FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Previous Volume 337:388-394 August 7, 1997 Number 6 Next

	Full Text PDF Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background Escherichia coli O157:H7 is a leading cause of diarrhea and the hemolytic–uremic syndrome. Current public health surveillance for E. coli O157:H7 requires considerable resources; traditional methods lack the sensitivity and specificity to detect outbreaks effectively.

Methods During 1994 and 1995, the Minnesota Department of Health requested that all clinical isolates of E. coli O157:H7 be submitted to our laboratory. Isolates were subtyped by pulsed-field gel electrophoresis (PFGE), and patients were interviewed about potential sources of infection.

Results In 1994 and 1995, 344 cases of E. coli O157:H7 infection were reported to the Minnesota Department of Health; 317 (92 percent) were subtyped by PFGE, and 143 distinct PFGE patterns were identified. Ten outbreaks of E. coli O157:H7 were identified; these accounted for 56 (18 percent) of the 317 subtyped cases. Four outbreaks were detected solely as a result of subtype-specific surveillance. In 11 two-week periods, the number of reported cases of E. coli O157:H7 doubled from the previous two weeks. In eight of these instances, the patterns identified were dissimilar and there were no outbreaks. Two of the remaining three increases resulted from multiple simultaneous outbreaks.

Conclusions Subtype-specific surveillance for E. coli O157:H7 can identify outbreaks that are not detected by traditional methods and can ascertain whether sudden increases in reported cases are due to sporadic isolated cases or to one or more outbreaks.

Source Information

From the Acute Disease Epidemiology Section (J.B.B., C.W.H., K.L.M., M.T.O.) and the Division of Public Health Laboratories (J.M.B., D.J.B.), Minnesota Department of Health, Minneapolis.

Address reprint requests to Dr. Bender at the Acute Disease Epidemiology Section, Minnesota Department of Health, 717 Delaware St. SE, Minneapolis, MN 55440-9441.

Full Text of this Article

This article has been cited by other articles:

