STRAIN OF E. COLI IDENTIFIED IN LIMERICK CRECHE IS UNUSUAL

No more than 24 hours after it was revealed that a Limerick crèche was forced to close due to an outbreak of E. coli, the BBC has reported that a nursery in Wales was closed as a precaution last Thursday after it too fell foul of the bacteria.

The testing that has been carried out so far has confirmed three cases of E. coli O157 in children attending the nursery.  Bearing in mind that the incubation period can range from one to 14 days, it is possible that further cases will emerge.  However, symptoms usually manifest themselves within three to four days of infection.

E. coli O157 is far more prevalent that the serogroup E. coli O26.  While the latter strain was responsible in the case of the Limerick crèche, it is something of a rarity, with most VTEC outbreaks in childcare settings involving E. coli O157.

Indeed there has been a worrying upward trend in the number of reported cases of E. coli O157 infections in this country over the last several years, with the result that we now have the dubious honour of having the highest per capita rate of infection in the European Union.

While investigations into the source of infection are ongoing in the Welsh case, it is difficult to identify a definitive source in an outbreak like this because the bug is so easily spread where young children are concerned.

Public health officials in that jurisdiction confirmed that no children or staff will be allowed to attend the nursery until they have received two negative tests for E. coli O157 taken at least 48 hours apart.  This is in line with protocols operated in this country where VTEC bacteria are detected in childcare settings.

Infection with E. coli O157 can be contracted by eating contaminated food, or through contact with infected people, farm animals or contaminated water.  As with E. coli O26, symptoms of E. coli O157 range from mild diarrhoea, stomach cramps and fever to severe bloody diarrhoea.  In around 15% of cases involving young children haemolytic uraemic syndrome (HUS) occurs.  This is a serious kidney condition which can have permanent side effects with 50% of those infected requiring dialysis.  Between 3% and 5% of cases of HUS prove fatal.

Due to the fact that E. coli O157 infection can spread rapidly from person to person, and because young children have a heightened risk of severe complications, it is vital that childcare facility operators exercise extreme vigilance in attempting to prevent the spread of E. coli O157 or any of the other VTEC serogroups such as E. coli O26 by ensuring that they apply all appropriate safeguards in relation to:

• food preparation and storage,
• toilet and hygienic practices,
• avoiding the spread of infection between children, and
• using a safe water supply.

While there is nothing to suggest that lax standards gave rise to either of the recent Irish or the Welsh outbreaks, in the event that a crèche or childcare facility at the centre of an E. coli outbreak was in fact found wanting in any of the above areas they would clearly have a significant exposure in damages to any child in their care who became infected.

Further information on prevention methods relating to children in care may be found in an information leaflet published by the Food Safety Authority of Ireland.