The patient count in Canada’s daycare center E. Coli outbreak now stands at 310 lab-confirmed cases and public health officials are doubling down on their determination that a central kitchen serving the centers was the source of the pathogen.

only 18 secondary infections — person-to-person infection rather than infection from the original source — have been identified, according to officials with Alberta Health Services, which is the lead agency investigating the outbreak among attendees of six daycare centers in Calgary. The vast majority of the patients are children younger than 5. A few of the patients are daycare center staff.

Of the 310 patients, 21 remain in hospitals and 20 of those have developed hemolytic uremic syndrome (HUS). Seven of the HUS patients are on dialysis. All of the patients in hospitals are children. Fourteen patients have already been discharged from hospitals. HUS attacks the kidneys and blood system, which also impacts other internal organs. It can lead to brain damage, transplants and other lifelong complications.

All of the 310 patients except the 18 secondary cases are attendees or staff from six Feeding Brains daycare centers. The chain, along with five other Calgary daycare centers, uses a central kitchen, KidsU Centennial – Fueling Minds Inc. only staff and children from the Feeding Brains centers have been infected.

The Alberta Health Services (AHS) environmental health division closed the central kitchen during the labor day weekend when the cluster of E. Coli O157:H7 infections was identified. Dr. Franco Rizzuti of AHS said it is not unusual for food businesses to have violations and that the department rarely uses legal routes to enforce codes. He said during a news conference Sept. 13 that he could not speak to next steps with the implicated kitchen, but it remains closed until further notice.

Dr. Tania Principi said despite the increasing numbers of people identified in the outbreak, it is not unusual to expect such situations. She said that some of the people added to the patient tally have been identified because of mandatory testing of attendees and staff that was initiated after the outbreak was identified. 

She said a number of the new cases being identified every day are asymptomatic and were therefore not immediately identified when the E. Coli cluster was discovered. Principi expects to see more patients identified but said the outbreak is likely past its peak.

All of the children who remain hospitalized are in stable condition, even though some are fighting serious complications of their infections, Principi said.

Rizzuti said this is a large outbreak but that he didn’t know how it compares to other outbreaks in Alberta or nationwide in Canada.

Eleven foods are being tested in relation to the outbreak, Rizzuti said. based on interviews with patients and their families health officials still believe the central kitchen used by the daycare centers was the source of the pathogen. Some test results on foods are still pending, but those that have come back so far have been negative for the outbreak strain of E. Coli.

An inspection of the central kitchen on Sept. 5 found several code violations, including three serious violations. Live and dead cockroaches were found and a pool of water was found under one of the kitchen’s coolers. A food thermometer was stored in a bucket with “non-cleanable” items.

Rizzuti said generally when similar violations are found an establishment is given time to correct them and is then subject to a follow-up inspection. However, because the kitchen was associated with an outbreak it was closed immediately.

In addition to the violations at the kitchen, “The operator indicated that cold foods were being transported to other locations in excess of 90 minutes without temperature control. Appropriate equipment for keeping food cold during transport was not available,” inspectors reported.

Prior to Sept. 5, the central kitchen was inspected in April this year. Two violations were found and both were corrected during the inspection so no follow-up inspection was scheduled.