Verotoxin-producing E. coli

E. coli bacteria normally live in the intestines of people and animals. Most E. coli bacteria are harmless and are an important part of a healthy intestine. However, some E. coli bacteria, like verotoxin-producing E. coli (VTEC), produce a toxin that can cause serious illness. Two other names can be used for this same verotoxin-producing E. coli: shiga toxin-producing E. coli (STEC) and enterohaemorrhagic E. coli (EHEC).

How is VTEC spread?

VTEC is spread by the fecal-oral route, mainly by eating or drinking contaminated food or water. Dairy and beef cattle and calves are one of the most common sources of VTEC. The bacteria can be spread through the feces (stool) of cattle or their meat. For example, ground beef that is not properly handled or cooked is often a cause of VTEC illness. Other animals often found at farms, petting zoos or country fairs, such as sheep, pigs, and goats, can also have VTEC and spread the bacteria. Fresh produce such as lettuce, spinach, sprouts and melons have also been known to be contaminated with the bacteria.

VTEC can also be found in the feces of an ill person. Person-to-person spread can happen if someone has direct contact with an ill person’s feces, objects contaminated with feces, or eats or drinks food or water contaminated from inadequate hand washing.
What are the symptoms of VTEC?

Symptoms of VTEC usually develop within 3 to 4 days, but can be as short as 1 day or as long as 8 days. Some people may have very mild symptoms; however, most people will feel very ill with severe abdominal pain, which is usually short lived, and diarrhea, which often becomes bloody after 2 or 3 days.

A small number of people develop hemolytic-uremic syndrome (HUS), a serious and sometimes fatal complication affecting their kidneys, 1 to 3 weeks after the start of the diarrhea, when diarrhea is improving. HUS is most likely to affect small children, the elderly, or people with weak immune systems. Signs that someone is developing HUS include a reduced amount of urine output (fewer diaper changes or drier diapers), fever, tiredness, losing pink color in cheeks and inside the lower eyelids, and decreased alertness (sleepy or confused).
Is there treatment for VTEC?
Most people recover from a VTEC infection with fluids and rest. However, people with more severe symptoms or weak immune systems may take longer to recover. If symptoms are persistent or severe, it is important to see a healthcare provider. The use of antibiotics or medications that slow down the diarrhea is not recommended.
Are there any restrictions or special considerations for people ill with VTEC?

Generally, people can return to work and school when they feel better and no longer have symptoms. Food handlers, health care workers, and those who work in or attend a child care centre must stay home and away from work or daycare if they are sick with or still carrying VTEC. Ottawa Public Health will advise when they may return to work.
How can I protect myself against VTEC?

To prevent becoming ill with VTEC:

  • Cook meats and ground beef to 74°C (165°F). For ground beef, no pink meat should remain, and the juices should be clear. Do not eat undercooked or raw ground beef.
  • Clean counters on which food is prepared with warm soapy water, and sanitize utensils, cutting boards and surfaces that may have been contaminated with raw meat or poultry.
  • Wash all fresh fruits and vegetables, including melons and leafy greens, in clean, running water before eating.
  • Store raw meats, poultry and fish away from ready to eat foods such as fruits and vegetables to prevent them from becoming contaminated with the bacteria.
  • Do not eat or drink unpasteurized (raw) milk or milk products or apple juice or cider.
  • Avoid food preparation or serving food or drinks for others if you have diarrhea.
  • Wash all parts of your hands well with soap and water for at least 15 seconds before preparing food, before eating, after using the toilet, after changing a diaper, after contact with animals and anytime hands might be dirty. Supervise hand washing of your children.
  • Test well water for bacteria 3 times a year; the testing is free for Ottawa residents through Ottawa Public Health.
  • Avoid swallowing recreational water while swimming (lakes, rivers, etc.).
  • Wait to resume sexual activity until you no longer have diarrhea. You may continue to have VTEC bacteria in your stool for a few weeks after you recover, so wash your body (genitals, anus, and hands especially) before and after sexual activity.
What is Ottawa Public Health’s role?

Ottawa Public Health (OPH) must be notified by health care providers and laboratories when a person is ill with VTEC. OPH conducts an investigation to try to determine the cause or source of infection, provides education to the ill person, and follows up with health care providers as necessary. OPH also investigates close contacts of an ill person. OPH will advise people ill with VTEC and their contacts when they may return to work and child care. If a common source of illness is identified, OPH will provide follow-up investigation.

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