Shiga Toxin-Producing E. coli Infections Associated with Romaine Lettuce - United States, 2018.
Shiga Toxin-Producing E. coli Infections Associated with Romaine Lettuce - United States, 2018.
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与长叶生菜相关的产志贺毒素大肠杆菌感染 - 美国，2018 年。
DOI：
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发表时间：
2019
影响因子：
11.8
通讯作者：
L. Gieraltowski
中科院分区：
文献类型：
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作者：
L. Bottichio;A. Keaton;Deepam Thomas;Tara Fulton;A. Tiffany;A. Frick;Mia C. Mattioli;A. Kahler;J. Murphy;M. Otto;Adiam T. Tesfai;A. Fields;Kelly E. Kline;Jennifer Fiddner;J. Higa;Amber Barnes;Francine Arroyo;Annabelle Salvatierra;April Holland;Wendy Taylor;J. Nash;B. Morawski;Sarah Correll;Rachel Hinnenkamp;J. Havens;K. Patel;Morgan N. Schroeder;L. Gladney;H. Martin;L. Whitlock;N. Dowell;Corinne Newhart;L. F. Watkins;V. Hill;S. Lance;Stic Harris;M. Wise;I. Williams;C. Basler;L. Gieraltowski
背景
产志贺毒素大肠杆菌(STEC)于1991年首次被发现。2018年4月，新泽西州和宾夕法尼亚州官员报告了一群STEC O157感染病例，与一家连锁餐厅的多个地点有关。疾控中心向国家食源性疾病监测实验室网络PulseNet查询了更多病例，并开始了一项全国性调查。
方法
病例被定义为在2018年3月13日至8月22日期间感染了22种已确认的与暴发相关的大肠杆菌O157：H7或大肠杆菌O61脉冲场凝胶电泳谱组合之一，或感染了通过全基因组测序与主要暴发菌株密切相关的菌株STEC O157。我们进行了流行病学和追溯性调查，以确定疾病亚群和共同来源。FDA领导的环境评估对水、土壤、粪便、堆肥和粪便样本进行了测试，以评估STEC污染物的潜在来源。
结果
我们确定了来自37个州的240例患者，其中104人住院，28人发展为溶血性尿毒症综合征，5人死亡。在179名接受采访的人中，152人(85%)报告在发病前一周食用了生菜。确定了20个亚星系团。从分组餐厅的产品追溯发现了许多生菜分销商和种植者；所有生菜都来自尤马种植区。从该地区一条灌溉渠采集的水样产生了STEC O157暴发菌株。
结论
我们报道了几十年来最大的多州绿叶相关STEC O157疫情。这项调查突显了调查涉及广泛环境污染的疫情的复杂性。
BACKGROUND
Produce-associated outbreaks of Shiga toxin-producing Escherichia coli (STEC) were first identified in 1991. In April 2018, New Jersey and Pennsylvania officials reported a cluster of STEC O157 infections associated with multiple locations of a restaurant chain. CDC queried PulseNet, the national laboratory network for foodborne disease surveillance, for additional cases and began a national investigation.
METHODS
A case was defined as an infection between March 13 and August 22, 2018 with one of the 22 identified outbreak-associated E. coli O157:H7 or E. coli O61 pulsed-field gel electrophoresis pattern combinations, or with a strain STEC O157 that was closely related to the main outbreak strain by whole genome sequencing. We conducted epidemiologic and traceback investigations to identify illness sub-clusters and common sources. An FDA-led environmental assessment, which tested water, soil, manure, compost, and scat samples, was conducted to evaluate potential sources of STEC contamination.
RESULTS
We identified 240 case-patients from 37 states; 104 were hospitalized, 28 developed hemolytic uremic syndrome, and five died. Of 179 people who were interviewed, 152 (85%) reported consuming romaine lettuce in the week before illness onset. Twenty sub-clusters were identified. Product traceback from sub-cluster restaurants identified numerous romaine lettuce distributors and growers; all lettuce originated from the Yuma growing region. Water samples collected from an irrigation canal in the region yielded the outbreak strain of STEC O157.
CONCLUSION
We report on the largest multistate leafy green-linked STEC O157 outbreak in several decades. The investigation highlights the complexities associated with investigating outbreaks involving widespread environmental contamination.