title: Food Source Prediction of Shiga Toxin-Producing Escherichia coli Outbreaks Using Demographic and Outbreak Characteristics, United States, 1998-2014.
abstract: Foodborne illness is a continuing public health problem in the United States. Although outbreak-associated illnesses represent a fraction of all foodborne illnesses, foodborne outbreak investigations provide critical information on the pathogens, foods, and food-pathogen pairs causing illness. Therefore, identification of a food source in an outbreak investigation is key to impacting food safety.
  
  
  
  The objective of this study was to systematically identify outbreak-associated case demographic and outbreak characteristics that are predictive of food sources using Shiga toxin-producing Escherichia coli (STEC) outbreaks reported to Centers for Disease Control and Prevention (CDC) from 1998 to 2014 with a single ingredient identified.
  
  
  
  Differences between STEC food sources by all candidate predictors were assessed univariately. Multinomial logistic regression was used to build a prediction model, which was internally validated using a split-sample approach.
  
  
  
  There were 206 single-ingredient STEC outbreaks reported to CDC, including 125 (61%) beef outbreaks, 30 (14%) dairy outbreaks, and 51 (25%) vegetable outbreaks. The model differentiated food sources, with an overall sensitivity of 80% in the derivation set and 61% in the validation set.
  
  
  
  This study demonstrates the feasibility for a tool for public health professionals to rule out food sources during hypothesis generation in foodborne outbreak investigation and to improve efficiency while complementing existing methods.
authors.affiliation: 1 Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver , Aurora, Colorado.
authors.forename: Alice
authors.initials: A
authors.lastname: White
authors.affiliation: 2 Colorado Department of Public Health and Environment, Denver, Colorado.
authors.forename: Alicia
authors.initials: A
authors.lastname: Cronquist
authors.affiliation: 3 Center for Biomedical Informatics and Statistics, The University of Arizona Health Sciences , Tucson, Arizona.
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Bedrick
authors.affiliation: 1 Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver , Aurora, Colorado.
authors.forename: Elaine
authors.initials: E
authors.lastname: Scallan
mesh_terms: D000818:Animals; D002487:Centers for Disease Control and Prevention, U.S.; D003611:Dairy Products / Q000009:adverse effects / Q000382:microbiology; D004196:Disease Outbreaks / Q000266:history*; D004927:Escherichia coli Infections / Q000453:epidemiology / Q000266:history / Q000382:microbiology*; D019453:Escherichia coli O157 / Q000254:growth & development; D005260:Female; D005506:Food Contamination; D005517:Foodborne Diseases / Q000453:epidemiology / Q000266:history / Q000382:microbiology*; D005759:Gastroenteritis / Q000453:epidemiology / Q000266:history / Q000382:microbiology*; D049673:History, 20th Century; D049674:History, 21st Century; D006801:Humans; D008297:Male; D008460:Meat / Q000009:adverse effects / Q000382:microbiology; D008954:Models, Biological; D018515:Plant Leaves / Q000009:adverse effects / Q000382:microbiology; D012042:Registries; D012621:Seasons; D054323:Shiga-Toxigenic Escherichia coli / Q000254:growth & development*; D014481:United States / Q000453:epidemiology; D014675:Vegetables / Q000009:adverse effects / Q000382:microbiology
keywords: E. Coli pathogens and food safety; Escherichia coli O157:H7; foodborne disease; foodborne outbreaks