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An Outbreak of Escherichia coli O157 Infection Following Exposure to a Contaminated Building
Jay K. Varma, MD;
Katherine D. Greene, AS;
Megan E. Reller, MD;
Stephanie M. DeLong, MPH;
Janine Trottier, BSN;
Scott F. Nowicki, MPH;
Mary DiOrio, MD, MPH;
Elizabeth M. Koch, MD, MPH&TM;
Tammy L. Bannerman, PhD;
Steven T. York, MPA;
Mary-Ann Lambert-Fair, BS;
Joy G. Wells, MS;
Paul S. Mead, MD, MPH
JAMA. 2003;290:2709-2712.
Context Infection with Escherichia coli O157 causes an estimated 70 000 diarrheal illnesses per year in the United States and can result in hemolytic-uremic syndrome and death. Environmental contamination with E coli O157 may be a public health problem.
Objectives To determine risk factors for E coli O157 infection during an outbreak investigation at a county fair and to evaluate environmental contamination as a possible cause of the outbreak.
Design, Setting, and Participants Case-control study of 23 patients (median age, 15 years) and 53 age-matched controls who had attended the Lorain County, Ohio, fair between August 20 and August 26, 2001. Case-patients had laboratory-confirmed E coli O157 infection, hemolytic-uremic syndrome, or bloody diarrhea within 7 days of attending the fair; controls attended the fair and did not have diarrhea.
Main Outcome Measures Risk factors for infection and isolates of E coli O157 from environmental specimens.
Results Six (26%) case-patients were hospitalized and 2 (9%) developed hemolytic-uremic syndrome. Case-patients were more likely than controls to have visited building A (a multipurpose community facility on the fairgrounds; matched odds ratio [MOR], 21.4 [95% confidence interval {CI}, 2.7-170.7]). Among visitors to building A, illness was independently associated with attending a dance in the building (MOR, 7.5; 95% CI, 1.4-41.2), handling sawdust from the floor (MOR, 4.6; 95% CI, 1.1-20.0), or eating and/or drinking in the building (MOR, 4.5; 95% CI, 1.2-16.6). Twenty-four (44%) of 54 specimens collected from building A 6 weeks after the fair grew Shiga toxin–producing E coli O157. Isolates from sawdust, the rafters, and other surfaces were identical by molecular fingerprinting to patient isolates. Sawdust specimens collected 42 weeks after the fair also grew the same E coli O157 strain.
Conclusions Absence of evidence implicating specific food or beverage sources and the recovery of E coli O157 from the rafters suggest that airborne dispersion of bacteria contributed to the contamination. Because E coli O157 can survive in the environment for more than 10 months, humans may be at risk of infection long after an environment is initially contaminated.
Author Affiliations: Foodborne and Diarrheal Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases (Drs Varma, Reller, and Mead and Mss Greene, DeLong, Lambert-Fair, and Wells) and Epidemic Intelligence Service, Epidemiology Program Office (Drs Varma and Reller), Centers for Disease Control and Prevention, Atlanta, Ga; Lorain County General Health District, Elyria, Ohio (Ms Trottier); and Ohio Department of Health, Columbus (Messrs Nowicki and York and Drs DiOrio, Koch, and Bannerman).
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