title: Multistate Outbreak of Escherichia coli O157:H7 Infections Associated with Consumption of Fresh Spinach: United States, 2006.
abstract: During September to October, 2006, state and local health departments and the Centers for Disease Control and Prevention investigated a large, multistate outbreak of Escherichia coli O157:H7 infections. Case patients were interviewed regarding specific foods consumed and other possible exposures. E. coli O157:H7 strains isolated from human and food specimens were subtyped using pulsed-field gel electrophoresis and multiple-locus variable-number tandem repeat analyses (MLVA). Two hundred twenty-five cases (191 confirmed and 34 probable) were identified in 27 states; 116 (56%) case patients were hospitalized, 39 (19%) developed hemolytic uremic syndrome, and 5 (2%) died. Among 176 case patients from whom E. coli O157:H7 with the outbreak genotype (MLVA outbreak strain) was isolated and who provided details regarding spinach exposure, 161 (91%) reported fresh spinach consumption during the 10 days before illness began. Among 116 patients who provided spinach brand information, 106 (91%) consumed bagged brand A. E. coli O157:H7 strains were isolated from 13 bags of brand A spinach collected from patients' homes; isolates from 12 bags had the same MLVA pattern. Comprehensive epidemiologic and laboratory investigations associated this large multistate outbreak of E. coli O157:H7 infections with consumption of fresh bagged spinach. MLVA, as a supplement to pulsed-field gel electrophoresis genotyping of case patient isolates, was important to discern outbreak-related cases. This outbreak resulted in enhanced federal and industry guidance to improve the safety of leafy green vegetables and launched an independent collaborative approach to produce safety research in 2007.
authors.affiliation: Epidemic Intelligence Service, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, Georgia 30329.|Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, Georgia 30329.
authors.forename: Umid M
authors.initials: UM
authors.lastname: Sharapov
authors.affiliation: Epidemic Intelligence Service, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, Georgia 30329.|Wisconsin Division of Public Health, 1 West Wilson Street, P.O. Box 2659, Madison, Wisconsin 53703.
authors.forename: Arthur M
authors.initials: AM
authors.lastname: Wendel
authors.affiliation: Wisconsin Division of Public Health, 1 West Wilson Street, P.O. Box 2659, Madison, Wisconsin 53703.
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Davis
authors.affiliation: Oregon Public Health Division, 800 N.E. Oregon Street, Portland, Oregon 97232.
authors.forename: William E
authors.initials: WE
authors.lastname: Keene
authors.affiliation: California Department of Health Services, P.O. Box 997377, MS 0500, Sacramento, California 95899, USA.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Farrar
authors.affiliation: Epidemic Intelligence Service, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, Georgia 30329.|Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, Georgia 30329.
authors.forename: Samir
authors.initials: S
authors.lastname: Sodha
authors.affiliation: Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, Georgia 30329.
authors.forename: Eija
authors.initials: E
authors.lastname: Hyytia-Trees
authors.affiliation: Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, Georgia 30329.
authors.forename: Molly
authors.initials: M
authors.lastname: Leeper
authors.affiliation: Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, Georgia 30329.
authors.forename: Peter
authors.initials: P
authors.lastname: Gerner-Smidt
authors.affiliation: Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, Georgia 30329.
authors.forename: Patricia M
authors.initials: PM
authors.lastname: Griffin
authors.affiliation: Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, Georgia 30329.
authors.forename: Chris
authors.initials: C
authors.lastname: Braden
mesh_terms: D004196:Disease Outbreaks; D016521:Electrophoresis, Gel, Pulsed-Field; D004926:Escherichia coli; D004927:Escherichia coli Infections / Q000453:epidemiology; D019453:Escherichia coli O157 / Q000302:isolation & purification*; D005517:Foodborne Diseases / Q000453:epidemiology; D005838:Genotype; D006801:Humans; D018724:Spinacia oleracea; D014481:United States
keywords: Epidemiology; Escherichia coli O157:H7; Multiple-locus variable-number tandem repeat analyses; Outbreak; Pulsed-field gel electrophoresis; Spinach