title: An outbreak of enterotoxigenic Escherichia coli (ETEC) infection in Norway, 2012: a reminder to consider uncommon pathogens in outbreaks involving imported products.
abstract: We investigated an outbreak of gastroenteritis following a Christmas buffet served on 4-9 December 2012 to ~1300 hotel guests. More than 300 people were reported ill in initial interviews with hotel guests. To identify possible sources of infection we conducted a cohort investigation through which we identified 214 probable cases. Illness was associated with consumption of scrambled eggs (odds ratio 9·07, 95% confidence interval 5·20-15·84). Imported chives added fresh to the scrambled eggs were the suspected source of the outbreak but were unavailable for testing. Enterotoxigenic Escherichia coli (ETEC) infection was eventually confirmed in 40 hotel guests. This outbreak reinforces that ETEC should be considered in non-endemic countries when the clinical picture is consistent and common gastrointestinal pathogens are not found. Following this outbreak, the Norwegian Food Safety Authority recommended that imported fresh herbs should be heat-treated before use in commercial kitchens.
authors.affiliation: Department of Infectious Disease Epidemiology,Norwegian Institute of Public Health,Oslo,Norway.
authors.forename: E
authors.initials: E
authors.lastname: MacDonald
authors.affiliation: Municipal Health Officer,Municipality of Ringerike,Norway.
authors.forename: K E
authors.initials: KE
authors.lastname: Møller
authors.affiliation: Department of Food-borne Infections,Norwegian Institute of Public Health,Oslo,Norway.
authors.forename: A L
authors.initials: AL
authors.lastname: Wester
authors.affiliation: Department of Food-borne Infections,Norwegian Institute of Public Health,Oslo,Norway.
authors.forename: U R
authors.initials: UR
authors.lastname: Dahle
authors.affiliation: Department of Microbiology,Oslo University Hospital,Oslo,Norway.
authors.forename: N O
authors.initials: NO
authors.lastname: Hermansen
authors.affiliation: Department of Medical Microbiology,Vestre Viken Hospital Trust,Bærum,Norway.
authors.forename: P A
authors.initials: PA
authors.lastname: Jenum
authors.affiliation: Department of Medicine,Vestre Viken Hospital Trust,Hønefoss,Norway.
authors.forename: L
authors.initials: L
authors.lastname: Thoresen
authors.affiliation: Department of Infectious Disease Epidemiology,Norwegian Institute of Public Health,Oslo,Norway.
authors.forename: L
authors.initials: L
authors.lastname: Vold
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004196:Disease Outbreaks; D054307:Enterotoxigenic Escherichia coli / Q000302:isolation & purification*; D004927:Escherichia coli Infections / Q000453:epidemiology* / Q000382:microbiology*; D005260:Female; D005516:Food Microbiology; D005759:Gastroenteritis / Q000453:epidemiology* / Q000382:microbiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009664:Norway / Q000453:epidemiology; D012189:Retrospective Studies; D055815:Young Adult
keywords: Escherichia coli; foodborne infections; outbreaks