Skip to main content
×
Home
    • Aa
    • Aa

Multistate outbreak of Escherichia coli O157:H7 infections associated with a national fast-food chain, 2006: a study incorporating epidemiological and food source traceback results

  • S. V. SODHA (a1), M. LYNCH (a1), K. WANNEMUEHLER (a1), M. LEEPER (a1), M. MALAVET (a2), J. SCHAFFZIN (a1) (a3), T. CHEN (a1) (a4), A. LANGER (a1) (a2), M. GLENSHAW (a1) (a2), D. HOEFER (a3), N. DUMAS (a3), L. LIND (a4), M. IWAMOTO (a1), T. AYERS (a1), T. NGUYEN (a1), M. BIGGERSTAFF (a1), C. OLSON (a1), A. SHETH (a1) and C. BRADEN (a1)...
Summary
SUMMARY

A multistate outbreak of Escherichia coli O157:H7 infections occurred in the USA in November–December 2006 in patrons of restaurant chain A. We identified 77 cases with chain A exposure in four states – Delaware, New Jersey, New York, and Pennsylvania. Fifty-one (66%) patients were hospitalized, and seven (9%) developed haemolytic uraemic syndrome; none died. In a matched analysis controlling for age in 31 cases and 55 controls, illness was associated with consumption of shredded iceberg lettuce [matched odds ratio (mOR) 8·0, 95% confidence interval (CI) 1·1–348·1] and shredded cheddar cheese (mOR 6·2, CI 1·7–33·7). Lettuce, an uncooked ingredient, was more commonly consumed (97% of patients) than cheddar cheese (84%) and a single source supplied all affected restaurants. A single source of cheese could not explain the regional distribution of outbreak cases. The outbreak highlights challenges in conducting rapid multistate investigations and the importance of incorporating epidemiological study results with other investigative findings.

Copyright
Corresponding author
*Author for correspondence: S. V. Sodha, M.D., M.P.H., 1600 Clifton Road, MS A-38, Atlanta, GA 30333, USA. (Email: ssodha@cdc.gov)
References
Hide All
1.Mead PS, et al. Food-related illness and death in the United States. Emerging Infectious Diseases 1999; 5: 607625.
2.Rangel JM, et al. Epidemiology of Escherichia coli O157:H7 outbreaks, United States, 1982–2002. Emerging Infectious Diseases 2005; 11: 603–9.
3.Centers for Disease Control and Prevention. Escherichia coli O157:H7 outbreak linked to home-cooked hamburger – California, July 1993. Morbidity and Mortality Weekly Report 1994; 43: 213216.
4.Centers for Disease Control and Prevention. Escherichia coli O157:H7 infections associated with eating a nationally distributed commercial brand of frozen ground beef patties and burgers – Colorado, 1997. Morbidity and Mortality Weekly Report 1997; 46: 777778.
5.Centers for Disease Control and Prevention. Multistate outbreak of Escherichia coli O157:H7 infections associated with eating ground beef – United States, June–July 2002. Morbidity and Mortality Weekly Report 2002; 51: 637639.
6.Vogt RL, Dippold L. Escherichia coli O157:H7 outbreak associated with consumption of ground beef, June–July 2002. Public Health Reports 2005; 120: 174178.
7.Hilborn ED, et al. A multistate outbreak of Escherichia coli O157:H7 infections associated with consumption of mesclun lettuce. Archives of Internal Medicine 1999; 159: 17581764.
8.Centers for Disease Control and Prevention. Ongoing multistate outbreak of Escherichia coli serotype O157:H7 infections associated with consumption of fresh spinach – United States, September 2006. Morbidity and Mortality Weekly Report 2006; 55: 10451046.
9.Ribot EM, et al. Standardization of pulsed-field gel electrophoresis protocols for the subtyping of Escherichia coli O157:H7, Salmonella, and Shigella for PulseNet. Foodborne Pathogens and Diseases 2006; 3: 5967.
10.Persson S, et al. Subtyping method for Escherichia coli Shiga toxin (Verocytotoxin) 2 variants and correlations to clinical manifestations. Journal of Clinical Microbiology 2007; 45: 20202024.
11.California Food Emergency Response Team. Environmental investigation of Escherichia coli O157:H7 outbreak associated with Taco Bell restaurants in northeastern states. Sacramento, CA, USA: California Department of Public Health, United States Food and Drug Administration, 2007.
12.Boerlin P, et al. Associations between virulence factors of Shiga toxin-producing Escherichia coli and disease in humans. Journal of Clinical Microbiology 1999; 37: 497503.
13.Wachtel MR, Charkowski AO. Cross-contamination of lettuce with Escherichia coli O157:H7. Journal of Food Protection 2002; 65: 465470.
14.Wachtel MR, Whitehand LC, Mandrell RE. Association of Escherichia coli O157:H7 with preharvest leaf lettuce upon exposure to contaminated irrigation water. Journal of Food Protection 2002; 65: 1825.
15.Beuchat LR, et al. Efficacy of spray application of chlorinated water in killing pathogenic bacteria on raw apples, tomatoes, and lettuce. Journal of Food Protection 1998; 61: 1305–11.
16.Niemira BA. Relative efficacy of sodium hypochlorite wash versus irradiation to inactivate Escherichia coli O157:H7 internalized in leaves of Romaine lettuce and baby spinach. Journal of Food Protection 2007; 70: 25262532.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Epidemiology & Infection
  • ISSN: 0950-2688
  • EISSN: 1469-4409
  • URL: /core/journals/epidemiology-and-infection
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords:

Metrics

Full text views

Total number of HTML views: 9
Total number of PDF views: 35 *
Loading metrics...

Abstract views

Total abstract views: 237 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 22nd October 2017. This data will be updated every 24 hours.