Doctors at Penrose St. Francis Health Services in Colorado quickly determined that the cause of William and Alexander’s diarrheal illness was likely to be infectious since both boys were experiencing similar symptoms. Each child submitted a stool specimen on August 16, 2005. Preliminary laboratory results were released on August 18 and showed that “sorbitol negative Escherichia coli” had been cultured from both Alexander and William’s specimens. Isolates were sent to the Colorado Department of Public Health and Environment (CDPHE) Public Health Laboratory for confirmatory testing and O157:H7 subtyping. A final laboratory report documenting the boys’ E. coli O157:H7 infection was issued on September 7, 2005.
The Communicable Disease Epidemiologist Program at the CDPHE was notified that the Faber children were ill with E. coli O157:H7 and on August 18, 2005 epidemiologist Steven Burnite interviewed Suzanne Faber about her children’s symptoms and potential risk factors for infection with the bacteria. During the interview Mr. Burnite learned of the USAF Academy faculty picnic held on August 8 and that both Alexander and William had consumed hamburgers served at the event.
Upon further follow up, Mr. Burnite learned that the hamburgers were purchased at a WalMart store and that they were manufactured by Flanders Provision Company, a Waycross Georgia firm. Mrs. Ladell Arnold, wife of picnic organizer Major Preston Arnold, said that she had originally purchased 3 five pound boxes of Flanders pre-formed frozen meat patties for the picnic. She later purchased 2 more 5-pound boxes of Flanders beef patties. Both purchases were at the same WalMart store located on East Woodmen Road in Colorado Springs.
The Faber children were not the only cases of E. coli O157:H7 who had consumed Flanders produced meat just prior to symptom onset. Earlier in the month the CDPHE had investigated E. coli O157:H7 in a Delta County (Colorado) man who had consumed Flanders meat. Soon a multi-state cluster of E. coli O157:H7 was identified through pulsed field gel electrophoresis (PFGE) subtyping and a national investigation was launched. The CDC identified PFGE pattern numbers EXHX01.0200 and EXHA26.0015 as the outbreak patterns. Ultimately DNA testing of isolates obtained from culture of William and Alexander’s stool specimens would confirm that the boys shared the Flanders outbreak patterns.
While the CDPHE investigation of the Faber children was still underway, the USDA issued a notice saying that approximately 900,000 pounds of frozen ground beef patties manufactured by Flanders Provision Company was being recalled because of possible contamination with E. coli O157:H7. The Class I recall described the meat as being produced on various dates from February 21, 2006 to March 10, 2005. It had been distributed nationwide at the retail level. Several weeks later the recall was expanded to include an additional 184,000 pounds of Flanders Provision Company ground beef patties produced on June 25, 2005.
Leftover meat from the USDA Academy picnic was still in the Arnold freezer and available for microbiologic testing. Only one box of the five boxes of Flanders frozen patties recoverable; the rest had been thrown away after the picnic. The USDA collected the one box, originally thought to be intact, but later deemed to be opened, labeled with production code 05195. Two ziplock bags holding 6 patties each were also collected. It was not possible to determine which of the other four boxes of patties purchased for the picnic contained the patties submitted for testing. Tests conducted at both the USDA and CDPHE laboratories did not find E. coli O157:H7 in any of the meat collected at the Arnold home.
In an email message from CDPHE epidemiologist, Steve Burnite, sent to Lieutenant Colonel Steven Niehoff, Public Health Flight Commander at the US Airforce Academy, Mr. Burnite explained that negative test results on the meat did not “necessarily rule out the beef as the source [of William and Alexander’s E. coli O157:H7] since it is just a small sample of the ground beef patties.” In the same email, Mr. Burnite wrote:
“The bottom line is that the Faber children (and a 3rd CO resident from early August) match by PFGE on 2 enzymes to a nationally recalled product, so from our epidemiological standpoint there is little doubt that they were exposed to this contaminated ground beef.”
The “contaminated ground beef” that Mr. Burnite was referencing was Flanders Provision Incorporated produced product.