title: Outbreak of Shiga toxin-producing Escherichia coli O104:H4 associated with organic fenugreek sprouts, France, June 2011.
abstract: BACKGROUND
  On 22 June 2011, 8 patients with hemolytic uremic syndrome (HUS) or bloody diarrhea were reported in France. All 8 were attendees of a community center event on 8 June near Bordeaux. Three Escherichia coli cases were confirmed by isolation of Shiga toxin-producing E. coli O104:H4 stx2 aggR producing a cefotaximase (CTX-M) β-lactamase (STEC O104:H4); the same rare serotype caused the outbreak in Germany in May-July 2011. An investigation was initiated to describe the outbreak, identify the vehicle for infection, and guide control measures.
  
  
  METHODS
  We conducted a retrospective cohort study among all adults attending the event, including food handlers. A standardized questionnaire was administered to participants. A case was an attendee who developed HUS or diarrhea between 8 and 24 June. Cases were confirmed by isolation of STEC O104:H4 or O104 serology. Relative risks (RRs) and 95% confidence intervals (CIs) by exposure were calculated using a Poisson regression model.
  
  
  RESULTS
  Twenty-four cases were identified (14% attack rate). Of these, 18 (75%) were women, 22 (92%) were adults, 7 (29%) developed HUS, 5 (21%) developed bloody diarrhea, and 12 (50%) developed diarrhea. Ten (42%) cases were confirmed. Fenugreek was the only sprout type with an independent association to illness (RR, 5.1; 95% CI, 2.3-11.1) in multivariable analysis.
  
  
  CONCLUSIONS
  This investigation identified a point-source STEC O104:H4 outbreak associated with consumption of fenugreek sprouts. Comparison of results from French and German STEC O104:H4 outbreak investigations enabled identification of a common food vehicle, fenugreek sprouts, and resulted in implementation of Europe-wide control measures in July 2011.
authors.affiliation: Department of Infectious Disease, Institut de Veille Sanitaire, Saint Maurice, France. l.king@invs.sante.fr
authors.forename: Lisa A
authors.initials: LA
authors.lastname: King
authors.forename: Francisco
authors.initials: F
authors.lastname: Nogareda
authors.forename: François-Xavier
authors.initials: FX
authors.lastname: Weill
authors.forename: Patricia
authors.initials: P
authors.lastname: Mariani-Kurkdjian
authors.forename: Estelle
authors.initials: E
authors.lastname: Loukiadis
authors.forename: Gaëlle
authors.initials: G
authors.lastname: Gault
authors.forename: Nathalie
authors.initials: N
authors.lastname: Jourdan-DaSilva
authors.forename: Edouard
authors.initials: E
authors.lastname: Bingen
authors.forename: Muriel
authors.initials: M
authors.lastname: Macé
authors.forename: Delphine
authors.initials: D
authors.lastname: Thevenot
authors.forename: Nathalie
authors.initials: N
authors.lastname: Ong
authors.forename: Christine
authors.initials: C
authors.lastname: Castor
authors.forename: Harold
authors.initials: H
authors.lastname: Noël
authors.forename: Dieter
authors.initials: D
authors.lastname: Van Cauteren
authors.forename: Martine
authors.initials: M
authors.lastname: Charron
authors.forename: Véronique
authors.initials: V
authors.lastname: Vaillant
authors.forename: Benedicte
authors.initials: B
authors.lastname: Aldabe
authors.forename: Véronique
authors.initials: V
authors.lastname: Goulet
authors.forename: Gilles
authors.initials: G
authors.lastname: Delmas
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Couturier
authors.forename: Yann
authors.initials: Y
authors.lastname: Le Strat
authors.forename: Christian
authors.initials: C
authors.lastname: Combe
authors.forename: Yahsou
authors.initials: Y
authors.lastname: Delmas
authors.forename: François
authors.initials: F
authors.lastname: Terrier
authors.forename: Benoit
authors.initials: B
authors.lastname: Vendrely
authors.forename: Patrick
authors.initials: P
authors.lastname: Rolland
authors.forename: Henriette
authors.initials: H
authors.lastname: de Valk
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; 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; D005602:France / Q000453:epidemiology; D006463:Hemolytic-Uremic Syndrome / Q000453:epidemiology / Q000382:microbiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012703:Serotyping; D054323:Shiga-Toxigenic Escherichia coli / Q000145:classification / Q000302:isolation & purification*; D029910:Trigonella / Q000382:microbiology*; D055815:Young Adult