An outbreak of Shiga toxin-producing Escherichia coli serogroup O157 linked to a lamb-feeding event.
Fifteen confirmed cases and 15 possible cases of Shiga toxin-producing Escherichia coli (STEC) O157 phage type 21/28 were linked to direct contact with lambs at a 'Lambing Live' event in the North West of England between 29 March and 21 April 2014. Twenty-one (70%) of the cases were female, 23 (77%) were children aged <16 years, of whom 14 (46%) were in the 0-5 years age group. Five children developed haemolytic uraemic syndrome. Multilocus variable number tandem repeat analysis (MLVA) profiles on 14 human cases were indistinguishable, and 6/10 animal isolates had a MLVA profile identical to the outbreak profile. Whole-genome sequencing analysis revealed that all isolates, both human and animal, fell within a 5-single nucleotide polymorphism cluster indicating the isolates belonged to the same point source. On inspection of the premises, extensive and uncontrolled physical contact between visitors and animals was occuring within the animal pens and during bottle-feeding. Public areas were visibly contaminated with animal faeces. Information to visitors, and the infection control awareness demonstrated by staff, was inadequate. Managing the risk to visitors of STEC O157 infection at animal petting events and open farms requires implementation of stringent control measures by the operator, as outlined in the industry code of practice. Enforcement action is sometimes required to prevent high-risk activities taking place at both permanent and temporary attractions.
Cumbria and Lancashire Public Health England Centre,Chorley,Lancashire,UK.
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Rowell
Cumbria and Lancashire Public Health England Centre,Chorley,Lancashire,UK.
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King
Gastrointestinal Bacteria Reference Unit,Public Health England,Colindale,London,UK.
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Jenkins
Gastrointestinal Bacteria Reference Unit,Public Health England,Colindale,London,UK.
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Dallman
Field Epidemiology Service North West,Public Health England,UK.
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Decraene
Cumbria and Lancashire Public Health England Centre,Chorley,Lancashire,UK.
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Lamden
South Ribble Borough Council,Leyland,Lancashire,UK.
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Howard
Animal and Plant Health Agency,Veterinary Investigation Centre,Thirsk,North Yorkshire,UK.
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Featherstone
Field Epidemiology Service North West,Public Health England,UK.
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Cleary
D000293:Adolescent; D000818:Animals; D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks; D004739:England / Q000453:epidemiology; D004927:Escherichia coli Infections / Q000453:epidemiology* / Q000382:microbiology; D019453:Escherichia coli O157 / Q000235:genetics / Q000502:physiology*; D005260:Female; D016680:Genome, Bacterial; D006463:Hemolytic-Uremic Syndrome / Q000453:epidemiology* / Q000382:microbiology; D006801:Humans; D007223:Infant; D008297:Male; D018598:Minisatellite Repeats; D010802:Phylogeny; D020641:Polymorphism, Single Nucleotide; D012307:Risk Factors; D017422:Sequence Analysis, DNA; D034561:Sheep, Domestic; D055815:Young Adult
Gastrointestinal infections; Shiga-like toxin-producing E. coli; public health microbiology; veterinary epidemiology and bacteriology