title: A multistate outbreak of Escherichia coli O157:H7 infection linked to consumption of beef tacos at a fast-food restaurant chain.
abstract: We investigated a multistate outbreak of Escherichia coli O157:H7 infections. Isolates from 13 case patients from California, Nevada, and Arizona were matched by pulsed-field gel electrophoresis subtyping. Five case patients (38%) were hospitalized, and 3 (23%) developed hemolytic uremic syndrome; none died. The median age was 12 years (range, 2-75 years), and 10 (77%) were female. Case-control studies found an association between illness and eating beef tacos at a national Mexican-style fast-food restaurant chain (88% of cases versus 38% of controls; matched OR, undefined; 95% confidence interval, 1.49 to infinity; P=.009). A trace-back investigation implicated an upstream supplier of beef, but a farm investigation was not possible. This outbreak illustrates the value of employing hospital laboratory-based surveillance to detect local clusters of infections and the effectiveness of using molecular subtyping to identify geographically dispersed outbreaks. The outbreak investigation also highlights the need for a more efficient tracking system for food products.
authors.affiliation: California Department of Health Services, Sacramento, USA. mjay@wifss.ucdavis.edu
authors.forename: Michele T
authors.initials: MT
authors.lastname: Jay
authors.forename: Valerie
authors.initials: V
authors.lastname: Garrett
authors.forename: Janet C
authors.initials: JC
authors.lastname: Mohle-Boetani
authors.forename: Myra
authors.initials: M
authors.lastname: Barros
authors.forename: Jeff A
authors.initials: JA
authors.lastname: Farrar
authors.forename: Richard
authors.initials: R
authors.lastname: Rios
authors.forename: Sharon
authors.initials: S
authors.lastname: Abbott
authors.forename: Rick
authors.initials: R
authors.lastname: Sowadsky
authors.forename: Ken
authors.initials: K
authors.lastname: Komatsu
authors.forename: Robert
authors.initials: R
authors.lastname: Mandrell
authors.forename: Jeremy
authors.initials: J
authors.lastname: Sobel
authors.forename: S Benson
authors.initials: SB
authors.lastname: Werner
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001130:Arizona / Q000453:epidemiology; D002140:California / Q000453:epidemiology; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks; D004927:Escherichia coli Infections / Q000453:epidemiology* / Q000382:microbiology; D019453:Escherichia coli O157; D005260:Female; D005516:Food Microbiology; D005517:Foodborne Diseases; D006801:Humans; D008297:Male; D008460:Meat / Q000382:microbiology; D008875:Middle Aged; D009505:Nevada / Q000453:epidemiology; D012147:Restaurants