title: An outbreak of Escherichia coli O157:H7 infections associated with leaf lettuce consumption.
abstract: In July 1995, 40 Montana residents were identified with laboratory-confirmed Escherichia coli O157:H7 infection; 52 residents had bloody diarrhea without laboratory confirmation. The median age of those with laboratory-confirmed cases was 42 years (range, 4- 86); 58% were female. Thirteen patients were hospitalized, and 1 developed hemolytic-uremic syndrome. A case-control study showed that 19 (70%) of 27 patients but only 8 (17%) of 46 controls reported eating purchased (not home-grown) leaf lettuce before illness (matched odds ratio, 25.3; 95% confidence interval, 3.9-1065.6). Pulsed-field gel electrophoresis identified a common strain among 22 of 23 isolates tested. Implicated lettuce was traced to two sources: a local Montana farm and six farms in Washington State that shipped under the same label. This outbreak highlights the increasing importance of fresh produce as a vehicle in foodborne illness. Sanitary growing and handling procedures are necessary to prevent these infections.
authors.affiliation: Foodborne and Diarrheal Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
authors.forename: M L
authors.initials: ML
authors.lastname: Ackers
authors.forename: B E
authors.initials: BE
authors.lastname: Mahon
authors.forename: E
authors.initials: E
authors.lastname: Leahy
authors.forename: B
authors.initials: B
authors.lastname: Goode
authors.forename: T
authors.initials: T
authors.lastname: Damrow
authors.forename: P S
authors.initials: PS
authors.lastname: Hayes
authors.forename: W F
authors.initials: WF
authors.lastname: Bibb
authors.forename: D H
authors.initials: DH
authors.lastname: Rice
authors.forename: T J
authors.initials: TJ
authors.lastname: Barrett
authors.forename: L
authors.initials: L
authors.lastname: Hutwagner
authors.forename: P M
authors.initials: PM
authors.lastname: Griffin
authors.forename: L
authors.initials: L
authors.lastname: Slutsker
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D016022:Case-Control Studies; D002417:Cattle; D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks; D004812:Epidemiologic Methods; D004927:Escherichia coli Infections / Q000453:epidemiology* / Q000209:etiology* / Q000503:physiopathology; D019453:Escherichia coli O157; D005260:Female; D006801:Humans; D018545:Lactuca / Q000506:poisoning*; D008070:Lipopolysaccharides / Q000097:blood / Q000276:immunology; D008297:Male; D008875:Middle Aged; D018515:Plant Leaves; D012756:Sheep
chemical_list: D008070:Lipopolysaccharides