E. coli O157 scenario Slides from 24th March 2014

Ellie Hothersall @DundeePublicH

Susan Law @satl101

PLEASE NOTE: All names etc. are fictional

Thursday afternoon

Toby Scott

5 years old

1 day history of haematuria

4 day history of diarrhoea

Currently in HDU in paediatrics

What features suggest E coli infection?

•Diarrhoea

•Haematuria

•Child’s age

•Fever

•Rapid onset

Haemolytic uraemic syndrome

• Generally starts with diarrhoea (can be bloody)

• Cramps

• Verocytotoxin-producing E coli (VTEC)

• 10% of VTEC cases thought to develop HUS

Surveillance questionnaire

This link for Dundee students (password protected):

https://mbchb.dundee.ac.uk/publichealth/files/2014/03/20130502-Enteric-Form.doc

Link for Health Protection Agency surveillance form (England)

Likely risk factors

Private water supply

Pet dog

Meat from local butchers’

Recent birthday party

Swimming

Nursery

Contact tracing

Sister (Emilia, 8) also has diarrhoea

Friday

Mother (Sarah Scott) now has diarrhoea

Which of the following jobs would mean she should excluded from working?

Hairdresser

Health care assistant

Car mechanic

Police woman

Journalist

Lab report confirms E. coli O157 in Toby’s stool

Sample sent for genotyping

Still awaiting results for Emilia

Later on Friday

Jayden Miller

Age 3

Bloody diarrhoea for 4 days

Lab confirms E. coli O157 for Emilia

Waleed Ibrahim (7) diarrhoea, seen by same GP as saw the Scott family

Wilma Saunders, 45, 2 day history of bloody diarrhoea

Works in café at Clearwater farm

What kind of study to we need here?

Prospective cohort

Retrospective cohort

Randomised controlled trial

Case control

Cases

Cases

3 children, 2 adults

Controls

4 children, 4 adults

Toby SToby S

Emilia SEmilia S

Rachel SRachel S

Sarah SSarah S

Jayden MJayden M

Wilma SWilma S

David SDavid S

Colm BColm B

Ashleigh MAshleigh M

Susan BSusan B

Steve SSteve S

Ryan BRyan B

Risks identified

2 butchers

Swimming

Open farm

Private water supply

Primary school

VTEC No VTEC

Ate meat from Flemming’s

butchers

2 3

Did not eat meat from

Flemming’s butchers

3 5

VTEC No VTEC

Ate meat from Dobie’s butchers

1 2

Did not eat meat from

Dobie’s butchers

4 6

VTEC No VTEC

Visited swimming pool

2 3

Did not visit swimming pool

3 5

VTEC No VTEC

Visited Clearwater open farm

4 5

Did not visit Clearwater open farm

1 3

VTEC No VTEC

Private water supply

2 6

Mains water supply

3 2

VTEC No VTEC

Connection to Forbes Primary

school

2 3

No connection to Forbes

Primary school

3 3

Location Odds ratio

Flemings butchers 1.1

Dobies butchers 0.75

Swimming 1.1

Open farm 2.4

Private water supply 0.2

Primary school 0.7

Where is the likely source?

Flemings butchers

Dobies butchers

Swimming

Open farm

Private water supply

Primary school

http://www.hpa.org.uk/webc/HPAwebFile/HPAweb_C/1317135762632

Outbreak management team

Public health

Environmental health

Veterinary medicine

(Scottish) Government

Health and Safety Exec

http://www.face-online.org.uk/docman/farmers/code-of-practice/download

http://www.hpa.org.uk/webc/HPAwebFile/HPAweb_C/1317135818622

http://www.face-online.org.uk/resources/preventing-or-controlling-ill-health-from-animal-contact-at-visitor-attractions-industry-code-of-practice

http://www.face-online.org.uk/resources/preventing-or-controlling-ill-health-from-animal-contact-at-visitor-attractions-industry-code-of-practice

http://www.face-online.org.uk/resources/preventing-or-controlling-ill-health-from-animal-contact-at-visitor-attractions-industry-code-of-practice