Abstract
There is a need for innovative methods to investigate outbreaks of food-borne infection linked to produce with a complex distribution network. The investigation of a large outbreak of Escherichia coli O157 PT34 infection in the United Kingdom in 2016 indicated that catering venues associated with multiple cases had used salad leaves sourced from one supplier. Our aim was to investigate whether catering venues linked to cases were more likely to have used salad leaves from this supplier. We conducted a matched case–control study, with catering venues as the units of analysis. We compared venues linked to cases to those without known linked cases. We included 43 study pairs and obtained information on salad leaf products received by each venue. The odds of a case venue being supplied with salad leaves by Supplier A were 7.67 times (95% confidence interval: 2.30–25.53) those of control venues. This association provided statistical evidence to support the findings of the other epidemiological investigations undertaken for this outbreak. This is a novel approach which is labour-intensive but which addresses the challenge of investigating exposures to food across a complex distribution network.
Highlights
Shiga toxin-producing Escherichia coli, such as E. coli O157 have the potential to cause severe gastrointestinal disease, with infection leading to haemolytic uraemic syndrome (HUS) in 5–14% of cases [1]
A large outbreak of E. coli O157 PT34 was reported in the United Kingdom (UK) in 2016; an overview of the outbreak and associated investigations is published in this issue [11]
Initial information from food chain investigations suggested that a number of catering venues associated with multiple cases had used salad leaves that were sourced from one company: Supplier A
Summary
Shiga toxin-producing Escherichia coli, such as E. coli O157 have the potential to cause severe gastrointestinal disease, with infection leading to haemolytic uraemic syndrome (HUS) in 5–14% of cases [1]. There have been a number of large E. coli O157 outbreaks in the United Kingdom (UK) [3,4], several linked to contaminated foods with wide distribution networks [5,6,7]. Food traceback investigations can be important for determining the source of E. coli outbreaks caused by contaminated food items [8,9,10]. Case–control and case–case studies were undertaken early in the outbreak investigation, which identified that consumption of mixed salad leaves and eating out at catering venues were significantly associated with illness [11]. Initial information from food chain investigations suggested that a number of catering venues associated with multiple cases had used salad leaves that were sourced from one company: Supplier A
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Schedule a callMore From: Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin
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