The South Carolina Department of Health and Environmental Control (DHEC) released its final update Friday regarding the recent E. coli outbreak associated with The Learning Vine childcare center in Greenwood County. The outbreak case count remains at 14 cases of Shiga toxin-producing E. coli (STEC). A 2-year-old boy who had attended the daycare died May 31 from complications of E. coli infection. There are no reports of ongoing transmission related to the investigation, nor have there been reports of new illnesses in students or staff of the childcare center since June 1, 2015. On May 18, DHEC was notified of a confirmed case of STEC in an individual associated with a childcare center. DHEC conducted an interview with the individual on May 19 and learned that the individual first became symptomatic on May 3, with symptoms ending on May 11. Although the individual indicated that some others in the childcare facility had been sick at about the same time, there was no indication given of any current illnesses at the facility. As part of routine practice, DHEC searched its database for other possible laboratory matches and found no other recent cases of E. coli in Greenwood County. On May 29, DHEC was notified of a case of hemolytic uremic syndrome (HUS) in Greenwood County. Interviews of the individual’s close contacts and a review of surveillance data revealed that this individual had first developed symptoms on or about May 10 and that the HUS case and the STEC case were both associated with the same childcare facility. In response, DHEC immediately opened an investigation of a cluster of E. coli infections for the purpose of identifying, notifying, interviewing and testing other individuals who might be at risk. As of June 7, DHEC had received laboratory confirmation of seven cases of STEC, and all of the cases involved individuals at the childcare facility and their family members. Lab cultures confirmed that four of these cases had infections with the same bacteria strain. On the same day, DHEC and the childcare center entered into a public health consent agreement to close the facility to limit the possibility of further spread of the infection. The Learning Vine reopened on June 15 after the facility demonstrated it had met the terms of the consent agreement. The Learning Vine had followed all recommendations issued by DHEC, and DHEC received confirmation from the South Carolina Department of Social Services (DSS) that the facility had corrected the deficiencies cited in DSS’s Inspection Report. Before returning to the facility, all students and staff had to show proof of at least one negative stool sample, with some individuals being required to have two negative stool samples based on their history or contact with cases. Additionally, all of the employees at the childcare center were required to view a hand-hygiene training video before being allowed to return to work. DHEC investigative efforts since May 29 have uncovered additional individuals who experienced symptoms of diarrheal illness as early as April who were also investigated for the possibility of being STEC cases. Subsequent testing confirmed a total of 14 cases of Shiga toxin-producing E. coli in individuals associated with The Learning Vine and their family members. As of July 24, 330 test results have been negative for STEC. Although the source of the contamination may never be identified, the staggered onsets of illness suggest person-to-person transmission rather than exposure to a single source such as food. The South Carolina health department has asked the Centers for Disease Control and Prevention for help in reviewing its response to the outbreak and its infectious disease program overall. (To sign up for a free subscription to Food Safety News, click here.)