Public Enquiry into the September 2005 outbreak of E.Coli 0157 in South Wales

http://wales.gov.uk/ecolidocs/3008707/reporten.pdf?lang=en

Hugh Pennington, March 2009
isbn 9780 7504 49588



The Outbreak
1. The Outbreak of E.coli O157 in South Wales in September 2005 was the largest outbreak
caused by this organism in Wales and the second largest to date in the UK.
2. A total of 157 cases were identified, of which 118 were confirmed microbiologically as
E.coli O157. Of those, 109 were of a strain unique to the Outbreak.
3. Most cases were children in 44 schools across four local authority areas. Thirty-one people
were admitted to hospital. Tragically, Mason Jones aged five, died.
The Inquiry
4. The Inquiry’s terms of reference were: “To enquire into the circumstances that led to
the Outbreak of E.coli O157 infection in South Wales in September 2005 and into the
handling of the Outbreak; and to consider the implications for the future and make
recommendations accordingly”.
5. Progress was affected by a criminal investigation and subsequent proceedings but the
Inquiry was able to work in parallel with both.
6. The Inquiry considered a substantial volume of written and oral evidence. All relevant
evidence and transcripts of proceedings can be accessed on the Inquiry’s web site www.ecoliinquirywales.org