The STEC infection potentially affecting eleven daycare centers in Calgary, Alberta has become a political issue.  As of September 15^th, public health authorities have identified 337 confirmed cases of E.coli infections with the majority of patients under five years of age.  There were 26 secondary cases, mainly among the siblings of those affected.  Of the confirmed cases, 37 required hospitalization with 11 developing hemolytic uremic syndrome and six children underwent dialysis.

The Premier of Alberta, Danielle Smith, organized a press conference on September 15^th in response to widespread negative publicity and a petition with more than a thousand signatures protesting lack of transparency.  The outbreak was recognized on September 4^th, but provincial authorities did not respond with a public meeting until Friday, September 15^th.  The position of the Government is that they responded quickly through Alberta Health Services, contacting parents as the outbreak progressed. 

The kitchen, recognized as the source of infection, Kids U Centennial Inc. was closed along with the six affected and five related daycare centers. On September 4^th, inspectors observed violations including insect infestation, accumulation of water on floors and other deficiencies in the kitchen. A factor contributing to the extent of the infection was that food was distributed from the central kitchen to daycare centers in a non-refrigerated vehicle with transit times of up to 90 minutes. Thermal abuse of a contaminated food item obviously promoted proliferation of the pathogen.

The Alberta Minister of Health, Adriana LaGrange, defended the Provincial Program of Disease Prevention noting the extent and frequency of inspections of kitchens and daycare centers.

As a concession to affected families, the Province will make a one-time compassionate payment of C$2,000 per outbreak patient.  Children who developed HUS will require extensive medical surveillance through adulthood and in some cases children requiring dialysis may at some stage in their future require kidney transplantation.

The literature contains many examples of foodborne infection in schools and daycare centers attributed to E. coli O157:H7.  The extent of the Calgary outbreak points to the risk associated with central catering facilities.  As with outbreaks investigated in a retrospective study in Switzerland, it was determined that benefits accrue to placing an emphasis on high-risk kitchens and commissaries with frequent in-person inspections and enforced high standards of cleaning of work surfaces, utensils, equipment and with appropriate training.  The Calgary daycare center outbreak represent an opportunity for the FDA and CDC in addition to local health authorities to review regulations and inspection procedures including frequency of inspections , monitoring of cold chains and sampling food ingredients for wholesomeness.