E. coli outbreak occurred over

The original source of an E. coli outbreak this spring at a Vancouver in-home day care remains unknown. A review by Clark County Public Health, however, determined the bacteria was spread through person-to-person contact as opposed to a single event, such as a serving of undercooked beef because of the length of time that people experienced the onset of symptoms.

A total of 23 children and four staff members were found to have either probable or confirmed cases of E. coli O157:H7.

One child, 4-year-old Ronan Wilson, died April 8 after a week at Doernbecher Childrens Hospital in Portland.

Three other children were hospitalized.

Last week, the Clark County commissioners, in their role as the Board of Health, heard from Dr. Alan Melnick, the countys public health officer.

The board had ordered a review of how the county responded to the outbreak.

The commissioners also received a letter from Dr. Anthony Marfin, the state epidemiologist for communicable diseases.

Marfin concluded the county acted within state guidelines.

The county learned of the first case Friday, March 19, after a child was hospitalized. Melnick said they were told the child attended the Fletch Family Daycare only on Fridays, and had last been at the day care on March 12.

An initial investigation showed there were no other sick children at the day care, Melnick said.

A physician who treated the first Cartier Watches child alerted the county on March 26 of a second case. The physician knew both children attended the same day care in west Hazel Dell, operated by Dianne and Larry Fletch.

The county started interviewing parents and ordering stool samples on all day care staff and children, Melnick said.

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Ronan was hospitalized April 1.

The county ordered the day care to close on April 2 after test results showed other people had E. coli, even though they werent experiencing symptoms.

The pediatrician who first saw Ronan concluded Ronan had the flu because he didnt have bloody diarrhea and said Ronan didnt need to be tested, even after learning Ronan attended a day care where other children had E. coli.

While bloody diarrhea occurs in up to 90 percent of E. coli cases, Ronan and others didnt initially have it, Melnick said.

According to the federal Center for Disease Control and Prevention, E. coli O157:H7 is the most common toxin-producing bacteria in North America. The original source of an infection is often cattle manure, and the bacteria can enter the body through undercooked hamburger or unpasteurized milk or fruit juices. The bacteria can spread when people dont thoroughly wash their hands after diapering a baby or using the toilet.

After the day care closed April 2, the Fletches allowed one parent, who didnt realize the day care had closed, to leave his child with them before school.

The state Department of Early Learning stepped in and subsequently revoked the Fletches license, citing other violations such as previously operating overcapacity. The Fletches, who had been in business for 20 years and had dedicated clients, were licensed for 12 children but sometimes their grandchildren put them over the limit.

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