Section 690.400  Escherichia coli Infections (E. coli O157 and Other Shiga Toxin-Producing E. coli) (Reportable by telephone, facsimile, or electronically as soon as possible, within 24 hours)

a)         Control of Case

1)         Food Handlers or Persons in Sensitive Occupations, Not Including Health Care Workers

Cases with E. coli infections caused by E. coli O157 or other Shiga toxin-producing E. coli shall not work as food handlers or in sensitive occupations until diarrhea has ceased for at least 48 hours and two consecutive negative stool specimens are obtained.  Specimens shall be obtained following clinical recovery of the patient, at least 24 hours apart, and not sooner than 48 hours after the last dose of antimicrobials, if administered.  Specimens shall be submitted beginning within one week after notification.

2)         Health Care Workers

Local health authorities may require specimens from health care workers or those who work in occupations requiring standard precautions if there is reason to believe that specimen testing is necessary (e.g., the nature of the work, including feeding patients, assisting patients with eating, providing or preparing meals for patients, denture or oral care, hygienic practices of the worker, dispensing or administering oral medications, or as part of an investigation of a cluster).  Specimens shall be obtained following clinical recovery, at least 24 hours apart and not sooner than 48 hours after the last dose of antimicrobials, if administered.  Specimens shall begin to be submitted within one week after notification, or the individual shall be restricted from patient care.  When specimen submission is required, health care workers who feed patients or assist patients with eating, provide or prepare meals for patients, provide denture or oral care or dispense or administer medications, shall be restricted from these duties until two negative stool specimens are obtained or the public health authority determines based on the number of cases, risk of further infections, or other factors that monitoring is no longer warranted.

3)         Day Care Attendees

Cases of E. coli O157 or other Shiga toxin-producing E. coli shall be excluded from attending a child care facility, an adult day care facility or a facility for the developmentally disabled if below the age of five years or incontinent of stool until two consecutive negative stool specimens are obtained.  Specimens shall be obtained following clinical recovery of the patient, at least 24 hours apart, and not sooner than 48 hours after the last dose of antimicrobials, if administered.

4)         Cases shall avoid swimming in public recreational water venues (e.g., swimming pools, whirlpool spas, wading pools, water parks, interactive fountains, lakes) while symptomatic and for two weeks after the date diarrhea has ceased.

b)         Control of Contacts

1)         Contacts Who Have Not Had Diarrhea During the Previous Four Weeks

A)        Food Handlers or Persons in Sensitive Occupations, Not Including Health Care Workers

i)          There are no work restrictions while submitting release specimens for contacts who are employed as food handlers or in sensitive occupations and who have had no symptoms of E. coli infections caused by E. coli O157 or other Shiga toxin-producing E. coli strains during the previous four weeks.

ii)         Contacts to cases with E. coli infections caused by O157 or other Shiga toxin-producing E. coli strains who are employed as food handlers or in sensitive occupations shall submit two consecutive negative stool specimens obtained at least 24 hours apart and not sooner than 48 hours after the last dose of antimicrobials, if administered.  These contacts shall be restricted from their occupations if they do not begin submitting release specimens within one week after notification. Release specimens shall be submitted at least once per week until two consecutive negative specimens are obtained, or the individual shall be restricted from working.

iii)        If either of the two release specimens is positive for E. coli infection caused by O157 or other Shiga toxin-producing strains, contacts shall be considered cases and shall comply with subsection (a)(1).

B)        Health Care Workers

Local health authorities may require specimens from health care workers or those who work in occupations requiring standard precautions if there is reason to believe that specimen testing is necessary (e.g., the nature of the work, including feeding patients, assisting patients with eating, providing or preparing meals for patients, denture or oral care, hygienic practices of the worker, dispensing or administering medications, or as part of an investigation of a cluster).  Specimens shall be obtained at least 24 hours apart.  Specimens shall begin to be submitted within one week after notification, or the individual shall be restricted from patient care. 

