Implications of screening and childcare exclusion policies for children with Shiga-toxin producing Escherichia coli infections: lessons learned from an outbreak in a daycare centre, Norway, 2012

نویسندگان

  • Emily MacDonald
  • Per Kjetil Dalane
  • Preben Aavitsland
  • Lin Thorstensen Brandal
  • Astrid Louise Wester
  • Line Vold
چکیده

BACKGROUND In Norway, it is recommended that children with Shiga-Toxin producing Escherichia coli (STEC) infections are excluded from daycare centers until up to five consecutive negative stool cultures are obtained. Children with gastrointestinal illness of unknown etiology are asked to remain home for 48 hours after symptoms subside. On 16 October 2012, two cases of STEC infection were reported from a daycare center, where other children were also symptomatic. Local health authorities temporarily closed the daycare center and all children and staff were screened for pathogenic E. coli. We present the results of the outbreak investigation in order to discuss the implications of screening and the exclusion policies for children attending daycare in Norway. METHODS Stool specimens for all children (n = 91) and employees at the daycare center (n = 40) were tested for pathogenic E. coli. Information on demographics, symptoms and potential exposures was collected from parents through trawling interviews and a web-based questionnaire. Cases were monitored to determine the duration of shedding and the resulting exclusion period from daycare. RESULTS We identified five children with stx1- and eae-positive STEC O103:H2 infections, and one staff member and one child with STEC O91:H- infections. Three additional children who tested positive for stx1 and eae genes were considered probable STEC cases. Three cases were asymptomatic. Median length of time of exclusion from daycare for STEC cases was 53 days (range 9 days-108 days). Survey responses for 75 children revealed mild gastrointestinal symptoms among both children with STEC infections and children with negative microbiological results. There was no evidence of common exposures; person-to-person transmission was likely. CONCLUSIONS The results of screening indicate that E. coli infections can spread in daycare centres, reflected in the proportion of children with STEC and EPEC infections. While screening can identify asymptomatic cases, the implications should be carefully considered as it can produce unanticipated results and have significant socioeconomic consequences. Daycare exclusion policies should be reviewed to address the management of prolonged asymptomatic shedders.

برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

منابع مشابه

Lessons Learned From Outbreaks of Shiga Toxin Producing Escherichia coli

In 2011, a large outbreak caused by a Shiga toxin producing E. coli (STEC) occurred in Northern Germany, with a satellite outbreak in Western France, including the highest number of hemolytic uremic syndrome (HUS) cases ever encountered during a STEC outbreak. The outbreak strain was characterized as an enteroaggregative E. coli of serotype O104:H4 expressing a phage-encoded Shiga toxin 2. The ...

متن کامل

Prevalence and molecular characterization of verotoxin-producing Escherichia coli O157:H7 in cattle and sheep in Shiraz-Iran

Shiga toxin producing Escherichia coli have been associated with HUS, HC and TTP in human. We found recto-anal mucosal sample in sheep as well in cattle is the main site for E. coli O157 localization. 1246 E. coli isolates from 872 both healthy and diarrheic animals were analyzed, by screening for the presence of Shiga toxin-producing (VT 1 and VT 2) and intimin (eae) genes used Multiplex PCR. ...

متن کامل

Detection of Shiga toxin-producing Escherichia coli (STEC) in faeces of healthy calves in Mashhad, Iran

The aim of this study was to identify virulent Shiga toxin-producing Escherichia coli (STEC) strains isolated from faecal samples of 100 clinically healthy calves. In the present study, a total of 100 Escherichia coli (E. coli) isolates from clinically healthy calves belonging to 6 different farms located in Khorasan Razavi province, Iran, were examined for presence of virulence genes character...

متن کامل

Screening policies for daycare attendees: lessons learned from an outbreak of E. coli O157:H7 in a daycare in Waterloo, Ontario.

OBJECTIVES Control measures for enteric outbreaks in child care 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 out...

متن کامل

Prevalence of Multidrug Resistant Shiga Toxin-Producing Escherichia coli in Cattle Meat and Its Contact Surfaces

Background: Shiga toxin-producing Escherichia coli (STEC) are group of E. coli causing bloody diarrhea. The goal of this survey was to determine the prevalence of multidrug resistant shiga toxin-producing E. coli in cattle meat and its contact surfaces. Methods: Swab samples (n=120) were randomly collected from meat and contact surface of butchery shops in Sharkia province, Egypt. Prevalence o...

متن کامل

ذخیره در منابع من


  با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید

برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

عنوان ژورنال:

دوره 14  شماره 

صفحات  -

تاریخ انتشار 2014