title: Epidemic Escherichia coli O157:H7 gastroenteritis and hemolytic-uremic syndrome in a Canadian inuit community: intestinal illness in family members as a risk factor.
abstract: OBJECTIVE
  To evaluate risk factors for childhood hemolytic-uremic syndrome (HUS) and gastroenteritis during an epidemic of Escherichia coli O157:H7 infection.
  
  
  METHODS
  Case-control study.
  
  
  METHODS
  Remote Inuit community of Arviat in northern Canada.
  
  
  METHODS
  Of the 565 Arviat residents less than 15 years of age, 19 had HUS and 65 more had E. coli O157:H7 gastroenteritis. The 19 children with HUS were compared with 19 age- and gender-matched children with uncomplicated E. coli O157:H7 gastroenteritis, and both HUS and gastroenteritis patients were compared with 19 healthy control subjects.
  
  
  METHODS
  Questionnaire administered face-to-face to parents of participants in the home.
  
  
  METHODS
  Rates of exposure to foods, travel, sources of water, and gastrointestinal illness in family members.
  
  
  RESULTS
  Patients with HUS and those with uncomplicated E. coli O157:H7 gastroenteritis differed only on measures of clinical severity. In the 7 days before the onset of gastrointestinal symptoms, children with HUS and those with uncomplicated gastroenteritis were more likely to have been exposed to a family member with diarrhea than were the healthy control subjects (odds ratio = 9 for HUS vs healthy control subjects; 95% confidence interval 2 to 43; p < 0.01). Undercooked ground meat and foods traditionally consumed by the Inuit were not implicated as risk factors in E. coli O157:H7 infection.
  
  
  CONCLUSIONS
  These findings emphasize the potential for extensive intrafamilial transmission of verotoxin-producing E. coli once infection is introduced into certain communities.
authors.affiliation: Canadian Pediatric Kidney Disease Reference Centre, Ottawa, Ontario.
authors.forename: P C
authors.initials: PC
authors.lastname: Rowe
authors.forename: E
authors.initials: E
authors.lastname: Orrbine
authors.forename: M
authors.initials: M
authors.lastname: Ogborn
authors.forename: G A
authors.initials: GA
authors.lastname: Wells
authors.forename: W
authors.initials: W
authors.lastname: Winther
authors.forename: H
authors.initials: H
authors.lastname: Lior
authors.forename: D
authors.initials: D
authors.lastname: Manuel
authors.forename: P N
authors.initials: PN
authors.lastname: McLaine
mesh_terms: D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D003967:Diarrhea / Q000453:epidemiology; D004196:Disease Outbreaks; D004926:Escherichia coli / Q000145:classification*; D004927:Escherichia coli Infections / Q000453:epidemiology* / Q000635:transmission; D005192:Family Health; D005260:Female; D005759:Gastroenteritis / Q000453:epidemiology* / Q000382:microbiology; D006463:Hemolytic-Uremic Syndrome / Q000453:epidemiology* / Q000382:microbiology; D006801:Humans; D007223:Infant; D004930:Inuit; D008297:Male; D015873:Northwest Territories / Q000453:epidemiology; D012307:Risk Factors; D012959:Socioeconomic Factors