title: Outbreak of campylobacteriosis associated with consumption of raw peas.
abstract: BACKGROUND
  Campylobacter jejuni is a leading cause of acute gastroenteritis worldwide, and most cases are identified as sporadic events rather than as parts of recognized outbreaks. We report findings from a substantial 2008 campylobacteriosis outbreak with general implications for fresh produce safety.
  
  
  METHODS
  We conducted a matched case-control study to determine the source of the outbreak and enhanced surveillance to identify additional cases. Clinical and environmental specimens were tested for Campylobacter, and isolates were subtyped by pulsed-field gel electrophoresis (PFGE).
  
  
  RESULTS
  By routine surveillance, we identified 63 cases of laboratory-confirmed infection. Only raw peas, consumed by 30 (67%) of 45 case-patients and by 15 (17%) of 90 control participants, were associated with illness (adjusted odds ratio: 8.2; P<.001). An additional 69 patients (26 laboratory-confirmed) who reported eating raw peas within 10 days of illness onset were identified through enhanced surveillance. In all, 5 cases were hospitalized, and Guillain-Barré syndrome developed in 1 case; none died. The implicated pea farm was located near a Sandhill crane (Grus canadensis) stopover and breeding site. Of 36 environmental samples collected, 16 were positive for C. jejuni-14 crane-feces samples and 2 pea samples. We identified 25 unique combined SmaI-KpnI PFGE patterns among clinical isolates; 4 of these combined PFGE patterns identified in 15 of 55 human isolates were indistinguishable from PFGE patterns identified in environmental samples.
  
  
  CONCLUSIONS
  This investigation established a rare laboratory-confirmed link between a campylobacterosis outbreak and an environmental source and identified wild birds as an underrecognized source of produce contamination.
authors.affiliation: Epidemic Intelligence Service, Office of Workforce and Career Development, Centers for Disease Control and Prevention, Atlanta, Georgia30333, USA. hgj7@cdc.gov
authors.forename: Tracie J
authors.initials: TJ
authors.lastname: Gardner
authors.forename: Collette
authors.initials: C
authors.lastname: Fitzgerald
authors.forename: Catherine
authors.initials: C
authors.lastname: Xavier
authors.forename: Ron
authors.initials: R
authors.lastname: Klein
authors.forename: Janet
authors.initials: J
authors.lastname: Pruckler
authors.forename: Steven
authors.initials: S
authors.lastname: Stroika
authors.forename: Joseph B
authors.initials: JB
authors.lastname: McLaughlin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000383:Agriculture; D000413:Alaska / Q000453:epidemiology; D000818:Animals; D001717:Birds; D002169:Campylobacter Infections / Q000453:epidemiology* / Q000209:etiology; D016123:Campylobacter jejuni / Q000302:isolation & purification; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D016000:Cluster Analysis; D004196:Disease Outbreaks; D016521:Electrophoresis, Gel, Pulsed-Field; D005243:Feces / Q000382:microbiology; D005260:Female; D005517:Foodborne Diseases / Q000453:epidemiology* / Q000209:etiology; D005759:Gastroenteritis / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D018532:Pisum sativum / Q000382:microbiology*; D011159:Population Surveillance; D012307:Risk Factors