Epidemiology and Infection

E. coli O157 phage type 21/28 outbreak in North Cumbria associated with pasteurized milk

S. GOH a1c1, C. NEWMAN a2, M. KNOWLES a3, F. J. BOLTON a4, V. HOLLYOAK a2, S. RICHARDS a5, P. DALEY a6, D. COUNTER a7, H. R. SMITH a8 and N. KEPPIE a2
a1 North Cumbria Health Authority, Wavell Drive, Rosehill, Carlisle, Cumbria CA1 2SE
a2 PHLS CDSC Northern & Yorkshire, BridlePath, Leeds, LS15 7TR
a3 Carlisle Public Health Laboratory, Cumberland Infirmary, Carlisle, CA2 7HY
a4 Food Safety Microbiology Laboratory, Central Public Health Laboratory, 61 Colindale Avenue, London, NW9 5HT
a5 West Cumberland Hospital, Whitehaven, CA28 8JG
a6 Environmental Health Department, Allerdale Borough Council, Allerdale House, Workington, CA14 3YJ
a7 Veterinary Laboratories Agency (MAFF), Merrythought, Penrith
a8 Laboratory of Enteric Pathogens, Central PHL, 61 Colindale Avenue, London, NW9 5HT


In March 1999, a large community outbreak of Escherichia coli O157 infection occurred in North Cumbria. A total of 114 individuals were reported to the Outbreak Control Team (OCT); 88 had laboratory confirmed E. coli O157. Twenty-eight (32%) of the confirmed cases were admitted to hospital, including three children (3·4%) with haemolytic uraemic syndrome. There were no deaths. A case-control study found that illness was strongly associated with drinking pasteurized milk from a local farm (P=<0·0001) on single variable analysis. Microbiological investigations at the farm revealed E. coli O157 phage type (PT) 21/28 VT 2 which was indistinguishable from the human isolates by pulsed field gel electrophoresis. At the time of occurrence this was the largest E. coli O157 outbreak in England and Wales and the first E. coli O157 PT 21/28 VT 2 outbreak associated with pasteurized milk. This outbreak highlights lessons to be learnt regarding on-farm pasteurization.

(Accepted August 19 2002)

c1 Author for correspondence.