• Suzuki, S., Shibata, N., Yamane, K., Wachino, J.-i., Ito, K., Arakawa, Y. (2009). Change in the prevalence of extended-spectrum-{beta}-lactamase-producing Escherichia coli in Japan by clonal spread. J Antimicrob Chemother 63: 72-79 [Abstract] [Full Text]  
• Tartof, S. Y., Solberg, O. D., Manges, A. R., Riley, L. W. (2005). Analysis of a Uropathogenic Escherichia coli Clonal Group by Multilocus Sequence Typing. J. Clin. Microbiol. 43: 5860-5864 [Abstract] [Full Text]  
• Hunter, S. B., Vauterin, P., Lambert-Fair, M. A., Van Duyne, M. S., Kubota, K., Graves, L., Wrigley, D., Barrett, T., Ribot, E. (2005). Establishment of a Universal Size Standard Strain for Use with the PulseNet Standardized Pulsed-Field Gel Electrophoresis Protocols: Converting the National Databases to the New Size Standard. J. Clin. Microbiol. 43: 1045-1050 [Abstract] [Full Text]  
• Bidet, P., Mariani-Kurkdjian, P., Grimont, F., Brahimi, N., Courroux, C., Grimont, P., Bingen, E. (2005). Characterization of Escherichia coli O157 : H7 isolates causing haemolytic uraemic syndrome in France. J Med Microbiol 54: 71-75 [Abstract] [Full Text]  
• LeJeune, J. T., Besser, T. E., Rice, D. H., Berg, J. L., Stilborn, R. P., Hancock, D. D. (2004). Longitudinal Study of Fecal Shedding of Escherichia coli O157:H7 in Feedlot Cattle: Predominance and Persistence of Specific Clonal Types despite Massive Cattle Population Turnover. Appl. Environ. Microbiol. 70: 377-384 [Abstract] [Full Text]  
• Noller, A. C., McEllistrem, M. C., Pacheco, A. G. F., Boxrud, D. J., Harrison, L. H. (2003). Multilocus Variable-Number Tandem Repeat Analysis Distinguishes Outbreak and Sporadic Escherichia coli O157:H7 Isolates. J. Clin. Microbiol. 41: 5389-5397 [Abstract] [Full Text]  
• Horan, J. M., Mallonee, S. (2003). Injury Surveillance. Epidemiol Rev 25: 24-42 [Full Text]  
• Davis, M. A., Hancock, D. D., Besser, T. E., Call, D. R. (2003). Evaluation of Pulsed-Field Gel Electrophoresis as a Tool for Determining the Degree of Genetic Relatedness between Strains of Escherichia coli O157:H7. J. Clin. Microbiol. 41: 1843-1849 [Abstract] [Full Text]  
• Noller, A. C., McEllistrem, M. C., Stine, O. C., Morris, J. G. Jr., Boxrud, D. J., Dixon, B., Harrison, L. H. (2003). Multilocus Sequence Typing Reveals a Lack of Diversity among Escherichia coli O157:H7 Isolates That Are Distinct by Pulsed-Field Gel Electrophoresis. J. Clin. Microbiol. 41: 675-679 [Abstract] [Full Text]  
• Lahti, E., Ruoho, O., Rantala, L., Hanninen, M.-L., Honkanen-Buzalski, T. (2003). Longitudinal Study of Escherichia coli O157 in a Cattle Finishing Unit. Appl. Environ. Microbiol. 69: 554-561 [Abstract] [Full Text]  
• Bopp, D. J., Sauders, B. D., Waring, A. L., Ackelsberg, J., Dumas, N., Braun-Howland, E., Dziewulski, D., Wallace, B. J., Kelly, M., Halse, T., Musser, K. A., Smith, P. F., Morse, D. L., Limberger, R. J. (2003). Detection, Isolation, and Molecular Subtyping of Escherichia coli O157:H7 and Campylobacter jejuni Associated with a Large Waterborne Outbreak. J. Clin. Microbiol. 41: 174-180 [Abstract] [Full Text]  
• Manges, A. R., Johnson, J. R., Foxman, B., O'Bryan, T. T., Fullerton, K. E., Riley, L. W. (2001). Widespread Distribution of Urinary Tract Infections Caused by a Multidrug-Resistant Escherichia coli Clonal Group. NEJM 345: 1007-1013 [Abstract] [Full Text]  
• Stamm, W. E. (2001). An Epidemic of Urinary Tract Infections?. NEJM 345: 1055-1057 [Full Text]  
• Johnson, J. R., Clabots, C., Azar, M., Boxrud, D. J., Besser, J. M., Thurn, J. R. (2001). Molecular Analysis of a Hospital Cafeteria-Associated Salmonellosis Outbreak Using Modified Repetitive Element PCR Fingerprinting. J. Clin. Microbiol. 39: 3452-3460 [Abstract] [Full Text]  
