Escherichia Coli 0157.H7 Outbreak Linked to Home-Cooked Hamburgers
Journal article by C. Turney, M. Green-Smith, C. Mordhorst, C. Whittingslow, L. Brawley, E. Bridges, G. Davis, J. Voss, R. Lee, M. Jay, S. Abbott, R. Bryant, K. Reilly, S.B. Werner, L. Barrett, R.J. Jackson, Iii G.W. Rutherford, H. Lior; Journal of Environmental Health, Vol. 57, 1994
Journal Article Excerpt
Escherichia Coli 0157.H7 Outbreak Linked to Home-Cooked Hamburgers. by C. Turney , M. Green-Smith , C. Mordhorst , C. Whittingslow , L. Brawley , E. Bridges , G. Davis , J. Voss , R. Lee , M. Jay , S. Abbott , R. Bryant , K. Reilly , S.B. Werner , L. Barrett , R.J. Jackson , III G.W. Rutherford , H. Lior Although outbreaks of Escherichia coli O157.H7 have been linked to consumption of contaminated ground beef, the organism is rarely isolated from the implicated meat. In addition, most epidemiologic investigations of illness associated with E. coli O157.H7 infections have been directed at restaurant-associated outbreaks, and the sources of infection for sporadic cases rarely have been identified. In July 1993, three cases of culture-confirmed E. coli O157.H7 was isolated from that meat. This report summarizes the investigation of these cases by local and state public health officials. On July 12, 1993, a hospital laboratory in Fort Bragg, California, reported a case of E. coli O157.H7 infection in a 13-year old girl to the Mendocino County Public Health Department (MCPHD). The patient had had onset of bloody diarrhea on July 7 and recovered. Members of her family reported having eaten home-cooked hamburgers on July 5 made from meat purchased from a local market (market A) on July 3; the hamburgers had been cooked "medium rare." All five family members who ate the hamburgers reported diarrhea; the index patient and her mother had bloody diarrhea. E. coli O157.H7 was isolated from leftover ground beef from the same package used to make the hamburgers. Two additional cases of culture-confirmed E. coli O157.H7 infection occurred in persons residing in the same community: an 18-year old man who had onset of bloody diarrhea on July 18 and an 84-year old woman with diabetes mellitus and chronic uremia who developed nonbloody diarrhea after eating the hamburger. Although no patients developed hemolytic uremic syndrome (HUS), the elderly woman died three weeks after hospitalization; her death attributed to her chronic renal disease. Media announcements from MCPHD requested persons who had experienced bloody diarrhea during July to contact the department. Of five persons who reported having had bloody diarrhea, four submitted stool for culture. Although all were negative, the cultures had been obtained 11-26 days after onset of diarrhea. Reviews of the emergency department log of the district hospital for July 1-22 did not identify additional cases of bloody diarrhea. Environmental health staff from MCPHD and staff from the U.S. Department of Agriculture (USDA) inspected market A and the other two markets in the community that sold ground meat (markets B and C) but did not identify violations in meat storage or grinding procedures. Shelf samples of ground beef from all three markets were obtained for testing. The owner of market A also initiated a voluntary recall of all ground beef purchased at that market during June 25-July 19; as a result, 91 packages of ground beef were returned. Of the 15 samples of ground beef obtained from market A and tested, four were positive for E. coli O157.H7. All positive samples had been placed on the shelves on July 3. Of 16 samples from market B, one was positive for E. coli O157.H7. None of seven samples obtained from market C were positive. The packages placed on the shelf of market A on July 3 were obtained from "chubs," which are large tubes of ground beef purchased from an outside supplier. The market often reground the meat in its own grinder and sometimes added "trim meat" from other sources. A traceback of the meat was not performed. Because the isolates produced an uninterpretable pattern by pulsed-field gel electrophoresis, selected isolates were further characterized by phage typing at the National Laboratory for Enteric Pathogens, Laboratory Center for Disease Control, in Ottawa (Ontario, Canada). Phage type 31 was identified in the three patient isolates, the leftover ground beef obtained from the freezer of the index patient's family, and the two isolates selected for testing from market A. The sample from market B (which was not implicated in the outbreak) was phage type 4. Following the investigation, MCPHD provided information to all county meat markets about optimal meat-grinding procedures and issued a press release advising consumers to cook ground beef thoroughly. Editorial NoteE. coli O157.H7 was first described as a pathogen in humans in 1982 following the investigation of two outbreaks of illness that were associated with consumption of hamburger from a fast-food restaurant chain (1). Since then, more ... |
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