Medical Advisory - National E. coli Cluster

Released April 10, 2017

​Issued by: M. Mustafa Hirji, MD, MPH, FRCPC Associate Medical Officer of Health

Current Situation

  • ​​Public Health Agency Canada is investigating a multi-provincial cluster of shiga toxin-producing non-0157 E. coli (STEC) cases
  • ​As of March 23, 2017, the cluster consists of 26 lab-confirmed cases with the same serotype; there have been no cases identified in Ontario at this time
  • On March 28, Robin Hood brand All-Purpose Flour, Original (only product with a best before date of April 17, 2018 (2018 AL 17) and the production code 6 291 548) is being recalled by the Canadian Food Inspection Agency as a potential cause of the outbreak

Requested Actions

Please submit stool specimens that meet the following criteria to the Public Health Ontario Lab (PHOL) for STEC testing:

  • acute onset of bloody diarrhea or hemolytic uremic syndrome (HUS)
  • routine enteric cultures are negative for other enteric pathogens including E.coli O157:H7, and
  • no other obvious etiology

How to Collect & Transport Specimen

  • ​Stool samples should be collected in usual stool culture media (Cary‐Blair), and refrigerated if possible
  • Prior to submitting a sample, call the PHOL Customer Service Centre toll free at 1‐877‐604‐4567 or 416‐235‐6556. After hours only, please contact the duty officer at 416‐605‐3113.
  • PHOL General Test Requisition can be found online 
  • Send to the closest Public Health Ontario Laboratory with the completed requisition (see below for specifications for the requisition)

Required Information on the PHOL General Test Requisition

  • Investigation number ONT-2017-001
  • Explicitly request for STEC direct testing ** Please instruct the primary laboratory on the requisition form that if routine enteric cultures are negative, to send the stool sample to PHOL for STEC direct testing **
  • State routine enteric culture negative for other enteric pathogens, including E.coli O157:H7
  • Symptoms, including whether HUS is present or suspected
  • Place and date of travel outside Ontario, if appropriate
  • Standard requirements for all laboratory submissions:
    • 2 personal health identifiers on the requisition and the sample,
    • submitter information, and
    • date of collection

For further information, please contact Niagara Region Public Health, Infectious Disease program at 1-888-505-6074 or 905-688-8248 ext. 7330 Monday to Friday 8:30 a.m. to 4:30 p.m., after hours 905-984-3690.


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