678. Outbreak of Shiga Toxin-Producing Escherichia coli Infections at Marine Corps Recruit Depot (MCRD), San Diego and Camp Pendleton, California: October–November, 2017

Abstract

BackgroundShiga toxin-producing Escherichia coli (STEC) infections are a major cause of foodborne illness and the principal cause of hemolytic-uremic syndrome (HUS). In November 2017, CDC and the US Navy responded to an outbreak of STEC illnesses in military recruits at the Marine Corps Recruit Depot in San Diego (MCRD). We investigated to determine the source of this outbreak and identify prevention and mitigation measures.MethodsIn October 2017, medical staff identified a high number of gastrointestinal (GI) illnesses at MCRD. Recruits with diarrhea submitted stool specimens for culture and/or culture-independent diagnostic testing (CIDT) for GI pathogens. We performed pulsed-field gel electrophoresis (PFGE) on culture isolates. Case-patients were defined as confirmed (PFGE-confirmed STEC infection matching outbreak strains), probable (diagnosis of HUS and/or CIDT evidence of STEC), or suspected (bloody diarrhea). We conducted environmental evaluations of dining facilities, training areas, and barracks. A case–control study was performed using PFGE-confirmed case-patients and platoon-matched controls. We performed product traceback for foods identified as exposure risks by interview or case–control study.ResultsWe identified 64 confirmed, 105 probable, and 91 suspected case-patients. Thirty case-patients required hospitalization and 15 had HUS. Ages ranged from 17 to 28 years (median: 18 years). Poor hygiene practices among recruits and inconsistent cooking temperatures within dining facilities were noted. Forty-three case-patients and 135 controls were interviewed about food, hygiene, and environmental exposures. Consumption of undercooked beef was significantly associated with illness (mOR 2.40, CI 1.04–5.72, P = 0.04). We identified a single ground beef supplier for MCRD, but dining facility records did not document the dates on which specific lots of ground beef were used.ConclusionCase–control analysis and environmental observations suggested undercooked ground beef as a potential source for this outbreak. We recommended the Navy and Marine Corps retain lot information, address food handling concerns, and improve hygiene among recruits.Disclosures All authors: No reported disclosures.

Magnitude, distribution, risk factors and care-seeking behaviour of acute, self-reported gastrointestinal illness among US Army Soldiers: 2015

“…Throughout military history, acute gastrointestinal illness (AGI) has been a significant cause of morbidity and mortality among US service members [1]. Diarrhoeal disease caused more deaths than enemy action during the Revolutionary War and during the Civil War diarrhoeal disease occurred with more frequency and produced more sickness and mortality than any other form of the disease [1, 2]. Symptoms of AGI include diarrhoea, vomiting, fever, malaise and/or weakness.…”

“…In 2012, diarrhoeal diseases caused more than 17 000 healthcare encounters affecting over 15 000 US service members [5]. In 2018, an outbreak of AGI caused by Shiga toxin-producing Escherichia coli, a major cause of foodborne illness, sickened 244 male recruits at the Marine Corps Recruit Depot, 15 of which had life-threatening complications[2]. Historically and recently, AGI is a critical impediment to military readiness.…”

Estimate of the annual burden of foodborne illness in nondeployed active duty US Army Service Members: five major pathogens, 2010–2015

“…In 2012, diarrhoeal diseases were responsible for more than 17 000 healthcare encounters affecting over 15 000 US service members [2]. An outbreak of AGI caused by Shiga toxin-producing Escherichia coli, a major cause of foodborne illness, sickened 244 male recruits at the Marine Corps Recruit Depot, 15 of which had life threatening complications [3]. Symptoms of AGI include diarrhoea, vomiting, fever, malaise and/or weakness.…”