ArticlesRisk factors for and prevention of sporadic infections with vero cytotoxin (shiga toxin) producing Escherichia coli 0157
Introduction
Vero cytotoxin (shiga toxin) producing Escherichia coli, particularly those of serogroup O157 (VTEC O157), are, arguably, the most important emerging foodborne pathogens, with highly publicised outbreaks in Scotland,1 Japan,2 and the USA.3 The resulting debate on food safety has been largely based on knowledge from outbreak reports4, 5 that indicate a bovine reservoir, with transmission via contaminated meat,3 milk,6 water,7 cooked foods,8 and direct spread from animals9 and person to person.10 However, 90% of VTEC O157 infection in England and Wales is sporadic.11 In North America, case-control studies show an association with undercooked beef.12, 13, 14 There have been few population-based case-control studies of sporadic VTEC O157 infection,14 and our study is the first to report not only food-related risk factors but also risk factors for person-to-person and zoonotic transmission.
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Methods
Since 1990, the eight public health laboratories and 11 National Health Service laboratories that serve Wales and the English border counties, have examined all first-time faecal specimens from individuals with acute gastrointestinal symptoms for VTEC O157 with Sorbitol MacConkey agar15 and latex agglutination with O157 antiserum (Oxoid, BioMerieux Marcy L'Etoile, France). Presumptive E coli O157 were forwarded to the laboratory of enteric pathogens, Central Public Health Laboratory, for
Results
Of 89 cases, 85 (96%) took part in the study. H typing was available for 76 cases, 48 of which were E coli O157:H7 and the remainder were E coli O157:H- (non-motile). 142 (74%) of the 193 controls took part. The median delay between the onset of gastrointestinal illness and interview was 15 (range 3–103) days for cases and 28 (8–134) days for controls.
Discussion
The outbreak of VTEC O157 in Scotland in November, 1996, focused public attention on the food safety, particularly from butchers' shops. The report published after this outbreak recommended a licensing system for premises that sell raw and cooked meat or meat products.5 In our study of sporadic VTEC O157 cases, infection was not associated with loose cooked sliced meats from butchers. However, consumption of a cooked sliced meat meal from a caterers (eg, in a sandwich) was associated with
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