An outbreak of Shigella dysenteriae type 2 among laboratory workers due to intentional food contamination
S. A. Kolavic, A. Kimura, S. L. Simons, L. Slutsker, S. Barth and C. E. Haley
State Branch, Division of Applied Public Health Training, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
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 degrees 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.
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