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Daycares reopen in Calgary E. coli outbreak, source of infections remains under investigation

All of the daycares that were closed in Alberta’s largest E. coli outbreak that occurred over the September long weekend, have reopened.

Speaking to the media on Wednesday, officials from AHS said that decision came after all of the facilities underwent a deep clean, addressed any outstanding health issues, and were determined by inspectors to be safe for children to return.

“These daycares have addressed any immediate risks found, and have met all requirements under the Public Health Act related to sanitation and safe operations of each facility were met,” said Dr. Francesco Rizzuti, Medical Officer of Health, Alberta Health Services Calgary Zone.

“Children and staff from facilities with confirmed cases must meet certain requirements, including providing negative stool sample results and a rescind letter from Alberta Health Services before returning to any daycare facility.”

The number of lab confirmed cases in the outbreak has risen to 310, up from 264 on Sept. 12. The number of patients who were in hospital on Wednesday was 21, down from the day before, as has the number of Hemolytic Uremic Syndrome (HUS) patients which has dropped to 20 from 22 the day prior.

Dr. Tania Principi, Section Chief, Pediatric Emergency Medicine, Alberta Children’s Hospital, said that so far during the outbreak there had been 18 secondary infections of E. coli, which were all limited to the households of those originally infected.

“This is heartening and shows that our quick response and communication with families have helped to limit that spread,” she said.

“I know how incredibly difficult this has been for patients and their families. No child or family should have to go through this, and I want to thank the patients and families for their patients and the strength they have shown going through this.”

Outbreak cases likely to rise, but severity dropping

Dr. Principi said that as more tests are completed for individuals connected to the outbreak, the number of cases is likely to rise, but that the majority of these will be amongst individuals who are asymptomatic.

"It can be frightening to see these numbers jump in the last few days, and a lot of that has to do with process. So those that were symptomatic or affected, we saw early on and picked up coming through various emergency departments,” she said.

"As public health required testing of all children in the daycare and household contacts, we anticipated that there would be an increase in numbers... and so this increase in numbers we're seeing has more to do when we're getting results from the lab on those tested previously."

She said that the number of patients who were presenting to hospital with illness had dramatically decreased.

The age of the patients during the outbreak have been a concern to doctors, as the vast majority of those who had been infected had been of daycare age.

"Unfortunately for this type of E. coli with the ShiGa toxin, we know that that risk of HUS or what people have classified as severe infection, unfortunately, is higher in that age group. And so I think that's why you're seeing this increase of admitted patients compared to other outbreaks of E. coli,” Dr Principi said.

The current aim, said Dr. Principi, was to address the medical needs of children needing treatment for HUS.

"The kids are doing well, and our aim is that they'll be coming off dialysis and not needing further care,” she said.

Source of infection remains under investigation

Dr. Rizzuti said that the food source for the E. coli outbreak remained under investigation, and that thus far samples taken from the central kitchen had not yet revealed a definitive source of the infections.

"Public health inspectors went to the kitchen we collected a number of samples. Some of these were left over foods, and many of these were foods that were still in the freezer," he said.

"Anything that we could test we have taken for testing, and these are working through the lab process. To my knowledge, all of these so far have been negative. However, the samples do take some time for us to have that our confirmatory results."

Dr. Rizzuti stressed that the complexity of the investigation and the size of the investigation was leading to answers not being immediately available.

"We are working as efficiently as we can but we also want to ensure that we're being robust and and thorough in this investigation,” Dr. Rizzuti said.

He said that the kitchen was continued to be believed to be the source of the infections, and that it would remain closed until AHS inspectors were satisfied of its safety to the public.

"The kitchen will not be permitted to reopen from a public health perspective until we are satisfied that the violations have been addressed to our satisfaction,” Dr. Rizzuti said.