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Shellie A. Kolavic, DMD, MPH; Akiko Kimura, MD; Shauna L. Simons; Laurence Slutsker, MD, MPH; Suzanne Barth, PhD; Charles E. Haley, MD, MS

JAMA. 1997;278(5):396-398.

Abstract
Context.
—Shigella dysenteriae type 2 is rare in the United States, and outbreaks associated with this pathogen are uncommon.

Objective.
—To determine the magnitude and source of an outbreak of S dysenteriae type 2.

Design.
—Retrospective cohort.

Setting.
—Laboratory of a large medical center.

Patients.
—Case patients were identified as laboratory workers who had diarrhea on or after October 28 and a positive stool culture or temperature greater than 37.8°C. Laboratory workers with diarrhea only were probable case patients.

Main Outcome Measures.
—We interviewed laboratory staff and performed identification, serotyping, and pulsed-field gel electrophoresis on isolates from case patients, implicated food, and laboratory stock culture.

Results.
—From October 29 through November 1, a total of 12 (27%) of 45 laboratory staff developed severe, acute diarrheal illness; 8 had S dysenteriae isolated from stool and 4 were hospitalized. All case patients reported having eaten muffins or doughnuts placed in the staff break room on October 29. Pulsed-field gel electrophoresis showed stool isolates from 9 case patients were indistinguishable from S dysenteriae type 2 recovered from an uneaten muffin and from the laboratory's stock strain, a portion of which was missing.

Conclusions.
—The source of the outbreak was most likely the laboratory's stock culture, which was used to contaminate the pastries. Results of this investigation underscore the need for adequate precautions to prevent inadvertent or intentional contamination from highly pathogenic laboratory specimens.

Author Affiliations
From the Epidemic Intelligence Service, State Branch, Division of Applied Public Health Training, Epidemiology Program Office, Centers for Disease Control and Prevention, and Bureau of Chronic Disease Prevention and Control, Texas Department of Health, Austin (Dr Kolavic); Epidemic Intelligence Service, Foodborne and Diarrheal Diseases Branch, Division of Bacterial and Mycotic Disease, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Ga (Dr Kimura); Foodborne and Diarrheal Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Ga (Dr Slutsker and Ms Simons); Bureau of Laboratories, Texas Department of Health, Austin (Dr Barth); and the Dallas County Health and Human Services, Dallas, Tex (Dr Haley).

Footnotes
Reprints: Laurence Slutsker. MD, MPH, Foodborne and Diarrheal Diseases Branch, Centers for Disease Control and Prevention, Mailstop A-38, 1600 Clifton Rd, Atlanta, GA 30333 (e-mail: LMS5@cdc.gov).

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