Outbreak of shiga toxin-producing Escherichia coli serotype O26: H11 infection at a child care center in Colorado

Abstract

Background: Shiga toxin-producing Escherichia coli (STEC) O26:H11 is an emerging cause of disease with serious potential consequences in children. The epidemiology and clinical spectrum of O26:H11 are incompletely understood. We investigated an outbreak of O26:H11 infection among children younger than 48 months of age and employees at a child care center.

Methods: Every employee at the center (n = 20) and every child <48 months (n = 55) were tested for STEC and administered a questionnaire. Thirty environmental health inspections and site visits were conducted. A cohorting strategy for disease control was implemented.

Results: Eighteen confirmed and 27 suspect cases were detected. There were no hospitalizations. The illness rate was 60% for children and employees. The risk of being a case in children <36 months was twice the risk among children of 36 to 47 months (risk ratio: 2.10; 95% confidence interval: 1.00, 4.42). The median duration of shedding among symptomatic confirmed cases was 30.5 days (range: 14-52 days). Four (22%) confirmed cases were asymptomatic and 3 (17%) shed intermittently. Nearly half (49%) of the household contacts of confirmed cases developed a diarrheal illness. The outbreak was propagated by person-to-person transmission; cohorting was an effective disease control strategy.

Conclusions: This was the largest reported outbreak of O26:H11 infection in the United States and the largest reported non-O157 STEC outbreak in a US child care center. Non-O157 STEC infection is a differential diagnosis for outbreaks of diarrhea in child care settings. Aggressive disease control measures were effective but should be evaluated for outbreaks in other settings.