In less than a week, that Kentucky-centered outbreak of the rare E. coli O103 has exploded to 44 cases in the Bluegrass State and spread to Tennessee, Ohio, and Georgia, the Minneapolis-based Center for Infectious Disease Research and Policy (CIDRAP) reports.

As recently as last Friday (March 29), the Kentucky case count stood at 24.

CIDRAP, headed by Dr. Michael Osterholm, Ph.D., MPH, University of Minnesota Regents Professor, and McKnight Presidential Endowed Chair in Public Health, reported on the escalating outbreak on Wednesday. The federal Centers for Disease Control and Prevention (CDC) in Atlanta has yet to issue a public report on the expanding multi-state outbreak.

CIDRAP reported that Dr. Mel Bennett, manager of the Infectious Disease Branch of Kentucky’s Department of Public Health suspects the source of the E. coli O103 is beef, chicken or sliced American cheese.

Six of the 44 infected Kentuckians have required hospitalization. E. coli O103 is far less common than the O157: H7 strain, which often causes foodborne disease illnesses.

Bennett also said the outbreak has spread to at least the three other states and that Kentucky health officials are in daily contact with CDC.

Kentucky Cabinet for Health and Family Services spokesman Doug Hogan says cases are spread across several counties, with five confirmed in Fayette County.  Hogan says some sort of food distribution service may be the root cause. Some early reports indicated fast food might be the source of the contamination.

At least 20 additional cases are being investigated by Kentucky public health officials. In addition to Indiana, Tennessee, Ohio, Georgia, and Indiana is also a possible location for infections.

“Exposure to E. coli bacteria can be debilitating and potentially life-threatening, especially for small children and individuals with weakened immune systems, said Kentucky Health Commissioner Dr. Jeff Howard. “With this in mind, the Department for Public Health has taken swift action to identify patients, ensure appropriate testing, and follow up care as we work to determine the source of the outbreak.

Healthcare providers across Kentucky have been alerted to this potential threat and are working with us to make sure patients are identified and are receiving appropriate care. Meanwhile, we encourage all Kentuckians to be aware of the signs and symptoms of E. coli illness and to seek care if they are ill.”

Symptoms of E. coli O103 illness typically include stomach cramps and diarrhea, including bloody diarrhea, and people generally become ill two to five days after consuming contaminated food. E. coli O103 disease sometimes leads to hemolytic-uremic syndrome (HUS), a severe complication that can cause kidney failure and can occur a week or more after the onset of diarrhea. Those most at risk of developing complications from E. coli infection include the very young, the elderly, and people with weakened immune systems State health officials are working with staff at local health departments in the counties with suspected or confirmed cases to determine the source of the infections.

E. coli O103 outbreaks are rare.   The last large one was almost 20 years ago.  In January of 2000, a total of 18 people fell ill after attending a banquet in Washington state. Their infections were ultimately linked to drinking punch served at the banquet hall. At least one victim is known to have developed HUS.