An outbreak of Escherichia coli O157:H7 infection from unpasteurized commercial apple juice
An outbreak of Escherichia coli O157:H7 infection from unpasteurized commercial apple juice
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DOI：
10.7326/0003-4819-130-3-199902020-00005
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发表时间：
1999-02-02
影响因子：
39.2
通讯作者：
Vugia, DJ
中科院分区：
文献类型：
--
作者：
Cody, SH;Glynn, MK;Vugia, DJ
背景：大肠杆菌 O157:H7 感染传统上与动物产品有关，但与农产品相关的疫情爆发的报道越来越频繁。 1996 年秋季，一小群大肠杆菌 O157:H7 感染在流行病学上与特定品牌（品牌 A）的未经高温消毒的苹果汁相关。目的：确定爆发范围、确认来源并确定苹果汁如何被污染。设计：描述性流行病学研究和追溯调查。地点：美国西部和加拿大不列颠哥伦比亚省。患者：大肠杆菌 O157:H7 感染患者测量：病例患者的临床结果和果汁暴露史、病例和果汁分离物的脉冲场凝胶电泳以及果汁生产实践。结果：确定了 70 名大肠杆菌 O157:H7 感染并接触过 A 品牌未经巴氏消毒的苹果汁的人。其中，25 人（36%）住院治疗，14 人（20%）出现溶血性尿毒症综合征，1 人（1%）死亡。召回的 1996 年 10 月 7 日生产的苹果汁培养了大肠杆菌 O157:H7，其脉冲场凝胶电泳图谱与病例分离株无法区分。几乎所有病例都是1996年10月7日生产的苹果汁，污染源怀疑是进口苹果。三批苹果可以解释果汁的污染：两批来自鹿经常光顾的果园，随后被证明携带大肠杆菌 O157:H7，另一批含有已打蜡的腐烂苹果。结论：生产未经巴氏消毒果汁的最先进工厂的标准程序不足以消除大肠杆菌 O157:H7 的污染。这次疫情表明，未经高温消毒的果汁必须被视为潜在危险食品，并导致新鲜果汁行业发生广泛变化。
Background: Escherichia coli O157:H7 infections have traditionally been associated with animal products, but outbreaks associated with produce have been reported with increasing frequency. In fall 1996, a small cluster of E. coli O157:H7 infections was epidemiologically linked to a particular brand (brand A) of unpasteurized apple juice.Objective: To define the extent of the outbreak, confirm the source, and determine how the apple juice became contaminated.Design: Descriptive epidemiologic study and traceback investigation.Setting: Western United States and British Columbia, Canada.Patients: Patients with E. coli O157:H7 infection who were exposed to brand A apple juice.Measurements: Clinical outcome and juice exposure histories of case-patients, pulsed-field gel electrophoresis of case and juice isolates, and juice production practices.Results: Seventy persons with E. coli O157:H7 infection and exposure to brand A unpasteurized apple juice were identified. Of these persons, 25 (36%) were hospitalized, 14 (20%) developed the hemolytic uremic syndrome, and 1 (1%) died. Recalled apple juice that was produced on 7 October 1996 grew E, coli O157:H7 with a pulsed-field gel electrophoresis pattern indistinguishable from that of case isolates. Apple juice produced on 7 October 1996 accounted for almost all of the cases, and the source of contamination was suspected to be incoming apples. Three lots of apples could explain contamination of the juice: Two lots originated from an orchard frequented by deer that were subsequently shown to carry E. coli O157:H7, and one lot contained decayed apples that had been waxed.Conclusions: Standard procedures at a state-of-the-art plant that produced unpasteurized juices were inadequate to eliminate contamination with E. coli O157:H7. This outbreak demonstrated that unpasteurized juices must be considered a potentially hazardous food and led to widespread changes in the fresh juice industry.