Division of Public Health Services  Disease Handbook for Childcare Providers 
Bureau of Infectious Disease Control   REVISED –January 2018 
E. COLI 0157:H7 
 
E. coli 0157:H7 is an intestinal illness caused by a 
bacterium that can cause severe bloody diarrhea, 
anemia, and –in some cases- kidney failure. 
 
Who gets this disease? 
Anyone is susceptible to this particular category of 
E. coli 0157:H7, but it most seriously affects young 
children and the elderly. 
 
How is it spread? 
This bacterium lives in a small number of healthy 
cattle.  When the infected animal is slaughtered, the 
meat can become contaminated.  The bacteria may 
also contaminate raw  milk by being present on the 
cow’s udder. 
 
E. coli 0157:H7 is spread by eating contaminated 
food – most often undercooked beef, especially 
undercooked ground beef.  Contaminated meat 
looks and smells normal.  Drinking unpasteurized 
milk and swimming in or  drinking sewage -
contaminated water can also cause infection. 
 
An infected person having diarrhea can pass the 
bacteria from one person to another if hand-washing 
habits are not adequate.  This is more likely to 
happen among toddlers who are not toilet trained. 
 
Young children usually continue to shed the 
bacteria in their stool a week or two following their 
illness. 
 
What are the symptoms? 
They vary from mild diarrhea to a bloody diarrhea 
with severe abdominal cramps and little or no fever.  
Vomiting may o ccur late in the illness.  A small 
percent may develop hemolytic uremic syndrome  
(HUS), a condition that destroys the red blood cells 
and causes kidney failure.  This is more likely to 
occur in children under five years of age and the 
elderly, and may lead to death. 
 
How soon do symptoms appear? 
Symptoms appear 12 -72 hours after exposure with 
the average being 48 hours. 
 
Can a person have this disease without 
knowing it? 
Yes.  The organism is identified through stool 
culture testing.  Usually symptoms disa ppear in a 
few days but the bacteria can remain in the 
intestinal tract for several weeks. 
 
What is the treatment? 
Seek medical help for identification of the 
organism.  Usually the person is treated for diarrhea 
dehydration with fluid replacement. 
 
How ca n the spread of this disease be 
prevented? 
1. Wash hands thoroughly after diapering and 
using the bathroom. 
2. Avoid eating undercooked beef, especially 
hamburger.   
3. Avoid drinking from unknown water sources ,, 
raw milk, and unpasteurized apple juice. 
4. Teach children good hand washing techniques 
 
Who should be excluded? 
Children who are infected with this bacterium will 
be excluded from childcare while they are 
symptomatic.  Infected adults should be excluded 
from childcare centers, food handling, and direct 
care healthcare, until their stool cultures are free of 
E. coli 0157:H7 on two (2) consecutive specimens 
collected not less than 24 -hours apart.  If antibiotics 
have been given, the initial cultures should be 
obtained at least 48-hours after the last dose. 
 
Reportable? 
Yes.  E. coli 0157:H7 is reportable by New 
Hampshire law to the Division of Public Health 
Services, Bureau of Infectious Disease Control  at 
(603) 271-4496.