Thirty-seven out of 48 people on a coach excursion to northern France developed gastrointestinal symptoms within 4 days of the trip. Twenty-six had stool samples positive for Escherichia coli O111, 8 were also positive for Campylobacter species, and 1 was positive for campylobacter alone. Strains of E. coli were positive for the effacing and attaching protein (eaeA) gene, but negative for other E. coli virulence genes, and therefore belonged to the enteropathogenic E. coli (EPEC) group. Twenty-two out of 37 people in a second party which followed the same itinerary 2 weeks later also became ill. One had a stool sample positive for E. coli O111. Analytical epidemiology suggested that the source of infections was a restaurant in northern France at which both parties had eaten.
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