AN OUTBREAK DUE TO ENTEROHEMORRHAGIC ESCHERICHIA-COLI O157 H7 IN A CHILDREN DAY-CARE-CENTER CHARACTERIZED BY PERSON-TO-PERSON TRANSMISSION AND ENVIRONMENTAL CONTAMINATION/

An outbreak of gastrointestinal disease and haemolytic uraemic syndrom e caused by Escherichia coli 0157:H7 was investigated. The outbreak oc curred in a day care centre located in northern Germany in August 1992 and involved 39 children and two adults. Furthermore, four asymptomat ic infections were detected among the staff. Initial and secondary cas es were reported over a 30-day interval, with cases occurring in three waves. Person-to-person contact and environmental contamination were assumed to be the main mode of transmission. The source of the outbrea k has remained unknown but it is likely that primary or secondary cont amination of the day care centre's kitchen, too, played a role in the spread of infections. The organisms were isolated from two open packs of deep-frozen stuffed cabbage rolls and turkey scallops in batter, an d furthermore from swabs from two kitchen utensils. Of the 39 cases wi th diarrhoea, three developed a haemolytic uraemic syndrome; one of th e latter patients died. In 8 of the cases as well as in four healthy a dult employees, E. coli 0157:H7 was isolated from stool samples, and i n two stool culture-negative cases the presence of IgM antibody to 015 7 LPS indicated recent infection. The E. roll 0157:H7 isolates from th e cases and the kitchen were of identical phage type and yielded ident ical biochemical reactions. All E. coli 0157: H7 isolates harboured st able slt-II genes. However, slt-I genes could only be demonstrated in the primary cultures and were lost during subcultivation. This is the largest outbreak caused by enterohaemorrhagic E. coli 0157:H7 that has been documented in Germany so far. The high infectivity of the organi sm which was demonstrated by person-to-person transmission and propaga tion within certain groups of children stresses the need for strict hy gienic measures and early case reporting when such infections occur in susceptible settings like day care centres, nursing homes, or hospita ls.