General Questions

What is E. coli?

E. coli is a type of bacteria that can cause diarrhea, which may be bloody. Certain strains of E. coli can cause more severe illness. Most individuals who get sick from E. coli improve without specific treatment within 10 days, but a proportion may develop more severe complications. Children, older adults, and those who are immunocompromised are at greater risk of complications from this strain of E. coli.

The type of E. coli related to this outbreak, Shiga toxin-producing E. coli (STEC) is different than typical E. coli infections in that it produces a toxin that can cause complications. STEC is a type of bacteria that can cause diarrhea, which may be bloody. Symptoms also include stomach cramps, vomiting and fever. Antibiotics are not helpful for this infection although your health care provider may provide them for other clinical reasons.

What are STEC (E. coli) symptoms?

You may have symptoms like diarrhea, stomach cramps, nausea, and vomiting. Symptoms usually start one to 10 days after eating food contaminated with the E. coli bacteria. If the infection is more serious, you may have a fever, bloody stool, or other symptoms.

What should I do if my child or I have symptoms?

If you have a connection to this outbreak (you or a family member attended any of the closed daycare facilities) and you start to develop symptoms, see a health care provider for assessment and have stool testing for STEC. If children develop severe symptoms (e.g., bloody diarrhea), visit an urgent care clinic or an emergency department as soon as possible. If known, it's important that you mention your possible exposure to STEC (E. coli) either prior to arrival or immediately upon arrival at the healthcare facility.

If your child attends a daycare connected to the outbreak, please also report any symptoms to your daycare operator as soon as possible.

What should I do if my child or I do not have symptoms?

If you or your child do NOT have any gastrointestinal symptoms e.g., diarrhea, nausea, vomiting, stomach cramps, or a fever without any respiratory symptoms and have NOT been told by AHS to be tested, you do not require testing or treatment at this time and can remain at home and continue to monitor for symptoms. AHS will continue to update the public with information on this investigation as it becomes available.

What is Hemolytic Uremic Syndrome (HUS) and what do parents and caregivers need to know about it?

HUS is a complication of STEC (E. coli) that affects the blood and kidneys. Children under five years of age are at the highest risk. Approximately 15% of children with STEC (E. coli) diarrhea develop HUS and 50% of those children may require dialysis. If you or your child tests positive for STEC (E. coli) it is important to seek medical care so a physician can evaluate and conduct additional testing to monitor for HUS.

How can I reduce the risk of transmission within our family?

If you are caring for someone who is ill with STEC (E. coli) or who may have been exposed to STEC (E. coli), wash your hands frequently to limit the risk of transmission.

Make sure persons with diarrhea, especially children, wash their hands carefully and frequently with soap to reduce the risk of spreading the infection.

Wash your hands often, including after you go to the washroom, before you prepare food, after you touch raw meat, after you change diapers, and before you eat.

Are there any tips for cleaning and sanitizing the home?

Rinsing with clean warm water, then wiping, spraying, or soaking for two minutes with sanitizers (like chlorine bleach) to kill germs, followed by airdrying. It's important to follow manufacturer's instructions to use sanitizers effectively and safely. Visit MyHealth.Alberta.ca for more information.

How did this outbreak occur?

Based on the epidemiology of the cases we've seen to date, it is highly likely the source of this outbreak is food that was distributed from the central kitchen. At this point, AHS has collected food samples for testing and awaiting results. At this time, AHS has not been able to identify a food item that was the source. We continue to investigate.

When can my child return to daycare?

To ensure the safety of others and to reduce transmission, young children (those not 5 years or older by Dec 31, 2023) and staff from facilities that were issued site-wide or room-wide exclusion orders who have had no gastrointestinal symptoms must test negative for STEC (E. coli) before they can attend any childcare facility. Children who attended a childcare room or facility impacted by STEC and had symptoms must provide at least one negative stool sample 48 hours after symptom resolution (diapered children will need to provide two, 24 hours apart).

