HEALTH

Update: Three children sickened by E. coli remain in hospital; others discharged

All but three of the children hospitalized for E. coli at East Tennessee Children's Hospital have now been discharged.

Microscopy image of E. coli bacteria.

Children's Hospital spokeswoman Erica Estep said Monday morning that three patients with E. coli remain — one in pediatric intensive care, two in regular units.

Since the last week of May, a dozen children, all younger than 5, had been hospitalized after being sickened with E. coli infections. At one point, the hospital had four children in intensive care. No children have died from this outbreak.

More:Father of toddlers critically sickened by E. coli: 'Not aware this was remotely possible'

More:Pre-cut melons sold at Sprouts, Gordon Foods in Tennessee linked to Salmonella outbreak, recalled

Two likely sources

The health department has traced the outbreak to two likely sources: raw milk from a cow-share at French Broad Farm in Northeast Knox County, and the toddler room at the Kids Place child care center on Millertown Pike in Mascot, where children may have been exposed "directly or indirectly" to farm animals who can carry the pathogen in their guts.

Both cleared to reopen

On Friday, the health department lifted its directive for French Broad Farm to temporarily cease operations, although health department Director Dr. Martha Buchanan warned public health's position is that people should drink only pasteurized milk and juice: 

"While the investigation thus far has revealed no specific problems with French Broad Farm, the risk in consuming raw milk cannot be mitigated. Even with safety precautions in place at a dairy and adherence to the strictest dairying procedures, there is no way to ensure raw milk, while legal, is safe for consumption."

But, though the farm was cleared to reopen, it has removed its Facebook page and calls have gone unanswered.

The health department on June 8 had lifted its directive for Kids Place to close the toddler department, and the day care has since reopened.

More:In the wake of E. coli outbreak linked to French Broad Farm, some ask what 'raw milk' is

Possible connection

As one of an array of investigation techniques, the health department is testing samples from raw milk and farm animal manure to look for a connection between the two sources. Health officials said Friday it would be "rare" but "possible" for two E. coli outbreaks to occur simultaneously but be unrelated.

Produces dangerous toxin

This particular type of E. coli — 0157 — produces a toxin, Shiga, in the human body that can cause diarrhea and other life-threatening complications, particularly in the very young and very old and in pregnant women and people whose immune systems are compromised. Between 5 percent and 10 percent of those infected can develop hemolytic uremic syndrome, which affects the kidneys and can cause kidney failure or death. 

HUS symptoms include urinating less frequently, feeling very tired and losing pink color in cheeks and inside the lower eyelids. People hospitalized with kidney failure from HUS can recover, but about one-third experience lifelong complications.

Most common sources

Most people infected with E. coli in the United States get it from food or drink. Raw dairy or juice is a common source, as is undercooked ground beef, and produce — like the recent Romaine lettuce outbreak — grown in contaminated animal manure or washed in dirty water. Since it's transmitted through feces, you can also get it from swimming pools, diaper changes or handling farm animals. 

More:E. coli infection: Five things you should know to keep your kids safe

How to avoid

The best ways to avoid E. coli: Avoid unpasteurized dairy or juice. Thoroughly cook ground beef. Carefully wash all produce. Don't swallow pool water. Above all, wash your hands frequently and thoroughly, with soap and hot water — especially after going to the bathroom, after changing diapers, after handling animals, and before eating.