Reporting & Investigation of E. Coli

Table of Contents

A. Purpose of Surveillance and Reporting

  • To identify whether the case may be a source of infection for other persons (e.g., a diapered child, child care attendee or food handler) and if so, to prevent further transmission.
  • To identify sources of public health concern (e.g., a contaminated food source or recreational water) and to stop transmission from such a source.

B. Laboratory and Healthcare Provider Reporting Requirements

Iowa Administrative Code 641-1.3(139) stipulates that the laboratory and the healthcare provider must report. The preferred method of reporting is by utilizing the Iowa Disease Surveillance System (IDSS).  However, if IDSS is not available, the reporting number for IDPH Center for Acute Disease Epidemiology (CADE) is (800) 362-2736; fax number (515) 281-5698, mailing address:

Iowa Department of Public Health, CADE
Lucas State Office Building, 5th Floor
321 E. 12th St.
Des Moines, IA 50319-0075

Laboratory Testing Services Available

The University of Iowa State Hygienic Laboratory (SHL) tests stool specimens for the presence of pathogenic E. coli and will confirm and serotype isolates obtained from clinical specimens at other laboratories. Additionally, all laboratories in Iowa are required to submit pathogenic E.coli isolates for typing to aid in the public health surveillance necessary to prevent transmission of this disease. For more information on submitting specimens call SHL at (319) 335-4500 or visit www.shl.uiowa.edu/.

SHL will test implicated food items from a cluster or outbreak of disease.  Food is submitted through local public health departments.

C. Local Public Health Agency Reporting/Follow-Up Responsibilities

Case Investigation

All cases of E. coli causing illness require public health follow-up, excluding urinary tract infections caused by normal bowel flora E. coli.

  1. It is the LPHA responsibility to complete an investigation by interviewing the case and others who may be able to provide pertinent information.
  2. Use the following guidelines to assist in completing the investigation:
  3. Record the demographic information, date of symptom onset, symptoms, and medical information.
  4. When asking about exposure history (food, travel, activities, etc.), use the incubation range for E. coli of (10 hrs -10 days). Specifically, focus on the period beginning a minimum of 10 hours prior to the case’s onset date back to no more than 10 days before onset. If the person ate ground meat, ask how well the meat was cooked.
  5. If possible, record any restaurants at which the case ate, including food item(s) and date consumed. If it is suspected that the case became infected through food, refer to the Iowa’s Foodborne Illness Outbreak Investigation Manual.
  6. Ask questions about water supply because pathogenic E. coli may be acquired through water consumption.
  7. Household/close contact, pet or other animal contact, child care, and food handler questions are designed to examine the case’s risk of having acquired the illness from, or potential for transmitting it to, these contacts. Determine whether the case attends or works at a child care facility and/or is a food handler.
  8. If several attempts have been made to obtain case information, but have been unsuccessful (e.g., the case or healthcare provider does not return calls or respond to a letter, or the case refuses to divulge information or is too ill to be interviewed), enter into IDSS as much information as has been gathered. Please explain in the notes section in IDSS the reason why the investigation could not be completed. If using IDSS, select the appropriate reason under the Event tab in the Event Exception field.

After completing the interview enter the information into IDSS.  If IDSS is not available, fax [(515), 281-5698] the investigation form or mail to:

IDPH, CADE
Lucas State Office Building, 5th Floor
321 E. 12th St.
Des Moines, IA 50319-0075

Institution of disease control measures is an integral part of case investigation. It is the LPHA responsibility to understand, and, if necessary, institute the control guidelines listed below in 4) Controlling Further Spread.