An Outbreak of <EMPH TYPE="ITAL">Escherichia coli</EMPH> O157 Infection Following Exposure to a Contaminated Building

Abstract

SCHERICHIA COLI O157, SUCH AS E coli O157:H7, causes approximately 70000 illnesses and 60 deaths annually in the United States. 1 Illness is often characterized by severe bloody diarrhea; renal failure from hemolytic-uremic syndrome (HUS) may occur in 3% to 7% of cases. 2 Healthy cattle are believed to be the most important reservoir of E coli O157. 2 Humans usually become infected from contaminated food or water or from contact with infected animals, infected humans, or either's excreta. 3,4 Because E coli O157 has a low infectious dose and can survive in the environment, environmental contamination with E coli O157 may be an important public health problem. 5,6 Outbreaks have been linked to contamination of surfaces regularly touched by animals, such as the soil of pastures or railings in petting zoos. 7-9 County fairs are popular throughout the United States. 10 Because fairs bring animals and humans into close contact, they are increasingly recognized as a setting for E coli O157 outbreaks. 11 Such outbreaks often affect multiple communities because fairs attract large numbers of individuals, particularly children, and person-toperson transmission may occur after a fair has ended. We describe an investigation of a fair-associated E coli O157 outbreak in which epidemiological and microbiological studies document that infections can be Author Affiliations are listed at the end of this article.

Indirect Transmission of Escherichia coli O157:H7 Occurs Readily among Swine but Not among Sheep

“…The recovery of E. coli O157:H7 from an air sample 24 h after cleaning suggests that some infectious particles remained in suspension for at least that long and emphasizes the low infectious dose of E. coli O157:H7 for pigs. This work also confirms the report by Varma et al demonstrating that inadvertent aerosolization of E. coli O157:H7 can result in transmission of the organism to humans or animals (22).…”

Hemolytic Uremic Syndrome

“…In 70% of cases in North America and Western Europe, Stx-HUS is secondary to infection with the E. coli serotype O157:H7 (13)(14)(15)(16)(17)(18)(19). This serotype has a unique biochemical property (lack of sorbitol fermentation) as to render it readily distinguishable from other fecal E. coli (20).…”

Isolation of Salmonella enterica and Shiga-Toxigenic Escherichia coli O157 from Feces of Animals in Public Contact Areas of United States Zoological Parks

“…These outbreaks are usually attributable to the protozoan Cryptosporidium parvum and to nontyphoid Salmonella enterica and especially to Shiga-toxigenic Escherichia coli (STEC) O157 bacterial infections (5,18). At least 17 animal exhibit-associated (agricultural fair, petting zoo, or open farm) STEC O157 outbreaks have occurred in the United States since 1999, and these outbreaks have affected 1,317 people, caused 69 hemolytic-uremic syndrome cases, and killed two persons (5,6,8,9,11,12,13,18,21). Since 1990, there have been at least four animal exhibit Salmonella enterica outbreaks in the United States attributable to Salmonella enterica serovars Typhimurium and Enteritidis (5).…”