title: Two outbreaks of diarrhoea in nurseries in Norway after farm visits, April to May 2009.
abstract: During a 2009 nationwide outbreak of sorbitolfermenting Escherichia coli O157 in Norway, the Norwegian Institute of Public Health was notified of diarrhoea outbreaks in two nurseries. A link to the nationwide outbreak was suspected and investigated, including retrospective cohort studies. Both nurseries had recently visited farms. Faecal specimens were obtained from symptomatic children as well as from the farm animals and tested for Campylobacter, Salmonella, Yersinia, Shigella and pathogenic E. coli, and isolates were further characterised. Nursery A had 12 symptomatic children, and we found the same strain of C. jejuni in faeces from children and lambs. Nursery B had nine symptomatic children, including one child with bloody diarrhoea carrying enterohaemorrhagic E. coli (EHEC) O26. EHEC O26 with a similar multiple-locus variable number tandem repeat analysis (MLVA)-profile was found in sheep. Five children had enteropathogenic E. coli (EPEC) O76. Animals were not tested for EPEC O76. We found no significant association between illness and risk factors for either nursery. The isolated pathogens differed from the one involved in the nationwide outbreak. In each nursery outbreak, the pathogens isolated from children matched those found in farm animals, implicating animal faeces as the source. Hygiene messages are important to prevent similar outbreaks.
authors.affiliation: Department of Infectious Disease Epidemiology, Norwegian Institute of Public Health, Oslo, Norway. janne.moller-stray@fhi.no
authors.forename: J
authors.initials: J
authors.lastname: Møller-Stray
authors.forename: H M
authors.initials: HM
authors.lastname: Eriksen
authors.forename: T
authors.initials: T
authors.lastname: Bruheim
authors.forename: G
authors.initials: G
authors.lastname: Kapperud
authors.forename: B A
authors.initials: BA
authors.lastname: Lindstedt
authors.forename: Å
authors.initials: Å
authors.lastname: Skeie
authors.forename: M
authors.initials: M
authors.lastname: Sunde
authors.forename: A M
authors.initials: AM
authors.lastname: Urdahl
authors.forename: B
authors.initials: B
authors.lastname: Øygard
authors.forename: L
authors.initials: L
authors.lastname: Vold
mesh_terms: D000818:Animals; D000829:Animals, Domestic; D002169:Campylobacter Infections / Q000453:epidemiology / Q000382:microbiology; D016123:Campylobacter jejuni / Q000235:genetics / Q000302:isolation & purification*; D002417:Cattle; D002648:Child; D002675:Child, Preschool; D003967:Diarrhea / Q000175:diagnosis* / Q000453:epidemiology / Q000382:microbiology; D004196:Disease Outbreaks; D004926:Escherichia coli / Q000235:genetics / Q000302:isolation & purification*; D004927:Escherichia coli Infections / Q000453:epidemiology / Q000382:microbiology; D005243:Feces / Q000382:microbiology; D006801:Humans; D009664:Norway / Q000453:epidemiology; D009724:Nurseries, Infant; D020641:Polymorphism, Single Nucleotide; D012189:Retrospective Studies; D012756:Sheep; D020080:Tandem Repeat Sequences