ALERT – Important Information

2006PHALT002

TO: Emergency Medical Services, Hospitals, Infection Control Practitioners, Maine Correctional Facilities, Maine Primary Care, Maine Emergency Management Agency, Public Health Nurses, Public Health, Regional Resource Centers, School Nurses, State and Federal Agencies, Maine Lab Facilities, Border Medical Officers

FROM: Dora Anne Mills, M.D., M.P.H., Public Health Director

SUBJECT: Re: Multiple States Investigating a Large Outbreak of E. coli O157:H7 Infections

DATE: September 15, 2006

TIME: 1:00 PM

PAGES: 2

PRIORITY: Urgent

Confidentiality Notice: This fax message is intended for the exclusive use of the individual or entity identified above. It may contain information, which is privileged and/or confidential under both state and federal law. If you are not notified otherwise, any further dissemination, copying, or disclosure of the communication is strictly prohibited. If you have received this transmittal in error, please immediately notify us at 287-3252 and return the original transmission to us by mail at Key Bank Plaza, 6^th Floor-286 Water Street. Augusta, ME 04333, without making a copy. Your cooperation in protecting confidential information is greatly appreciated.

Re: Multiple States Investigating a Large Outbreak of E. coli O157:H7 Infections

Public health officials in multiple states, with the assistance of the Centers for Disease Control and Prevention, are investigating a large outbreak of E. coli O157:H7 infections. Thus far, 50 cases with matching pulsed-field gel electrophoresis (PFGE) pattern have been reported from CT (1), ID (3), IN (4), MI (3), OR (5), NM (2), UT (11), WI (20). Eight patients developed the hemolytic uremic syndrome (HUS) and one patient died. Most cases are recent: for those with known illness onset, the range of onset is 08/25/2006 to 09/03/2006. The outbreak is likely ongoing.

Preliminary findings from case interviews indicate that pre-packaged spinach is the most likely source. Additional investigation is necessary to determine the brand or brands of pre-packaged spinach involved. State and CDC investigators are working with FDA to quickly gather information to take action to protect the public. The FDA advises that consumers not eat bagged fresh spinach at this time.

The E. coli O157:H7 bacterium causes diarrhea that is often bloody and accompanied by abdominal cramps, but fever is absent or mild. The illness typically resolves within a week. However, some people, especially young children and the elderly, develop the hemolytic uremic syndrome, or HUS.

Year to date, the Maine CDC has received 13 reports of confirmed E. coli O157:H7 infections. Since August 1^st, 2006, seven confirmed cases of E. coli O157:H7 have been reported, two of which are related to the ongoing multi-state outbreak according to evidence from genetic “fingerprinting.” The Maine CDC continues to monitor and investigate reports of infections associated with shigatoxin producing organisms.

Recommendations: In addition to the FDA advisory to consumers not to eat bagged fresh spinach, healthcare providers and hospital laboratories are encouraged to test for shigatoxin production in persons with suspected E. coli infection and send broths to the Health and Environmental Testing Laboratory for O157 or non-O157 determination and confirmation.

For more information concerning E. coli O157 infection, please see the CDC website: http://www.cdc.gov/ncidod/diseases/submenus/sub_ecoli.htm.

For more information or to report suspect cases, please call the Maine CDC disease reporting and consultation line at 1 800 821 5821.

**ALERT – Important Information**

Re: Multiple States Investigating a Large Outbreak of E. coli O157:H7 Infections

ALERT – Important Information