E. coli outbreak hits peninsula

Health authorities stumped by source; 5 cases confirmed

Posted: Thursday, July 20, 2000

An outbreak of the bacteriological infection E. coli on the Kenai Peninsula has public health authorities scrambling to find a connection between the people affected, so the spread of the disease can be stopped.

Dr. Michael Beller, a medical epidemiologist with the state Division of Epidemiology in Anchorage, said there have been five cases confirmed through laboratory tests; another five cases are suspected. The people became ill between July 11 and Monday, he said.

Marty Richman, director of Central Peninsula General Hospital in Soldotna, said three people were hospitalized at CPGH because of the infection.

Of the three, two were from Sterling and one from Kenai. One of them, a 26-year-old man, recovered and recently was discharged from CPGH. The other two, a 70-year-old woman and a 57-year-old man, are in stable condition in the hospital.

"We don't want to start a panic," Richman said. "It's out there all the time, but if people don't take the proper precautions preparing food, we have problems."

Of the 10 cases, there are two people from Soldotna, two from Kenai, three from Sterling and one from Anchorage. Beller did not know where the other two were from. The 10 range in age from 5 1/2 to 74 and are evenly broken down between genders.

It is not known if the 10 people had any connection with each other, such as eating at the same restaurant or shopping at the same grocery store.

"That's what we're working on right now," Beller said.

The source of the infection could be a restaurant, a church social, a backyard barbecue or a grocery store -- any place where food is bought or served, he said. Once a person is infected, they can then spread it from person to person through poor personal hygiene.

"That is a considerable problem, because if one person in a family is sick, they can spread it to others," Beller said. "However, it can be prevented by good hand washing and good hygiene in general."

According to the Centers for Disease Control and Prevention in Atlanta, Ga., infections also can occur as the result of swimming in or drinking sewage-contaminated water.

Clustered outbreaks like this, only the second Beller can remember in Alaska in the last 10 years, often come from common sources. Nevertheless, the state sees less than a dozen individual cases a year, he said.

Consequently, the state is taking the outbreak seriously, he said.

"There is the potential for a lot of harm to be done, and we want to stop it as fast as we can," he said.

The source of the disease can be anything from sprouts used on salads to unpasteurized juices such as apple cider to -- most commonly -- hamburger.

"When people buy a pound of hamburger at the grocery store, it's not all from one cow," Beller said. "If one poor cow out of 500 is infected, then all the hamburger gets infected."

Because E. coli can live deep inside a hamburger patty, the meat must be cooked well-done to kill it, he said. If a steak is contaminated, it is usually just on the surface, and is killed by grilling, even if the interior is rare, he said.

Symptoms of E. coli infection include stomach pain, diarrhea and, in some cases, bloody diarrhea, Beller said.

"That's what often leads people to get medical attention," he said.

The diarrhea can cause dehydration, which in severe cases can cause kidney failure. Likewise, extremely bloody diarrhea can cause a person to lose an excess amount of blood.

Dehydration is not usually a serious problem for healthy adults, but can be dangerous for the very young or the very old.

"If someone is dehydrated or has bloody diarrhea or renal failure, that needs to be managed," Beller said. "But treating diarrhea with antibiotics is unhelpful. It increases the chance of a patient having renal failure, which is not a good thing."

It's the diarrhea that flushes the intestines of the E. coli. An infection usually runs its course in four to five days.

Beller said this strain of the disease infecting the five confirmed cases is known as Escherichia coli O157:H7. There are many other strains, some harmful to humans, others not. The human gastrointestinal tract always has E. coli in it, but not usually a dangerous strain, Beller said. E. coli O157:H7 was first identified in hamburgers in 1982.

There are a reported 73,000 cases of infection and 61 deaths from E. coli in the United States each year.

Though cases on the peninsula started showing up over a week ago, the state didn't issue a public health alert until Wednesday afternoon because of the length of time it took to confirm an outbreak. The incubation period for E. coli can be anywhere from two to eight days. Richman said it also takes time for the CPGH laboratory to identify the disease, after which, the results had to be forwarded to the state for confirmation. He said he notified CPGH doctors at the beginning of the week of the outbreak.

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