Abstract
BackgroundOn 20–21 February 2006, six cases of diarrhoea-associated haemolytic uraemic syndrome (HUS) were reported by paediatricians to the Norwegian Institute of Public Health. We initiated an investigation to identify the etiologic agent and determine the source of the outbreak in order to implement control measures.MethodsA case was defined as a child with diarrhoea-associated HUS or any person with an infection with the outbreak strain of E. coli O103 (defined by the multi-locus variable number tandem repeats analysis (MLVA) profile) both with illness onset after January 1st 2006 in Norway. After initial hypotheses-generating interviews, we performed a case-control study with the first fifteen cases and three controls for each case matched by age, sex and municipality. Suspected food items were sampled, and any E. coli O103 strains were typed by MLVA.ResultsBetween 20 February and 6 April 2006, 17 cases were identified, of which 10 children developed HUS, including one fatal case. After pilot interviews, a matched case-control study was performed indicating an association between a traditional cured sausage (odds ratio 19.4 (95% CI: 2.4–156)) and STEC infection. E. coli O103:H25 identical to the outbreak strain defined by MLVA profile was found in the product and traced back to contaminated mutton.ConclusionWe report an outbreak caused by a rare STEC variant (O103:H25, stx2-positive). More than half of the diagnosed patients developed HUS, indicating that the causative organism is particularly virulent. Small ruminants continue to be important reservoirs for human-pathogen STEC. Improved slaughtering hygiene and good manufacturing practices for cured sausage products are needed to minimise the possibility of STEC surviving through the entire sausage production process.
Highlights
On 20–21 February 2006, six cases of diarrhoea-associated haemolytic uraemic syndrome (HUS) were reported by paediatricians to the Norwegian Institute of Public Health
Shiga toxin producing E. coli (STEC) can cause bloody diarrhoea which in 2–15% of cases, in children, develop into haemolytic uraemic syndrome (HUS) which can lead to renal failure and death [1]
Epidemiological investigation Case definition and case finding For the outbreak investigation we defined an outbreakrelated case as a child less than 16 years old, hospitalised in Norway with diarrhoea-associated HUS or a person of any age with an infection with the outbreak strain of E. coli O103 (defined by a specific multi-locus variable number tandem repeats analysis (MLVA) profile), both with onset after January 1, 2006
Summary
On 20–21 February 2006, six cases of diarrhoea-associated haemolytic uraemic syndrome (HUS) were reported by paediatricians to the Norwegian Institute of Public Health. Shiga toxin producing E. coli (STEC) can cause bloody diarrhoea which in 2–15% of cases, in children, develop into haemolytic uraemic syndrome (HUS) which can lead to renal failure and death [1]. More than 90% of diarrhoea-associated HUS cases are due to STEC infections. Sporadic STEC infections may be transmitted through food, contact with animals or farming environments or by person-to-person, the last two affecting mainly young children [3]. Have been associated with a wide variety of products, including undercooked minced beef, unpasteurized milk or apple juice, yoghurt, cheese, lettuce, vegetables, cured sausages and drinking water [1]
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