title: Public health approach to detection of non-O157 Shiga toxin-producing Escherichia coli: summary of two outbreaks and laboratory procedures.
abstract: Routine laboratory testing may not detect non-O157 Shiga toxin-producing Escherichia coli (STEC) reliably. Active clinical, epidemiological, environmental health, and laboratory collaboration probably influence successful detection and study of non-O157 STEC infection. We summarized two outbreak investigations in which such coordinated efforts identified non-O157 STEC disease and led to effective control measures. Outbreak 1 involved illness associated with consuming unpasteurized apple cider from a local orchard. Public health personnel were notified by a local hospital; stool specimens from ill persons contained O111 STEC. Outbreak 2 involved bloody diarrhoea at a correctional facility. Public health personnel were notified by the facility infection control officer; O45 STEC was the implicated agent. These reports highlight the ability of non-O157 STEC to cause outbreaks and demonstrate that a coordinated effort by clinicians, infection-control practitioners, clinical diagnostic laboratorians, and public health personnel can lead to effective identification, investigation, and prevention of non-O157 STEC disease.
authors.affiliation: Epidemic Intelligence Service, Scientific Education and Professional Development Program Office, Centers for Disease Control and Prevention, Atlanta, GA, USA. joshua.schaffzin@cchmc.org
authors.forename: J K
authors.initials: JK
authors.lastname: Schaffzin
authors.forename: F
authors.initials: F
authors.lastname: Coronado
authors.forename: N B
authors.initials: NB
authors.lastname: Dumas
authors.forename: T P
authors.initials: TP
authors.lastname: Root
authors.forename: T A
authors.initials: TA
authors.lastname: Halse
authors.forename: D J
authors.initials: DJ
authors.lastname: Schoonmaker-Bopp
authors.forename: M M
authors.initials: MM
authors.lastname: Lurie
authors.forename: D
authors.initials: D
authors.lastname: Nicholas
authors.forename: B
authors.initials: B
authors.lastname: Gerzonich
authors.forename: G S
authors.initials: GS
authors.lastname: Johnson
authors.forename: B J
authors.initials: BJ
authors.lastname: Wallace
authors.forename: K A
authors.initials: KA
authors.lastname: Musser
mesh_terms: D000328:Adult; D000818:Animals; D002417:Cattle; D003967:Diarrhea / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology*; D004196:Disease Outbreaks; D004812:Epidemiologic Methods; D004927:Escherichia coli Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology* / Q000635:transmission; D005243:Feces / Q000382:microbiology; D005516:Food Microbiology; D006801:Humans; D007124:Immunoenzyme Techniques; D015994:Incidence; D009518:New York; D060888:Real-Time Polymerase Chain Reaction; D022622:Shiga Toxin 1 / Q000032:analysis / Q000235:genetics; D022641:Shiga Toxin 2 / Q000032:analysis / Q000235:genetics; D054323:Shiga-Toxigenic Escherichia coli / Q000235:genetics / Q000302:isolation & purification*
chemical_list: D022622:Shiga Toxin 1; D022641:Shiga Toxin 2