Public Health Services, Health Protection Division
Mailing Address:
nd
110 King Street West, 2
P.O. Box 897
Floor, Hamilton, ON L8P 4S6
Phone: (905) 546-2063
Hamilton, ON L8N 3P6
Fax: (905) 546-4078
www.hamilton.ca
MEDICAL ADVISORY E. COLI NON-0157 MULTI-PROVINCIAL CLUSTER TO:
Family Physicians Emergency Departments Infectious Disease Physicians LTCH Administrators/Directors of Care Medical Laboratories Infection Control Professionals (please inform Labs) St. Joseph’s Centre for Ambulatory Health Services, Urgent Care
FOR YOUR INFORMATION: Central West Medical Officers of Health Academy of Medicine Dr. Richard McLean, VP Medical, Hamilton Health Sciences Dr. David Higgins, President, St. Joseph’s Healthcare Dr. Peter Fitzgerald, President McMaster Children’s Hospital Dr. Thomas Stewart, Chief of Staff, St. Joseph’s Healthcare FROM:
Dr. Jessica Hopkins
DATE:
March 23, 2017
CURRENT SITUATION Since January 4, 2017 there has been ongoing investigation of a multi-provincial cluster of E. coli non-0157 cases. As of March 14, 2017, the cluster consists of 26 confirmed cases, with 12 cases from British Columbia, five cases from Newfoundland, four cases from Saskatchewan, four cases from Alberta, and one case from the United States. Onset dates for the cases range from November 13, 2016 to February 26, 2017. Twenty-four isolates have been serotyped as E. coli O121. The investigation into potential sources of exposure is ongoing. To date, no cases have been identified on Ontario. Currently in Ontario, routine stool culture does not identify E. coli O121 or any other non-O157 shiga toxin-producing E. coli (STEC), also known as verotoxin-producing E. coli (VTEC); however, laboratory testing for E. coli O121 and other STEC is available at the Public Health Ontario Laboratory (PHOL) upon request. REQUESTED ACTIONS Public Health Ontario is requesting submission of stool specimens to PHOL for cases meeting the following criteria. Testing submission criteria: • The acute onset of bloody diarrhea or hemolytic uremic syndrome (HUS) when routine enteric cultures are negative for other enteric pathogens including E.coli O157:H7, and there is no other obvious etiology.
How to collect and transport test: • Stool samples should be collected in usual stool culture media (Cary‐Blair), and kept refrigerated if possible. • Prior to submitting a sample, call the PHOL Customer Service Centre toll free at 1‐ 877‐604‐4567 or 416‐235‐6556. After hours only, please contact the duty officer at 416‐605‐3113. Required information on the PHOL general test requisition: • Explicitly request for shiga toxin-producing E. coli (STEC) direct testing • Routine enteric culture negative for other enteric pathogens, including E.coli O157:H7 • Investigation number ONT-2017-001 • Symptoms, including whether HUS is present or suspected • Place and date of travel outside Ontario, if appropriate • Standard requirement for all laboratory submissions (including two personal health identifiers on both the requisition and the sample, submitter information, and date of collection) Where to send test: Send to the closest Public Health Ontario Laboratory with the completed requisition (see above for specifications for the requisition). For additional PHOL specimen information for shiga toxin, refer to http://www.publichealthontario.ca/en/ServicesAndTools/LaboratoryServices/Pages/Shiga_Toxin.aspx. If you have any questions about this advisory, or to report cases of verotoxin-producing E. coli including Hemolytic Uremic Syndrome (HUS), please contact Public Health Services, Infectious Disease Program at 905-546-2063, Monday to Friday 8:30 a.m. to 4:30 p.m. After hours, on holidays and on weekends please call 905-546-2063 and ask to speak with the Infectious Disease Public Health Inspector on call.
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