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E. coli outbreak at Calgary daycares largest in Alberta history

Calgary’s E. coli outbreak, which was declared on Sept. 4 after dozens of children presented to hospital with significant gastrointestinal illness, has become Alberta’s largest.

As of Sept. 12, there have been 264 lab confirmed cases of E. coli infection amongst children and a small handful of adults, stemming from what officials say was likely food from a centralized kitchen located near Eau Claire. The exact source of the infection is, as of Tuesday, unknown.

Dr. Mark Joffe, Chief Medical Officer of Health for Alberta, said that Alberta Health Services staff have been doing everything they can for the patients.

“Our physicians, our nurses, our lab staff, and other frontline providers are all working around the clock to provide the very best care to their patients. This has not been easy. The age of the children the severity of the illness, and the numbers involved have all made this extremely challenging,” he said.

Dr. Joffe said that AHS took swift action in closing the centralized kitchen operated by Fueling Minds Inc., and that prevented further spread of E. coli infections.

“Our public health physicians, inspectors in the entire public health team continue to investigate the cause of this outbreak, to work with those who have become ill to analyze incredibly large volumes of information and to ensure that everything possible is done before these daycares can safely reopen,” Dr. Joffe said.

“I want to be absolutely clear that this has been an extraordinary outbreak, both in terms of the numbers and the severity. It is certainly the largest E coli outbreak in Alberta that I’m aware of. It’s particularly serious, given that it has largely impacted young children who are at most risk of severe outcomes.”

The largest previous outbreak of E. coli in Alberta occurred in 2014, after people across the province ate tainted pork products. In that outbreak, 119 people were lab confirmed as infected, 23 were hospitalized, and six developed hemolytic uremic syndrome (HUS).

As of Tuesday, 25 people are currently in hospital—the majority at the Alberta Children’s Hospital—11 patients have been discharged, and 22 patients have developed varying severity of HUS.

Dr. Joffe said that on average, Alberta sees between 200 to 300 cases of E. coli per year in the province.

In order to treat the large number of patients requiring daily blood testing, clinics for patients of the outbreak have been set up at the Alberta Children’s Hospital, the Peter Lougheed Hospital, and the South Heath Campus.

Dr. Tania Principi, section chief, Pediatric Emergency Medicine, Alberta Children’s Hospital said that staff have been taking extraordinary measures including extra shifts to care for their child patients.

“We want to make sure that they don’t have to go through the busy emergency department and have long wait on top of what they’re already managing and dealing with,” she said.

Kitchen to remain closed, daycare centres reopening

Dr. Joffe said that the centralized kitchen would remain closed until AHS inspectors were satisfied that it is safe.

He said that the kitchen had been inspected five times this year, and that the average that a commercial kitchen is inspected once per year in Alberta.

"The latest inspection took place on September the fifth, immediately following the proactive closure of the kitchen. Prior to the closure, the facility had last been inspected in April 2023. Two infractions were found at that time, and they were immediately corrected as of the end of April 2023," Dr. Joffe said.

Records kept by Alberta Health Services show that the commercial kitchen had been inspected 12 times since July of 2021.

Among the critical issues found by inspectors were issues with a dishwasher that was insufficiently cleaning and sanitizing utensils, which was noted on July 27 and Aug. 9 in 2021, on Oct. 25 in 2022, and on January 25, January 26, April 26, and Sept. 5, 2023.

Another critical compliance issue noted by inspectors on Sept. 5 was that foods were being transported to other sites from the kitchen in excess of 90 minutes without temperature control, and that appropriate equipment to keep food cold was not available.

The kitchen was also noted to have had a significant pest control issue, with inspectors noting live adult cockroaches on the side of stainless steel equipment around the dishwashing area.

"During the inspection a week ago and these violations related to food handling, sanitation and pest control. There were also two non critical violations there identified related to an odor in the kitchen as well as the storage of some utensils. Now this information all together is part of the ongoing investigation report has been posted," said Dr. Joffe.

Seven of the childcare facilities where the outbreak occurred were set to be reopened on Tuesday.

"I want to reassure parents, as the closure orders are rescinded for the seven impacted child care facilities, that it is safe to send your children back," said Dr. Joffe.

"There's no reason to think that there's ongoing risk or contamination in the daycare sites, and those sites have all now undergone a thorough deep cleaning and disinfection. Again, with the removal of any of the contaminated potentially contaminated food sources, there is no reason to believe that there should be any ongoing risk, and most daycares are now set to reopen."

Investigation taking time because of complexity, lack of evidence

Adriana LaGrange, Minister of Health, addressed concerns about the length of time it was taking to get answers surrounding the outbreak by citing the complexity of the ongoing situation.

"We've been mobilizing all of the necessary components so that the work can be done, and we wanted to make sure when we came out, we had some information to share. So, we now seem to have more information that is worth sharing," she said.

"We have to come get down to the root cause of what the problem was. Figure it out and then make sure that it never happens again and utilize all of the all of the opportunities and technologies that are out there to help them."

Among the investigative techniques already having being utilized by the province were the collection of available food samples, genetic sequencing of this outbreak's E. coli strain, taking blood samples from people who were infected and not infected at the daycares to compare, and doing interviews with patients to determine what they ate prior to feeling sick.

The latter, given that the ages of the patients, has been a difficult part of the investigation said Dr. Joffe.