Outbreak of Shiga toxin-producing Escherichia coli O104:H4 associated with organic fenugreek sprouts, France, June 2011

On 22 June 2011, 8 patients with hemolytic uremic syndrome (HUS) or bloody diarrhea were reported in France. All 8 were attendees of a community center event on 8 June near Bordeaux. Three Escherichia coli cases were confirmed by isolation of Shiga toxin-producing E. coli O104:H4 stx2 aggR producing...

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Published in:	Clinical infectious diseases Vol. 54; no. 11; p. 1588
Main Authors:	King, Lisa A, Nogareda, Francisco, Weill, François-Xavier, Mariani-Kurkdjian, Patricia, Loukiadis, Estelle, Gault, Gaëlle, Jourdan-DaSilva, Nathalie, Bingen, Edouard, Macé, Muriel, Thevenot, Delphine, Ong, Nathalie, Castor, Christine, Noël, Harold, Van Cauteren, Dieter, Charron, Martine, Vaillant, Véronique, Aldabe, Benedicte, Goulet, Véronique, Delmas, Gilles, Couturier, Elisabeth, Le Strat, Yann, Combe, Christian, Delmas, Yahsou, Terrier, François, Vendrely, Benoit, Rolland, Patrick, de Valk, Henriette
Format:	Journal Article
Language:	English
Published:	United States 01.06.2012
Subjects:	Adolescent Adult Aged Cohort Studies Diarrhea - epidemiology Diarrhea - microbiology Disease Outbreaks Escherichia coli Infections - epidemiology Escherichia coli Infections - microbiology Female Foodborne Diseases - epidemiology Foodborne Diseases - microbiology France - epidemiology Hemolytic-Uremic Syndrome - epidemiology Hemolytic-Uremic Syndrome - microbiology Humans Male Middle Aged Retrospective Studies Serotyping Shiga-Toxigenic Escherichia coli - classification Shiga-Toxigenic Escherichia coli - isolation & purification Trigonella - microbiology Young Adult France
ISSN:	1537-6591, 1537-6591
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Abstract	On 22 June 2011, 8 patients with hemolytic uremic syndrome (HUS) or bloody diarrhea were reported in France. All 8 were attendees of a community center event on 8 June near Bordeaux. Three Escherichia coli cases were confirmed by isolation of Shiga toxin-producing E. coli O104:H4 stx2 aggR producing a cefotaximase (CTX-M) β-lactamase (STEC O104:H4); the same rare serotype caused the outbreak in Germany in May-July 2011. An investigation was initiated to describe the outbreak, identify the vehicle for infection, and guide control measures. We conducted a retrospective cohort study among all adults attending the event, including food handlers. A standardized questionnaire was administered to participants. A case was an attendee who developed HUS or diarrhea between 8 and 24 June. Cases were confirmed by isolation of STEC O104:H4 or O104 serology. Relative risks (RRs) and 95% confidence intervals (CIs) by exposure were calculated using a Poisson regression model. Twenty-four cases were identified (14% attack rate). Of these, 18 (75%) were women, 22 (92%) were adults, 7 (29%) developed HUS, 5 (21%) developed bloody diarrhea, and 12 (50%) developed diarrhea. Ten (42%) cases were confirmed. Fenugreek was the only sprout type with an independent association to illness (RR, 5.1; 95% CI, 2.3-11.1) in multivariable analysis. This investigation identified a point-source STEC O104:H4 outbreak associated with consumption of fenugreek sprouts. Comparison of results from French and German STEC O104:H4 outbreak investigations enabled identification of a common food vehicle, fenugreek sprouts, and resulted in implementation of Europe-wide control measures in July 2011.
