title: Epidemiology of a large restaurant-associated outbreak of Shiga toxin-producing Escherichia coli O111:NM.
abstract: In August 2008, a large outbreak of Shiga toxin-producing Escherichia coli (STEC) O111:NM infections associated with a buffet-style restaurant in rural Oklahoma was identified. A case-control study of restaurant patrons and a retrospective cohort study of catered event attendees were conducted coupled with an environmental investigation to determine the outbreak's source and mode of transmission. Of 1823 persons interviewed, 341 (18·7%) met the outbreak case definition; 70 (20·5%) were hospitalized, 25 (7·3%) developed haemolytic uraemic syndrome, and one died. Multiple food items were significantly associated with illness by both bivariate and multivariate analyses, but none stood out as a predominant transmission vehicle. All water, food, and restaurant surface swabs, and stool cultures from nine ill employees were negative for the presence of Shiga toxin and E. coli O111:NM although epidemiological evidence suggested the outbreak resulted from cross-contamination of restaurant food from food preparation equipment or surfaces, or from an unidentified infected food handler.
authors: Oklahoma State Department of Health, Oklahoma City, OK 73117-1299, USA. kristyb@health.ok.gov
authors: K K
authors: KK
authors: Bradley
authors: J M
authors: JM
authors: Williams
authors: L J
authors: LJ
authors: Burnsed
authors: M B
authors: MB
authors: Lytle
authors: M D
authors: MD
authors: McDermott
authors: R K
authors: RK
authors: Mody
authors: A
authors: A
authors: Bhattarai
authors: S
authors: S
authors: Mallonee
authors: E W
authors: EW
authors: Piercefield
authors: C K
authors: CK
authors: McDonald-Hamm
authors: L K
authors: LK
authors: Smithee
mesh_terms: D000328:Adult; D000369:Aged, 80 and over; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003085:Colic / Q000453:epidemiology / Q000382:microbiology; D003967:Diarrhea / Q000453:epidemiology / Q000382:microbiology; D004196:Disease Outbreaks; D004927:Escherichia coli Infections / Q000453:epidemiology* / Q000382:microbiology*; D005260:Female; D005517:Foodborne Diseases / Q000453:epidemiology* / Q000382:microbiology*; D006463:Hemolytic-Uremic Syndrome / Q000453:epidemiology / Q000382:microbiology; D006801:Humans; D007223:Infant; D007410:Intestinal Diseases / Q000453:epidemiology / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009825:Oklahoma / Q000453:epidemiology; D012189:Retrospective Studies; D054323:Shiga-Toxigenic Escherichia coli / Q000145:classification* / Q000235:genetics / Q000302:isolation & purification* / Q000502:physiology