• Barkocy-Gallagher, G. A., Arthur, T. M., Siragusa, G. R., Keen, J. E., Elder, R. O., Laegreid, W. W., Koohmaraie, M. (2001). Genotypic Analyses of Escherichia coli O157:H7 and O157 Nonmotile Isolates Recovered from Beef Cattle and Carcasses at Processing Plants in the Midwestern States of the United States. Appl. Environ. Microbiol. 67: 3810-3818 [Abstract] [Full Text]  
• Elliott, E J, Robins-Browne, R M, O'Loughlin, E V, Bennett-Wood, V, Bourke, J, Henning, P, Hogg, G G, Knight, J, Powell, H, Redmond, D, Contributors to the Australian Paediatric Surveill, (2001). Nationwide study of haemolytic uraemic syndrome: clinical, microbiological, and epidemiological features. Arch. Dis. Child. 85: 125-131 [Abstract] [Full Text]  
• Bender, J. B., Hedberg, C. W., Boxrud, D. J., Besser, J. M., Wicklund, J. H., Smith, K. E., Osterholm, M. T. (2001). Use of Molecular Subtyping in Surveillance for Salmonella enterica Serotype Typhimurium. NEJM 344: 189-195 [Abstract] [Full Text]  
• Stapp, J. R., Jelacic, S., Yea, Y.-L., Klein, E. J., Fischer, M., Clausen, C. R., Qin, X., Swerdlow, D. L., Tarr, P. I. (2000). Comparison of Escherichia coli O157:H7 Antigen Detection in Stool and Broth Cultures to That in Sorbitol-MacConkey Agar Stool Cultures. J. Clin. Microbiol. 38: 3404-3406 [Abstract] [Full Text]  
• Jackson, L. A., Keene, W. E., McAnulty, J. M., Alexander, E. R., Diermayer, M., Davis, M. A., Hedberg, K., Boase, J., Barrett, T. J., Samadpour, M., Fleming, D. W. (2000). Where's the Beef?: The Role of Cross-contamination in 4 Chain Restaurant-Associated Outbreaks of Escherichia coli O157:H7 in the Pacific Northwest. Arch Intern Med 160: 2380-2385 [Abstract] [Full Text]  
• Klapproth, J.-M. A., Scaletsky, I. C. A., McNamara, B. P., Lai, L.-C., Malstrom, C., James, S. P., Donnenberg, M. S. (2000). A Large Toxin from Pathogenic Escherichia coli Strains That Inhibits Lymphocyte Activation. Infect. Immun. 68: 2148-2155 [Abstract] [Full Text]  
• Hilborn, E. D., Mermin, J. H., Mshar, P. A., Hadler, J. L., Voetsch, A., Wojtkunski, C., Swartz, M., Mshar, R., Lambert-Fair, M.-A., Farrar, J. A., Glynn, M. K., Slutsker, L. (1999). A Multistate Outbreak of Escherichia coli O157:H7 Infections Associated With Consumption of Mesclun Lettuce. Arch Intern Med 159: 1758-1764 [Abstract] [Full Text]  
• Hutin, Y. J.F., Pool, V., Cramer, E. H., Nainan, O. V., Weth, J., Williams, I. T., Goldstein, S. T., Gensheimer, K. F., Bell, B. P., Shapiro, C. N., Alter, M. J., Margolis, H. S., The National Hepatitis A Investigation Team, (1999). A Multistate, Foodborne Outbreak of Hepatitis A. NEJM 340: 595-602 [Abstract] [Full Text]  
• Keskimäki, M., Saari, M., Heiskanen, T., Siitonen, A. (1998). Shiga Toxin-Producing Escherichia coli in Finland from 1990 through 1997: Prevalence and Characteristics of Isolates. J. Clin. Microbiol. 36: 3641-3646 [Abstract] [Full Text]  
• Heuvelink, A. E., van den Biggelaar, F. L. A. M., de Boer, E., Herbes, R. G., Melchers, W. J. G., Huis In 't Veld, J. H. J., Monnens, L. A. H. (1998). Isolation and Characterization of Verocytotoxin-Producing Escherichia coli O157 Strains from Dutch Cattle and Sheep. J. Clin. Microbiol. 36: 878-882 [Abstract] [Full Text]  
• Gouveia, S., Proctor, M. E., Lee, M.-S., Luchansky, J. B., Kaspar, C. W. (1998). Genomic Comparisons and Shiga Toxin Production among Escherichia coli O157:H7 Isolates from a Day Care Center Outbreak and Sporadic Cases in Southeastern Wisconsin. J. Clin. Microbiol. 36: 727-733 [Abstract] [Full Text]  
• Nataro, J. P., Kaper, J. B. (1998). Diarrheagenic Escherichia coli. Clin. Microbiol. Rev. 11: 142-201 [Abstract] [Full Text]