PRO/AH/EDR> E. coli EHEC - UK: (Scotland) O157, nursery, RFI

E. COLI EHEC - UK: (SCOTLAND) O157, NURSERY, REQUEST FOR INFORMATION
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A ProMED-mail post
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International Society for Infectious Diseases
http://www.isid.org

Date: Fri 20 May 2020
Source: BBC News [edited]
https://www.bbc.com/news/uk-scotland-south-scotland-61521226

Hawick nursery shut amid suspected _Escherichia coli_ outbreak
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A nursery in the [Scottish] Borders has been closed due to a suspected _E. coli_ O157 outbreak. The region's health board said a number of children had been affected at Cherrytrees nursery in Hawick. Anyone who attends or works at the site has been asked to stay at home and get tested to try to contain the spread of the illness. NHS Borders said the nursery would reopen as soon as was practical following the outbreak. The health board said it would be in touch with anyone directly affected.

Director of public health Dr Tim Patterson said: "I want to reassure people that the measures we are taking are preventative in order to limit the spread of this infection. He said anyone who had visited the nursery since 9 May 2022 and contracted symptoms should contact their GP or NHS 24 if their surgery is closed. "I would like to take this opportunity to thank the management and staff of Cherrytrees in Hawick for their co-operation in this process," he added.

A post on the nursery's Facebook page praised the "speed and efficiency" with which staff had handled the situation. "We are very, very grateful for the understanding and support from our parents, and truly humbled by your kind words," it added.

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communicated by: ProMED

[Enteric infections including EHEC can spread easily in the childcare setting. Infections with _E. coli_ that produce Shiga toxin, the prototypic strain being O157:H7, can result in bloody, usually non-febrile, diarrhea that may progress to kidney failure and breakdown of red blood cells related to the toxin's effect on the kidney. The use of antibacterials in the early stages of the infection can increase the risk of complications, especially hemolytic uremic syndrome.

Evaluation of asymptomatic children in the setting of an EHEC outbreak in the daycare setting can be an important part of control:

Gilbert M, Monk C, Wang H-L, et al. Screening policies for daycare attendees: lessons learned from an outbreak of _E. coli_ O157:H7 in a daycare in Waterloo, Ontario. Can J Public Health. 2008; (4):281-5; https://doi.org/10.1007/bf03403755
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Abstract
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"Objectives
Control measures for enteric outbreaks in childcare settings frequently include screening by stool cultures from symptomatic children only. We present evidence from an investigation of _Escherichia coli_ (_E. coli_) O157:H7 in a daycare in Waterloo, Ontario to support implementation of a mandatory screening policy for all children during an outbreak.
"Methods
In addition to routine outbreak control measures employed by the health unit, stool samples from all children and staff were collected, with positive _E. coli_ cultures typed by pulsed field gel electrophoresis (PFGE). We conducted a cohort study, using data from the environmental investigation and questionnaires administered to parents and staff, to look for risk factors for infection and to survey parent/staff knowledge regarding appropriate management of diarrhea.
"Results
Overall 11 _E. coli_ O157:H7 cases were identified (7 lab-confirmed); 9 were children. No common source of infection was identified. Factors identified as possibly contributing to person-to-person transmission within the daycare included: i) the underreporting and possible attendance of symptomatic children despite alerting parents to the outbreak and requirements to keep symptomatic children at home, ii) possible transmission from an asymptomatic infected child, and iii) inconsistent understanding among parents and staff regarding diarrhea and appropriate management of a child with diarrhea.
"Discussion/conclusion
This investigation reveals that in childcare settings, _E. coli_ O157:H7 outbreak screening policies based on reported symptoms only may be insufficient. We recommend that such policies be amended to include the collection of at least one stool culture from all children in attendance, regardless of symptom history."

Hawick is a town in the Scottish Borders council area and in the county of Roxburghshire in the east Southern Uplands of Scotland. - Mod.LL

The above report -- and others I have seen online -- offers no case numbers or clinical details. ProMED would be pleased to hear from well-informed sources. - Mod.SH