title: An international outbreak of Vero cytotoxin-producing Escherichia coli O157 infection amongst tourists; a challenge for the European infectious disease surveillance network.
abstract: In March 1997, an outbreak of Vero cytotoxin-producing Escherichia coli O157 (VTEC) infection occurred amongst holidaymakers returning from Fuerteventura, Canary Islands. For the investigation, a confirmed case was an individual staying in Fuerteventura during March 1997, with either E. coli O157 VTEC isolated in stool, HUS or serological evidence of recent infection; a probable case was an individual with bloody diarrhoea without laboratory confirmation. Local and Europe-wide active case finding was undertaken through national centres, Salm-Net and the European Programme of Intervention Epidemiology, followed by a case-control study. Fourteen confirmed and one probable case were identified from England (7), Finland (5), Wales (1), Sweden (1) and Denmark (1) staying in four hotels. Three of the four hotels were supplied with water from a private well which appeared to be the probable vehicle of transmission. The case-control study showed illness was associated with consumption of raw vegetables (OR 8.4, 95% CI 1-5-48.2) which may have been washed in well water. This investigation shows the importance of international collaboration in the detection and investigation of clusters of enteric infection.
authors.affiliation: European Programme for Intervention Epidemiology Training, National Public Health Institute, Helsinki, Finland.
authors.forename: R G
authors.initials: RG
authors.lastname: Pebody
authors.forename: C
authors.initials: C
authors.lastname: Furtado
authors.forename: A
authors.initials: A
authors.lastname: Rojas
authors.forename: N
authors.initials: N
authors.lastname: McCarthy
authors.forename: G
authors.initials: G
authors.lastname: Nylen
authors.forename: P
authors.initials: P
authors.lastname: Ruutu
authors.forename: T
authors.initials: T
authors.lastname: Leino
authors.forename: R
authors.initials: R
authors.lastname: Chalmers
authors.forename: B
authors.initials: B
authors.lastname: de Jong
authors.forename: M
authors.initials: M
authors.lastname: Donnelly
authors.forename: I
authors.initials: I
authors.lastname: Fisher
authors.forename: C
authors.initials: C
authors.lastname: Gilham
authors.forename: L
authors.initials: L
authors.lastname: Graverson
authors.forename: T
authors.initials: T
authors.lastname: Cheasty
authors.forename: G
authors.initials: G
authors.lastname: Willshaw
authors.forename: M
authors.initials: M
authors.lastname: Navarro
authors.forename: R
authors.initials: R
authors.lastname: Salmon
authors.forename: P
authors.initials: P
authors.lastname: Leinikki
authors.forename: P
authors.initials: P
authors.lastname: Wall
authors.forename: C
authors.initials: C
authors.lastname: Bartlett
mesh_terms: D000293:Adolescent; D000328:Adult; D001427:Bacterial Toxins / Q000096:biosynthesis*; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D018563:Disease Notification; D004196:Disease Outbreaks; D004768:Enterotoxins / Q000096:biosynthesis*; D004927:Escherichia coli Infections / Q000453:epidemiology*; D019453:Escherichia coli O157 / Q000378:metabolism*; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D022622:Shiga Toxin 1; D013997:Time Factors; D014195:Travel; D014871:Water Microbiology
chemical_list: D001427:Bacterial Toxins; D004768:Enterotoxins; D022622:Shiga Toxin 1