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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Summary: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.
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ISSN:1537-6591
1537-6591
DOI:10.1093/cid/cis255