title: An international outbreak of Shiga toxin-producing Escherichia coli O157 infection due to lettuce, September-October 2007.
abstract: Between 14 September and 20 October 2007, an outbreak of Shiga toxin-producing Escherichia coli (STEC) O157 simultaneously occurred in the Netherlands and Iceland. A total of 50 laboratory-confirmed cases were reported with a STEC O157 infection caused by the same clone. The strain was of type O157:H-, PT8, positive for stx1, stx2, eae and e-hly, and sorbitol negative. The most probable cause of this international outbreak was contaminated lettuce, shredded and pre-packed in a Dutch food processing plant. Samples of the environment, raw produce and end products, taken at several vegetable growers and processing plants all tested negative for STEC O157. However, the only epidemiological link between the cases in the Netherlands and in Iceland was the implicated Dutch processing plant. In Europe, food products are often widely distributed posing the risk of potential spread of food borne pathogens simultaneously to several countries. This international outbreak emphasises the importance of common alert and surveillance systems in earlier detection of international outbreaks and better assessment of their spread.
authors.affiliation: Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands. ingrid.friesema@rivm.nl
authors.forename: I
authors.initials: I
authors.lastname: Friesema
authors.forename: G
authors.initials: G
authors.lastname: Sigmundsdottir
authors.forename: K
authors.initials: K
authors.lastname: van der Zwaluw
authors.forename: A
authors.initials: A
authors.lastname: Heuvelink
authors.forename: B
authors.initials: B
authors.lastname: Schimmer
authors.forename: C
authors.initials: C
authors.lastname: de Jager
authors.forename: B
authors.initials: B
authors.lastname: Rump
authors.forename: H
authors.initials: H
authors.lastname: Briem
authors.forename: H
authors.initials: H
authors.lastname: Hardardottir
authors.forename: A
authors.initials: A
authors.lastname: Atladottir
authors.forename: E
authors.initials: E
authors.lastname: Gudmundsdottir
authors.forename: W
authors.initials: W
authors.lastname: van Pelt
mesh_terms: D004196:Disease Outbreaks / Q000706:statistics & numerical data*; D019453:Escherichia coli O157 / Q000302:isolation & purification*; D005060:Europe / Q000453:epidemiology; D005506:Food Contamination / Q000706:statistics & numerical data*; D005516:Food Microbiology; D005517:Foodborne Diseases / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D018545:Lactuca / Q000382:microbiology*; D011159:Population Surveillance; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D054323:Shiga-Toxigenic Escherichia coli / Q000302:isolation & purification