On May 12, 2008 the Lawrence County Health Department (LCHD) was notified of a case of HUS in a child with a history of bloody diarrhea. The health care provider reported that the child had consumed unpasteurized goat’s milk obtained from a local store, the Herb Depot, in Barry County, Missouri. The milk had been purchased on April 29, 2008. It was quickly learned that an additional Barry County child that had cultured positive for E. coli O157:H7 had also consumed unpasteurized goat’s milk from the same store. As a result, the LCHD contacted the Missouri Department of Health and Senior Services (DHSS) who began a full epidemiological and environmental investigation of the illnesses. The investigation revealed that the milk consumed by both ill children had been produced at Autumn Olive Farms.
At the conclusion of its investigation, the DHSS ultimately announced that there were four cases of E. coli O157:H7 associated with the outbreak. Of these, three were laboratory confirmed, and one was identified as a probable case. Each of these individuals resided in different counties in Southwest Missouri, and were not known to have any relation to each other. Nonetheless, each shared a common exposure to milk from Autumn Olive Farms. In addition, the three culture-confirmed cases shared a common, indistinguishable genetic strain of E. coli O157:H7. The strain was identified as a unique subtype of E. coli O157:H7, never before reported in Missouri. Each of the four cases had consumed milk from Autumn Olive Farms within 3-4 days of onset of illness. The DHSS reported: “no other plausible sources of exposure common to all four cases were identified [other than the milk.]” The final outbreak report ultimately concluded: “the epidemiological findings strongly suggest the unpasteurized goat’s milk from Farm A [Autumn Olive] was the likely source of infection for each of the cases associated with this outbreak.”
Larry Pedersen had just turned one year old when he developed an E. coli O157:H7 in May 2008. When his diarrhea turned bloody, his parents took him for medical treatment. He was admitted to the hospital on May 8. Shortly thereafter, Larry developed hemolytic uremic syndrome (HUS) and was transferred to a specialty care facility. As is typical of HUS, Larry was then suffering from acute renal failure. He was started on dialysis, which was necessary at that point for his survival. He required 15 days of dialysis before his kidneys recovered enough to function on their own. Larry was discharged on May 29, to continue recovery and treatment on an outpatient basis. The medical bills associated with his care approached $90,000. As the result of damage to his kidneys suffered during his bout with HUS, Larry is at significant risk for severe renal complications in the future. These complications include end stage renal disease (ESRD) and kidney transplant.
Nicole Riggs developed an E. coli O157:H7 infection in May 2008 from consumption of raw goat’s milk. She was nine years old at the time. Nicole suffered from symptoms typical of E. coli O157:H7 infections – bloody diarrhea, cramping, and nausea – that quickly intensified and led to her hospitalization on May 8, 2008. Once hospitalized, Nicole developed renal failure, anemia, and thrombocytopenia (low platelet count) indicating that she was developing HUS. She was transferred to a Children’s hospital and started on dialysis in order to save her life. She received dialysis for 18 days. Nicole’s renal function slowly returned to the point that she was deemed healthy enough for discharge on June 1. After discharge, she remained under the care of a nephrologist. In addition, damage suffered during her HUS has required that her gall bladder be removed. Medical costs to this point exceed $180,000. As the result of damage to her kidneys suffered during her bout with HUS, Nicole is at significant risk for severe renal complications in the future. These complications include end stage renal disease (ESRD) and kidney transplant.