How E. coli got in daycare meat loaf, sickening hundreds, may never be known: report

A report into a massive E. coli outbreak at Calgary child-care facilities that saw hundreds fall ill says it was likely tied to meat loaf at one meal, but how it got there can’t be determined for sure.

The report released Monday by Alberta Health Services says it’s not possible to say if the bacteria came from a contaminated ingredient in the meat loaf or into the meat loaf from elsewhere on the menu or through an infected kitchen worker.

The E. coli outbreak, declared on Sept. 4, 2023, led to at least 448 infections.

There were 38 children and one adult hospitalized for severe illness.

Of the severe cases, 23 were diagnosed with hemolytic uremic syndrome (HUS), a condition that damages blood vessels and kidneys and can lead to life-threatening kidney failure.

Eight received peritoneal dialysis, which is done to remove waste products from the blood when the kidneys are failing.

Another 33 secondary cases have also been linked, including household contacts and children in other daycare facilities.

There were no deaths.

The outbreak was linked to Shiga toxin-producing Escherichia coli, or STEC for short.

“This is the largest gastrointestinal outbreak in AHS history and likely one of the largest STEC outbreaks involving child-care facilities anywhere,” said the report.

“The central kitchen served up to 1,275 attendees and 250 child-care facility workers during the period in question, in addition to exposures to kitchen staff and people in the community who ate leftovers.”

The eight-week outbreak was traced back to Fueling Minds, a catering company and school lunch delivery service provider that prepared food for its Fueling Brains locations and other daycares in Calgary.

The report narrowed the E. coli down to a single meal served from the Fueling Minds central kitchen on Aug. 29, 2023.

"One meal originating from the central kitchen came out with extremely high odds as being the source of inspection. The beef meat loaf served at lunch on Aug. 29, 2023, was the probable food item containing the E. coli,” said the report.

"Workers who ate beef meat loaf were 23 times more likely to become a confirmed STEC case than workers who did not eat beef meat loaf."

E. coli is a type of bacteria that can cause bloody diarrhea. Some strains cause more severe illness. Shiga toxin-producing E. coli is different as it produces a toxin that can cause complications.

In response to the outbreak, the province launched a third-party review to determine how to prevent similar outbreaks in the future.

That report, by the Food Safety and Licensed Facility-Based Child Care Review Panel and also released Monday, made 12 main recommendations to protect the health and safety of children in licensed child-care facilities.

The Alberta government said it has already started work on implementing some of the recommendations, including increasing the frequency of inspections at child-care facilities, mandatory training programs for food workers and improving response times in child-care facilities where food safety concerns have been raised.

Planning is also underway to require all licensed child-care providers to prominently post their most recent public health inspection reports for parents to review.

"Last fall, families in Calgary experienced a living nightmare ... an E. coli outbreak affecting 17 licensed child-care facilities around the city," said Premier Danielle Smith.

"When parents put their children in daycare they do so trusting that their kids will be cared for and kept safe. We know this outbreak has shaken that trust and as policymakers we must do whatever we can to ensure this doesn't happen again."

Matt Jones, minister of jobs, economy and trade, said the government will make sure that child-care operators follow the new rules.

"We are going to put in tools to hold people accountable and we're going to increase transparency so the parents can see an operators’ track record," Jones said.

The Opposition NDP said the government needs to act faster in the future.

“It took the UCP government a full week to show any form of public accountability as the E. coli outbreak in Calgary unfolded,” Diana Batten, the NDP child-care critic, said in a statement.

"Every parent, at a bare minimum, should expect that a facility they are trusting with the care of their child will be safe and free of harm."

Sarah MacDonald's four-year-old son was among the children hospitalized due to the outbreak and she says she's cautiously optimistic about the report but disappointed there have been no consequences.

"I'm very happy the government is taking action but in order for us to move forward, we need closure. An apology for this failure of the system to keep our children safe is necessary for us to move forward," she said.

Her son continues to receive care after developing HUS and she says the entire experience has been traumatic.

"It's just such violent, extreme illness and stress," she said.

"At the onset of symptoms, he had diarrhea probably every 15 to 20 minutes for about 60 hours straight. He had to sleep on the toilet. I mean, just watching that as a parent, at a certain point when that isn't slowing down or stopping, you really start to think you're going to lose your child. Ongoing, we need to monitor his kidneys for the rest of his life."

Food-safety expert Keith Warriner from the University of Guelph says the report failed to address specific issues with this outbreak, like why food inspectors didn't act on repeated violations at Fueling Minds.

"It's superficial. It doesn't get to the main points of why wasn't there action on the inspector's reports. They had five visits over a period of a year and some of those violations like insect infiltration would warrant closing down and they let it ride," he said.

Warriner says the report focuses more on how to respond to outbreaks rather than how to prevent them.

"All in all, I don't think this report got to the point of the crisis and that's if the kitchen serving those daycares was closed down at the first violation, which was a serious violation when we think of insect infestation, then the outbreak wouldn't have occurred and that's the bottom line," he said.

The Fueling Minds kitchen was closed after the outbreak and reopened in November under a different food provider.

The daycare operator offered a brief statement after the announcement.

"The health and safety of our kids and families is our top priority, and we look forward to reviewing the report in detail," it said.

Fueling Minds and its directors has been charged by the City of Calgary with serving food to the child-care centres without a licence.

They have pleaded not guilty and face fines up to $120,000, and a trial is set for September.

With files from Teri Fikowski.

This report by The Canadian Press was first published July 29, 2024.