title: Endemically acquired foodborne outbreak of enterotoxin-producing Escherichia coli serotype O169:H41.
abstract: OBJECTIVE
  Enterotoxigenic Escherichia coli (ETEC) is traditionally recognized as a common cause of traveler's diarrhea, but is becoming a more frequent cause of foodborne disease outbreaks in the United States. It is important for public health practitioners and clinicians to be aware of ETEC as a domestic cause of gastroenteritis. We investigated a foodborne disease outbreak to understand the epidemiology of ETEC in this setting.
  
  
  METHODS
  We conducted a cohort study of 63 employees of Company A. A case was defined as an employee who experienced diarrhea or vomiting or fever and cramps after eating a catered meal at Company A from August 14th-15th. A standardized questionnaire was administered to cases and controls.
  
  
  RESULTS
  Of 63 employees, 36 met the case definition (Attack Rate = 57.1%). Diarrhea (94%) and cramps (74%) were common, whereas vomiting was not (3%). Mean duration of illness was 2.7 days. Coleslaw at the August 15th lunch was significantly associated with illness (Odds ratio = 4.4, 95% CI = 1.1-17). Stool specimens were positive for heat-stable enterotoxin-producing E. coli O169:H41. Contamination likely occurred at the point of service.
  
  
  CONCLUSIONS
  This outbreak illustrates the changing epidemiology of enterotoxigenic E. coli and the importance for healthcare practitioners to consider ETEC as a potential cause of domestically acquired gastroenteritis.
authors.affiliation: Tennessee Department of Health, Nashville, Tenn 37247, USA.
authors.forename: Rose A
authors.initials: RA
authors.lastname: Devasia
authors.forename: Timothy F
authors.initials: TF
authors.lastname: Jones
authors.forename: Jennifer
authors.initials: J
authors.lastname: Ward
authors.forename: Lila
authors.initials: L
authors.lastname: Stafford
authors.forename: Henrietta
authors.initials: H
authors.lastname: Hardin
authors.forename: Cheryl
authors.initials: C
authors.lastname: Bopp
authors.forename: Mark
authors.initials: M
authors.lastname: Beatty
authors.forename: Eric
authors.initials: E
authors.lastname: Mintz
authors.forename: William
authors.initials: W
authors.lastname: Schaffner
mesh_terms: D000328:Adult; D004196:Disease Outbreaks; D004768:Enterotoxins / Q000096:biosynthesis*; D004926:Escherichia coli / Q000145:classification / Q000276:immunology / Q000378:metabolism*; D004927:Escherichia coli Infections / Q000453:epidemiology* / Q000382:microbiology; D005516:Food Microbiology; D005517:Foodborne Diseases / Q000453:epidemiology* / Q000382:microbiology; D006801:Humans; D008875:Middle Aged; D019081:O Antigens / Q000032:analysis; D013714:Tennessee / Q000453:epidemiology
chemical_list: D004768:Enterotoxins; D019081:O Antigens