Section 690.400  Escherichia coli Infections (E. coli O157:H7 and Other Shiga toxin-producing E. coli, Enterotoxigenic E. coli, Enteropathogenic E. coli and Enteroinvasive E. coli) (Reportable by telephone or facsimile as soon as possible, within 24 hours)

a)         Control of Case.

1)         Standard Precautions shall be followed.  Contact Precautions shall be followed for diapered or incontinent persons or during institutional outbreaks until absence of diarrhea for 24 hours.

2)         Food Handlers or Persons in Sensitive Occupations, not including Health Care Workers.  Cases with E. coli infections caused by O157:H7 or other Shiga toxin-producing E. coli shall not work as food handlers or in sensitive occupations until diarrhea has ceased for at least 24 hours and 2 consecutive negative stool specimens are obtained.  Specimens shall be obtained following clinical recovery of the patient, at least 24 hours apart and not sooner than 48 hours after the last dose of antimicrobials, if administered.  Specimens shall be submitted beginning within one week after notification.

3)         Health Care Workers.  Local health departments may require specimens from health care workers or those who work in occupations requiring Standard Precautions if there is reason to believe specimen testing is necessary (e.g., the nature of the work, including feeding or oral care, hygienic practices of the worker or as part of an investigation of a cluster).

4)         Cases of enterotoxigenic E. coli, enteropathogenic E. coli or enteroinvasive E. coli shall not work as food handlers or in sensitive occupations, including health care, until diarrhea has ceased for at least 24 hours.  Release specimens are not required for persons with these types of E. coli infections.

b)         Control of Contacts.

1)         Contacts Who Have Not Had Diarrhea During the Previous 4 Weeks.

A)        Food Handlers or Persons in Sensitive Occupations, not including Health Care Workers.

i)          There are no work restrictions while submitting release specimens for contacts who are employed as food handlers or in sensitive occupations and who have had no symptoms of E. coli infections caused by O157:H7 or other Shiga toxin-producing strains during the previous 4 weeks.

ii)         Contacts to cases with E. coli infections caused by O157:H7 or other Shiga toxin-producing strains who are employed as food handlers or in sensitive occupations shall submit 2 consecutive negative stool specimens obtained at least 24 hours apart and not sooner than 48 hours after the last dose of antimicrobials, if administered.  These contacts shall be restricted from their occupations if they do not begin submitting release specimens within one week after notification. Release specimens shall be submitted at least once per week until 2 consecutive negative specimens are obtained or the individual shall be restricted from working.

iii)         If either of the 2 release specimens is positive for E. coli infection caused by O157:H7 or other Shiga toxin-producing strains, contacts shall be considered cases and shall comply with subsection (a)(2) of this Section.

B)        Health Care Workers.  Local health departments may require specimens from health care workers or those who work in occupations requiring Standard Precautions if there is reason to believe specimen testing is necessary (e.g., the nature of the work, including feeding or oral care, hygienic practices of the worker or as part of an investigation of a cluster).

C)        Contacts to cases of enterotoxigenic E. coli, enteropathogenic E. coli or enteroinvasive E. coli who are employed as foodhandlers or in sensitive occupations, including health care workers, and have not had diarrhea within the previous 4 weeks are not required to submit release specimens.

2)         Contacts Who Currently Have Diarrhea or Have Had Diarrhea During the Previous 4 Weeks.

A)        Food Handlers or Persons in Sensitive Occupations, not including Health Care Workers.

i)          All contacts to cases of E. coli infections caused by O157:H7 or other Shiga toxin-producing strains employed as food handlers or in sensitive occupations, and who currently have diarrhea or have had diarrhea during the previous 4 weeks, shall not work in their occupations until diarrhea has ceased for at least 24 hours and they have submitted 2 consecutive negative stool specimens.  Specimens shall be obtained following clinical recovery of the patient, at least 24 hours apart, and not sooner than 48 hours after the last dose of antimicrobials, if administered.  Specimens shall begin to be submitted within one week after notification.

ii)         If either of the 2 release specimens is positive for E. coli infection caused by O157:H7 or other Shiga toxin-producing strains, contacts shall be considered cases and shall comply with subsection (a)(3) of this Section.

B)        Health Care Workers.  Local health departments may require specimens from health care workers or those who work in occupations requiring Standard Precautions if there is reason to believe specimen testing is necessary (e.g., the nature of the work, including feeding or oral care, hygienic practices of the worker or as part of an investigation of a cluster).

C)        Contacts to cases of enterotoxigenic E. coli, enteropathogenic E. coli or enteroinvasive E. coli who are employed as foodhandlers or in sensitive occupations, including health care workers, and have had diarrhea within the previous 4 weeks and the diarrhea has resolved are not required to submit release specimens.

D)        Contacts to cases of enterotoxigenic E. coli, enteropathogenic E. coli or enteroinvasive E. coli who are employed as food handlers or in sensitive occupations, including health care, and currently have diarrhea, shall not work until diarrhea has ceased for at least 24 hours.  Release specimens are not required for persons with these types of E. coli infections.

c)         Sale of Food, Milk, etc. (See Section 690.1000(b).)

d)         Laboratory Reporting.

1)         Laboratories shall report to the local health authority all patients who have a positive result from a stool specimen or any laboratory test indicative of and specific for detecting Escherichia coli O157, other Shiga toxin-producing E. coli, enterotoxigenic E. coli, enteropathogenic E. coli or enteroinvasive E. coli infection.

2)         Laboratories shall submit E. coli O157 or other Shiga toxin-producing isolates, broth or specimens to the Department's laboratory. 

3)         Laboratories shall report and submit to the Department's laboratory any food, environmental or animal E. coli isolates resulting from an outbreak investigation.

(Source:  Amended at 32 Ill. Reg. 3777, effective March 3, 2008)