AHS will only provide those children and staff with clearance to return to daycare once they have reviewed those negative tests. Health Link or Environmental Public Health will inform parents of completed lab results and will issue them with clearance letters when appropriate.

Please note that a verbal rescind does not qualify children or daycare staff to return to their site. Parents require a written rescind notice/clearance letter from AHS to qualify their child to return to their specific daycare site

It is crucial for parents who have children who attend these daycares to follow the guidance being given to them by healthcare professionals. If you have received an exclusion order, please keep your children at home. Only send your child to a childcare facility once you have been issued a clearance letter from AHS.

Testing

Who must/should get tested?

Stool testing can be used to help identify individuals with STEC (E. coli). AHS contacts all individuals and families that have been exposed to this outbreak and provides specific testing guidance for these affected individuals.

You MUST get testing if you are a:

• Daycare attendee of any of the closed facilities with gastrointestinal symptoms on or after August 25, 2023
• A parent/caregiver, sibling who will not be 5 years old by December 31, 2023, or any other person living in the same house as an attendee who has gastrointestinal symptoms
  • AND you either attend a daycare or work as a food handler, childcare or healthcare staff regardless of symptoms.

You SHOULD get testing if you are a:

• Parent/caregiver, sibling, or any other person living in the same house as the attendee with gastrointestinal symptoms on or after August 25, 2023
• Anyone experiencing symptoms should seek medical care to be evaluated before being tested.
• If you and your child do not have symptoms and have not been contacted by AHS, you do not require stool testing.

How do I access testing?

If you have symptoms, it is recommended to get testing done after a medical evaluation by a family doctor or in an emergency department or urgent care center. If you do not have symptoms, testing kits can be accessed at their childcare facility (if you have no symptoms, only seek testing if you have been informed by AHS to get testing).

Test kits are also available for collection and drop-off at the Provincial Laboratory for Public Health located at Foothills Medical Centre, Special Services Building on the ground floor, 3030 Hospital Drive NW, Calgary. The entrance is on the south side of the Foothills Medical Centre and open seven days a week, 7 a.m. to 7 p.m.

Where can I find my testing results?

AHS Public Health staff have started to contact individuals directly to discuss test results and discuss any new symptoms. Verbal and written rescind notices will be provided as they are confirmed. We appreciate your patience as we carefully work through this process. Individuals will be updated directly. Please do not call AHS or Health Link for results.

Individuals who do not have symptoms should not come to healthcare facilities for testing or results, except to collect test kits at the Provincial Laboratory (location and hours above).

How do I get my rescind notice/clearance letter?

After a stool specimen is submitted to the lab, it can take up to 5 days for the AHS Public Health team to receive your result. AHS will review the results and determine eligibility for a rescind notice/clearance letter. AHS will then phone individuals to confirm eligibility for a rescind notice/clearance letter.

AHS will provide both a verbal and written rescind notice/clearance letter. Please note that a verbal rescind does not qualify children or daycare staff to return to their site. Parents require a written rescind notice/clearance letter from AHS to qualify their child to return to their specific daycare site.

When should the first stool test be done if I qualify for testing? Do symptoms need to be resolved?

If you have not yet been tested, the first stool test can be done as soon as you are able to access it.

If you have been tested and have been notified that you will need to provide additional stool tests to ensure you are no longer infectious, additional testing should be done two days after your symptoms have resolved.

For people who require two negative tests, what is the required spacing between test 1 and test 2?

These tests should occur at least 24 hours apart and 48 hours after symptoms have resolved.

How long does it take to get test results?

The Laboratories are currently processing a large volume of stool specimens related to this outbreak. Initial positive results may be available within 24- 48h. Negative results typically take up to five days.

If you are waiting for results to help you return to daycare or work, those tests may take about five days for a negative result.

Why does it take up to five days to get a negative result?

