As of Thursday afternoon, the NC Division of Public Health (DPH) reported that it was investigating 28 cases related to the E. coli outbreak. Twelve cases have been confirmed, and sixteen cases are under investigation.

Here is the latest list of counties and cases reported:

Wake               13

Sampson           6

Cleveland           1

Durham              2

Johnston             1

Lenoir                  1

Orange                2

Wilson                 2

Four of the confirmed cases involve children who have been hospitalized with hemolytic uremic syndrome (HUS). Health officials say the outbreak appears to be linked to people who attended the State Fair in mid-October.

On Monday, State Epidemiologist Megan Davies, MD, explained that investigators are using an exhaustive interview process to help pinpoint the source of the E. coli O157. This includes further interviews involving confirmed or suspected cases, and interviews with more than seventy randomly chosen people who attended the fair but did not become ill. By using a control group, officials hope to find some commonality that may provide additional clues as to the source, but Davies cautioned that it’s possible they may not learn what the specific exposure was.

The investigation is expected to be completed by early next week. DPH officials have been working closely with the Agriculture Department and local health departments. Updates on the investigation are being posted daily by 4:00 pm at: http://epi.publichealth.nc.gov/gcdc/ecoli.html.

State law requires that all suspected shiga toxin-producing E. coli infections and HUS cases be reported within 24 hours to the local health department or by contacting the epidemiologist on call at 919-733-3419. Suspected cases do not require laboratory confirmation to be reported.