Parents struggle as 27 hospitalized in Calgary daycare E. coli outbreak

Stephanie Ivey was shocked to hear the words 'E. coli outbreak' come out of the admitting nurse's mouth when she brought her 22-month-old daughter to Rockyview Hospital in Calgary on Sunday afternoon.

Until then the only information she had received from Fuelling Brains Braeside, the daycare both her daughter and 3-year-old son attend, was regarding a one-off case of foot-and-mouth disease the week prior. 

"I felt like a terrible mom because if I had known there was E. coli at the [daycare], I would have brought her in much sooner."

Ivey's daughter, whose name CBC is withholding for privacy, was lethargic and had no appetite throughout the day on Saturday. Then she began to vomit and had multiple bouts of diarrhea. 

That was a week ago. Now, Ivey's daughter is in serious condition. She has to have blood work done every 12 hours, and hasn't been able to eat since Friday.

On Saturday afternoon, Ivey was asked to sign blood transfusion paperwork — her daughter's hemoglobin levels are so low that her doctors believe she may need a transfusion to help her continue to battle the infection. 

Ivey's daughter is one of 27 patients currently hospitalized after an outbreak of shiga toxin-producing E. coli (STEC) forced the closure of 11 daycare sites in Calgary over the Labour Day weekend. Of those hospitalized, 19 are confirmed to be fighting "severe illness" or hemolytic uremic syndrome (HUS), a serious complication of STEC that affects multiple organs, according to an AHS statement released Saturday afternoon. 

The health-care agency said that it is "highly likely" that the 164 lab-confirmed cases of E. coli in the city are a result of food contamination in a central kitchen that a number of the daycare sites share. 

If I had known there was E. coli at the [daycare], I would have brought her in much sooner.- Stephanie Ivey

"Based on the epidemiology of the cases we've seen to date, it is highly likely the source of this outbreak is food that was distributed from the central kitchen," the AHS statement reads.

"AHS has collected food samples for testing and awaiting results. At this time AHS has not been able to identify with certainty the exact food item that was the source. We continue to investigate."

Ivey said she was frustrated to hear the news that the likely cause of the outbreak is from the food her children ate at daycare. 

"We chose this [daycare] for a number of reasons: the teachers are lovely, the programs are lovely, but one of the big things for us too, was the food that they were going to be feeding our kids," she said.

"I wanted them to have healthy, nutritious meals while they weren't at home. I was sending them to what I thought was a safe, fun place."

Largest outbreak recorded

Dr. Stephen Freedman, a professor of pediatrics and emergency medicine at the University of Calgary, told CBC News that the age of the children infected, the strain of E. coli they are infected with, and the sheer number of cases are the three main factors that make this outbreak so severe. 

"In terms of the size of the outbreak, this unfortunately is also probably the single largest point source outbreak in children under five years of age recorded," said Freedman.

"So there have been other larger STEC outbreaks, but generally those have affected adults as well as older children."

Children under the age of five are especially vulnerable to developing more serious complications from STEC, such as hemolytic uremic syndrome (HUS). 

As opposed to less dangerous strains of E. coli, like those that cause travelers diarrhea or urinary tract infections, STEC toxins enter the bloodstream and cause inflammation, which can lead to blockages in small blood vessels. This can in turn lead to kidney failure, but also to HUS, which varies in severity, said Freedman. 

"Some children who develop HUS do not require dialysis and those children often recover and can be sent home from the hospital within several days if it's a mild case," said Freedman. 

For those who do require dialysis, the complications caused by HUS may last anywhere from several days to several weeks, he added. 

"The other thing to realize is that HUS is not a disease restricted to the kidney, it also consists classically of anemia, so low red blood cells, as well as thrombocytopenia," a condition characterized by a low platelet count in blood, said Freedman.

"HUS is a coagulation or basically a blockage of the small blood vessels. These blood vessels go everywhere in the body, including the brain, the heart, the liver and the pancreas for example, and can cause significant damage in those areas as well."

Freedman added that he isn't surprised to see the climb in case numbers of those infected, based on the typical timeline of the strain of E. coli, in addition to the number and ages of those initially exposed to the bacteria. 

"At the end of the day it comes back to each individual child and their family. This is a devastating illness, and even if they don't develop HUS, it is incredibly distressing knowing that that is a potential complication of an infection that your child has."

The Alberta Children's Hospital has established a dedicated clinic to monitor symptomatic patients after their initial emergency department visit and for patients who have been discharged from hospital. 

Help from community

Cathy Wang is part of a community of people offering their support to the families affected by the outbreak. 

Wang said she felt moved to start a GoFundMe page when she started seeing on one of her Facebook pages about what parents of sick children were dealing with on a daily basis.

"Watching all the other parents suffer through it, all the long waits, the daily blood tests, the stress and anxiety and missing work — it breaks my heart to read it because I can't imagine what they're going through," said Wang. 

"It's every parent's worst nightmare."

Ivey, whose daughter is going on her seventh straight night spent in the hospital, said it's been difficult for their family to navigate being apart. 

Her husband is at home with their now discharged 3-year-old son and has had to miss a week of work. She added that her son is struggling without her and doesn't understand why she can't come home.

Meanwhile, she has had to sit by and watch as her daughter continues to fight her infection, often in a lot of pain.

"My daughter is normally the snuggliest little girl, she will just melt into me. But since being admitted to the hospital, she just doesn't want me to touch her," Ivey said through tears. 

"It's just crushing."

With files from Taylor Braat and Omar Sherif