2018年美国与罗马生菜有关的产志贺毒素大肠埃希氏菌感染。

Lyndsay Bottichio, Amelia Keaton, Deepam Thomas, Tara Fulton, Amanda Tiffany, Anna Frick, Mia Mattioli, Amy Kahler, Jennifer Murphy, Mark Otto, Adiam Tesfai, Angela Fields, Kelly Kline, Jennifer Fiddner, Jeffrey Higa, Amber Barnes, Francine Arroyo, Annabelle Salvatierra, April Holland, Wendy Taylor, June Nash, Bozena M Morawski, Sarah Correll, Rachel Hinnenkamp, Jeffrey Havens, Kane Patel, Morgan N Schroeder, Lori Gladney, Haley Martin, Laura Whitlock, Natasha Dowell, Corinne Newhart, Louise Francois Watkins, Vincent Hill, Susan Lance, Stic Harris, Matthew Wise, Ian Williams, Colin Basler, Laura Gieraltowski
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引用次数: 0

摘要

背景:与农产品相关的产志贺毒素大肠杆菌(STEC)疫情于 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与一家连锁餐馆多个分店相关的 STEC O157 感染群。美国疾病控制和预防中心(CDC)查询了食源性疾病监测国家实验室网络 PulseNet,以了解更多病例,并开始了全国性调查:病例的定义是在 2018 年 3 月 13 日至 8 月 22 日期间感染了 22 种已确定的与疫情相关的大肠杆菌 O157:H7 或大肠杆菌 O61 脉冲场凝胶电泳模式组合中的一种,或通过全基因组测序感染了与主要疫情菌株密切相关的 STEC O157 菌株。我们开展了流行病学和溯源调查,以确定疾病亚群和共同来源。美国食品和药物管理局牵头开展了一项环境评估,对水、土壤、粪便、堆肥和粪便样本进行了检测,以评估 STEC 污染的潜在来源:我们确定了来自 37 个州的 240 名病例患者,其中 104 人住院治疗,28 人出现溶血性尿毒症,5 人死亡。在 179 名受访者中,152 人(85%)称在发病前一周食用过莴苣。确定了 20 个亚群。通过对子群餐馆的产品追踪,确定了许多莴苣经销商和种植商;所有莴苣均来自尤马种植区。从该地区一条灌溉渠中采集的水样检出了 STEC O157 暴发菌株:我们报告了几十年来最大规模的多州叶菜类 STEC O157 疫情。此次调查凸显了调查涉及广泛环境污染的疫情的复杂性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Shiga Toxin-Producing Escherichia coli Infections Associated With Romaine Lettuce-United States, 2018.

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. The Centers for Disease Control and Prevention (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 13 March and 22 August 2018 with 1 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 subclusters and common sources. A US Food and Drug Administration-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 5 died. Of 179 people who were interviewed, 152 (85%) reported consuming romaine lettuce in the week before illness onset. Twenty subclusters were identified. Product traceback from subcluster 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.

Conclusions: We report on the largest multistate leafy greens-linked STEC O157 outbreak in several decades. The investigation highlights the complexities associated with investigating outbreaks involving widespread environmental contamination.

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