An E. coli outbreak during a school trip to the Appalachian Fairgrounds is continuing to leave children in the hospital.

According to the Northeast Regional Health Office, eight children have been hospitalized and four others seriously ill. The kids who have contracted the bacteria were students in Washington County, Tennessee and Sullivan County.

According to a statement from Northeast Regional Health Office Medical Director Dr. David, Kirschke, the illnesses occurred after elementary school classes visited an animal exhibit at the fairgrounds.

Appalachian Fairgrounds Manager Phil Booher said during a phone call that he wasn’t sure what animals the guest came into contact with.

Less than three weeks ago, some Tennessee elementary school students took a field trip.
E. coli is bacteria, the CDC explains. Many strains are harmless, but there are some that can make you sick. Among those is Shiga toxin-producing E. coli, the strain health officials have determined the children were exposed to during their field trip. 

Though health officials have not identified an exact source for the infection, they did provide resources on staying healthy around animal exhibits – a common place for germs like E. coli, Cryptosporidium, and Salmonella, according to the CDC. 

The Outbreak:

According to news reports as many as fifteen people have been sickened by an E. coli outbreak linked to Miguel’s Cocina in the 4S Ranch community of San Diego, including seven who had to be hospitalized, according to county health officials. 

Those who fell ill, or their families, reported eating at Miguel’s 4S Ranch location from Oct. 6 to Oct. 18 and developed symptoms from Oct. 13 to Oct. 19, according to the county’s Health and Human Services Agency (HHSA). On Wednesday, the HHSA confirmed two new cases linked to the outbreak bringing the total to 15.

County health officials are still investigating the specific food items that were the source of the Shiga-toxin-producing E. coli (STEC) at the restaurant. Miguel’s voluntarily closed its doors on Tuesday and has been working closely with the County to identify the outbreak.

“People who visited the restaurant and are feeling ill should see their doctor as soon as possible,” said Wilma J. Wooten, M.D., M.P.H., County public health officer.  

“We want them to get tested and have the results sent to the local health department. Those most at risk from infection are children, adults 65 and older and people with weakened immune systems,” Wooten said.

The ages of the patients range from 6 to 87, according to the county. At least one of those cases has developed into the more severe complication of the infection called hemolytic uremic syndrome.   

Parents Speak Out:

Yalda Bahar says it “breaks her heart” to have watched her son lying in a hospital bed after being diagnosed with E. coli.

Bahar believes her 7-year-old was one of the first customers to contract E. coli amid an outbreak at the Miguel’s Cocina location in 4S Ranch.

She says they ate at the restaurant on October 8th. On October 14th, her son was rushed to the hospital after she noticed his stool was bloody.

“I’ve never seen him with that much pain. It was terrible,” said Bahar.

According to records Bahar shared with ABC 10News, her son was diagnosed with Shiga toxin-producing Escherichia coli O157 infection.

A 14-year-old boy is fighting for his life at Rady Children’s Hospital after getting diagnosed with E. coli following a night out with family dining at Miguel’s Cocina in 4S Ranch.

“I’m trying to be strong for my son, so he’s not afraid,” Rachele Byrd said. “It’s hard to see your child suffer like that.”

Byrd’s son is among seven hospitalized from the E. coli infections. 

On Oct. 14, Byrd says her family dined at the restaurant. Two days later, her son, who ate carne asada that night, complained of a headache. The next day a fever, then excruciating diarrhea. Now, he’s on dialysis.

E. coli:  Marler Clark, The Food Safety Law Firm, is the nation’s leading law firm representing victims of E. coli outbreaks and hemolytic uremic syndrome (HUS). The E. coli lawyers of Marler Clark have represented thousands of victims of E. coli and other foodborne illness infections and have recovered over $850 million for clients. Marler Clark is the only law firm in the nation with a practice focused exclusively on foodborne illness litigation.  Our E. coli lawyers have litigated E. coli and HUS cases stemming from outbreaks traced to ground beef, raw milk, lettuce, spinach, sprouts, and other food products.  The law firm has brought E. coli lawsuits against such companies as Jack in the Box, Dole, ConAgra, Cargill, and Jimmy John’s.  We have proudly represented such victims as Brianne Kiner, Stephanie Smith and Linda Rivera.

If you or a family member became ill with an E. coli infection or HUS after consuming food and you’re interested in pursuing a legal claim, contact the Marler Clark E. coli attorneys for a free case evaluation.

Additional Resources:

• About E. coli – a complete online resource with information on symptoms and risks of E. coli infection
• About hemolytic uremic syndrome (HUS) – a complete online resource with information about acute kidney failure
• Marler Clark E. coli Lawsuits and Litigation
• A downloadable Family Health Guide

It is not just the isles of your grocery stores that are concerning, the food served at restaurants can cause havoc as well.

