Epidemiology and Infection
- Epidemiology and Infection / Volume 139 / Issue 02 / February 2011, pp 309-316
- Copyright © Cambridge University Press 2010 This is a work of the U.S. Government and is not subject to copyright protection in the United States
- DOI: http://dx.doi.org/10.1017/S0950268810000920 (About DOI), Published online: 30 April 2010
Gastroenteritis and food poisoning
Multistate outbreak of Escherichia coli O157:H7 infections associated with a national fast-food chain, 2006: a study incorporating epidemiological and food source traceback results
S. V. SODHAa1 c1, M. LYNCHa1, K. WANNEMUEHLERa1, M. LEEPERa1, M. MALAVETa2, J. SCHAFFZINa1a3, T. CHENa1a4, A. LANGERa1a2, M. GLENSHAWa1a2, D. HOEFERa3, N. DUMASa3, L. LINDa4, M. IWAMOTOa1, T. AYERSa1, T. NGUYENa1, M. BIGGERSTAFFa1, C. OLSONa1, A. SHETHa1 and C. BRADENa1
a1 Centers for Disease Control and Prevention, Atlanta, GA, USA
a2 New Jersey Department of Health and Senior Services, Trenton, NJ, USA
a3 New York State Department of Health, Albany, NY, USA
a4 Pennsylvania Department of Health, Harrisburg, PA, USA
SUMMARY
A multistate outbreak of Escherichia coli O157:H7 infections occurred in the USA in November–December 2006 in patrons of restaurant chain A. We identified 77 cases with chain A exposure in four states – Delaware, New Jersey, New York, and Pennsylvania. Fifty-one (66%) patients were hospitalized, and seven (9%) developed haemolytic uraemic syndrome; none died. In a matched analysis controlling for age in 31 cases and 55 controls, illness was associated with consumption of shredded iceberg lettuce [matched odds ratio (mOR) 8·0, 95% confidence interval (CI) 1·1–348·1] and shredded cheddar cheese (mOR 6·2, CI 1·7–33·7). Lettuce, an uncooked ingredient, was more commonly consumed (97% of patients) than cheddar cheese (84%) and a single source supplied all affected restaurants. A single source of cheese could not explain the regional distribution of outbreak cases. The outbreak highlights challenges in conducting rapid multistate investigations and the importance of incorporating epidemiological study results with other investigative findings.
(Accepted March 30 2010)
(Online publication April 30 2010)
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Correspondence:
c1 Author for correspondence: S. V. Sodha, M.D., M.P.H., 1600 Clifton Road, MS A-38, Atlanta, GA 30333, USA. (Email: ssodha@cdc.gov)
