title: Outbreak of Shiga toxin-producing Escherichia coli O111:H8 infections among attendees of a high school cheerleading camp.
abstract: Few US clinical laboratories screen stool specimens for Shiga toxin-producing Escherichia coli (STEC) other than E. coli O157. An outbreak of STEC O111:H8 infections indistinguishable from E. coli O157:H7 at a youth camp highlights the need to improve non-O157 STEC surveillance. Interviews of 521 (80%) of 650 attendees revealed 55 (11%) were ill; 2 developed hemolytic-uremic syndrome. Illness was associated with consuming salad during the camp's first lunch meal (hazard ratio [HR], 4.68; P<.01), consuming ice provided in barrels on the camp's final day (HR, 3.41; P<.01), eating cob corn (HR, 3.22; P<.01), and eating a dinner roll (HR, 2.82; P<.01). Cultures of 2 of 11 stools yielded E. coli O111:H8. Results of serologic testing and additional stool cultures demonstrated no evidence of infection with other bacterial pathogens, including E. coli O157, and supported infection with E. coli O111. Clinical laboratories should routinely screen suspect specimens for non-O157 STEC and should serotype and report Shiga-positive isolates.
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: John T
authors.initials: JT
authors.lastname: Brooks
authors.forename: David
authors.initials: D
authors.lastname: Bergmire-Sweat
authors.forename: Malinda
authors.initials: M
authors.lastname: Kennedy
authors.forename: Kate
authors.initials: K
authors.lastname: Hendricks
authors.forename: Marianne
authors.initials: M
authors.lastname: Garcia
authors.forename: Lisa
authors.initials: L
authors.lastname: Marengo
authors.forename: Joy
authors.initials: J
authors.lastname: Wells
authors.forename: Michelle
authors.initials: M
authors.lastname: Ying
authors.forename: William
authors.initials: W
authors.lastname: Bibb
authors.forename: Patricia M
authors.initials: PM
authors.lastname: Griffin
authors.forename: Robert M
authors.initials: RM
authors.lastname: Hoekstra
authors.forename: Cindy R
authors.initials: CR
authors.lastname: Friedman
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D004196:Disease Outbreaks; D004926:Escherichia coli / Q000302:isolation & purification*; D004927:Escherichia coli Infections / Q000150:complications / Q000453:epidemiology* / Q000276:immunology / Q000382:microbiology; D005260:Female; D006463:Hemolytic-Uremic Syndrome / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012698:Serologic Tests; D022621:Shiga Toxin / Q000378:metabolism*; D013781:Texas / Q000453:epidemiology
chemical_list: D022621:Shiga Toxin