title: A cluster of Escherichia coli O157:H7 infections with the hemolytic-uremic syndrome and death in California. A mandate for improved surveillance.
abstract: In mid-January 1993, an outbreak of Escherichia coli O157:H7 infections associated with eating hamburger patties at a fast-food restaurant chain (chain A) was reported in Washington State. From mid-December to mid-January, 9 cases of E coli O157:H7-associated bloody diarrhea and the hemolytic-uremic syndrome had been reported in San Diego County, California. A total of 34 persons had bloody diarrhea, the hemolytic-uremic syndrome, or E coli O157:H7 organisms isolated from stool during the period November 15, 1992, through January 31, 1993. Organisms of E coli O157:H7 identified from 6 persons were indistinguishable from those of the Washington outbreak strain. Illness was associated with eating at chain A restaurants in San Diego (odds ratio, 13; 95% confidence interval, 1.7, 99) and with eating regular-sized hamburgers (odds ratio, undefined; lower-limit 95% confidence interval, 1.3). Improved surveillance by mandating laboratory- and physician-based reporting of cases of E coli O157:H7 infection and the hemolytic-uremic syndrome might have alerted health officials to this outbreak sooner, which could have resulted in earlier investigation and the institution of measures to prevent more cases.
authors.affiliation: Division of Field Epidemiology, National Center For Infectious Diseases, Atlanta, Georgia, USA.
authors.forename: A M
authors.initials: AM
authors.lastname: Shefer
authors.forename: D
authors.initials: D
authors.lastname: Koo
authors.forename: S B
authors.initials: SB
authors.lastname: Werner
authors.forename: E D
authors.initials: ED
authors.lastname: Mintz
authors.forename: R
authors.initials: R
authors.lastname: Baron
authors.forename: J G
authors.initials: JG
authors.lastname: Wells
authors.forename: T J
authors.initials: TJ
authors.lastname: Barrett
authors.forename: M
authors.initials: M
authors.lastname: Ginsberg
authors.forename: R
authors.initials: R
authors.lastname: Bryant
authors.forename: S
authors.initials: S
authors.lastname: Abbott
authors.forename: P M
authors.initials: PM
authors.lastname: Griffin
mesh_terms: D000293:Adolescent; D000328:Adult; D000818:Animals; D002140:California / Q000453:epidemiology; D016022:Case-Control Studies; D002417:Cattle; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D016001:Confidence Intervals; D003967:Diarrhea / Q000453:epidemiology / Q000382:microbiology; D018563:Disease Notification; D004196:Disease Outbreaks; D004927:Escherichia coli Infections / Q000453:epidemiology* / Q000401:mortality; D019453:Escherichia coli O157 / Q000302:isolation & purification; D005243:Feces / Q000382:microbiology; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000453:epidemiology / Q000382:microbiology; D006463:Hemolytic-Uremic Syndrome / Q000453:epidemiology* / Q000401:mortality; D006801:Humans; D007223:Infant; D008297:Male; D008460:Meat / Q000382:microbiology; D008875:Middle Aged; D016017:Odds Ratio; D011159:Population Surveillance; D012147:Restaurants; D014861:Washington / Q000453:epidemiology