1. NEIL ABERCROMBIE LORETTA J. FUDDY, A.C.S.W., M.P.H.
GOVERNOR OF HAWAII DIRECTOR OF HEALTH
STATE OF HAWAII
In reply, please refer to:
DEPARTMENT OF HEALTH File:
P. O. BOX 3378
HONOLULU, HI 96801-3378
March 19, 2013
MEDICAL ADVISORY: CLUSTER OF ESCHERICHIA COLI O157:H7 ON OAHU
Dear Oahu Healthcare Provider:
The Hawaii Department of Health (HDOH) is investigating a cluster of six confirmed, molecularly
matched E. coli O157:H7 infections with illness onsets from February 19 to March 2, 2013. Five of
the six cases are children, while the sixth is elderly; all are Oahu residents with no travel history.
Three of the six cases have been hospitalized with two developing hemolytic uremic syndrome
(HUS). Five cases have recovered or are recovering; one remains hospitalized. Investigation is
ongoing, now with a likely seventh case (onset in the past week and subsequent HUS and
hospitalization).
This particular molecular pattern of E. coli O157:H7 is very uncommon both nationally as well as in
Hawaii. We ask all medical providers to consider E. coli O157 when evaluating patients with severe
or bloody diarrhea and order a stool culture to specifically isolate E. coli O157. HDOH also requests
you report cases of bloody diarrhea with onset within the past month and going forward (contact
numbers listed below).
Clinical Presentation: E. coli O157:H7 enterocolitis presents usually 3–4 days after infection with
severe abdominal cramps and nonbloody diarrhea that may progress to diarrhea with visible or occult
blood. Patients may or may not have a fever; vomiting is uncommon. HUS may develop 1–2 weeks
after diarrhea onset and may occur in ~5–10% of all persons with E. coli O157:H7 infection but in up
to 20% of children. Persons at increased risk of HUS include those at the extremes of age and
patients with more severe diarrhea, fever, or an elevated WBC.
Transmission: E. coli O157 transmission is fecal-oral and is usually associated with contaminated
food or water and occasionally direct contact with an infected person. No source has yet been
identified for this current cluster.
Diagnosis: E. coli O157 infection is diagnosed by isolating the bacterium in stool. All patients who
present with acute bloody diarrhea should have stool tested for E. coli O157. You must specifically
request E. coli O157 testing on stools when the infection is suspected as such testing is not always
performed routinely.
Treatment: Most persons recover without specific treatment in 5–10 days as the infection is usually
self-limited. There is no conclusive evidence that antibiotics improve the course of illness.
Antidiarrheal/antimotility agents, such as loperamide, should be avoided, especially in the pediatric
population.
Promoting Lifelong Health & Wellness

2. MEDICAL ADVISORY: CLUSTER OF ESCHERICHIA COLI O157:H7 ON OAHU
March 19, 2013
Page 2
Reporting suspected or confirmed E. coli O157. Any suspected cases of E. coli O157 infection
should be reported immediately to HDOH by phone:
Oahu (Disease Investigation Branch).............................. (808) 586-4586
Maui District Health Office............................................. (808) 984-8213
Kauai District Health Office............................................ (808) 241-3563
Big Island District Health Office (Hilo).......................... (808) 933-0912
Big Island District Health Office (Kona)......................... (808) 322-4877
After hours on Oahu......................................................... (808) 566-5049
After hours on neighbor islands.......................................1(800) 360-2575 (toll free)
Thank you for your assistance in protecting the health of our residents and visitors.
Sincerely,
Sarah Y. Park, MD, FAAP
State Epidemiologist
Hawaii Department of Health