title: Transmission of shiga toxin-producing Escherichia coli O104:H4 at a family party possibly due to contamination by a food handler, Germany 2011.
abstract: We investigated a cluster of shiga toxin-producing Escherichia coli (STEC) O104:H4 infections after a family party during a large STEC O104:H4 outbreak in Germany. To identify the vehicle we conducted a retrospective cohort study. Stool samples of party guests, and food and environmental samples from the catering company were tested for STEC. We defined cases as party guests with gastrointestinal symptoms and laboratory-confirmed STEC infection. We found 23 cases among 71 guests. By multivariable analysis consumption of salmon [odds ratio (OR) 15, 95% confidence interval (CI) 2.3-97], herb cream (OR 6.5, 95% CI 1.3-33) and bean salad (OR 6.1, 95% CI 1.4-26) were associated with STEC infection. STEC O104:H4 was detected in samples of bell pepper and salmon. The food handler developed STEC infection. Our results point towards transmission via several food items contaminated by a food handler. We recommend regular education of food handlers emphasizing their role in transmitting infectious diseases.
authors.affiliation: Governmental Institute of Public Health of Lower Saxony (NLGA), Hannover, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Diercke
authors.forename: M
authors.initials: M
authors.lastname: Kirchner
authors.forename: K
authors.initials: K
authors.lastname: Claussen
authors.forename: E
authors.initials: E
authors.lastname: Mayr
authors.forename: I
authors.initials: I
authors.lastname: Strotmann
authors.forename: J
authors.initials: J
authors.lastname: Frangenberg
authors.forename: A
authors.initials: A
authors.lastname: Schiffmann
authors.forename: G
authors.initials: G
authors.lastname: Bettge-Weller
authors.forename: M
authors.initials: M
authors.lastname: Arvand
authors.forename: H
authors.initials: H
authors.lastname: Uphoff
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D016358:Contact Tracing; D004196:Disease Outbreaks; D004927:Escherichia coli Infections / Q000453:epidemiology / Q000382:microbiology / Q000635:transmission*; D005243:Feces / Q000382:microbiology; D005260:Female; D005511:Food Handling; D005517:Foodborne Diseases / Q000453:epidemiology / Q000382:microbiology*; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D054323:Shiga-Toxigenic Escherichia coli / Q000302:isolation & purification*; D011795:Surveys and Questionnaires
references.citation: Emerg Infect Dis. 2012 Jan;18(1):169-70
references.pmid: 22261344
references.citation: Lancet. 2005 Mar 19-25;365(9464):1073-86
references.pmid: 15781103
references.citation: Jpn J Infect Dis. 2010 Mar;63(2):146-7
references.pmid: 20332583
references.citation: Euro Surveill. 2011 Aug 04;16(31):
references.pmid: 21871216
references.citation: N Engl J Med. 2011 Nov 10;365(19):1763-70
references.pmid: 22029753
references.citation: N Engl J Med. 2011 Nov 10;365(19):1771-80
references.pmid: 21696328
references.citation: Euro Surveill. 2011 Jun 30;16(26):
references.pmid: 21749817
references.citation: Epidemiol Infect. 2013 Feb;141(2):277-83
references.pmid: 22717224
references.citation: Lancet Infect Dis. 2011 Oct;11(10):732-3
references.pmid: 21958580
references.citation: Euro Surveill. 2011 Aug 04;16(31):
references.pmid: 21871215
references.citation: J Food Prot. 2009 Nov;72(11):2332-6
references.pmid: 19903397
references.citation: BMC Infect Dis. 2010 Sep 15;10:269
references.pmid: 20843351
references.citation: Lancet Infect Dis. 2011 Sep;11(9):671-6
references.pmid: 21703928