As of Thursday night, October 29, 2015, the number of outbreak associated cases of Shigella reported to Santa Clara County Public Health Department (SCCPHD) now stands at 190; 152 of these cases are Santa Clara County residents and 38 reported cases are people who live in other counties. Of the 190 total cases, 99 are lab confirmed; 78 of which are Santa Clara County residents. There are 21 confirmed cases from other jurisdictions, including San Mateo , Alameda, Santa Cruz, Marin and Merced Counties. Nearly all of the cases have reported that they ate at Mariscos San Juan #3 restaurant on Friday October 16th or Saturday October 17th.
The Whatcom County Health Department (WCHD) in Bellingham investigated an outbreak of Shiga toxin-producing E. coli O157:H7 infections. The Washington State Department of Health and the Centers for Disease Control and Prevention assisted with the investigation.
Environmental contamination with E. coli O157:H7 of the Dairy Barn at the Northwest Washington Fairgrounds was the likely source of this outbreak. All of the ill people either attended the Milk Makers Fest between April 21 and 23 at the Northwest Fairgrounds; helped with the event between April 20 and 24; or were close contacts of people associated with the event. Most of the ill people were children, including older children who helped with the event. More than 1,000 children from primary schools in Whatcom County attended the event on these days.
Final Case Counts
Disease investigators calculated case counts based only on lab-confirmed infection with E. coli O157:H7 or physician-diagnosed hemolytic uremic syndrome (HUS), a type of kidney failure.
- 25 people were confirmed cases.
- 9 of these cases were considered secondary cases (the ill person didn’t attend the event but had close contact with someone who did attend).
- No one died.
- 10 people were hospitalized.
- 6 people developed HUS.
Final Environmental Sampling Results
Multiple samples from the environment where the event was held were collected on two different days (April 30 and May 13) and submitted for laboratory testing. The samples indicated that several areas of the north end of the Dairy Barn at the Northwest Washington Fairgrounds were contaminated with the same strain of E. coli that made people ill. Negative results do not rule out contamination in other parts of the barn.
The outbreak strain of E. coli O157:H7 was identified in the following areas of the Dairy Barn:
- Manure bunker
- Hay maze area
- Bleachers by east wall
- Bleachers by west wall
Contamination of the environment most likely occurred before the Milk Makers Fest. Any environment where animals have been kept, such as barns, should be considered contaminated. E. coli O157:H7 can survive in the environment up to 42 weeks (Varma, 2003 JAMA).
Epidemiologic Investigation Findings
As part of the investigation, officials interviewed many of the confirmed cases to find out what they did during the event before they got ill. Officials also interviewed “controls,” meaning people who attended the Milk Makers Fest but did not get ill to find out what they might have done differently.
The results of analyzing the data collected during the interviews are not final, but a few preliminary findings stand out:
- Event attendees who reported washing or sanitizing their hands before eating lunch were less likely to become ill.
- Children who reported always biting their nails were more likely to become ill.
- Leaving animal areas without washing hands might have contributed to an increased risk of transmission.
- Eating in animal areas might have contributed to an increased risk of transmission.
Recommendations for Event Organizers:
- Evaluate and update plans for cleaning and disinfection before, during, and after events, particularly surfaces with high levels of hand contact (such as seats, door or fence handles, and hand railings).
- Evaluate and update measures to restrict access to areas more likely to be contaminated with animal manure.
- This is especially important for people at higher risk for severe illness. These people include young children, pregnant women, adults older than 65, and people with weakened immune systems.
- Ensure access to hand washing facilities with soap, running water, and disposable towels.
- Display signs and use other reminders to attendees to wash hands when leaving animal areas.
- Store, prepare, or serve food and beverages only in non-animal areas.
Recommendations for the Public:
- Consider any environment where animals have been kept, such as barns, to be contaminated with bacteria or viruses that can make people ill.
- Hands should always be washed immediately when exiting animal areas, after removing dirty clothing or shoes, and before eating or drinking.
- Hand washing with soap, running water, and disposable towels is the most effective method.
- Adults should always supervise young children while they wash their hands.
- Food and beverages should be consumed in non-animal areas and only after washing hands first.
- Be aware that objects such as clothing, shoes, and stroller wheels can become soiled and serve as a source of germs after leaving an animal area.
- Nine secondary cases were reported during this outbreak. It’s important for people infected with E. coli or those with a family member infected with E. coli to follow these precautions to prevent secondary infection:
- Wash your hands thoroughly with soap and water immediately after using the restroom or changing a child’s diaper.
- Wash your hands before and after preparing food for yourself and others.
- Stay home from school or work while diarrhea persists; most people can return to work or school when they no longer have diarrhea. Special precautions are needed for food handlers, health care workers, and child care providers and attendees. Check with your employer before returning to work, and check with your child’s child care center before resuming child care.
Update: AP now reports that Washington and Oregon Health officials are investigating an E. coli outbreak linked to six Chipotle restaurants in Washington state and Oregon, health officials said Saturday. Three people in the Portland area and at least 19 people in Washington have become sick after eating at the Mexican food chain since October 14.
The Skagit Valley Herald reports that the Skagit County Department of Public Health announced Friday that it has closed Chipotle Mexican Grill in Burlington pending an investigation of several E. coli infections among recent diners.
Of five cases under investigation since October 15, four individuals were hospitalized, according to the health department news release. Results of specimens sent to the state health lab for analysis are expected early next week.
The Department of Public Health advised those who have had close contact with someone ill with symptoms of E. coli infection to see a doctor. Symptoms include diarrhea (often bloody), abdominal cramps, vomiting and nausea.
