Late in the day on Friday, August 29, 2003, staff in the Communicable Disease (CD) section at the St. Clair County Health Department (SCCHD) received a telephone call from Brett Hellinga, a Sangamon County (Illinois) resident, who reported that he, his roommate and fiance (Jamie Eastwood Hellinga), and a friend from Rantoul, Illinois (Katie Reed) had recently traveled to the St. Clair area to attend a wedding in St. Louis. All three were now experiencing bloody diarrhea and had gone to emergency rooms in their respective hometowns for treatment. Laboratory results were pending. CD staff notified the SCCHD Environmental Health section.
On Tuesday, September 2, Mr. Hellinga notified the SCCHD that E. coli O157:H7 had been detected in his stool specimen. He and his friends had determined that they had shared only two meals: one at the wedding reception and one at Habaneros Mexican Restaurant located in the St. Clair Square mall. As no one else who had attended the wedding was reporting symptoms, they suspected the food at Habaneros was the source of their illness. At the same time the SCCHD began receiving other reports of diarrheal illness in patients seen by local physicians. Preliminary interviews of ill persons also revealed that all had eaten at Habaneros just prior to the onset of diarrhea. A foodborne outbreak investigation was conducted.
In total 64 persons, including seven employees, who had eaten at Habaneros between August 15, 2003 and September 5, 2003, were interviewed. Thirty (47%) reported having diarrheal symptoms; ten sought medical care. An extensive food consumption history was obtained from each person interviewed. Attack rates were calculated for each food item; none were statistically associated with illness.
Five individuals were laboratory confirmed with E. coli O157:H7 (this includes Brett Hellinga, Katie Reed, Stanley Pawlow, and Patty Timko). All five ate at Habaneros on either August 23 or August 24. Pulsed field gel electrophoresis (PFGE) analysis of the five isolates obtained from culture confirmed patients revealed that all five had an indistinguishable PFGE pattern, indicating that they were infected with the same strain of E. coli O157:H7.
On September 2, upon hearing that there was a laboratory confirmed case of E. coli O157:H7 with a possible connection to Habaneros restaurant, the SCCHD EH staff conducted an on-site environmental investigation. The temperature of ground beef hot held on the steam table was acceptable, but inadequate cooling of ground beef cooked two days earlier was noted. The assistant manager reported no ill employees.
A second on-site inspection occurred on September 4. At this time health inspectors observed that the walk-in cooler was so crowded that air could not circulate around meat containers. The containers were “stacked in between boxed chicken and a large container of shredded cheese.” Employees were instructed to cook meat in smaller batches, which would allow for more rapid cooling. See Health Department Records, as Attachment No. 1.
By September 5, the number of confirmed cases of E. coli O157:H7 had increased to five Habaneros patrons. A sixth person, Jaime Eastwood Hellinga, who had eaten at Habaneros with Brett Hellinga and Katie Reed but did not have a stool sample tested, was considered to be a probable case of E. coli O157:H7. The restaurant agreed to voluntarily cease operations while the foodborne outbreak investigation was underway. See John Kobayashi, M.D. Report and Curriculum Vitae, as Attachment No. 2.