2)         Contacts Who Currently Have Diarrhea or Have Had Diarrhea During the Previous Four Weeks

A)        Food Handlers or Persons in Sensitive Occupations, Not Including Health Care Workers

i)          All contacts to cases of E. coli infections caused by O157 or other Shiga toxin-producing E. coli strains employed as food handlers or in sensitive occupations, and who currently have diarrhea or have had diarrhea during the previous four weeks, shall not work in their occupations until diarrhea has ceased for at least 48 hours and they have submitted two consecutive negative stool specimens.  Specimens shall be obtained following clinical recovery of the patient, at least 24 hours apart, and not sooner than 48 hours after the last dose of antimicrobials, if administered.  Specimens shall begin to be submitted within one week after notification.

ii)         If either of the two release specimens is positive for E. coli infection caused by O157 or other Shiga toxin-producing E. coli strains, contacts shall be considered cases and shall comply with subsection (a)(1).

B)        Health Care Workers

Local health authorities may require specimens from health care workers or those who work in occupations requiring standard precautions if there is reason to believe that specimen testing is necessary (e.g., the nature of the work, including feeding patients, assisting patients with eating, providing or preparing meals for patients, denture or oral care, hygienic practices of the worker, dispensing or administering oral medications, or as part of an investigation of a cluster).  Specimens shall be obtained following clinical recovery of the patient, at least 24 hours apart and not sooner than 48 hours after the last dose of antimicrobials, if administered.  Specimens shall begin to be submitted within one week after notification, or the individual shall be restricted from patient care. When specimen submission is required, health care workers who feed patients or assist patients with eating, provide or prepare meals for patients, provide denture or oral care, or dispense or administer oral medications, shall be restricted from these duties until two negative stool specimens are obtained, or if the public health authority determines based on case numbers, risk of further infections or other factors that monitoring is no longer warranted.

C)        Day Care Attendees

Contacts to cases of E. coli O157 or other Shiga toxin-producing E. coli strains who currently have or have had diarrhea during the previous four weeks who attend a child care facility, an adult day care facility or a facility for the developmentally disabled and are below the age of five years or incontinent of stool shall submit two consecutive negative stool specimens.  Specimens shall be obtained following clinical recovery of the patient, at least 24 hours apart, and not sooner than 48 hours after the last dose of antimicrobials, if administered. Release specimens shall be submitted within one week after notification, or the individual shall be restricted from attendance.  If either of the two specimens is positive for E. coli infection caused by O157 or other Shiga toxin producing E. coli strains, contacts shall be considered cases and shall comply with subsection (a)(3).

c)         Shiga Toxin Producing E. coli Outbreaks at a Facility Where Food Handling Occurs

When an outbreak occurs in a facility where food handling exists, food handlers at the facility shall be considered contacts to cases and shall submit two consecutive negative stool specimens obtained at least 24 hours apart and not sooner than 48 hours after the last dose of antimicrobials, if administered.  Local health authorities, in consultation with the Department, may require two consecutive negative specimens from food handlers before food handlers return to work, if there is reason to believe these individuals may be the source of the illness or could transmit disease. In all other outbreaks where there is no reason to believe these individuals may be the source of the illness or could transmit disease, food handlers shall be restricted from their occupations if they do not begin submitting specimens within one week after notification, and specimens shall be submitted at least once per week until two consecutive negative specimens are obtained, or the individual shall be restricted from food handling until the public health authority determines that monitoring is no longer warranted.

d)         Sale of Food, Milk, etc. (See Section 690.30(b).)

e)         Laboratory Reporting

1)         Laboratories shall report to the local health authority all patients who have a positive result from a stool specimen or any laboratory test indicative of and specific for detecting Escherichia coli O157, other Shiga toxin-producing E. coli.

2)         Laboratories shall submit E. coli O157 or other Shiga toxin-producing isolates, broth or specimens to the Department's laboratory in accordance with the Department's specimen submission criteria, which can be accessed at: https://dph.illinois.gov/topics-services/lab-testing-services/general-requirements.html. 

(Source:  Amended at 48 Ill. Reg. 4098, effective February 27, 2024)