The E. coli outbreak appears to be isolated to the downtown YMCA day-care center, health officials said Wednesday.
Eight children linked to the center have been diagnosed with E. coli. Only one has been hospitalized, and her condition has been upgraded from serious to fair.
More than 100 people will be tested for the bacteria. That includes all center staff members, all children with symptoms, family members with symptoms and all children cared for in the same three rooms as the sick children.
Twenty of the children in those rooms have symptoms, such as diarrhea, stomach cramps or fever. The other 21 kids in the three rooms don’t have symptoms.
No other related E. coli cases have been found in Washington, Oregon or Idaho, leading investigators to believe that the outbreak is not related to a food distributor.
“That’s encouraging,” said Dr. John Kobayashi, senior epidemiologist with the Washington state Health Department. “We’re not dealing with some widely distributed product.”
But it’s still difficult for investigators to determine what they’re dealing with. On Wednesday, for the third day in a row, workers from the Spokane Regional Health District tried to pinpoint the bacteria’s origin at the YMCA.
Investigators are especially interested in one of the toddler rooms, where four of the sick children were.
“We can begin to speculate that something seems to have started in that one room,” said Dr. Kim Thorburn, health officer for the district.
Those four children got sick about the same time. This means they may have caught the bacteria from another child who still hasn’t been identified, Thorburn said.
That’s why the district wants to test every child cared for in the same room as one of the sick children.
On Wednesday, investigators brought cooking thermometers to the kitchen, because a lot of hamburger is prepared at meals.
One investigator met with the maintenance supervisor to look at disinfectant chemicals and the room layouts. The kitchen was examined. Classrooms were observed.
An investigator from the U.S. Food and Drug Administration also looked at the kitchen.
“We’re still just pretty impressed with their procedures,” Thorburn said. “Things are just done pretty darn well there.”
The source of the E. coli may stay hidden. The bacteria is common, found everywhere. It can appear in any unpasteurized or undercooked foods, under the right conditions. It often lives in the intestines of cows, sheep and birds. It can be spread to people when fruit touches manure.
A small outbreak several years ago in central Washington implicated pea salad, stored beneath raw beef.
The bacteria killed three and sickened 600 in the state in 1993. That outbreak was linked to infected hamburger meat at Jack in the Box restaurants.
E. coli tied to unpasteurized apple juice from Odwalla Inc. killed one person and sickened more than 70 in 1996 in the West.
The bacteria is eliminated by cleaning and pasteurizing.
Last year, 10 cases of E. coli were diagnosed in Spokane County, and all were isolated cases. None were traced to a specific cause.
In this outbreak, investigators have determined that the cases are related.
On Wednesday, DNA fingerprinting showed that four of the sick children caught the same strain of E. coli 0157:H7. The other cases still haven’t been run through the sophisticated DNA test.
One of the four children is 6 and doesn’t attend the day-care center, but her younger sister does. This 13-month-old girl showed symptoms for a couple of days, but later tested negative for the bacteria, Thorburn said.
But the DNA tests from the state lab show that the little girl must have had E. coli in order to pass it to her older sister, health officials said.
That’s why the number of confirmed cases was increased from seven to eight on Wednesday.
“This really isn’t a new case,” said Dr. Paul Stepak, epidemiologist at the Spokane district. “This is what we suspected all along.”
Other test results from the day-care center probably won’t be available for a few days.
The center, which cares for more than 150 children, plans to stay open, although the outbreak has been tough on children, families and staff.
“They do an excellent job, and they’re working under stress right now,” said Rich Wallis, executive director at the center. “I’m very proud of them.”