Epidemic Escherichia coli O157:H7 gastroenteritis and hemolytic-uremic syndrome in a Canadian Inuit community: Intestinal illness in family members as a risk factor

• Published in: The Journal of pediatrics Vol. 124; no. 1; pp. 21 - 26
• Main Authors: Rowe, Peter C., Orrbine, Elaine, Ogborn, Malcolm, Wells, George A., Winther, Wendy, Lior, Hermy, Manuel, Douglas, McLaine, Peter N.
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 1994; Elsevier
• Subjects: Bacterial diseases; Bacterial diseases of the digestive system and abdomen; Biological and medical sciences; Case-Control Studies; Child; Child, Preschool; Diarrhea - epidemiology; Disease Outbreaks; Escherichia coli - classification; Escherichia coli Infections - epidemiology; Escherichia coli Infections - transmission; Family Health; Female; Gastroenteritis - epidemiology; Gastroenteritis - microbiology; Hemolytic-Uremic Syndrome - epidemiology; Hemolytic-Uremic Syndrome - microbiology; Human bacterial diseases; Humans; Infant; Infectious diseases; Inuits; Male; Medical sciences; Northwest Territories - epidemiology; Risk Factors; Socioeconomic Factors; Canada; North America; America; Northwest Territories; OR; CI; VT; HUS; Human; Urinary system disease; Hemolytic uremic syndrome; Family study; Escherichia coli; Gastroenteritis; Hemopathy; Hemolytic anemia; Renal failure; Risk factor; Digestive diseases; Bacteria; Intestinal disease; Transmission from man to man; Child; Enterobacteriaceae; Gastric disease
• ISSN: 0022-3476; 1097-6833
• DOI: 10.1016/S0022-3476(94)70249-7

Objective: To evaluate risk factors for childhood hemolytic-uremic syndrome (HUS) and gastroenteritis during an epidemic of Escherichia coli O157:H7 infection. Design: Case-control study. Setting: Remote Inuit community of Arviat in northern Canada. Participants: Of the 565 Arviat residents less than 15 years of age, 19 had HUS and 65 more had E. coli O157:H7 gastroenteritis. The 19 children with HUS were compared with 19 age- and gender-matched children with uncomplicated E. coli O157:H7 gastroenteritis, and both HUS and gastroenteritis patients were compared with 19 healthy control subjects. Interventions: Questionnaire administered face-to-face to parents of participants in the home. Main outcome measures: Rates of exposure to foods, travel, sources of water, and gastrointestinal illness in family members. Results: Patients with HUS and those with uncomplicated E. coli O157:H7 gastroenteritis differed only on measures of clinical severity. In the 7 days before the onset of gastrointestinal symptoms, children with HUS and those with uncomplicated gastroenteritis were more likely to have been exposed to a family member with diarrhea than were the healthy control subjects (odds ratio = 9 for HUS vs healthy control subjects; 95% confidence interval 2 to 43; p <0.01). Undercooked ground meat and foods traditionally consumed by the Inuit were not implicated as risk factors in E. coli O157:H7 infection. Conclusions: These findings emphasize the potential for extensive intrafamilial transmission of verotoxin-producing E. coli once infection is introduced into certain communities. (J P EDIATR 1994;124:21-6)