title: Investigation of a national outbreak of STEC Escherichia coli O157 using online consumer panel control methods: Great Britain, October 2014.
abstract: In October 2014, Public Health England (PHE) identified cases of Shiga toxin-producing Escherichia coli (STEC) serogroup O157 sharing a multiple locus variable-number tandem repeat analysis (MLVA) profile. We conducted a case-control study using multivariable logistic regression to calculate adjusted odds ratios (aOR) and 95% confidence intervals (CI) testing a range of exposures. Cases were defined as laboratory-confirmed STEC O157 with the implicated MLVA profile, were UK residents aged ⩾18 years with symptom onset between 25 September and 30 October 2014, and had no history of travel abroad within 5 days of symptom onset. One hundred and two cases were identified. Cases were mostly female (65%; median age 49, range 2-92 years). It was the second largest outbreak seen in England, to date, and a case-control study was conducted using market research panel controls and online survey methods. These methods were instrumental in the rapid data collection and analysis necessary to allow traceback investigations for short shelf-life products. This is a new method of control recruitment and this is the first in which it was a standalone recruitment method. The case-control study suggested a strong association between consumption of a ready-to-eat food and disease (aOR 28, 95% CI 5·0-157) from one retailer. No reactive microbiological testing of food items during the outbreak was possible due to the short shelf-life of the product. Collaboration with industrial bodies is needed to ensure timely traceback exercises to identify contamination events and initiate appropriate and focused microbiological testing and implement control measures.
authors.affiliation: UK Field Epidemiology Training Programme,Public Health England,London,UK.
authors.forename: C
authors.initials: C
authors.lastname: Sinclair
authors.affiliation: Gastrointestinal Bacteria Reference Unit,National Infection Services,Public Health England,London,UK.
authors.forename: C
authors.initials: C
authors.lastname: Jenkins
authors.affiliation: National Infection Services,Public Health England,London,UK.
authors.forename: F
authors.initials: F
authors.lastname: Warburton
authors.affiliation: Gastrointestinal Infections Department,National Infections Service,Public Health England,London,UK.
authors.forename: G K
authors.initials: GK
authors.lastname: Adak
authors.affiliation: Gastrointestinal Infections Department,National Infections Service,Public Health England,London,UK.
authors.forename: J P
authors.initials: JP
authors.lastname: Harris
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D003625:Data Collection / Q000379:methods; D004196:Disease Outbreaks; D004739:England; D004927:Escherichia coli Infections / Q000453:epidemiology* / Q000382:microbiology; D019453:Escherichia coli O157 / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D005260:Female; D005517:Foodborne Diseases / Q000453:epidemiology* / Q000382:microbiology; D005838:Genotype; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D018598:Minisatellite Repeats; D058889:Molecular Typing; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult
keywords: Outbreak; panel control methods; STEC O157; salad