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

• 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
• ISSN: 0093-0415; 1476-2978

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