title: Factors contributing to the emergence of Escherichia coli O157 in Africa.
abstract: In 1992, a large outbreak of bloody diarrhea caused by Escherichia coli O157 infections occurred in southern Africa. In Swaziland, 40,912 physician visits for diarrhea in persons ages >5 years were reported during October through November 1992. This was a sevenfold increase over the same period during 1990-91. The attack rate was 42% among 778 residents we surveyed. Female gender and consuming beef and untreated water were significant risks for illness. E. coli O157:NM was recovered from seven affected foci in Swaziland and South Africa; 27 of 31 patient and environmental isolates had indistinguishable pulsed-field gel electrophoresis patterns. Compared with previous years, a fivefold increase in cattle deaths occurred in October 1992. The first heavy rains fell that same month (36 mm), following 3 months of drought. Drought, carriage of E. coli O157 by cattle, and heavy rains with contamination of surface water appear to be important factors contributing to this outbreak.
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. pveffler@mail.health.state.hi.us
authors.forename: E
authors.initials: E
authors.lastname: Effler
authors.forename: M
authors.initials: M
authors.lastname: Isaäcson
authors.forename: L
authors.initials: L
authors.lastname: Arntzen
authors.forename: R
authors.initials: R
authors.lastname: Heenan
authors.forename: P
authors.initials: P
authors.lastname: Canter
authors.forename: T
authors.initials: T
authors.lastname: Barrett
authors.forename: L
authors.initials: L
authors.lastname: Lee
authors.forename: C
authors.initials: C
authors.lastname: Mambo
authors.forename: W
authors.initials: W
authors.lastname: Levine
authors.forename: A
authors.initials: A
authors.lastname: Zaidi
authors.forename: P M
authors.initials: PM
authors.lastname: Griffin
mesh_terms: D000353:Africa, Southern / Q000453:epidemiology; D000818:Animals; D002417:Cattle; D002418:Cattle Diseases / Q000453:epidemiology / Q000382:microbiology; D002675:Child, Preschool; D021821:Communicable Diseases, Emerging / Q000453:epidemiology* / Q000382:microbiology; D003967:Diarrhea / Q000453:epidemiology* / Q000382:microbiology; D004196:Disease Outbreaks; D004927:Escherichia coli Infections / Q000453:epidemiology* / Q000382:microbiology; D019453:Escherichia coli O157 / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D006801:Humans; D007223:Infant; D011159:Population Surveillance; D012307:Risk Factors