Randolph Girl
Stricken with E. coli
By Sandy Cooch

Mary Pavone of the White River Partnership tests the water at this spot on the White River in Bethel for E. coli, as well as taking samples for variables such as the water's phosphorous and nitrogen levels and its conductivity. These teses are performed weekly or monthly at various sites along the river by volunteers from the Partnership. (Herald / Tim Calabro)

Reported cases of human infection by the E. coli strain O157:H7 are relatively rare in Vermont, with somewhere between 2 to 18 cases reported annually over the last five years.

In Vermont, the disease has been mostly limited to isolated cases. However, the bacterial infection is readily spread and major outbreaks—for example, the Californian spinach that sickened dozens of people last year—do occur.

"Incredibly rare," is a serious complication of an O157:H7 infection, which destroys red blood cells and causes kidney failure, according to Gifford Medical Center pediatrician and medical director, Dr. Lou DiNicola. Only about 8% of those who seek treatment for the symptoms of O157:H7 infection go on to develop hemolytic uremic syndrome (HUS).

So it is surprising, worrisome, and perplexing that two young children from Central Vermont, a three-year-old from Randolph and a five-year-old from Barre, were rushed to Boston hospitals in the last week and a half, with O157:H7 infections and the potentially life-threatening complication, HUS.

Intensive care treatment for the two young patients has included blood transfusions and kidney dialysis.

The father of the Randolph three-year-old called The Herald from Boston yesterday, and reported that she was "still very sick but stable."

The father, who asked that the family not be identified, said his daughter remained on dialysis, but was doing better.

"She’s a fighter," he added.

The Randolph girl was diagnosed at the Gifford emergency room last Thursday, and then quickly taken to Dartmouth-Hitchcock Medical Center, and then to Massachusetts General Hospital, where she remains this week.

According to published reports, the Barre girl, diagnosed June 18 and still receiving treatment at Children’s Hospital in Boston, is recovering.

No Connection Found

Both Dr. DiNicola and Dr. Patricia Tassler, a state epidemiologist, said this week that the two cases appear at this point to be unrelated and isolated, and not part of a larger E. coli outbreak.

Dr. Tassler said she has spoken to the parents of both children and has been unable find anything to link the cases, nor to identify the source of their respective infections.

There are lots of ways to contract an E. coli infection, including contaminated foods or water (drinking or swimming), or contact with an infected person, usually through unwashed hands.

While E. coli outbreaks can usually be traced to a particular source—perhaps a meat packing plant or a daycare center—the source of individual "sporadic" cases can rarely be pinpointed, Dr. Tassler noted.

That fact that two Central Vermont children got E. coli infections that developed into the very rare and more serious HUS could just be an extraordinary coincidence, Drs. Tassler and DiNicola said.

However, Gifford’s medical staff remains on special alert for any of the hallmark symptoms of O157:H7 infection, and its serious complication, DiNicola said.

He noted that last week’s HUS diagnosis was the first case that he had seen in his 30 years at Gifford.

Most kids suffering from diarrhea have a "nuisance virus," but any young child with "profuse diarrhea, especially bloody," should be taken to the hospital for testing, he said. Stool testing can identify E. coli infection, and blood tests can identify HUS.

Dr. DiNicola urged parents with questions to contact their physicians.

Precautions

Dr. Tassler noted that E. coli has hundreds of strains, most of them harmless. The O157:H7 strain that sickens humans can be commonly found in the intestines of healthy cattle, deer, goats, and sheep, none of which are adversely affected by it.

Unsanitary food handling, spreading fresh manure on food crops, or storm water run-off from farms can put the bacteria in the human food supply and in open bodies of water.

Several common sense steps can reduce the likelihood of contracting an infection. The Centers for Disease Control (CDC) notes undercooked ground beef is the most common source of E. coli infections.

Dr. DiNicola also advised thoroughly washing "everything you eat," even those foods labeled "pre-washed."

DiNicola also feels that children should never be given unpasteurized milk, which could be contaminated during milking.

A small backyard swimming pool can also be a source of infection, he noted, if, for example, an infected child in diapers previously used it.

Municipal pools are safe, because their waters are chlorinated, but open bodies of water can have high levels of E. coli due to farm run-off, especially after rains.

This week, Mary Russ, executive director of the White River Partnership, issued a report on E. coli levels in the White River Watershed.

She noted that in the six years that volunteers have been testing 26 sites in the watershed, E. coli levels have been dropping. However, after a big rain, numbers can soar, especially in smaller streams where farm or sewer run-off can have a big impact.

At those times, she said, it would be better not to let children swim in the local swimming hole. Russ’s report on river water testing will be in next week’s Herald.