The Case

On July 24, 2000, two unusual events came to the attention of the City of Milwaukee Health Department. The first was receipt of several E. coli cultures in the health department's laboratory. The second was a call from the infection control nurse at Children's Hospital of Wisconsin who reported several children had been admitted with apparent E. coli-related diarrhea.

By the next day, the cultures were confirmed and several patient histories revealed a common dining experience at a local restaurant. An inspector from the health department visited the restaurant and assessed food handling practices and employee symptoms and collected specimens of food for culture. There was sufficient evidence to request the restaurant to remain closed pending further investigation.

The investigation and subsequent case interviews disclosed that the first diner, who was later proven to be infected with E. coli O157:H7, ate at the restaurant on July 12, 2000. The typical incubation period for E. coli O157:H7 is 3 to 4 days, but can range from 2 to 8 days. The first symptoms were developed by July 14 and by July 18, approximately 8 people per day were developing symptoms of diarrhea that later cultured positive. The first hospitalizations occurred around July 20 while the health department was still completely unaware of the outbreak in progress.

Ultimately, the City of Milwaukee Health Department identified 63 people with culture-proven E. coli O157:H7. Over twenty people were hospitalized, including four children who developed hemolytic uremic syndrome (HUS), a life-threatening complication. One of the children, a three-year old girl, died after a week-long battle with HUS.

The rapid, coordinated response of the City of Milwaukee Health Department to this E. coli outbreak was the same that would be required in response to any disaster. A bioterrorism incident could have presented itself in the same way. In fact, this possibility was not immediately ruled out. Contemporary public health challenges demand that public health agencies not only be proactive in prevention, but also prepared to respond quickly and definitively when the community is threatened.

Source:
Testimony by Seth Foldy, MD, Health Commissioner, City of Milwaukee Health Department at Wisconsin Assembly Committee on Public Health