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Outbreak of haemolytic uraemic syndrome in Norway caused by stx2-positive Escherichia coli O103:H25 traced to cured mutton sausages.

Schimmer B, Nygard K, Eriksen HM, Lassen J, Lindstedt BA, Brandal LT, Kapperud G, Aavitsland P - BMC Infect. Dis. (2008)

Bottom Line: E. coli O103:H25 identical to the outbreak strain defined by MLVA profile was found in the product and traced back to contaminated mutton.Small ruminants continue to be important reservoirs for human-pathogen STEC.Improved slaughtering hygiene and good manufacturing practices for cured sausage products are needed to minimise the possibility of STEC surviving through the entire sausage production process.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Infectious Disease Epidemiology, Norwegian Institute of Public Health, Oslo, Norway. barschimmer@gmail.com

ABSTRACT

Background: On 20-21 February 2006, six cases of diarrhoea-associated haemolytic uraemic syndrome (HUS) were reported by paediatricians to the Norwegian Institute of Public Health. We initiated an investigation to identify the etiologic agent and determine the source of the outbreak in order to implement control measures.

Methods: A case was defined as a child with diarrhoea-associated HUS or any person with an infection with the outbreak strain of E. coli O103 (defined by the multi-locus variable number tandem repeats analysis (MLVA) profile) both with illness onset after January 1st 2006 in Norway. After initial hypotheses-generating interviews, we performed a case-control study with the first fifteen cases and three controls for each case matched by age, sex and municipality. Suspected food items were sampled, and any E. coli O103 strains were typed by MLVA.

Results: Between 20 February and 6 April 2006, 17 cases were identified, of which 10 children developed HUS, including one fatal case. After pilot interviews, a matched case-control study was performed indicating an association between a traditional cured sausage (odds ratio 19.4 (95% CI: 2.4-156)) and STEC infection. E. coli O103:H25 identical to the outbreak strain defined by MLVA profile was found in the product and traced back to contaminated mutton.

Conclusion: We report an outbreak caused by a rare STEC variant (O103:H25, stx2-positive). More than half of the diagnosed patients developed HUS, indicating that the causative organism is particularly virulent. Small ruminants continue to be important reservoirs for human-pathogen STEC. Improved slaughtering hygiene and good manufacturing practices for cured sausage products are needed to minimise the possibility of STEC surviving through the entire sausage production process.

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Distribution of outbreak related cases of HUS and E. coli O103 infection by county, Norway, January-March 2006 (n = 17).
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Figure 2: Distribution of outbreak related cases of HUS and E. coli O103 infection by county, Norway, January-March 2006 (n = 17).

Mentions: Dates of symptom onset ranged between January 22 and March 13, 2006, with 15 cases reporting first symptoms between February 12 and March 13 (Figure 1). Ten cases came from mid-Norway, in two neighbouring counties. Among the other cases residing in seven other counties (Figure 2), one had visited one of the first counties the week before illness. Eleven (65%) cases were female, and all cases were children aged 1–11 years, except the asymptomatic case (aged 40) and another adult (aged 18) with diarrhoea only. All HUS cases were less than 9 years old.


Outbreak of haemolytic uraemic syndrome in Norway caused by stx2-positive Escherichia coli O103:H25 traced to cured mutton sausages.

Schimmer B, Nygard K, Eriksen HM, Lassen J, Lindstedt BA, Brandal LT, Kapperud G, Aavitsland P - BMC Infect. Dis. (2008)

Distribution of outbreak related cases of HUS and E. coli O103 infection by county, Norway, January-March 2006 (n = 17).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2335110&req=5

Figure 2: Distribution of outbreak related cases of HUS and E. coli O103 infection by county, Norway, January-March 2006 (n = 17).
Mentions: Dates of symptom onset ranged between January 22 and March 13, 2006, with 15 cases reporting first symptoms between February 12 and March 13 (Figure 1). Ten cases came from mid-Norway, in two neighbouring counties. Among the other cases residing in seven other counties (Figure 2), one had visited one of the first counties the week before illness. Eleven (65%) cases were female, and all cases were children aged 1–11 years, except the asymptomatic case (aged 40) and another adult (aged 18) with diarrhoea only. All HUS cases were less than 9 years old.

Bottom Line: E. coli O103:H25 identical to the outbreak strain defined by MLVA profile was found in the product and traced back to contaminated mutton.Small ruminants continue to be important reservoirs for human-pathogen STEC.Improved slaughtering hygiene and good manufacturing practices for cured sausage products are needed to minimise the possibility of STEC surviving through the entire sausage production process.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Infectious Disease Epidemiology, Norwegian Institute of Public Health, Oslo, Norway. barschimmer@gmail.com

ABSTRACT

Background: On 20-21 February 2006, six cases of diarrhoea-associated haemolytic uraemic syndrome (HUS) were reported by paediatricians to the Norwegian Institute of Public Health. We initiated an investigation to identify the etiologic agent and determine the source of the outbreak in order to implement control measures.

Methods: A case was defined as a child with diarrhoea-associated HUS or any person with an infection with the outbreak strain of E. coli O103 (defined by the multi-locus variable number tandem repeats analysis (MLVA) profile) both with illness onset after January 1st 2006 in Norway. After initial hypotheses-generating interviews, we performed a case-control study with the first fifteen cases and three controls for each case matched by age, sex and municipality. Suspected food items were sampled, and any E. coli O103 strains were typed by MLVA.

Results: Between 20 February and 6 April 2006, 17 cases were identified, of which 10 children developed HUS, including one fatal case. After pilot interviews, a matched case-control study was performed indicating an association between a traditional cured sausage (odds ratio 19.4 (95% CI: 2.4-156)) and STEC infection. E. coli O103:H25 identical to the outbreak strain defined by MLVA profile was found in the product and traced back to contaminated mutton.

Conclusion: We report an outbreak caused by a rare STEC variant (O103:H25, stx2-positive). More than half of the diagnosed patients developed HUS, indicating that the causative organism is particularly virulent. Small ruminants continue to be important reservoirs for human-pathogen STEC. Improved slaughtering hygiene and good manufacturing practices for cured sausage products are needed to minimise the possibility of STEC surviving through the entire sausage production process.

Show MeSH
Related in: MedlinePlus