The number of people infected in an E. coli O145 outbreak in Iceland has more than doubled to almost 50.
Landlaeknir (the Public Health Directorate) previously said that 23 students from Mánagarði kindergarten in Reykjavík’s Vesturbær district had been ill. The update was reported in the December edition of EPI-ICE, an electronic newsletter from the chief epidemiologist on communicable diseases in Iceland.
In October, the first child was confirmed to have an infection caused by Shiga toxin-producing E. coli (STEC). At the same time, two other children from the same kindergarten were in hospital with similar symptoms. Suspicions arose that there was a cluster of infections at the kindergarten and the daycare was temporarily closed that evening. By the middle of the next day, the number of cases had risen to 10.
The Reykjavík Health Inspectorate conducted an on-site inspection at the school and representatives from the Epidemiology Department contacted parents to assess food consumption and timeline of symptoms to find the source of the infection.
A total of 49 people were diagnosed with STEC infection in the outbreak, 45 of whom were children in kindergarten. Other patients included an employee, an employee’s child, a parent and a sibling.
A dozen HUS cases
The severity of the illnesses ranged from mild diarrhea to severe illnesses requiring hospitalization and dialysis due to renal failure. Twelve children were diagnosed with hemolytic uremic syndrome (HUS), five were admitted to intensive care and two required dialysis treatment.
Early in the investigation, suspicion arose that the source of the infection was the ground beef served at the kindergarten on October 17.
Analysis of samples at Matís, a government-owned research agency, confirmed that the same serotype, E. coli O145, was found in both stool samples from kindergarten children and in a sample of frozen ground beef used with meals. Sequencing revealed that the origin was the same. STEC was not detected in samples taken from other foods at the site.
Guidelines and recommendations were issued on when children and related contacts could return to school or work. The kindergarten reopened on November 5 and by the time six weeks had passed since the start of the cluster infection, most of the children had returned.
The study showed that the kindergarten did not handle minced meat sufficiently when cooking. A final report is being prepared and will be published later.
The meat was a mixed beef and mutton mince from a company called Kjarnafæði. It was not sold in general sales, but to larger kitchens, such as restaurants, canteens and kindergartens.
The Icelandic Food and Veterinary Authority (MAST) contacted the company when evidence pointed to the meat. On the same day, the company informed all parties that it had received ground meat from the same production batch used in the kindergarten. There were no confirmed reports of infections among other consumers.
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