Research from the University of Calgary helped halve the expected number of serious complications during a massive E. coli outbreak that sickened hundreds of local children, a new study has found. The findings, published in JAMA Network Open, reveal that a coordinated, evidence-based approach to the 2023 outbreak at several Calgary daycares resulted in fewer children developing life-threatening conditions. The outbreak involved Shiga toxin-producing Escherichia coli (STEC), a bacterium that causes bloody diarrhea. While Alberta has one of the highest STEC incidence rates in North America, the 2023 event was unprecedented, infecting 448 people according to the province. Of that, the study states 285 cases were outbreak-linked confirmed STEC infections in children. Dr. Stephen Freedman, a professor at the University of Calgary’s Cumming School of Medicine, said years of research allowed his team to implement a rapid response once the outbreak began. “When the outbreak happened, we knew that daily laboratory monitoring and treating dehydration could prevent complications and potentially save lives,” Freedman said. Historically, families were told to monitor symptoms at home and return to the emergency room if conditions worsened. However, researchers found that physical symptoms often do not appear until a serious complication known as hemolytic uremic syndrome (HUS) is fully developed. HUS can cause kidney failure and carries a mortality rate of one to three per cent. During the peak of the outbreak, between 30 and 40 children required daily blood tests at the Alberta Children’s Hospital. “When a blood test detected early changes and warning signs of HUS, we admitted the child to hospital before they became critically ill,” said Dr. Mohamed Eltorki, an associate professor of pediatrics. Of the 285 infected children, 40 were hospitalized, 21 developed HUS and nine required dialysis. Researchers noted the number of children who developed HUS was less than half of what is typically expected in an outbreak of this scale. For Kirrily Hull, whose son and daughter were among the infected, the daily monitoring provided a sense of security. “My opinion is that if it hadn’t been for that pathway, the outcome for my daughter and a few of the other families would have been very different and that could have included the deaths of our children,” she said. While her son has fully recovered, her daughter continues to face health complications from the infection. “During her hospitalization, she had some kidney issues. Kidney failure. She had a seizure. She spent six weeks in the Children’s Hospital. Every day since she has had to take medication,” Hull said. “It’s a parent’s worst nightmare.” Hull has since become a patient-partner advocate to raise awareness about the bacterium and push for system-wide improvements. Fueling Minds Inc. which provided snacks and meals to children at several daycares pleaded guilty last year to four offences relating to the company’s failure to have a catering license. It was fined $10,000. The province also made several recommendations to improve food services and increase safety inspections as a result of the outbreak.
