Wisconsin Division of Public Health Disease Surveillance Manual (EpiNet, February 2005)
I. IDENTIFICATION
A. CLINICAL DESCRIPTION: An infection of variable severity characterized by diarrhea (often bloody), abdominal cramps and fatigue. Illness may be complicated by hemolytic uremic syndrome (HUS) or thrombotic thrombocytopenic purpura (TTP); asymptomatic infections may also occur.
B. REPORTING CRITERIA: Laboratory confirmation.
C. LABORATORY CRITERIA FOR CONFIRMATION:
- Isolation of Escherichia coli O157:H7 or E. coli O157:NM from a clinical specimen, OR
- Isolation of Shiga toxin-producing E. coli O157:NM from a clinical specimen.
NOTE: Strains of E. coli O157:H7 that have lost flagellar “H” antigen become non-motile and are designated “NM”.
D. WISCONSIN CASE DEFINITION: A case that is laboratory confirmed.
II. ACTIONS REQUIRED / PREVENTION MEASURES
A. WISCONSIN DISEASE SURVEILLANCE CATEGORY II: Report to the patient's local health officer on an Acute and Communicable Disease Case Report (DPH 4151) or other means within 72 hours of the identification of a case or suspected case.
B. EPIDEMIOLOGY REPORTS REQUESTED:
- Acute and Communicable Disease Case Report (DPH 4151)
- Routine Enteric Follow-up Worksheet (All sections requested)
C. PUBLIC HEALTH INTERVENTIONS:
- Conduct case-control investigation if two or more cases occur in close geographic or temporal setting or if cases share a common potential exposure (e.g., restaurants, recreational water, community event, farm or animal-related exposure).
- Assess case for association with high-risk (e.g., day care, food handling, or health care provider).
- Educate public about proper hand washing after using the toilet or handling contaminated clothing or linens, before cooking, or associating with high-risk individuals.
- Exclude infected individuals from high-risk settings until they are asymptomatic AND two consecutive negative stool cultures (collected at least 24-hours apart and obtained at least 48 hours after discontinuance of antimicrobial therapy) are obtained.
- Source investigation by LHD.
- Determine if case is outbreak-related and notify DPH Regional Office or CDES.
- Obtain E. coli O157:H7 isolate from laboratory and forward to the Wisconsin State Laboratory of Hygiene for pulsed-field gel electrophoresis analysis.
III. CONTACTS FOR CONSULTATION
A. BCDP / COMMUNICABLE DISEASE EPIDEMIOLOGY SECTION: (608) 267-9009.
B. REGIONAL STAFF: See Epinet Introduction: “REGIONAL OFFICE CONTACTS”.
C. WSLH / BACTERIOLOGY: (608) 263-3421.
IV. RELATED REFERENCES1. “E. coli 0157:H7 Infections” DPH Disease Fact Sheet Series: View a list of all current Communicable Disease Fact Sheets
2. Heymann DL, ed. DIARRHEA CAUSED BY ESCHERICHIA COLI 1. DIARRHEA CAUCED BY ENTEROHEMORRHAGIC STRAINS. In: Control of Communicable Diseases Manual. 18 th ed. Washington , DC : American Public Health Association, 2004:160-170.
3. Pickering LK, ed. Escherichia coli Diarrhea (Including Hemolytic-Uremic Syndrome). In: Red Book: 2003 Report of the Committee on Infectious Diseases. 26 th ed. Elk Grove Village , IL : American Academy of Pediatrics, 2003:275-280.
4. CDC. Outbreak of Escherichia coli O157:H7 Infection Associated With Eating Fresh Cheese Curds – Wisconsin , June 1998.
V. DISEASE TRENDS
E. coli O157:H7 / Shiga Toxin-Producing E. coli (Non-O157) / HUS Work Sheet