Getting a negative result is important to determine if someone is considered infectious and if they can return to daycares or work. An accurate negative result may take a few more days to confirm than a positive result. The timing to get results back may also be impacted by the total number of tests being processed in lab facilities.

Isolation

When should someone isolate?

If an individual has STEC (E. coli) symptoms (diarrhea, nausea, stomach cramps, vomiting, fever), they should not attend schools/daycares or work, especially work that involves food handling or caring for children, patients, or seniors.

Everyone with symptoms should remain home until at least two days after symptoms have resolved, regardless of their test result. Some individuals, including diapered children who attend daycare, adults who work in food handling, healthcare and/or childcare, or other special circumstances will be informed and may need to stay home for longer and require negative tests before returning to those settings.

Who is considered a STEC 'contact'?

A contact is anyone who has likely had an exposure to STEC. This typically refers to caregivers, members of the same household, or those exposed to the same source as someone ill with STEC.

Can I take my child to another daycare (mine is closed), dayhome, friend's house or other setting outside my home?

Your child may be at risk of spreading their illness to others so should not go to another daycare or visit others if:

• If your child is symptomatic, and/or
• tested positive for STEC (E. coli), and/or
• has been told by AHS that they are a contact who is currently excluded from higher risk settings.

One or more of my children has attended a childcare setting associated with this outbreak. Can my other children go to school?

If your other children are school-aged and have not had symptoms, they can go to school. If your other children have symptoms, they should remain home until two days after their symptoms resolve. AHS may recommend testing for other children in the home.

Can family members in the same household use the same bathroom?

If there is one bathroom in your home for all family members, everyone can use the same one and proper hand hygiene should be done after using the bathroom. If there are multiple bathrooms, those who are ill can use one while other family members use the other(s).

I see my child-care site is listed under 'Exclusion Order.' What does that mean?

A childcare site under 'Exclusion Order' means that there have been cases of STEC associated with this facility and that it will remain closed until further direction is provided.

When will closed sites re-open?

Currently, sites are expected to re-open during the week of September 11, 2023. However, depending on your individual circumstances (for example if you have symptoms, have tested positive for STEC, are a contact still excluded from high-risk settings) you or your child may not be able to return to the daycare immediately after it has re-opened.

AHS is rescinding the closure orders for some facilities (see chart) effective September 11, as long as no one from the site tests positive for STEC (E. coli) before this time. Any decisions on site reopening after the closure orders are lifted are made by the operator. Staff and children from these four facilities do not need stool testing to return if they have had no gastrointestinal symptoms and have not been told otherwise by AHS.

Public Health Inspectors have assessed the readiness of these four facilities to reopen and ensured that they have taken appropriate measures such as cleaning and disinfection.

Some people from the other facilities have tested positive for STEC (E. coli). Young children (those not 5 years or older by Dec 31, 2023) and staff from these facilities who have had NO gastrointestinal symptoms must test negative for STEC (E. coli) before they can attend ANY childcare facility to ensure the safety of others.

The closure orders for the remaining even facilities will be rescinded September 12th. Young children (those not 5 years or older by Dec 31, 2023) and staff will require clearance from health officials for the safety of all at the childcare facility.

For Child-Care Facility Operators

I'm struggling with this situation. Are mental health supports available?

We understand that this situation has had a significant emotional impact on those that are involved. We'd urge anyone who has been affected by this and needs support to call the Mental Health Help Line, which is available 24/7 at 1-877-303-2642. You can also call Health Link at 811 and follow the prompts.

Can staff from outbreak sites experiencing closure orders report to other settings?

Staff from outbreak sites are recommended to not report to other settings, and must not if:

• they have STEC symptoms, or
• tested positive for STEC, or
• have been told by AHS that they are contacts who are currently excluded from high-risk settings.

Food safety agencies in Alberta - including AHS - continue to monitor all Alberta food facilities, ensuring safety of food is protected.