An outbreak of E.coli at multiple daycares in Calgary has resulted in numerous hospitalizations and left officials perplexed at the exact source.
As of Wednesday afternoon, 96 lab-confirmed E.coli cases were linked to the outbreak, according to Calgary Zone medical officer of health Dr. Franco Rizzuti.
The number is a significant jump from the 56 reported cases on Tuesday.
More children have also been hospitalized as the week has gone on, 22 reported to be in hospital Wednesday, seven more than Tuesday. Sixteen of the kids are at the Alberta Children’s Hospital while six are at the pediatric ward of the Peter Lougheed Centre.
Rizzuti said a “handful” of children in hospital have developed more serious outcomes of their Shiga toxin-producing E. coli infection. He did not provide details on what those more serious outcomes were or how many, but noted that hemolytic uremic syndrome (HUS) is among the possibilities.
What caused the outbreak?
Alberta Health Services (AHS) has not yet identified a source of the infection. The Calgary Zone MOH said health inspectors were at the central kitchen linked to all of the daycares on Tuesday, taking food samples for further testing.
In total, 11 daycares have been shuttered “until issues are resolved.”
Rizzuti noted that when he declared the outbreak over the weekend, following multiple reports from hospitals of children with bloody diarrhea, the kitchen was in compliance with health inspections.
However, according to documents posted on the Alberta Health Services website, The Fueling Brains Academy Kitchen and one of the Fueling Brains daycare locations had been found in violation of public health regulations related to food handling before.
A central kitchen is an off-site facility that produces food to be delivered to multiple locations.
Andrea Hannen, executive director of the Association of Daycare Operators of Ontario, told Global News the centralized kitchen model “is not problematic in and of itself.”
She notes that there are a number of safeguards in place to ensure food and cooking surfaces are safe.
“It’s very difficult to know where the source of something like this is because it may not necessarily be in the kitchen itself. It could be something that came in with one of the food ingredients,” Hannen said.
Foods most likely to be contaminated with toxic strains of E.coli include raw or undercooked ground meat products, raw milk and vegetables, according to the World Health Organization (WHO).
Hannen says that many companies that specialize in catering for childcare centres and schools are seeing a big shift toward including fresher foods in menus.
The challenge, then, is that supply chains — not just catering companies or centralized kitchens — are dealing with a greater number of ingredients susceptible to E.coli contamination, Hannen says.
“It’s kind of a double-edged sword. You definitely want to have fresh, healthy, wholesome food, lots of fresh fruits and vegetables. But on the flip side that can potentially, in the supply chain, pose its own risks,” she said.
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How do central kitchens and catering systems work?
There are multiple ways in which a daycare’s food service can be organized.
One is a multi-site operation of daycare centres where one company runs a centralized kitchen for multiple daycares — which is the system linked to the outbreaks in Calgary. Food for, say, a dozen daycares is prepared in one kitchen and then transported.
Another system is where daycares enlist in catering from companies specialized in serving meals to schools and licensed childcare centres. These companies can service hundreds of daycares every day.
The third option is for daycares to have their own kitchen, with their own staff and chefs.
Daycares choose a system based on the size of their operation and what their facilities can accomodate, Hannen says.
What is E.coli?
E. coli stands for Escherichia coli, which is a type of fecal coliform bacteria. Jason Tetro, microbiologist and author of The Germ Code, explains that the bacteria is found in animal and human feces and survives in most environments.
The bacteria spreads through fecal matter from an infected animal or human, which leads to the contamination of hands or food that eventually end up in people’s mouths.
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“We know that the fecal-oral route, as gross as it sounds, is a normal process that occurs,” Tetro told Global News.
E.coli is a non-pathogenic bacteria, meaning it is not naturally infectious, but some strains produce toxins that cause illness.
Human bodies will try to eliminate toxins, Tetro says, which is what leads to the symptoms of an E.coli infection. That includes diarrhea which can turn bloody if the toxin starts to degrade the intestinal layer. From there, the toxin may enter the bloodstream which would then go to the kidneys and possibly lead to problems such as HUS.
Adults infected with E.coli will likely only experience stomach cramps and dehydration, Tetro says. Children are more vulnerable to severe outcomes due to their heightened susceptibility to toxins.
“If you find yourself in a situation where a child has been infected with a toxin-producing E.coli, you want to make sure that they have regular medical treatment and observation, which is essentially daily analysis, daily blood tests and if necessary, IV fluids to make sure they’re hydrated,” Tetro said.
“The sooner that we can pick up some troubles, whether it be stress, inflammation or whatever, the better the likelihood is that we’re going to be able to do what’s necessary to stop the problems that are occurring.”
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How to protect yourself and others from E.coli infection
The oral-fecal route of bacteria is very contagious, Tetro says, which is why infection prevention control is a huge issue in any environment.
“A daycare is probably one of the largest (environments) because it’s almost impossible to stop the spread of bodily fluids, including saliva, tears and of course, fecal matter,” he said.
The primary way of preventing infection is by washing hands with water and soap, Tetro says.
“When you touch your face with contaminated hands, there’s a good likelihood it’s going to get into your mouth, especially when it comes to children.”
Next, it’s important to ensure that food being eaten is safe by properly cooking and storing food items including vegetables and raw meat, Tetro says. It’s also essential that surfaces where food is prepared are disinfected after each use.
AHS has also launched a webpage for parents with more information about the outbreak investigation.
Hannen says parents with young children across the country shouldn’t worry now about sending their kids to daycare, unless they were affected by the current outbreak.
“The reality is thousands and thousands of these meals are served every day without incident. This isn’t necessarily a common occurrence,” she said.
–With files from Global News’ Adam Toy.
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