As of Monday, October 26, 2015, the number of outbreak-associated cases of Shigella reported to Santa Clara County Public Health Department (SCCPHD) now stands at 188; 150 of these cases are Santa Clara County residents and 38 reported cases are people who live in other counties. Of the 188 total cases, 85 are lab confirmed; 65 of which are Santa Clara County residents. There are 20 confirmed cases from other jurisdictions, including the counties of San Mateo, Alameda, Santa Cruz, Marin and Merced. Nearly all of the cases have reported that they ate at Mariscos San Juan #3 restaurant on Friday October 16th or Saturday October 17th.
And, here are the lawsuits:
Two San Jose men and one woman who ate at the restaurant and caught shigella filed separate lawsuits last week alleging negligence against the restaurant owners. The suits were filed through Rains Lucia Stern in California and Marler Clark, a Seattle-based firm specializing in food-borne illness litigation.
The total breaks down to 144 cases in Santa Clara County and 38 across the other four counties, public health officials said.
Of the 72 people with a confirmed infection, 55 are in Santa Clara County while the remaining 17 are in Santa Cruz, Alameda, Marin and Merced counties, according to public health officials.
Eight adults and a child in Alameda County have been confirmed with the infection, Alameda County public health spokeswoman Sherri Willis said.
In Santa Cruz County, three people have been found with shigella, one being through a secondary source, and two others are suspected to have the illness.
San Mateo County Health System officials have reported three confirmed cases of shigella.
The restaurant was closed on Oct. 18 after a majority of the sick people ate there one or two days earlier. Inspectors from the Santa Clara County Department of Environmental Health continue to investigate the outbreak.
Most people who get sick from E. coli recover within 5 to 7 days. Supportive care, such as making sure a person drinks plenty of liquids and gets rest are important for people with the illness. For severe cases, particularly in children, elderly people or those with underlying health problems, a health care provider should be consulted.
The El Dorado County Environmental Management Division, Public Health Division and California Department of Public Health are working closely with the management at High Hill Ranch to determine the source of the potential contamination. The High Hill Ranch Management has pulled the product from the shelves.
“WARNING: This product has not been pasteurized and, therefore, may contain harmful bacteria that can cause serious illness in children, the elderly, and persons with weakened immune systems.”
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As of October 22, 2015 the number of outbreak-associated cases of Shigella reported to Santa Clara County Public Health Department (SCCPHD) has risen to 141; 118 of these cases are Santa Clara County residents and 23 reported cases are people who live in other counties. Of the 141 total cases, 49 are lab confirmed; 35 of which are Santa Clara County residents. There are 14 confirmed cases from other jurisdictions, including San Mateo County, Alameda County and Santa Cruz County. Almost all of the cases ate at Mariscos San Juan #3 restaurant on Friday or Saturday (October 16th or 17th). Many of the ill ate at Mariscos San Juan restaurant #3, a Mexican seafood eatery at 205 N. Fourth St. last Friday or Saturday, Santa Clara County public health officials said.
Santa Clara County public health officials expect to receive laboratory results taken from food handlers of the restaurant next week.
An inspection report dated Sunday showed partially cooked food including shrimp broth and octopus were not properly cooled to 41 degrees before they were placed in refrigerator inserts, which presented a major risk.
The report called for the food preparation surface to be sanitized.
Another inspection report on August 5th showed the restaurant did not have food handler cards available but met requirements for storing food at appropriate temperatures; proper eating, drinking and tasting at the food preparation area; and adequate hand-washing facilities.
Idaho Public Health officials are investigating eight illnesses in southwest Idaho likely associated with drinking unpasteurized (raw) milk. To date, four Campylobacter and four E. coli 0157:H7 cases have reported drinking raw milk produced by the Natural Farm Fresh Dairy of Kuna in the week prior to getting sick. The investigation is ongoing with Southwest and Central District Health departments, working in association with the Idaho State Department of Agriculture.
“If people have recently purchased raw milk from this dairy, we advise them not to drink it and to discard it,” says Dr. Leslie Tengelsen, State Public Health Veterinarian with the Idaho Department of Health and Welfare.
The Idaho State Department of Agriculture is working with Natural Farm Fresh Dairy to confirm if the raw milk from that facility was the source of the reported illnesses. The dairy is fully cooperating with the investigation and issued the following statement: “Natural Farm Fresh is committed to providing a safe and wholesome product to its customers. Effective immediately, we are voluntarily removing all raw milk products currently on the shelves in retail stores and we will discontinue further distribution of our raw milk until additional product testing is completed.”
People should inform themselves of possible health risks before consuming raw, unpasteurized dairy products or providing these products to family members, particularly those considered members of high risk groups. Those at higher risk of illness after consuming raw, unpasteurized milk include young children, pregnant women, the elderly, and those with compromised immune systems.
Common symptoms of acute Campylobacter infection include fever, diarrhea (sometimes bloody), abdominal pain, general discomfort, and vomiting. Symptoms often begin 2-5 days after consumption of contaminated foods and last for about a week in most people; in 20 percent of cases symptoms can last for up to three weeks. Symptoms of E. coli O157:H7 infection typically include stomach cramps and diarrhea, including bloody diarrhea. Symptoms often occur 3-4 days after exposure, but can be as short as 1 day and as long as 10 days. E. coli O157:H7 infections sometimes lead to a serious complication called hemolytic uremic syndrome (HUS), which can cause kidney failure and can occur a week or more after the onset of diarrhea. People with any symptoms of illness after consuming unpasteurized milk from Natural Farm Fresh of Kuna should seek medical attention.