Top 5 Takeaways

1. Outbreak Detection: The Oregon Health Authority Public Health Division (OPHD) identified an outbreak of Shiga toxigenic Escherichia coli in a child care center in August 2021.
2. Initial Cases: Two pediatric cases from the same household tested positive for Shiga toxin, with E. coli O157:H7 isolated from stool cultures.
3. Investigation: OPHD conducted case ascertainment, infection prevention education, and collected stool specimens from children and staff members at the child care center.
4. Pathogen Detection: BioFire FilmArray Gastrointestinal Panel testing identified multiple enteric pathogens, including enteropathogenic E. coli (EPEC), norovirus, rotavirus, sapovirus, astrovirus, and Campylobacter.
5. Public Health Response: The child care center was temporarily closed, and household members were informed to monitor for symptoms, resulting in no additional reported cases.

Original Article Author and Citation

Corresponding Author

Kimberly E. Bonner, voq2@cdc.gov, 503-484-0157

Suggested Citation

Bonner KE, Carter M, Zielinski C, et al. Notes from the Field: Enteropathogenic Escherichia coli Outbreak at a Child Care Center — Oregon, August 2021. MMWR Morb Mortal Wkly Rep 2022;71:527. DOI: http://dx.doi.org/10.15585/mmwr.mm7114a3

Summary

In August 2021, the Oregon Health Authority Public Health Division (OPHD) identified an outbreak of Shiga toxigenic Escherichia coli (STEC) in a child care center. Initial cases involved two pediatric patients from the same household who tested positive for Shiga toxin. During the investigation, OPHD collected stool specimens from children and staff at the center, identifying multiple enteric pathogens, including enteropathogenic E. coli (EPEC) and norovirus. The child care center was temporarily closed, and no additional cases were reported.

Methods

OPHD conducted case ascertainment, collected clinical information on gastrointestinal symptoms, and obtained stool specimens from children and staff members at the child care center. Stool specimens were tested using the BioFire FilmArray Gastrointestinal Panel to detect 22 enteric pathogens.

Discussion

This outbreak marked the first detected EPEC outbreak in Oregon. Several patients experienced coinfections with other enteric pathogens. The use of multiplex gastrointestinal assays has increased the detection of EPEC outbreaks. The public health implications of asymptomatic EPEC infections remain unclear, highlighting the need for guidance on managing EPEC outbreaks in congregate settings.

Conclusion

The outbreak was effectively managed through rapid identification, case ascertainment, and temporary closure of the child care center. The increasing detection of EPEC through multiplex assays underscores the need for specific outbreak management guidelines in child care and similar settings.

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