December 23, 2005

Non-O157 Verotoxin-Producing E. coli in Human Stools: Manitoba
Relatively few enhanced surveillance studies have been undertaken to investigate the extent to which verotoxin-producing non-O157 serotypes of E. coli occur in stool samples received for the detection of verotoxin-producing organisms. The prevalence, molecular and epidemiological characteristics, and geographical patterns associated with non-O157 verotoxin-producing E. coli (VTEC) in Manitoba were described. Thirty-two VTEC isolates consisting of 10 serogroups and 13 different serotypes were isolated over a 22-month period. Twenty-three isolates (71.8%) possessed verotoxin-encoding gene stx1 only, five isolates (15.6%) possessed stx2 only, two isolates (6.3%) possessed both stx1 and stx2, and two isolates (6.3%) possessed stx2c. Only three instances of indistinguishable pulsed-field gel electrophoresis patterns were identified. The age of the individuals from whom non-O157 VTEC were isolated ranged from eight months to 87 years. Mean and median ages were 30 and 22 years of age, respectively. The present study demonstrated a large number of infections associated with non-O157 VTEC in Manitoba. Most non-O157 cases appear to result from sporadic infections, and these occur typically in rural areas. Continued enhanced surveillance is necessary to understand the temporal patterns of non-O157 VTEC and the underlying epidemiological factors driving these patterns.
Source: Canadian Journal of Infectious Diseases and Medical Microbiology, Volume 16, No. 6, November/December 2005

Salmonella Outbreak (Update): Ontario
A recent outbreak of salmonellosis linked to consumption of bean sprouts appears to have ended. Since 1 October, 648 cases of salmonellosis have been reported across Ontario. An order issued by Toronto Public Health on 25 November against a Toronto bean sprout producer to stop distribution of sprouts has been lifted. The Ontario Ministry of Health and Long-Term Care will continue to monitor for cases and compile data from the outbreak.
Source: News Release, Ontario Ministry of Health and Long-Term Care, 14 December 2005

E. coli Outbreak: Washington and Oregon
An outbreak of E. coli infections in Clark and Cowlitz counties have been linked to consumption of raw milk prompting the Washington State Department of Health to remind consumers of the health hazards of unpasteurized dairy products. The outbreak has left five children hospitalized, three with possible kidney failure. Three Oregon residents were sickened presumably by E. coli O157:H7 linked to unpasteurized milk from Cowlitz County, according to the Oregon Department of Human Services. The three Oregon cases are all members of the same family who drank milk from the dairy and who all seem to be recovering. Laboratory testing is underway and the investigation is ongoing.
Sources: News Release, Washington State Department of Health, 15 December 2005; News Release, Oregon Department of Human Services, 15 December 2005

Influenza-Associated Deaths Among Children: United States
Although influenza is common among children, pediatric mortality related to laboratory-confirmed influenza has not been assessed nationally. During the 2003-2004 influenza season, the state health departments were requested to report any death associated with laboratory-confirmed influenza in a U.S. resident younger than 18 years of age. Case reports, medical records, and autopsy reports were reviewed, and available influenza-virus isolates were analyzed at CDC. One hundred fifty-three influenza-associated deaths among children were reported by 40 state health departments. The median age of the children was three years, and 96 of them (63%) were younger than five years old. Forty-seven of the children (31%) died outside a hospital setting, and 45 (29%) died within three days after the onset of illness. Bacterial coinfections were identified in 24 of the 102 children tested (24%). Thirty-three percent of the children had an underlying condition recognized to increase the risk of influenza-related complications, and 20% had other chronic conditions; 47% had previously been healthy. Chronic neurologic or neuromuscular conditions were present in one third. The mortality rate was highest among children younger than six months of age.
Source: New England Journal of Medicine, Volume 353, No. 24, 15 December 2005

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NOTE: The Infectious Diseases News Brief will not be published on December 30, 2005.

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The details given are for information only and may be very provisional. Where incidents are considered of national importance and are ongoing, the initial report will be updated as new information becomes available.