The County of San Diego Health and Human Services Agency (HHSA) is reporting an outbreak of 13 confirmed or probable cases of Shiga-toxin-producing E. Coli (STEC) linked to dining at Miguel’s Cocina 4S Ranch location in San Diego.  

HHSA Epidemiology Program and the County Department of Environmental Health and Quality are investigating the cluster of E. coli infections. Ages range from 6 to 87 years of age.   

The ill persons or their families reported eating at the Miquel’s 4S Ranch location from Oct. 6 to Oct. 18 and had symptoms from Oct. 13 to Oct. 19.  Seven cases were hospitalized with at least one case developing the more severe complication of the infection called hemolytic uremic syndrome.   

The specific food items that were sources of the E. coli bacteria at the restaurant are under investigation.  The restaurant is cooperating and working closely with the County. This morning its management voluntarily decided to close until the source can be identified.     

“People who visited the restaurant and are feeling ill should see their doctor as soon as possible,” said Wilma J. Wooten, M.D., M.P.H., County public health officer.  “We want them to get tested and have the results sent to the local health department. Those most at risk from infection are children, adults 65 and older and people with weakened immune systems.”  

County Environmental Health inspectors visited the 4S location, yesterday afternoon, Oct. 23, 2023, because some cases diagnosed with STEC reported Miquel’s among their possible exposure locations. During that inspection, there were no operational major risk factors for foodborne illness identified.  

Most people with a STEC infection start feeling sick three to four days after eating or drinking something that contains the bacteria. However, illnesses can start anywhere from 1 to 10 days after exposure. Symptoms vary from person-to-person and often include:  
• Severe abdominal cramps  
• Watery or bloody diarrhea (3 or more loose stools in a 24 hour period)  
• Vomiting  

Symptoms may occur with or without a fever. When present, the fever usually is not very high (less than 101˚F/38.5˚C). Most people get better within 5 to 7 days. Some infections are very mild, but others are severe or even life-threatening.   

The public is asked to contact your health care provider if you have experienced these symptoms on or after Oct. 6, and especially if you have diarrhea that lasts for more than three days or diarrhea that is accompanied by a fever higher than 102˚F, or blood in the stool, or so much vomiting that you cannot keep liquids down and you pass very little urine. 

Well, this just popped into my inbox.

My thought is that it seems odd that with nine cases in the student body, that a location could not be determined. Also, the fact that the Health Departments are looking into other clusters across the country is intriguing.

From: Huntley High School
Date: Thu, Oct 19, 2023, 2:06 PM
Subject: E. coli update from MCDH

Seven children are hospitalized, including four who are seriously ill, following a field trip to an animal exhibit in Northeast Tennessee, officials said Friday.

Students from Washington and Sullivan counties visited an animal exhibit at the Appalachian Fairgrounds on September 26-27. Since then, several cases of illness caused by Shiga-toxin-producing E. coli have been reported.

I have been warning against this since at lease 2005:

2005 washington fair assoc from Bill Marler

See also, www.fair-safety.com

Now from our friends at MMWR:

On June 22, 2022, the Tennessee Department of Health (TDH) was notified of a child hospitalized with Shiga toxin–producing Escherichia coli (STEC) O157:H7 after attending a farming camp at farm A. Three days later, TDH was notified of a second hospitalized child with hemolytic uremic syndrome, whose brother had attended the same camp, prompting an investigation. During the summer, farm A held three week-long summer camps teaching animal husbandry to children aged 6–10 years by assigning campers a baby goat (kid) to care for. STEC resides in the gastrointestinal tract of ruminants such as cattle, goats, sheep, and deer without causing illness in the animal* (1). Outbreaks among humans associated with petting zoos are well documented (2–5).

Investigation and Outcomes

On June 28 and 29, TDH conducted an environmental assessment at farm A. In addition to an onsite interview with the farm owners and employees, the assessment included facility observations of animal pens, public petting areas, areas where children cared for the animals, food service facilities, handwashing and sanitizing facilities, play areas, and toilets. Health department staff members collected camp attendee registration and goat assignment records and conducted environmental sampling, including the collection of 41 samples from animals, animal feces, animal pens, water sources, and toilets.

TDH also sent an online survey to the parents and guardians of all 82 children who had attended camp at farm A during June 6–24 to ascertain dates of attendance, illnesses and outcomes, foods consumed, and camp activities. The outbreak-specific survey was completed by parents or guardians of 53 (65%) campers.

Survey responses facilitated conduct of a case-control analysis. Cases were defined in terms of 1) the person who was ill (primary versus secondary) and 2) the symptoms and laboratory results (probable versus confirmed). A primary case was defined as an illness in a person who attended any of the three camps during June 6–24; a secondary case was a compatible illness within 10 days of exposure to a primary case in the same household or to a close contact of a summer camp attendee (irrespective of illness in the attendee). Probable cases included the onset of diarrhea within 10 days of attending the summer camp (primary cases) or within 10 days of exposure to a secondary case; confirmed outbreak cases were defined as a positive polymerase chain reaction or enzyme immunoassay Shiga toxin test result from a specimen collected after June 6.† Twelve primary cases (including two confirmed and 10 probable) and two secondary cases (one confirmed and one probable) were identified (patient age range = 2–38 years) (Figure). One patient each with a primary and secondary case was hospitalized; one death occurred in a child aged 2 years with a secondary confirmed case.