AbstractList	On 22 June 2011, 8 patients with hemolytic uremic syndrome (HUS) or bloody diarrhea were reported in France. All 8 were attendees of a community center event on 8 June near Bordeaux. Three Escherichia coli cases were confirmed by isolation of Shiga toxin-producing E. coli O104:H4 stx2 aggR producing a cefotaximase (CTX-M) β-lactamase (STEC O104:H4); the same rare serotype caused the outbreak in Germany in May-July 2011. An investigation was initiated to describe the outbreak, identify the vehicle for infection, and guide control measures. We conducted a retrospective cohort study among all adults attending the event, including food handlers. A standardized questionnaire was administered to participants. A case was an attendee who developed HUS or diarrhea between 8 and 24 June. Cases were confirmed by isolation of STEC O104:H4 or O104 serology. Relative risks (RRs) and 95% confidence intervals (CIs) by exposure were calculated using a Poisson regression model. Twenty-four cases were identified (14% attack rate). Of these, 18 (75%) were women, 22 (92%) were adults, 7 (29%) developed HUS, 5 (21%) developed bloody diarrhea, and 12 (50%) developed diarrhea. Ten (42%) cases were confirmed. Fenugreek was the only sprout type with an independent association to illness (RR, 5.1; 95% CI, 2.3-11.1) in multivariable analysis. This investigation identified a point-source STEC O104:H4 outbreak associated with consumption of fenugreek sprouts. Comparison of results from French and German STEC O104:H4 outbreak investigations enabled identification of a common food vehicle, fenugreek sprouts, and resulted in implementation of Europe-wide control measures in July 2011. On 22 June 2011, 8 patients with hemolytic uremic syndrome (HUS) or bloody diarrhea were reported in France. All 8 were attendees of a community center event on 8 June near Bordeaux. Three Escherichia coli cases were confirmed by isolation of Shiga toxin-producing E. coli O104:H4 stx2 aggR producing a cefotaximase (CTX-M) β-lactamase (STEC O104:H4); the same rare serotype caused the outbreak in Germany in May-July 2011. An investigation was initiated to describe the outbreak, identify the vehicle for infection, and guide control measures.BACKGROUNDOn 22 June 2011, 8 patients with hemolytic uremic syndrome (HUS) or bloody diarrhea were reported in France. All 8 were attendees of a community center event on 8 June near Bordeaux. Three Escherichia coli cases were confirmed by isolation of Shiga toxin-producing E. coli O104:H4 stx2 aggR producing a cefotaximase (CTX-M) β-lactamase (STEC O104:H4); the same rare serotype caused the outbreak in Germany in May-July 2011. An investigation was initiated to describe the outbreak, identify the vehicle for infection, and guide control measures.We conducted a retrospective cohort study among all adults attending the event, including food handlers. A standardized questionnaire was administered to participants. A case was an attendee who developed HUS or diarrhea between 8 and 24 June. Cases were confirmed by isolation of STEC O104:H4 or O104 serology. Relative risks (RRs) and 95% confidence intervals (CIs) by exposure were calculated using a Poisson regression model.METHODSWe conducted a retrospective cohort study among all adults attending the event, including food handlers. A standardized questionnaire was administered to participants. A case was an attendee who developed HUS or diarrhea between 8 and 24 June. Cases were confirmed by isolation of STEC O104:H4 or O104 serology. Relative risks (RRs) and 95% confidence intervals (CIs) by exposure were calculated using a Poisson regression model.Twenty-four cases were identified (14% attack rate). Of these, 18 (75%) were women, 22 (92%) were adults, 7 (29%) developed HUS, 5 (21%) developed bloody diarrhea, and 12 (50%) developed diarrhea. Ten (42%) cases were confirmed. Fenugreek was the only sprout type with an independent association to illness (RR, 5.1; 95% CI, 2.3-11.1) in multivariable analysis.RESULTSTwenty-four cases were identified (14% attack rate). Of these, 18 (75%) were women, 22 (92%) were adults, 7 (29%) developed HUS, 5 (21%) developed bloody diarrhea, and 12 (50%) developed diarrhea. Ten (42%) cases were confirmed. Fenugreek was the only sprout type with an independent association to illness (RR, 5.1; 95% CI, 2.3-11.1) in multivariable analysis.This investigation identified a point-source STEC O104:H4 outbreak associated with consumption of fenugreek sprouts. Comparison of results from French and German STEC O104:H4 outbreak investigations enabled identification of a common food vehicle, fenugreek sprouts, and resulted in implementation of Europe-wide control measures in July 2011.CONCLUSIONSThis investigation identified a point-source STEC O104:H4 outbreak associated with consumption of fenugreek sprouts. Comparison of results from French and German STEC O104:H4 outbreak investigations enabled identification of a common food vehicle, fenugreek sprouts, and resulted in implementation of Europe-wide control measures in July 2011.
Author	Delmas, Yahsou Nogareda, Francisco Van Cauteren, Dieter Charron, Martine Le Strat, Yann Goulet, Véronique Thevenot, Delphine Combe, Christian Gault, Gaëlle Vendrely, Benoit Jourdan-DaSilva, Nathalie Weill, François-Xavier Vaillant, Véronique Delmas, Gilles Rolland, Patrick Couturier, Elisabeth de Valk, Henriette Ong, Nathalie Aldabe, Benedicte King, Lisa A Mariani-Kurkdjian, Patricia Terrier, François Bingen, Edouard Macé, Muriel Loukiadis, Estelle Noël, Harold Castor, Christine
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Snippet	On 22 June 2011, 8 patients with hemolytic uremic syndrome (HUS) or bloody diarrhea were reported in France. All 8 were attendees of a community center event...
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SubjectTerms	Adolescent Adult Aged Cohort Studies Diarrhea - epidemiology Diarrhea - microbiology Disease Outbreaks Escherichia coli Infections - epidemiology Escherichia coli Infections - microbiology Female Foodborne Diseases - epidemiology Foodborne Diseases - microbiology France - epidemiology Hemolytic-Uremic Syndrome - epidemiology Hemolytic-Uremic Syndrome - microbiology Humans Male Middle Aged Retrospective Studies Serotyping Shiga-Toxigenic Escherichia coli - classification Shiga-Toxigenic Escherichia coli - isolation & purification Trigonella - microbiology Young Adult
Title	Outbreak of Shiga toxin-producing Escherichia coli O104:H4 associated with organic fenugreek sprouts, France, June 2011
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