Prevention and Control of Communicable Diseases
Shiga toxin-producing Escherichia coli (STEC) and Hemolytic Uremic Syndrome (HUS)
Reportable to local or state health department
Consult the health department before posting/distributing Parent/Guardian fact sheet.
Cause
Shiga toxin-producing Escherichia coli bacteria
Symptoms
Watery or bloody diarrhea, stomach cramps, and low-grade fever. Some infected persons may have mild symptoms or no symptoms at all.
In some cases, people infected with STEC can develop HUS, which is a serious disease that affects the kidneys and the blood’s ability to clot. HUS is more common in children than in adults.
Spread
STEC bacteria leave the body through the feces of an infected person and enter another person when hands, food, objects (such as toys) contaminated with feces are placed in the mouth, or through contact with cattle or the farm environment. Cattle are a source of these bacteria. These bacteria can easily spread from person to person, especially from children in diapers.
Outbreaks have been linked to ground beef, exposure to animals in public settings including petting zoos, unpasteurized dairy products or fruit juices, raw fruits and vegetables, salami, yogurt, drinking water, and recreational water.
Incubation
For most E. coli strains is 10 hours to 6 days; for STEC, the incubation period usually is 3 to 4 days (range from 1 to 10 days) from exposure until symptoms develop.
Contagious Period
STEC bacteria can be transmitted as long as it is in the feces. STEC typically disappear from the feces by the time the illness is resolved, but may be shed for several weeks, even after symptoms go away. Young children tend to carry STEC longer than adults. A few people keep shedding these bacteria for several months.
Exclusion
Child Care: Until diarrhea has ceased for 24 hours, and two follow-up tests at the state public health laboratory obtained at least 24 hours apart have tested negative. Specimens should not be obtained earlier than 48 hours after discontinuation of antibiotics. Further requirements may be necessary during outbreaks.
The child care should be closed to new admissions during the outbreaks, and no transfer of exposed children to other centers should be allowed.
School: Until free of diarrhea for at least 24 hours. Further exclusion may be necessary during outbreaks.
No one with STEC should use swimming beaches, pools, water parks, spas, or hot tubs until 2 weeks after diarrhea has stopped.
Food service employees with STEC infection should be excluded from working in food service. An employee may return to work once they are free of the STEC infection based on test results showing 2 consecutive negative stool specimens that are taken at least 24 hours after diarrhea ceases, not earlier than 48 hours after discontinuation of antibiotics, and at least 24 hours apart; or the food employee may be reinstated once they have been asymptomatic for more than 7 calendar days.
Outbreaks: Screenings should be conducted by the Missouri State Public Health Lab.
Other restrictions may apply; call your local/state health department for guidance.
Diagnosis
Recommend parents/guardians call their healthcare provider if their child has symptoms of STEC or HUS.
Treatment
Diarrhea caused by STEC usually goes away after a few days without any treatment. Antibiotics and drugs to stop diarrhea are usually not recommended because they may actually increase the likelihood of HUS. Treatment of HUS usually requires hospitalization and often dialysis (artificial kidney) and blood or platelet transfusions. Vomiting and diarrhea may lead to dehydration, which may be a medical emergency.
Prevention/Control
- Regular and thorough handwashing is the best way to prevent the spread of communicable diseases. Wash hands thoroughly with soap and warm running water after using the toilet and changing diapers and before preparing or eating food. Staff should closely monitor/assist handwashing of all children, as appropriate, after they have used the bathroom or have been diapered.
- Restrict students from sharing any communal food items that are brought from home. In the classroom, children should not serve themselves food items that are not individually wrapped. The teacher should hand out these items after washing his/her hands. (This is not intended to discourage family- style serving in the absence of an outbreak.)
- Avoid having contact with cattle, particularly calves, at a petting zoo or farm. Wash hands thoroughly with soap and warm running water after touching any animals.
- Clean and disinfect diapering area and potty chairs after each use and bathroom toilets, sinks, and toys at least daily and when soiled.
- Clean and sanitize mouthed objects and surfaces at least daily and when soiled.
- Food Safety
- Thoroughly cook all hamburger or ground beef until it is brown, not pink, inside and the juices are clear. Heat kills the bacteria. Use a thermometer to ensure that the internal temperature of the meat is at least 155 o F.
- DO NOT drink unpasteurized milk or fruit juices.
- Wash and disinfect all cutting boards, knives, utensils, or dishes that have been used for raw meat before using with uncooked foods, such as fruits or vegetables, and cooked foods.
For more information, call the Missouri Department of Health and Senior Services (MDHSS) Bureau of Communicable Disease Control and Prevention at 573-751-6113 or 800-392-0272 (24/7), or call your local health department.
STEC Parent Fact Sheet
Your child may have been exposed to:
STEC
Shiga Toxin-Producing Escherichia Coli (STEC) Infection can cause a bacterial infection of the intestines.
If you think your child has STEC:
- Tell your child care provider and call the school.
- Need to stay home?
- Child Care:
Yes, until diarrhea has ceased for 24 hours, and two follow-up tests at the state public health laboratory obtained at least 24 hours apart have tested negative.
School:
Yes, until free of diarrhea for at least 24 hours.
- Child Care:
Symptoms
Your child may have watery or bloody diarrhea, stomach cramps, and fever. Most people get better within 5-7 days. Some infections are very mild, but others may result in life- threatening complications such as Hemolytic Uremic Syndrome (HUS).
If your child is infected with STEC, it may take 1 to 10 days for symptoms to start.
Spread
- By eating or drinking contaminated food or beverages.
- By touching contaminated hands, surfaces, or objects.
- By handling pets and farm animals.
Contagious Period
STEC bacteria can be transmitted as long as it is in the feces. STEC typically disappear from the feces by the time the illness is resolved, but may be shed for several weeks, even after symptoms go away. Young children tend to carry STEC longer than adults. A few people keep shedding these bacteria for several months.
Call your Healthcare Provider
- If anyone in your home is suspected of having STEC.
- Ask how to prevent dehydration. Your child may become dehydrated due to vomiting and diarrhea.
Prevention
- Wash hands after using the toilet and changing diapers and before preparing food or eating. Your child may need help with handwashing.
- Clean and disinfect any objects that come in contact with feces. This includes toilets (potty chairs), sinks, toys, and diaper changing areas. Use a product that kills bacteria.
- Farm animals (especially cattle and calves) can carry STEC. Wash your hands after touching pets and farm animals.
- Cook food thoroughly and do not drink unpasteurized milk or juice. Always sanitize food preparation surfaces.
- Anyone with STEC should not use swimming beaches, pools, water parks, spas, or hot tubs until 2 weeks after the diarrhea has stopped.
For more information, call the Missouri Department of Health and Senior Services (MDHSS) Bureau of Communicable Disease Control and Prevention at 573-751-6113 or 800-392-0272 (24/7), or call your local health department.