context: In October/November 2005, the largest outbreak of verotoxin-producing Escherichia coli (VTEC) ever recorded in Ireland occurred. Eighteen E. coli O157 culture-positive cases, phage type 32, verotoxin 2 positive, were identified in a small rural area of mid-west Ireland. Half of these patients were asymptomatic. Two children were admitted to hospital with haemolytic uraemic syndrome, one of whom required peritoneal dialysis, and both recovered. All 18 culture-positive patients had indistinguishable or closely related pulsed field gel electrophoresis (PFGE) patterns. Nine of the VTEC O157 culture-positive individuals were in preschool children attending two local cr�ches. Several culture-positive individuals apparently had exposure to a vulnerable private group water scheme (GWS) in an agricultural area. No microbiological evidence of VTEC was found in food or water. One veterinary sample (an animal rectal swab) was positive for E. coli O157 and the PFGE strain was indistinguishable from the outbreak strain. A case control study showed analytical epidemiological evidence of risk related to potential exposure to the GWS but not related to reported consumption of that water. Selection of cases and controls proved challenging. Transmission occurred primarily in childcare and family settings, with significant person-to-person spread. Control measures included voluntary closure of the cr�ches, exclusion of culture-positive individuals in risk groups until microbiological clearance was achieved and the issuing of a �boil water� advisory for drinking water pending upgrading of disinfection facilities.
  In October 2005, the notification of a case of HUS-associated VTEC O157 led to the identification of a large outbreak in Ireland [16].
  Both faecal and drinking water samples were analysed in the Biosafety Level 3 laboratory using the immunomagnetic separation method for the isolation of E. coli O157 and polymerase chain reaction for detection of VT1 and VT2 genes. Epidemiological investigations included the use of a trawling questionnaire on all culture-positive individuals. Twenty one water samples and one food sample were tested specifically for E. coli O157. Rainfall data supplied by Met �ireann (the Irish Meteorological Service) at a nearby station for the period around the outbreak was collated. A questionnaire was compiled and piloted. Two cases were hospitalised. A �boil water� advisory was issued to users of the GWS pending upgrading of disinfection facilities. A point source was initially suspected, possibly from environmental contamination of vulnerable drinking water, but this was not proven. Subsequent to the outbreak, an education initiative advising childcare facilities about VTEC was launched in 2006
  
  
answers: {'answer_start': [1534], 'text': ['boil water� advisory']}