U. S. Food and Drug Administration
Center for Food Safety and Applied Nutrition
From the Centers for Disease Control and Prevention
Morbidity and Mortality Weekly Report
Centers for Disease Control and Prevention
MMWR 42(4):1993 Feb 5
Preliminary Report: Foodborne Outbreak
of Escherichia coli 0157:H7 Infections from Hamburgers--Western
United States, 1993
During January 1-29, 1993, 230 persons with culture-confirmed infection with
Escherichia coli 0157: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 0157: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: E. coli 0157: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 0157: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
person-to-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 0157: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 0157: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 0157: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 0157: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 0157: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
0157:H7. J Clin Microbiol 1989;27:1675-7.
Morbidity and Mortality Weekly Report 42(4):1993 Feb 5
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