The case-control analysis included 12 ill camp attendees as case-patients and 58 healthy children identified from the camp attendee list as controls. Chi-square analysis was used to calculate odds ratios; 95% CIs that excluded 1 were considered statistically significant. Because the camp’s food and activity schedules did not change between weeks, and no contributing factors were identified in farm A’s food service establishment, neither a specific activity nor food was considered to be associated with illness. Attendance during the first week of camp, however, was significantly associated with illness (odds ratio = 13.1; 95% CI = 2.59–66.57). Camp operators reported being aware of the National Association of State Public Health Veterinarians Animal Contact Compendium§ and reported incorporating handwashing stations, observing children during animal interactions, and keeping the animal areas clean and disinfected.

Investigators were able to isolate STEC by culture in six samples collected at farm A; these were further subtyped into three STEC serotypes by core genome multilocus sequence typing: H14 (one rectal swab [kid] and one stool swab [kid]), O157:H7 (one stool swab [kid] and one wood swab [inside kid barn]), and O26:H11 (two stool samples [kids]).¶ Only STEC O157:H7 was associated with clinical illnesses. The two farm A STEC O157:H7 isolates were closely related by whole genome sequencing to the three outbreak-associated STEC O157:H7 patient isolates.

Preliminary Conclusions and Actions

In response to the outbreak, farm A voluntarily closed the camp, expedited the demolition of the kid barn, euthanized two kids with positive STEC test results, and moved the kid herd off the property. During closure, farm A independently consulted with veterinarians and other petting zoos to identify additional methods for reducing disease transmission. Based on recommendations provided, the facility discontinued the animal husbandry portion of the camp, increased signage encouraging handwashing after touching animals or objects throughout the facility, and increased messaging on their website about zoonotic diseases, populations at highest risk, and ways to mitigate risk for infection. On July 18, farm A reopened their summer camp without the goat husbandry component.

TDH concluded that this outbreak was associated with STEC O157:H7-infected kids and involved secondary transmission. Hand-to-mouth contact has been observed to occur almost three times per hour among children aged 6–10 years,** supporting the potential for STEC ingestion from contaminated environmental surfaces. The hypothesis of prolonged contact between campers and kids resulting in illness is strengthened by the finding that, after conducting routine monitoring of pathogen and case report forms as well as complaint surveillance systems, STEC was not identified by patrons of the farm apart from camp attendees and their household members. Animal farms, petting zoos, and other environments where small children might have direct contact with ruminant animals should be aware of the risk for zoonotic STEC transmission and make efforts to mitigate these risks by promoting proper hand hygiene during and after animal contact.

Acknowledgments

Tennessee Department of Health Communicable and Environmental Diseases and Emergency Preparedness Food Outbreak Team; Tennessee Department of Health Public Health Laboratory Team; Tennessee Department of Health Environmental Health Team; Nathan Miller, Mark Morgan, University of Tennessee Agricultural Extension; Eric Coffey, Tennessee Department of Health Southeast Regional Office; Mary-Margaret Fill, Tennessee Department of Health.

References

1. Schlager S, Lepuschitz S, Ruppitsch W, et al. Petting zoos as sources of Shiga toxin-producing Escherichia coli (STEC) infections. Int J Med Microbiol 2018;308:927–32. https://doi.org/10.1016/j.ijmm.2018.06.008 PMID:30257809
2. CDC. Outbreak of Shiga toxin-producing Escherichia coli O157 infection associated with a day camp petting zoo—Pinellas County, Florida, May–June 2007. MMWR Morb Mortal Wkly Rep 2009;58:426–8. PMID:19407735
3. Laughlin M, Gambino-Shirley K, Gacek P, et al. Notes from the field: outbreak of Escherichia coli O157 infections associated with goat dairy farm visits—Connecticut, 2016. MMWR Morb Mortal Wkly Rep 2016;65:1453–4. https://doi.org/10.15585/mmwr.mm655051a6 PMID:28033314
4. CDC. Outbreaks of Escherichia coli O157:H7 associated with petting zoos—North Carolina, Florida, and Arizona, 2004 and 2005. MMWR Morb Mortal Wkly Rep 2005;54:1277–80. PMID:16371942
5. Daly RF, House J, Stanek D, Stobierski MG; National Association of State Public Health Veterinarians Animal Contact Compendium Committee. Compendium of measures to prevent disease associated with animals in public settings, 2017. J Am Vet Med Assoc 2017;251:1268–92. https://doi.org/10.2460/javma.251.11.1268PMID:29154705