e. coli o157 scenario slides from 24 th march 2014 ellie hothersall @dundeepublich susan law...
TRANSCRIPT
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E. coli O157 scenario Slides from 24th March 2014
Ellie Hothersall @DundeePublicH
Susan Law @satl101
PLEASE NOTE: All names etc. are fictional
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Thursday afternoon
Toby Scott
5 years old
1 day history of haematuria
4 day history of diarrhoea
Currently in HDU in paediatrics
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What features suggest E coli infection?
•Diarrhoea
•Haematuria
•Child’s age
•Fever
•Rapid onset
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Haemolytic uraemic syndrome
• Generally starts with diarrhoea (can be bloody)
• Cramps
• Verocytotoxin-producing E coli (VTEC)
• 10% of VTEC cases thought to develop HUS
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Surveillance questionnaire
This link for Dundee students (password protected):
https://mbchb.dundee.ac.uk/publichealth/files/2014/03/20130502-Enteric-Form.doc
Link for Health Protection Agency surveillance form (England)
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Likely risk factors
Private water supply
Pet dog
Meat from local butchers’
Recent birthday party
Swimming
Nursery
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Contact tracing
Sister (Emilia, 8) also has diarrhoea
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Friday
Mother (Sarah Scott) now has diarrhoea
Which of the following jobs would mean she should excluded from working?
Hairdresser
Health care assistant
Car mechanic
Police woman
Journalist
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Lab report confirms E. coli O157 in Toby’s stool
Sample sent for genotyping
Still awaiting results for Emilia
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Later on Friday
Jayden Miller
Age 3
Bloody diarrhoea for 4 days
Lab confirms E. coli O157 for Emilia
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Waleed Ibrahim (7) diarrhoea, seen by same GP as saw the Scott family
Wilma Saunders, 45, 2 day history of bloody diarrhoea
Works in café at Clearwater farm
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What kind of study to we need here?
Prospective cohort
Retrospective cohort
Randomised controlled trial
Case control
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Cases
Cases
3 children, 2 adults
Controls
4 children, 4 adults
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Toby SToby S
Emilia SEmilia S
Rachel SRachel S
Sarah SSarah S
Jayden MJayden M
Wilma SWilma S
David SDavid S
Colm BColm B
Ashleigh MAshleigh M
Susan BSusan B
Steve SSteve S
Ryan BRyan B
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Risks identified
2 butchers
Swimming
Open farm
Private water supply
Primary school
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VTEC No VTEC
Ate meat from Flemming’s
butchers
2 3
Did not eat meat from
Flemming’s butchers
3 5
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VTEC No VTEC
Ate meat from Dobie’s butchers
1 2
Did not eat meat from
Dobie’s butchers
4 6
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VTEC No VTEC
Visited swimming pool
2 3
Did not visit swimming pool
3 5
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VTEC No VTEC
Visited Clearwater open farm
4 5
Did not visit Clearwater open farm
1 3
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VTEC No VTEC
Private water supply
2 6
Mains water supply
3 2
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VTEC No VTEC
Connection to Forbes Primary
school
2 3
No connection to Forbes
Primary school
3 3
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Location Odds ratio
Flemings butchers 1.1
Dobies butchers 0.75
Swimming 1.1
Open farm 2.4
Private water supply 0.2
Primary school 0.7
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Where is the likely source?
Flemings butchers
Dobies butchers
Swimming
Open farm
Private water supply
Primary school
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http://www.hpa.org.uk/webc/HPAwebFile/HPAweb_C/1317135762632
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Outbreak management team
Public health
Environmental health
Veterinary medicine
(Scottish) Government
Health and Safety Exec
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http://www.hpa.org.uk/webc/HPAwebFile/HPAweb_C/1317135818622
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http://www.face-online.org.uk/resources/preventing-or-controlling-ill-health-from-animal-contact-at-visitor-attractions-industry-code-of-practice
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http://www.face-online.org.uk/resources/preventing-or-controlling-ill-health-from-animal-contact-at-visitor-attractions-industry-code-of-practice
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http://www.face-online.org.uk/resources/preventing-or-controlling-ill-health-from-animal-contact-at-visitor-attractions-industry-code-of-practice