A cluster of Escherichia coli O157:H7 infections with the hemolytic-uremic syndrome and death in California. A mandate for improved surveillance

In mid-January 1993, an outbreak of Escherichia coli O157:H7 infections associated with eating hamburger patties at a fast-food restaurant chain (chain A) was reported in Washington State. From mid-December to mid-January, 9 cases of E coli O157:H7-associated bloody diarrhea and the hemolytic-uremic...

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Bibliographic Details
Published in:The Western journal of medicine 1996-07, Vol.165 (1-2), p.15-19
Main Authors: Shefer, A M, Koo, D, Werner, S B, Mintz, E D, Baron, R, Wells, J G, Barrett, T J, Ginsberg, M, Bryant, R, Abbott, S, Griffin, P M
Format: Article
Language:English
Subjects:
Adolescent
Adult
Analysis
Animals
California - epidemiology
Case studies
Case-Control Studies
Cattle
Cause of Death
Child
Child, Preschool
Confidence Intervals
Demographic aspects
Diarrhea - epidemiology
Diarrhea - microbiology
Disease Notification
Disease Outbreaks
Escherichia coli
Escherichia coli infections
Escherichia coli Infections - epidemiology
Escherichia coli Infections - mortality
Escherichia coli O157 - isolation & purification
Feces - microbiology
Female
Food handling
Food poisoning
Gastrointestinal Hemorrhage - epidemiology
Gastrointestinal Hemorrhage - microbiology
Hemolytic-Uremic Syndrome - epidemiology
Hemolytic-Uremic Syndrome - mortality
Humans
Infant
Male
Meat - microbiology
Middle Aged
Odds Ratio
Population Surveillance
Restaurants
Washington - epidemiology
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Summary:In mid-January 1993, an outbreak of Escherichia coli O157:H7 infections associated with eating hamburger patties at a fast-food restaurant chain (chain A) was reported in Washington State. From mid-December to mid-January, 9 cases of E coli O157:H7-associated bloody diarrhea and the hemolytic-uremic syndrome had been reported in San Diego County, California. A total of 34 persons had bloody diarrhea, the hemolytic-uremic syndrome, or E coli O157:H7 organisms isolated from stool during the period November 15, 1992, through January 31, 1993. Organisms of E coli O157:H7 identified from 6 persons were indistinguishable from those of the Washington outbreak strain. Illness was associated with eating at chain A restaurants in San Diego (odds ratio, 13; 95% confidence interval, 1.7, 99) and with eating regular-sized hamburgers (odds ratio, undefined; lower-limit 95% confidence interval, 1.3). Improved surveillance by mandating laboratory- and physician-based reporting of cases of E coli O157:H7 infection and the hemolytic-uremic syndrome might have alerted health officials to this outbreak sooner, which could have resulted in earlier investigation and the institution of measures to prevent more cases. Images
ISSN:0093-0415
1476-2978