A child in the United States is thought to be part of an E. coli outbreak linked to a farm in Iceland that has affected 21 people.

A spokeswoman from Maine Center for Disease Control and Prevention (CDC) told Food Safety News it was aware of one case that is potentially linked to the outbreak in Iceland.

“The person is a Maine resident who had diarrheal illness after travel to the tourist attraction in Iceland that has been linked to the outbreak. Maine CDC is investigating this case,” said the spokeswoman.

Brittany Behm, from the U.S. Centers for Disease Control and Prevention, said once the agency receives genetic data about the E. coli outbreak strain it will monitor the PulseNet database to see if there are additional cases in the country.

A Shiga toxin-producing E. coli (STEC) O26: H11 outbreak has been linked to the tourist attraction Efstidalur II farm in Blaskogabyggd in the south of the country.

There are 19 ill children aged between 5 months and 12 years old and six developed hemolytic uremic syndromes (HUS), a severe condition associated with E. coli infections that causes kidney failure. One child needed peritoneal dialysis.

Dates of illness onset are from June 13 to July 10. Seven are girls and 12 are boys but there is no connection between them.

Two adults ill

The strongest epidemiological link is with consumption of ice cream but half of the children also petted calves.

Two adults are also part of the outbreak. One of these works at the farm and has been asymptomatic but did not work with food.

The other person is a tourist thought to be from Sweden who came to Iceland on July 5. They visited Efstadal on July 8 and fell ill on July 11. The patient consumed food, including ice cream, but did not report animal contact.

Previously, officials from the Directorate of Health urged anyone who visited the farm between June 10 and July 4, and developed diarrhea within 10 days, to contact a doctor and be tested for the bacterium.

However, as the latest case has an illness onset date after July 4, the Directorate of Health reported measures put in place from that date had not stopped the risk of infection. General cleaning and disinfection have since taken place in the restaurant and adjacent rooms.

Björgvin Jóhannesson, one of the owners of the business which is run by four families, previously told Food Safety News ice cream production and contact with calves had been stopped while investigations continue into the incident.

Testing of ice cream did not find the outbreak strain but samples were not from the same batch as the children had eaten. The E. coli serotype that infected the children was detected in feces from calves.