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
- 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).
Abstract
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.
