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Public health approach to detection of non-O157 Shiga toxin-producing Escherichia coli: summary of two outbreaks and laboratory procedures

  • J. K. SCHAFFZIN (a1) (a2), F. CORONADO (a1) (a2), N. B. DUMAS (a3), T. P. ROOT (a3), T. A. HALSE (a3), D. J. SCHOONMAKER-BOPP (a3), M. M. LURIE (a2), D. NICHOLAS (a4), B. GERZONICH (a4), G. S. JOHNSON (a2), B. J. WALLACE (a2) and K. A. MUSSER (a3)
  • DOI:
  • Published online: 05 May 2011

Routine laboratory testing may not detect non-O157 Shiga toxin-producing Escherichia coli (STEC) reliably. Active clinical, epidemiological, environmental health, and laboratory collaboration probably influence successful detection and study of non-O157 STEC infection. We summarized two outbreak investigations in which such coordinated efforts identified non-O157 STEC disease and led to effective control measures. Outbreak 1 involved illness associated with consuming unpasteurized apple cider from a local orchard. Public health personnel were notified by a local hospital; stool specimens from ill persons contained O111 STEC. Outbreak 2 involved bloody diarrhoea at a correctional facility. Public health personnel were notified by the facility infection control officer; O45 STEC was the implicated agent. These reports highlight the ability of non-O157 STEC to cause outbreaks and demonstrate that a coordinated effort by clinicians, infection-control practitioners, clinical diagnostic laboratorians, and public health personnel can lead to effective identification, investigation, and prevention of non-O157 STEC disease.

Corresponding author
*Author for correspondence: J. K. Schaffzin, M.D., Ph.D., Cincinnati Children's Hospital Medical Center, Division of General and Community Pediatrics, MLC 2011, 3333 Burnet Ave, Cincinnati, OH 45229-3039, USA. (Email:
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1.KE Johnson , CM Thorpe , CL Sears . The emerging clinical importance of non-O157 shiga toxin-producing Escherichia coli. Clinical Infectious Diseases 2006; 43: 15871595.

2.LW Riley , Hemorrhagic colitis associated with a rare Escherichia coli serotype. New England Journal of Medicine 1983; 308: 681685.

3.MK Viljanen , Outbreak of diarrhea due to Escherichia coli O111:B4 in schoolchildren and adults: association of Vi antigen-like reactivity. Lancet 1990; 336: 831834.

5.Centers for Disease Control and Prevention.Community outbreak of hemolytic uremic syndrome attributable to Escherichia coli O111:NM – South Australia, 1995. Morbidity and Mortality Weekly Report 1995; 44: 550551, 557558.

6.N Banatvala , Shiga-like toxin-producing Escherichia coli O111 and associated hemolytic-uremic syndrome: a family outbreak. Pediatric Infectious Diseases 1996; 15: 10081011.

7.PI Tarr , Hemolytic-uremic syndrome in a six-year-old girl after a urinary tract infection with shiga-toxin producing Escherichia coli O103:H2. New England Journal of Medicine 1996; 335: 635638.

8.H Karch , Epidemiology of shiga toxin-producing Escherichia coli infections. Diagnostic Microbiology and Infectious Diseases 1999; 34: 229243.

9.TA McCarthy , Hemolytic-uremic syndrome and Escherichia coli O121 at a lake in Connecticut, 1999. Pediatrics 2001; 108: 59.

10.JT Brooks , Outbreak of shiga toxin-producing Escherichia coli O111:H8 infections among attendees of a high school cheerleading camp. Clinical Infectious Diseases 2004; 38: 190198.

11.TB Brooks , Non-O157 Shiga toxin-producing Escherichia coli infections in the United States, 1983–2002. Journal of Infectious Diseases 2005; 192: 14221429.

12.Centers for Disease Control and Prevention.Laboratory-confirmed non-O157 shiga toxin-producing Escherichia coli – Connecticut, 2000–2005. Morbidity and Mortality Weekly Report 2007; 56: 2931.

20.M Pulz , Comparison of a shiga-toxin enzyme-linked immunosorbent assay and two types of PCR for the detection of shiga toxin-producing Escherichia coli in human stool specimens. Journal of Clinical Microbiology 2003; 41: 46714675.

21.L Beutin , S Zimmermann , K Gleier . Pseudomonas aeruginosa can cause false-positive identification of verotoxin (shiga-like toxin) production by a commercial enzyme immune assay system for the detection of shiga-like toxins (SLTs). Infection 1996; 24: 267268.

23.SD Manning , Surveillance for shiga toxin-producing Escherichia coli, Michigan, 2001–2005. Emerging Infectious Diseases 2007; Feb. (

26.AC Voetsch , Laboratory practices for stool-specimen culture for bacterial pathogens, including Escherichia coli O157:H7, in the FoodNet Sites, 1995–2000. Clinical Infectious Diseases 2004; 38 (Suppl. 3): S190S197.

27.MB Cohen . Shiga toxin-producing Escherichia coli: two tests are better than one. Journal of Pediatrics 2002; 141: 155156.

28.NJ Cohen , Identifying shiga toxin-producing Escherichia coli: results of a laboratory evaluation. Foodborne Pathogens and Disease 2008; 5: 295301.

29.D Hoefer , Laboratory practices for the identification of shiga toxin-producing Escherichia coli in the United States, FoodNet Sites, 2007. Foodborne Pathogens and Disease 2011; 8: 555560.

30.DJ Bopp , Detection, isolation, and molecular subtyping of Escherichia coli 0157:H7 and Campylobacter jejuni associated with a large waterborne outbreak. Journal of Clinical Microbiology 2003; 41: 174180.

31.EM Ribot , Standardization of pulsed-field gel electrophoresis protocols for the subtyping of Escherichia coli O157:H7, Salmonella, and Shigella for PulseNet. Foodborne Pathogens and Disease 2006; 3: 5967.

35.CS Wong , The risk of the hemolytic-uremic syndrome after antibiotic treatment of Escherichia coli O157:H7 infections. New England Journal of Medicine 2000; 342: 19301936.

36.BP Bell , Predictors of hemolytic uremic syndrome in children during a large outbreak of Escherichia coli O157:H7 infections. Pediatrics 1997; 100: 12.

37.JA Ake , Relative nephroprotection during Escherichia coli O157:H7 infections: association with intravenous volume expansion. Pediatrics 2005; 115: 673680.

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Epidemiology & Infection
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