A lab has confirmed 20 E. coli cases but the number is expected to grow, said Chris Urbina with Denver Public Health.
The strain E. coli O157 primarily affected children on the Front Range, from Boulder to El Paso County.
"While the investigation is ongoing, we suspect that these infections are linked to attending the National Western Stock Show, which was held in Denver from Jan. 10 to Jan. 25," the Colorado Department of Public Health and Environment said in a news release.
Although health officials haven't pinpointed the exact cause of the E. coli, the common denominator in all the cases is the stock show, Urbina said.
The National Western Stock show had 643,100 visitors over 16 days. It was a 4.5 percent drop from last year but it's the 12th straight year that attendance has topped the 600,000 mark.
A call to the spokeswoman of National Western Stock Show has not been returned.
Many schools and child care centers organized trips to the stock show, and many children attended with their families, so there is the potential that the number of cases could jump, health officials said. CDPHE said it is working with local public health agencies to fully investigate cases as they are reported.
Part of the problem is that it takes up to eight days for E. coli to incubate and for those infected to show symptoms, and in that time, the bacteria can spread very easily from one person to another, especially among young children, Urbina said.
Several of the affected children attend child care. At least two of the children appear to have become ill from contact with other ill children and one of these illnesses was transmitted in a child care center, the CDPHE confirmed.
Health officials say E. coli infections among child care center attendees are very concerning because E. coli infections can be very serious in young children.
Urbina said this strain was particularly toxic and if the toxins aren't properly filtered by the kidney it can cause damage to the kidney. They can lead to hospitalization and in some cases a complication called hemolytic uremic syndrome, or HUS, which can cause kidney failure, CDPHE said.
That is why on Wednesday, the CDPHE sent a letter to daycare centers alerting them to the outbreak and asking the staff to take special precautions.
The public health notice sent to daycares is below:
At this point, the CDPHE recommends the following:
For child care centers:
o Report any cases of bloody diarrhea (even if there is only one) to your local public health agency or to CDPHE immediately.
o Report any increase in the number of children or staff with diarrhea who attend your facility to your local health department or to CDPHE immediately.
o Children or staff must not attend childcare while ill with diarrhea.
o If it is known that a child/staff member with diarrhea attended the stock show, or if the facility took a trip to the stock show, the child/staff member should be referred to his/her health care provider for follow up and stool testing before returning to class. That stool test must be negative and the diarrhea must have resolved before the child/staff member can return to child care.
o Any child/staff member with bloody diarrhea, regardless of whether he/she went to the stock show should be referred to his/her health care provider for follow up and stool testing before returning to class. That stool test must be negative and the diarrhea must have resolved before the child/staff member can return to child care.
o If a child/staff member has diarrhea that is not bloody and did not attend the stock show, then the child/staff member is not required to provide a negative stool specimen, however diarrhea must be resolved before returning to child care.
Children and staff who are diagnosed with E. coli O157 must have two stool specimens that are negative for E. coli O157 or shiga toxin before returning to child care.
o Report any cases of bloody diarrhea (even if there is only one) to your local public health agency or to CDPHE (number below) immediately.
o Report any increase in the number of children or staff with diarrhea who attend you facility to your local health department or to CDPHE (number below) immediately.
o Children should not attend school while ill with diarrhea.
o If it is known that a child with diarrhea has attended the stock show, or if the child has bloody diarrhea, we strongly recommend the child be referred to his/her provider for follow up and stool testing.
o Because transmission of E. coli O157 from one person to another is rare in school settings, children who are diagnosed with E. coli O157 are not required to have negative stool specimens before returning to school. They should, however, be free of diarrhea before returning to class.
School staff who are diagnosed with E. coli O157 are also not required to have negative stool specimens before returning to work, unless the staff member handles food as part of his/her job.
General control measures:
o Regular agents that are used for sanitizing and disinfection, such as sodium hypochlorite and quaternary ammonia based solutions, are effective against E. coli. No special disinfectants are necessary to kill E. coli.
o Consider increasing cleaning frequency of sanitizing and/or disinfection, particularly in restrooms and diaper changing areas.
o Meticulous hand hygiene following diaper changing is extremely important in controlling the spread of many pathogens. Both the child’s and caregiver’s hands should be washed immediately following diaper changing and toileting.
o Handwashing is also extremely important for food handlers and before eating meals. Caregivers should supervise children during handwashing to ensure that the process is adequate.
Again, staff responsible for preparing meals in child care facilities and in schools should not handle food if they have diarrhea or have been diagnosed with E coli. Food handlers with diarrhea should not return to work until their diarrhea has resolved and should be encouraged to visit a physician to have their stool tested. Food handlers diagnosed with E coli, should not return to work until they have had two negative stool samples.
CDPHE has asked health care providers to obtain stool specimens from children presenting with bloody diarrhea.
* Please ensure the laboratory will test for E. coli O157 or for shiga toxin, as not all laboratories do this routinely.
* Consider obtaining stool specimens from children with non-bloody diarrhea if diarrhea has persisted for more than 2 days, or is accompanied by fever, severe abdominal cramping or other symptoms.
* Report cases of bloody diarrhea in children to CDPHE at 303-69... until further notice.
* Children should not attend child care while they have diarrhea. Children who are diagnosed with E. coli O157 must have two stool specimens that are negative for E. coli O157 or shiga toxin before returning to child care. Please explain these exclusion policies to parents of children who are ill and who attend child care.
Antibiotics are generally not recommended for E. coli O157 infection and may be associated with development of hemolytic uremic syndrome (HUS).
If outbreaks or ill children are identified in your facility, your local public health agency will work with you to determine if additional control measures are necessary.
Please maintain this enhanced vigilance for illness and the extra screening measures for some children with diarrhea from now to Feb. 16, 2009.
For disease reporting or other questions please contact the CDPHE Communicable Disease program at 303-692-2700.