title: Multistate outbreak of Escherichia coli O157:H7 infections associated with in-store sampling of an aged raw-milk Gouda cheese, 2010.
abstract: In 2010, 41 patients ill with Escherichia coli O157:H7 isolates determined to be indistinguishable by pulsed-field gel electrophoresis were identified among residents of five Southwestern U.S. states. A majority of patients reported consuming complimentary samples of aged raw-milk  Gouda cheese at national warehouse chain store locations; sampling Gouda cheese was significantly associated with illness (odds ratio, 9.0; 95 % confidence interval, 1.7 to 47). Several Gouda samples yielded the O157:H7 outbreak strain, confirming the food vehicle and source of infections.  Implicated retail food-sampling operations were inconsistently regulated among affected states, and sanitation deficiencies were common among sampling venues. Inspection of the cheese manufacturer indicated deficient sanitation practices and insufficient cheese curing times. Policymakers should  continue to reexamine the adequacy and enforcement of existing rules intended to ensure the safety of raw-milk cheeses and retail food sampling. Additional research is necessary to clarify the food safety hazards posed to patrons who consume free food samples while shopping.
authors.affiliation: Epidemic Intelligence Service, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. jeffrey.mccollum@us.army.mil
authors.forename: J T
authors.initials: JT
authors.lastname: McCollum
authors.forename: N J
authors.initials: NJ
authors.lastname: Williams
authors.forename: S W
authors.initials: SW
authors.lastname: Beam
authors.forename: S
authors.initials: S
authors.lastname: Cosgrove
authors.forename: P J
authors.initials: PJ
authors.lastname: Ettestad
authors.forename: T S
authors.initials: TS
authors.lastname: Ghosh
authors.forename: A C
authors.initials: AC
authors.lastname: Kimura
authors.forename: L
authors.initials: L
authors.lastname: Nguyen
authors.forename: S G
authors.initials: SG
authors.lastname: Stroika
authors.forename: R L
authors.initials: RL
authors.lastname: Vogt
authors.forename: A K
authors.initials: AK
authors.lastname: Watkins
authors.forename: J R
authors.initials: JR
authors.lastname: Weiss
authors.forename: I T
authors.initials: IT
authors.lastname: Williams
authors.forename: A B
authors.initials: AB
authors.lastname: Cronquist
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D002611:Cheese / Q000382:microbiology*; D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks; D004927:Escherichia coli Infections / Q000453:epidemiology*; D019453:Escherichia coli O157 / Q000302:isolation & purification*; D005260:Female; D005506:Food Contamination / Q000032:analysis*; D005511:Food Handling / Q000379:methods*; D005516:Food Microbiology; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D008892:Milk / Q000382:microbiology; D015206:Southwestern United States / Q000453:epidemiology; D055815:Young Adult