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An outbreak of Escherichia coli O157 infection linked to paddling pools
J M Hildebrand1, H C Maguire, R E Holliman
1Merton, Sutton and Wandsworth Health Wilson Hospital, Mitcham, Surrey.
Insights
A 1993 London outbreak of Escherichia coli O157 infection sickened six children, with three developing severe haemolytic uraemic syndrome. Inadequate disinfection at paddling pools was identified as a likely source of this bacterial infection.
Area of Science:
- Infectious Diseases
- Public Health
- Pediatrics
Background:
- Community outbreaks of Escherichia coli O157 infection pose significant public health risks, particularly to children.
- Haemolytic uraemic syndrome (HUS) is a severe complication of E. coli O157 infection, with potential for fatal outcomes.
Purpose of the Study:
- To investigate a community outbreak of Escherichia coli O157 infection in South West London during the summer of 1993.
- To identify the source and transmission routes of the E. coli O157 outbreak among affected children.
- To inform public health interventions for preventing future outbreaks.
Main Methods:
- Case ascertainment and epidemiological investigation of affected children.
- Microbiological analysis of faecal specimens for E. coli O157 isolation and phage typing.
- Serological testing for antibodies to E. coli O157 lipopolysaccharide.
- Environmental sampling and analysis of water from suspected sources, including paddling pools.
Main Results:
- Six children in South West London were infected with E. coli O157, with three developing HUS and one fatality.
- E. coli O157 phage type 2 was identified in most cases, including a secondary case in a mother.
- Inadequate disinfection procedures at a paddling pool were implicated, with E. coli detected in the water.
- Exposure to paddling pools was a common factor among several cases.
Conclusions:
- Paddling pools with inadequate disinfection can serve as a source for community outbreaks of E. coli O157 infection.
- Prompt public health action, including improving disinfection protocols, is crucial to control such outbreaks.
- Enhanced surveillance and preventative measures are necessary to protect children from waterborne E. coli O157 infections.
Abstract:
In a one month period in the summer of 1993 a community outbreak of Escherichia coli O157 infection affected six children living within an area of 1.5 miles radius in south west London. Three children developed haemolytic uraemic syndrome, one of whom died. E. coli O157 phage type 2 was isolated from faeces in five cases and serological tests showed the sixth child had antibodies to E. coli O157 lipopolysaccharide. E. coli O157 phage type 2 was isolated from a faecal specimen from this child's mother who was a secondary case. Three of the cases, whose onset dates were within three days of each other, had all been exposed to a paddling pool where disinfection procedures were found to be inadequate. Samples of water taken from this pool contained E. coli, although not the O157 serotype. A fourth case had played at a different paddling pool in the three days before becoming ill. Action has been taken to improve disinfection procedures at municipal paddling pools in the London borough concerned.