title: Severe Outbreak of Sorbitol-Fermenting Escherichia coli O157 via Unpasteurized Milk and Farm Visits, Finland 2012.
abstract: Shiga toxin-producing, sorbitol-fermenting Escherichia coli O157 (SF O157) has emerged as a cause of severe human illness. Despite frequent human findings, its transmission routes and reservoirs remain largely unknown. Foodborne transmission and reservoir in cattle have been suspected, but with limited supporting evidence. This study describes the outbreak of SF O157 that occurred in Finland in 2012. The outbreak originated from a recreational farm selling unpasteurized milk, as revealed by epidemiologic and microbiological investigations, and involved six hospitalized children and two asymptomatic adults with culture-confirmed infection. An identical strain of SF O157 was isolated from patients, cattle and the farm environment, and epidemiologic analysis suggested unpasteurized milk as the vehicle of transmission. This study reports the first milkborne outbreak of SF O157, provides supporting evidence of cattle as a reservoir and highlights the health risks related to the consumption of unpasteurized milk.
authors.affiliation: Finnish Food Safety Authority Evira, Helsinki, Finland.
authors.forename: A
authors.initials: A
authors.lastname: Jaakkonen
authors.affiliation: National Institute for Health and Welfare (THL), Helsinki, Finland.
authors.forename: S
authors.initials: S
authors.lastname: Salmenlinna
authors.affiliation: National Institute for Health and Welfare (THL), Helsinki, Finland.
authors.forename: R
authors.initials: R
authors.lastname: Rimhanen-Finne
authors.affiliation: City of Turku, Finland.
authors.forename: H
authors.initials: H
authors.lastname: Lundström
authors.affiliation: Finnish Food Safety Authority Evira, Kuopio, Finland.
authors.forename: S
authors.initials: S
authors.lastname: Heinikainen
authors.affiliation: Finnish Food Safety Authority Evira, Helsinki, Finland.
authors.forename: M
authors.initials: M
authors.lastname: Hakkinen
authors.affiliation: Finnish Food Safety Authority Evira, Helsinki, Finland.
authors.forename: S
authors.initials: S
authors.lastname: Hallanvuo
mesh_terms: D000818:Animals; D002417:Cattle; D002418:Cattle Diseases / Q000453:epidemiology / Q000382:microbiology*; D004196:Disease Outbreaks; D004197:Disease Reservoirs; D004781:Environmental Exposure; D004783:Environmental Microbiology; D004927:Escherichia coli Infections / Q000453:epidemiology / Q000382:microbiology / Q000635:transmission / Q000662:veterinary*; D019453:Escherichia coli O157 / Q000145:classification / Q000302:isolation & purification*; D005285:Fermentation; D005387:Finland / Q000453:epidemiology; D005516:Food Microbiology; D006801:Humans; D008892:Milk / Q000382:microbiology*; D061352:Pasteurization; D015047:Zoonoses
keywords: O157; Shiga toxin-producing Escherichia coli; cattle; milk; outbreak; sorbitol-fermenting