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Nuneaton & Bedworth Borough Council,
Town Hall, Coton Road,
Nuneaton, Warwickshire,
CV11 5AA.

Tel: 024 7637 6376

Food Matters

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ENTERO-PATHOGENIC ESCHERICHIA COLI (EPEC)

These strains are a significant cause of diarrhoea in the very young, usually via community epidemics and outbreaks in hospital nurseries. The strains do not have entero-invasive properties (like EIEC) or produce toxins (like ETEC) but still manage to cause diarrhoea.

Incubation Period, Symptoms & Duration

Incubation Period
18 - 72 hours (average = 36 hours)

Symptoms
In infants, the illness is more severe than many other diarrhoeal infections. Symptoms include vomiting, watery or bloody diarrhoea, fever and malaise.
Occasionally, diarrhoea is prolonged, leading to dehydration, electrolyte imbalance and death (50% mortality rates have been reported in Third World countries).

Duration
Up to 3 days but can be more than 2 weeks in infants.

Source & Spread

Sources/Associated Foods

Human cases and excreters.
Foods involved have mainly been raw or undercooked beef and chicken, but can involve any faecally contaminated food

Spread
Spread is mostly by the faecal:oral route but can also be foodborne or waterborne.

Control

Enteric isolation precautions - admit no further children to a contaminated institutional setting e.g. nursery.

Exclusion/Return to Work Parameters

Cases in risk groups 1- 4 not to return until 48 hours after first normal stool.

[Group 1 - food handlers; Group 2 - health care workers; Group 3 - children under 5 in nurseries etc.; Group 4 - older children and adults who may find it difficult to implement good standards of personal hygiene]
Additionally, cases of EPEC admitted to hospital should be isolated if possible until 3 consecutive faecal specimens collected at intervals of at least 24 hours are negative.

Additional Information

The bacterium is a rod-shaped, Gram -ve, non-sporeforming, motile (via peritrichous flagella) and aerobic/facultatively anaerobic organism.
EPEC are highly infectious for infants and the infective dose is therefore very low. In the few documented cases of adult diseases, the infective dose is thought to be relatively high at 10⁶ - 10¹¹ organisms.
Source(s) and prevalence of EPEC are controversial because foodborne outbreaks are sporadic and incidence varies on a worldwide basis (countries with poor sanitation practices having the most frequent outbreaks).

Growth Factors

Minimum A_w: >0.96
pH range: 4.5 - 9.0
Optimum pH: 6.5 - 7.5
Temperature range: 10^oC - 55^oC ; i.e. a mesophile

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