TY - JOUR
T1 - Outbreak of Shiga toxin-producing Escherichia coli O157 linked with consumption of a fast-food product containing imported cucumbers, United Kingdom, August 2020
AU - Mulchandani, Ranya
AU - Brehmer, Clare
AU - Butt, Saira
AU - Vishram, Bhavita
AU - Harrison, Melissa
AU - Marchant, Elizabeth
AU - Ferris, Simon
AU - Jorgensen, Frieda
AU - Smith, Robert
AU - Godbole, Gauri
AU - Jenkins, Claire
AU - Dallman, Timothy J
AU - Verlander, Neville Q
AU - Phin, Nick
AU - Todkill, Dan
AU - Gharbia, Saheer
AU - Hawker, Jeremy
N1 - Copyright © 2021 The Author(s). Published by Elsevier Ltd.. All rights reserved.
PY - 2021/10
Y1 - 2021/10
N2 - BACKGROUND: In August 2020, an outbreak of Shiga toxin-producing Escherichia coli (STEC) O157:H7 occurred in the United Kingdom. Whole genome sequencing revealed that these cases formed a genetically distinct cluster.METHODS: Hypotheses generated from case interviews were tested in analytical studies, and results informed environmental sampling and food chain analysis. A case-case study used non-outbreak 'comparison' STEC cases; a case-control study used a market research panel to recruit controls.RESULTS: A total of 36 cases were identified; all cases reported symptom onset between August 3 and August 16, 2020. The majority of cases (83%) resided in the Midlands region of England and in Wales. A high proportion of cases reported eating out, with one fast-food restaurant chain mentioned by 64% (n = 23) of cases. Both the case-case study (adjusted odds ratio (aOR) 31.8, 95% confidence interval (CI) 1.6-624.9) and the case-control study (aOR 9.19, 95% CI 1.0-82.8) revealed statistically significant results, showing that the consumption of a specific fast-food product was independently associated with infection.CONCLUSIONS: Consumption of a specific fast-food product was a likely cause of this outbreak. The only ingredient specific to the product was cucumbers. The supply of cucumbers was immediately halted, and no further cases have been identified.
AB - BACKGROUND: In August 2020, an outbreak of Shiga toxin-producing Escherichia coli (STEC) O157:H7 occurred in the United Kingdom. Whole genome sequencing revealed that these cases formed a genetically distinct cluster.METHODS: Hypotheses generated from case interviews were tested in analytical studies, and results informed environmental sampling and food chain analysis. A case-case study used non-outbreak 'comparison' STEC cases; a case-control study used a market research panel to recruit controls.RESULTS: A total of 36 cases were identified; all cases reported symptom onset between August 3 and August 16, 2020. The majority of cases (83%) resided in the Midlands region of England and in Wales. A high proportion of cases reported eating out, with one fast-food restaurant chain mentioned by 64% (n = 23) of cases. Both the case-case study (adjusted odds ratio (aOR) 31.8, 95% confidence interval (CI) 1.6-624.9) and the case-control study (aOR 9.19, 95% CI 1.0-82.8) revealed statistically significant results, showing that the consumption of a specific fast-food product was independently associated with infection.CONCLUSIONS: Consumption of a specific fast-food product was a likely cause of this outbreak. The only ingredient specific to the product was cucumbers. The supply of cucumbers was immediately halted, and no further cases have been identified.
KW - Case-Control Studies
KW - Cucumis sativus
KW - Disease Outbreaks
KW - Escherichia coli Infections/epidemiology
KW - Escherichia coli O157/genetics
KW - Food Microbiology
KW - Humans
KW - Shiga-Toxigenic Escherichia coli/genetics
KW - United Kingdom/epidemiology
U2 - 10.1016/j.ijid.2021.04.001
DO - 10.1016/j.ijid.2021.04.001
M3 - Article
C2 - 33895409
SN - 1201-9712
VL - 110
SP - S62-S68
JO - International Journal of Infectious Diseases
JF - International Journal of Infectious Diseases
ER -