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E. coli outbreak occurred over time

Review: Rash of cases that killed boy not tied to a single event

By Stephanie Rice
Published: September 27, 2010, 12:00am

The original source of an E.coli outbreak this spring at a Vancouver in-home day care remains unknown, but a review by Clark County Public Health determined the bacteria was spread through person-to-person contact — as opposed to a single event, such as a serving of undercooked beef — because of the length of time that people experienced the onset of symptoms.

A total of 23 children and four staff members were found to have either probable or confirmed cases of E.coli O157:H7.

One child, 4-year-old Ronan Wilson, died April 8 after a week at Doernbecher Children’s Hospital in Portland.

Three other children were hospitalized.

Last week, the Clark County commissioners, in their role as the Board of Health, heard from Dr. Alan Melnick, the county’s public health officer.

The board had ordered a review of how the county responded to the outbreak.

The commissioners also received a letter from Dr. Anthony Marfin, the state epidemiologist for communicable diseases.

Marfin concluded the county acted within state guidelines.

The county learned of the first case Friday, March 19, after a child was hospitalized. Melnick said they were told the child attended the Fletch Family Daycare only on Fridays, and had last been at the day care on March 12.

An initial investigation showed there were no other sick children at the day care, Melnick said.

A physician who treated the first child alerted the county on March 26 of a second case. The physician knew both children attended the same day care in west Hazel Dell, operated by Dianne and Larry Fletch.

The county started interviewing parents and ordering stool samples on all day care staff and children, Melnick said.

Ronan was hospitalized April 1.

The county ordered the day care to close on April 2 after test results showed other people had E.coli, even though they weren’t experiencing symptoms.

The pediatrician who first saw Ronan concluded Ronan had the flu because he didn’t have bloody diarrhea and said Ronan didn’t need to be tested, even after learning Ronan attended a day care where other children had E. coli.

While bloody diarrhea occurs in up to 90 percent of E.coli cases, Ronan and others didn’t initially have it, Melnick said.

According to the federal Center for Disease Control and Prevention, E. coli O157:H7 is the most common toxin-producing bacteria in North America. The original source of an infection is often cattle manure, and can enter the body through undercooked hamburger or unpasteurized milk or fruit juices. The bacteria can spread when people don’t thoroughly wash their hands after diapering a baby or using the toilet.

After the day care closed April 2, the Fletches allowed one parent, who didn’t realize the day care had closed, to leave his child with them before school.

The state Department of Early Learning stepped in and subsequently revoked the Fletches’ license, citing other violations such as previously operating overcapacity. The Fletches, who had been in business for 20 years and had dedicated clients, were licensed for 12 children but sometimes their grandchildren put them over the limit.

Ronan’s parents, Anthony and Bonnie Wilson, attended the Sept. 22 Board of Health meeting and listened to Melnick’s presentation.

Sketchy withheld

When invited to ask more questions of Melnick by Commissioner Steve Stuart, they declined.

“I appreciate you being here,” Stuart told the Wilsons. “There are no words. I can’t even imagine. A horrible, horrible tragedy. I’m so sorry for your loss.”

Melnick told commissioners that investigators later learned that some parents and staff members had initially underreported symptoms.

That could be because they had difficulty remembering mild symptoms, or they might have been reluctant to share personal health information with the government, Melnick said.

Melnick said the county did not close the day care earlier over concerns parents would take their children to other day cares and potentially expose other people.

He also said the Fletches did not always keep children with diarrhea from attending day care, if they thought the diarrhea could be contained in the child’s diaper or if they thought the diarrhea was attributable to teething.

There’s no medical reason why teething should cause diarrhea, Melnick said, but it’s a popular myth.

Children with diarrhea should not be in day care, he said.

No county alert issued

Earlier, the Wilsons had questioned why the county did not issue a press release about the outbreak or an alert to health care providers.

After the meeting, Melnick said the county did not send out a provider alert because of the relatively small number of children involved.

A provider alert was sent out this summer after a child who tested positive for E.coli had played at Lake Shore Athletic Club, for example, after the county tried contacting 200 families.

The county issues press releases when they have no other way of contacting potentially infected people, such as when a food worker tests positive and they need to contact everyone who ate at the worker’s restaurant.

Instead, in the Fletch case, health department investigators contacted parents and told them to have their children tested.

Larry Fletch said last week that he couldn’t comment on the county’s findings because of possible pending litigation.

Ronan, who was born 12 weeks premature and had a weakened immune system, was the first Clark County resident to die from E.coli since at least 1988, which is how far back the state’s computerized records go.

Stephanie Rice: 360-735-4508 or stephanie.rice@columbian.com.

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