which red blood cells are destroyed and the kidneys fail. Transfusions of blood or blood clotting factors, as well as kidney dialysis, may be necessary. A prolonged hospital stay is often required. Fortunately, most people with HUS recover completely, but it can be fatal.

What can I do to prevent infection?

Do not eat undercooked hamburger or other ground beef products. Cook roasts to at least 130 degrees F and other ground beef to 155 degrees F. Venison should be cooked to 165 degrees F. Make sure cooked ground beef is brown throughout (not pink) and the juices run clear. Drink only pasteurized milk, milk products and fruit juices. Carefully wash all produce, kitchen utensils and countertops. Wash hands carefully with soap after using the toilet or changing a child's diaper to reduce the risk of spreading disease. Wash hands with hot, soapy water, rubbing hands together for 20 seconds.

Outbreaks

The largest Washington state E. coli O1757:H7 outbreak was in 1993, when 477 people were infected from contaminated, undercooked hamburger. In 1994, 11 people were infected from contaminated ground beef and also in 1994, 15 people were infected from contaminated salami. Additional outbreaks have occurred in the United States from non-beef sources including lettuce and salad bars where foods were contaminated by improperly cleaned utensils, working surfaces and infected food handlers. In addition, outbreaks have occurred in people who have consumed garden vegetables fertilized with animal manure and unpasteurized apple cider.

Cases

Most E. coli O157:H7 infections are single cases and not associated with outbreaks. The numbers of reported cases in Washington of E. coli O157:H7 peaked in 1993, and have mostly been dropping since then. Case counts for 1991-1996 are listed below: 1991 -- 164 cases 1992 -- 300 cases 1993 -- 741 cases 1994 -- 174 cases 1995 -- 140 cases 1996 -- 187 cases

How can I get more information?

Contact the food protection program at 360/753-2555 or communicable disease epidemiology at 206/361-2914.