E. coli O157 associated with travel to Benidorm in Spain

27 November 2009

The Health Protection Agency is investigating a number of cases of the gastrointestinal infection E. coli O157 associated with travellers returning from the resort of Benidorm in Spain.

So far the HPA has been made aware of 14 confirmed cases of E. coli O157 among travellers returning to the UK, with onset dates ranging from 12th - 21st November. All laboratory confirmed cases are adults. Four people are known to have been admitted to hospital after returning to the UK. Two have since been discharged.

The agency is working with the Spanish health authorities to assist in their investigation. HPA will be supporting the investigation by conducting interviews with people affected in the UK to help identify a possible source.

As gastrointestinal infections can be contracted from a number of different sources, identifying the source involved in this cluster will be key to offering definitive advice to travellers. However there are some simple measures that people visiting Benidorm can take to protect themselves and their families against this infection:

Because E. coli can be transmitted through the oral-faecal route it is important to practice good hand hygiene procedures (wash hands thoroughly with soap and hot water) especially before eating, after going to the toilet and after touching any animals
Ensure food is cooked thoroughly to avoid contamination and avoid food outlets where uncooked meat is in contact with cooked food or food that isn't cooked prior to serving e.g. salads

After being infected by the E. coli bacteria it usually takes three to four days before symptoms develop, but it can be between one and 14 days. Symptoms experienced by people with E. coli O157 can vary from no illness through to having mild or bloody diarrhoea. A small minority of cases (2-7%, and mainly children) can experience more severe symptoms such as kidney failure.

Any travellers who have recently returned from this resort and who suspect that they or their children may have E. coli O157 infection should contact their GP as soon as possible. The Health Protection Agency is advising the following to prevent other people being affected by secondary infection in the home or workplace:

Anyone who has had an E. coli O157 infection should stay at home until they have been completely free of symptoms for 48 hours
Wash hands thoroughly with soap in running water (everyone should wash their hands after contact with anyone with symptoms, particularly after handling their clothes or bedding)
Wash soiled clothing and bed linen separately from other clothes at the highest temperature possible (e.g. 60°C)
Clean and disinfect hard surfaces such as toilet seats and door handles using hot water and detergent
Dispose of cloths used to clean surfaces by placing them in a plastic bag, sealing the neck and placing in household waste. Thoroughly wash rubber gloves in hot water and detergent after use, then rinse and allow to dry

As the source of infection has not yet been identified it is possible that future cases of E. coli O157 linked to Benidorm may be identified in coming weeks. HPA is collating information to assist local investigations and provide data to inform actions that might be taken at an international level.

Notes to editors

General information on E.coli:

Escherichia coli (commonly referred to as E. coli) O157 bacteria usually cause diarrhoea which settles within seven days without treatment. The diarrhoea may contain blood. Occasionally, serious kidney and blood complications can occur. Good hygiene is very important in preventing person-to person spread and small children should be supervised with hand washing after using the toilet and before eating.
E. coli is a species of bacteria commonly found in the intestines of humans and animals. There are many different types of E. coli, and while some live in the intestine quite harmlessly, others may cause a variety of diseases. The bacterium is found in faeces and can survive in the environment.
To avoid getting strains capable of causing intestinal disease people should avoid eating undercooked meat, in particular inadequately cooked minced beef and avoid drinking unpasteurised milk. Individuals working with uncooked meats or on farms should pay close attention to good hygiene practices, as should visitors to farms.
Infection can result after the ingestion of a low number of organisms, and as a result household or other secondary cases are common. This can be prevented by good hygiene such as hand washing and cleaning of potentially contaminated surfaces.
Hand washing in young children should be supervised.

The Health Protection Agency's web page on E. coli O157 can be found at the link below.
http://www.hpa.org.uk/HPA/Topics/InfectiousDiseases/InfectionsAZ/1191942153441/

The agency has provided a helpful factsheet including advice for people at home and in other environments where someone has the E. coli O157 infection. http://www.hpa.org.uk/web/HPAwebFile/HPAweb_C/1254510413069

For further information on this press release please contact the Health Protection Agency's Centre for Infections press office on:

Kate Swan                  020 8327 7097
David Daley                 020 8327 6647
Georgina Fletcher       020 8327 6690
Alexandra Baker          020 8327 7098
Louise Brown              020 8327 7080
Eleanor Bunch            020 8327 6217

Last reviewed: 27 November 2009