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10/27/2003 Public Health Update: E. Coli Outbreak in a Portola Valley Retirement Community

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October 27, 2003 As of 4 p.m. today, two residents reporting gastrointestinal symptoms have been added to the list of potential cases. An 85-year-old resident of the Sequoias died on Sunday, October 26, after developing Hemolytic-Uremic Syndrome (HUS) and Thrombotic Thrombocytopenic Purpura (TTP). HUS and TTP are rare consequences of E. coli 0157 infection, and can, especially in the very young and very old, be life-threatening. The patient had been hospitalized since October 14. Two residents remain hospitalized. The health department epidemiologists are working with the state lab to further analyze the data. More results will be available later this week. Ground beef and sprouts have been ruled out as possible sources. Soil from the communal garden, which was fertilized with manure, was tested for E. coli 0157 and is negative. After completing detailed interviews with over 70 residents and staff at the Sequoias, the health department has determined that the initial group of symptomatic residents came in contact with E. coli bacteria the first week in October. The E. coli outbreak began on October 9, the date when many of the individuals with confirmed cases of E. coli first became ill. (The incubation period for E. coli is two to eight days.) E. coli 0157 Symptomatic Individuals 13 Confirmed residents 4 Probable residents 15 Potential residents 0 Confirmed employees 13 Potential employees 45 Total residents and employees being monitored by County Health Department Individuals who are confirmed cases are those with laboratory confirmation of E. coli in the stool, regardless of symptoms. Probable cases refer to individuals who experienced more severe symptoms, but whose lab tests were negative. Potential cases refer to any individual that had two episodes of diarrhea in a 24-hour period, regardless of  laboratory confirmation. A negative stool culture for E. coli indicates that, at the time the specimen was collected, no E. coli was present in the person's system. This, however, does not mean that the individual's symptoms were not a result of the E. coli bacteria. All residents and employees that were previously listed as negative or pending are now being classified as potential, even though they have cultured negative for E. coli. Symptoms of E. coli 0157 include watery or bloody diarrhea, fever, abdominal cramps, nausea, and vomiting. Illness may be asymptomatic, mild or severe. Young children and the elderly are more likely to have severe symptoms, including kidney failure, and, in rare instances, may die. While most people get E. coli 0157 from contaminated food (such as undercooked ground beef), it also can be passed in the manure (feces) of young calves and other cattle. Animals do not have to be ill to transmit E. coli 0157 to humans. Consumers can prevent E. coli 0157 infection by thoroughly cooking ground beef, by rinsing vegetables thoroughly, by avoiding unpasteurized dairy products and by washing hands before, during and after food preparation. Scrupulous hand washing with soap and water remains our most powerful defense in preventing the transmission of disease. For more information about E. coli, visit this Centers for Disease Control Web site: http://www.cdc.gov/healthypets/diseases/ecoli.htm