A Swimming-Associated Outbreak of Hemorrhagic Colitis Caused by Escherichia coli O157:H7 and Shigella Sonnei
William E. Keene, Jeremy M. McAnulty, Frederick C. Hoesly, L. Paul Williams, Katrina Hedberg, Gary L. Oxman, Timothy J. Barrett, Michael A. Pfaller, and David W. Fleming
Background In the summer of 1991, simultaneous outbreaks ofbloody diarrhea and hemolytic-uremic syndrome caused by Escherichiacoli O157:H7 and of bloody diarrhea caused by Shigella sonneiwere traced to a lakeside park near Portland, Oregon.
Methods We identified cases primarily from routine surveillancereports. In case-control studies, the activities of personswith park-associated E. coli O157:H7 or S. sonnei infectionswere compared independently with those of three sets of controls.We also evaluated environmental conditions at the park and subtypedthe bacterial isolates.
Results We identified 21 persons with park-associated E. coliO157:H7 infections (all of them children; median age, six years)and 38 persons with S. sonnei infections (most of them children).These 59 people had visited the park over a 24-day period. Theirillnesses were not associated with food or beverage consumption.All the case patients reported swimming, however, and in case-controlstudies swimming was strongly associated with both types ofinfection (P = 0.015 or less). The case patients were more likelythan the controls to report having swallowed lake water, andthey had spent more time in the lake. Numbers of enterococciindicative of substantial fecal contamination (geometric mean,>50 per deciliter) were detected in the swimming area duringsome but not all of the outbreak period. Park-associated E.coli O157:H7 isolates were identical by pulsed-field gel electrophoresisand were distinguishable from other isolates in the Portlandarea.
Conclusions Lake water that was fecally contaminated by batherswas the most likely vehicle for the transmission of both theE. coli O157:H7 and the S. sonnei infections. The unusuallyprolonged outbreak suggests both the survival of these entericorganisms in lake water and a low infectious dose.
Source Information
From the Center for Disease Prevention and Epidemiology, Oregon Health Division, Portland (W.E.K., J.M.M., F.C.H., L.P.W., K.H., D.W.F.); the Epidemic Intelligence Service (J.M.M.) and the Enteric Diseases Branch (T.J.B.), Centers for Disease Control and Prevention, Atlanta; the Multnomah County Health Department, Portland, Oreg. (G.L.O.); and the Department of Pathology, Oregon Health Sciences University, Portland (M.A.P.).
Address reprint requests to Dr. Keene at the Oregon Health Division, 800 NE Oregon St., Suite 772, Portland, OR 97232.
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