Preliminary Report: Foodborne Outbreak of
Escherichia coli O157:H7 Infections from Hamburgers --
Western United States, 1993
During January 1-29, 1993, 230 persons with culture-confirmed
infection with Escherichia coli O157:H7 resulting in bloody
diarrhea
and, in some cases, hemolytic uremic syndrome (HUS) were reported
in
the state of Washington. Culture results are pending for 80 others
with similar illnesses. Preliminary investigations by public health
agencies linked cases to consumption of hamburgers from one
fast-food
restaurant chain. E. coli O157:H7 has been isolated from
epidemiologically implicated lots of ground beef; an interstate
recall was initiated by the restaurant on January 18. Meat from the
same lots of ground beef had been distributed to at least three
other
western states in which increased numbers of cases of bloody
diarrhea
have been reported. CDC, the U.S. Department of Agriculture, state
and county health departments, and state agriculture investigators
are investigating whether cases of bloody diarrhea in the other
states are linked to consumption of meat from the same lots of
ground
beef and are determining the possible sources of the contaminated
meat.
Reported by: Enteric Diseases Br, Div of Bacterial and Mycotic
Diseases, National Center for Infectious Diseases; Div of Field
Epidemiology, Epidemiology Program Office, CDC.
Editorial Note
Editorial Note: E. coli O157:H7 is an emerging infectious agent
first
linked to human illness in 1982; its importance as a human pathogen
appears to be increasing (1,2). Infection with E. coli O157:H7 may
result in a spectrum of illnesses, including mild diarrhea, severe
bloody diarrhea (hemorrhagic colitis), HUS often leading to acute
renal failure requiring dialysis, and death (3). Infection with
this
organism has been associated with consumption of contaminated beef
and raw milk and through personto-person transmission by the
fecal-oral route (2). Measures to prevent transmission include
thorough cooking of beef, pasteurization of milk, and careful
handwashing with soap. In particular, ground beef should be cooked
until it is no longer pink. Diagnosis of E. coli O157:H7 infection
in the clinical laboratory setting requires specific culture of
stool
specimens for the organism on modified MacConkey medium containing
sorbitol (4).
Physicians who have patients with severe bloody diarrhea of
unknown etiology or HUS should consider infection with E. coli
O157:H7 and should request the appropriate cultures be done. This
outbreak illustrates how surveillance with rapid reporting and
prompt
investigation of cases can lead to timely public health action.
Physicians and laboratories are encouraged to report cases of E.
coli
O157:H7 infection to their county and state health departments.
References
Lederberg J, Shope RE, Oaks SC Jr., eds. Emerging infections:
microbial threats to health in the United States. Washington, DC:
National Academy Press, 1992.
Griffin PM, Tauxe RV. The epidemiology of infections caused by
Escherichia coli O157:H7, other enterohemorrhagic E. coli, and the
associated hemolytic uremic syndrome. Epidemiol Rev 1991;13:60-98.
Griffin PM, Ostroff SM, Tauxe RV. Illnesses associated with
Escherichia coli O157:H7 infections: a broad clinical spectrum. Ann
Intern Med 1988;109:705-12.
March SB, Ratnam S. Latex agglutination test for detection of
Escherichia coli serotype O157:H7. J Clin Microbiol 1989;27:1675-7.
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