1. E. coli O157 NHS Dumfries and Galloway Health Protection Team

2. www.dghps.org

3. We will cover: What is E. coli O157? Transmission and sources Clinical features of illness Public Health Function Exercise

4. We will cover: What is E. coli O157? Transmission and sources Clinical features of illness Public Health Function Exercise

5. What is E. coli O157? A bacterium that can live harmlessly in the gut of wild, farm and domestic animals (especially cows and sheep)

6. Scotland 200 – 250 cases a year. Consistently the highest rate in the UK and among the highest in Europe.

8. We will cover: What is E. coli O157? Transmission and sources Clinical features of illness Public Health Function Exercise

9. Transmission Humans only need to ingest a minute amount to become infected – Hands, food, water, or environmental surfaces are even faintly contaminated this may result in infection Person to person transmission – Faeco-oral route – Incubation period 1-14 days, usually 3-4 days – Excretion period 2-4 weeks

10. Transmission – Most common sources Direct contact with animals (stroking, petting, handling) especially at farm parks and animal sanctuaries. Any land or water where animals have been, especially in wet weather. Bacteria can be swallowed in contaminated water or get on hands from shoes, clothes, fences and gates.

11. Transmission – Most common sources Person to person contact in households and institutions (eg nurseries) on hands, surfaces, handles, shared items such as toys, kitchen utensils, towels, toilets Contaminated food eg undercooked meat (especially beef), unpasteurised milk, raw salad and veg.

12. We will cover: What is E. coli O157? Transmission and sources Clinical features of illness Public Health Function Exercise

13. Clinical Features Spectrum of illness: Mild diarrhoea Abdominal pains Pyrexia Bloody diarrhoea Haemolytic Uraemic Syndrome (HUS) Renal failure Death

14. HUS HUS is caused by verocytotoxin produced by several serotypes of E. coli including O157 – Approximately 10% of people infected with E. coli O157 will develop HUS – <= 5% of these will die Most at risk: – children <5 – elderly aged >60 – pregnant women and those who are otherwise immunosuppressed or in poor health Deterioration in the patient’s condition can be very rapid

15. We will cover: What is E. coli O157? Transmission and sources Clinical features of illness Public Health Function Exercise

16. Public Health Function Aims: Identify all cases and contacts and ascertain whether there is an outbreak Determine possible sources and vehicles of infection Implement control measures to prevent further spread and reduce morbidity and mortality Maximise opportunities to educate and advise on prevention

17. Public Health Function Coordinating Function – GP/Clinician – Public Health Team – Environmental Standards

18. We will cover: What is E. coli O157? Transmission and sources Clinical features of illness Public Health Function Exercise

19. Question 1 The Microbiology laboratory phone to say that they have a probable E. coli O157 case and give details of a 2 year old girl from Sanquhar. What do you need to do?

20. Question 2 The GP is managing the child at home, the child currently has mild diarrhoea but no obvious blood in stools. What needs to happen now?

21. Question 3 What is the rationale of taking blood?

22. Question 4 Who needs to be informed now?

23. Question 5 Child’s mother (age 31) works as a nurse in DGRI on a medical ward, father (aged 33) is a builder. The Siblings – brother (aged 8) is at Sanquhar Primary School, the other brother (aged 6) is also at Sanquhar primary school. The sister (who is 3 years old) is at nursery in Sanquhar. What will you now do?

24. Question 6 Who investigates the case to identify the source of infection?

25. Question 7 Mother is excluded from work as is 3 year old child at nursery and 6 year old sibling. Who needs to be informed?

26. Question 8 Mother now becomes symptomatic and is positive for E coli O157. The 8 year old and 3 year old are also positive. What do you need to do?

27. Question 9 What are the likely sources of E. coli O157 in Dumfries & Galloway?

28. Question 10 What information resources have we got?