In the last couple weeks, the posse has gotten bigger, but the source of a troubling E. coli O157:H7 outbreak on the Utah-Arizona border still has not been identified.

Now joined in the ongoing investigation into the Hildale,UT/Colorado City, AZ, area outbreak are the Southwest Utah Public Health Department, Mohave County Department of Health, Utah Department of Health, and the Arizona Department of Health Services. The local and state agencies have also been joined by representatives of the federal Centers for Disease Control and Prevention.

All the agencies are challenged by the  location of the Hildale/Colorado City communities, which were originally settled by polygamists because of their remoteness.

Mohave County epidemiologist Anna Scherzer was in Colorado City when she most recently updated by phone the Mohave County Board of Health, which was meeting in the county seat of Kingman, AZ . Kingman and Colorado City are separated by the Grand Canyon and the drive between them takes four hours.

Scherzer said 11 confirmed cases are included in the outbreak with most being children with a median age of 3. “Four kids had hemolytic uremic syndrome, or HUS, and unfortunately tow have died, “ she told the health board. Seven of the 11 required hospitalization.

The first victim was a 3-year-old boy who died in June. He and the other fatality, a 6-year-old girl, were not related but they lived in the same multi-family complex in Hildale.

While there was an early focus on that building, more recent victims did not live there and the geographic focus has widened to include the nearby Arizona communities of Colorado City and Centennial Park.

Public health investigators have looked at water quality and issued standard warnings to the public to not consume raw milk or recently purchased ground beef. With the federal help, they are now conducting interviews and working with parents to see wher kids congregate and determine what foods they were eating before they got sick.

Scherzer told her board none of the efforts have yet identified a “smoking gun” as the cause of the outbreak.

The Southwest Utah health officials have used Facebook to communicate with the communities. In the last 24 hours, it has reached out to parents and primary caregivers of children who have not had diarrhea since June 1 to answer a “5-minute” outbreak survey.

The agency has also warned about person-to-person contact:

“Because E. coli can be passed from several different sources, including person to person, it is always important to follow these practices to prevent infection:

• Wash hands with warm, soapy water before and after preparing or eating food, after using the bathroom and changing diapers, after contact with animals or environments with exposure to animal feces, and before touching anything that enters an infant’s mouth.
• 
Don’t allow raw food to touch cooked food. Carefully clean all surfaces and objects that have touched raw meat.
• 
 Cook meats thoroughly. Ground beef should be cooked to an internal temperature of 160 degrees. Use a meat thermometer.
- Avoid raw (unpasteurized) milk, dairy products, and juices.
• 
Don’t swallow water when swimming.