Published Date: 2003-11-28 23:50:00
Subject: PRO> E. coli O157, aerosol route susp. - USA (OH) 2001
Archive Number: 20031128.2945
E. COLI O157, AEROSOL ROUTE SUSPECTED - USA (OHIO) 2001
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Date: Wed, 26 Nov 2003 10:22:49 -0000
From: A-Lan Banks <a-Lan.Banks@derwent.co.uk>
Source: ABC News [edited]
<http://abcnews.go.com/wire/Living/ap20031125_1157.html>
At least 19 people who had gone to a county fair in Ohio in 2001 fell
ill with _E. coli_ after the bacteria apparently spread through
sawdust in the air at an exhibition hall, the first time researchers
have connected an outbreak to a contaminated building. Testing at the
building in Lorain County found _E. coli_ O157 in the rafters, the
walls, and the sawdust in some cases 10 months after the fair.
"This is an entirely new mode of transmission," said Dr. Michael S.
Donnenberg, professor of medicine and head of infectious diseases at
the University of Maryland, who was not involved in the study. The
study was conducted by the Centers for Disease Control and Prevention
and published in Wed, 26 Nov 2003 Journal of the American Medical
Association.
Tainted food is the most common source of _E. coli_ outbreaks, which
cause an average of 61 deaths and 73 000 illnesses a year in the USA.
People can also become infected from animal or human feces.
Altogether, 23 people who had attended the fair became sick with _E.
coli_. 19 of them had gone to a dance at the hall or had otherwise
visited the building, which contained exhibits involving cattle,
sheep, horses, and dogs. The building had a clay floor covered with
sawdust, and some of those at the dance complained the air was dusty.
"We do not have any proof that persons were infected because the _E.
coli_ O157 landed directly in their mouth, but our study suggests
this is possible," said Dr. Jay K. Varma of the CDC, who led the
study. Researchers were also surprised at how long _E. coli_ remained
in the building.
"It is possible that the _E. coli_ that live for that long are not
abundant enough or virulent enough to cause infection," Varma said,
but the study "raises this as a dangerous possibility."
Researchers said the few precautions available for reducing the risk
of outbreaks at fairs include not using sawdust, providing soap and
water, and disallowing eating at places where animals are on display.
Since the study, the CDC has learned of 2 other outbreaks that might
have been caused by building contamination, Varma said. One happened
at the University of Wisconsin, the other at the Lane County Fair in
Oregon.
--
ProMED-mail
<promed@promedmail.org>
[This outbreak occurred 2 years ago, but the data suggesting aerosol
transmission of the bacterium has prompted ProMED-mail to post the
description published in JAMA at this time. The abstract of the
article follows:
Varma JK, Greene KD, Reller ME, et al. An Outbreak of _Escherichia
coli_ O157 Infection Following Exposure to a Contaminated Building.
JAMA. 2003; 290:2709-12.
Context: Infection with _Escherichia coli_ O157 causes an estimated
70 000 diarrheal illnesses per year in the USA and can result in
hemolytic-uremic syndrome and death. Environmental contamination with
_E. coli_ O157 may be a public health problem.
Objectives: To determine risk factors for _E. coli_ O157 infection
during an outbreak investigation at a county fair and to evaluate
environmental contamination as a possible cause of the outbreak.
Design, Setting, and Participants: Case-control study of 23 patients
(median age, 15 years) and 53 age-matched controls who had attended
the Lorain County, Ohio, fair between 20 and 26 Aug 2001.
Case-patients had laboratory-confirmed _E. coli_ O157 infection,
hemolytic-uremic syndrome, or bloody diarrhea within 7 days of
attending the fair; controls attended the fair and did not have
diarrhea.
Main Outcome: Measures Risk factors for infection and isolates of _E.
coli_ O157 from environmental specimens.
Results: 6 (26 percent) case-patients were hospitalized and 2 (9
percent) developed hemolytic-uremic syndrome. Case-patients were more
likely than controls to have visited building A (a multipurpose
community facility on the fairgrounds; matched odds ratio [MOR], 21.4
[95 percent confidence interval {CI}, 2.7-170.7]). Among visitors to
building A, illness was independently associated with attending a
dance in the building (MOR, 7.5; 95 percent CI, 1.4-41.2), handling
sawdust from the floor (MOR, 4.6; 95 percent CI, 1.1-20.0), or eating
and/or drinking in the building (MOR, 4.5; 95 percent CI, 1.2-16.6).
24 (44 percent) of 54 specimens collected from building A 6 weeks
after the fair grew Shiga toxin-producing _E. coli_ O157. Isolates
from sawdust, the rafters, and other surfaces were identical by
molecular fingerprinting to patient isolates. Sawdust specimens
collected 42 weeks after the fair also grew the same _E. coli_ O157
strain.
Conclusions: Absence of evidence implicating specific food or
beverage sources and the recovery of _E. coli_ O157 from the rafters
suggest that airborne dispersion of bacteria contributed to the
contamination. Because _E. coli_ O157 can survive in the environment
for more than 10 months, humans may be at risk of infection long
after an environment is initially contaminated. - Mod.LL]
See Also
E. coli O157, retirement home - USA (CA) 20031017.2615E. coli O157 - USA (ND) 20031016.2610
E. coli O157, salad - USA (CA) (02) 20031010.2552
E. coli O157, salad - USA (CA) 20031009.2542
E. coli O157, day care - UK (N Ireland) (03) 20030918.2366
E. coli O157, day care - UK (N Ireland) (02) 20030917.2356
E. coli O157, day care - UK (N Ireland) 20030916.2347
E. coli, VTEC non-O157 - UK (Scotland) 20030825.2144
E. coli O157, petting zoo - USA (PA): confirmed 20030823.2128
E. coli O157, day care center - USA (California) (02) 20030111.0093
E. coli O157, day care center - USA (California) 20030110.0078 2002
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E. coli O157, family outbreak - UK (Scotland) 20021205.5969
E. coli O157 - Canada (multiprovince) 20021109.5760
E. coli O157, sorbitol fermenting - UK (Scotland) 20021101.5685 E. coli
O157, county fair - USA (Oregon) 20020827.5168
E. coli O157, campers - UK (Scotland) (02) 20020807.4985
E. coli O157, lettuce: alert (03) 20020803.4934
E. coli O157, petting zoo - New Zealand 20020724.4849
E. coli O157, summer camp - USA (Washington): alert 20020719.4807
E. coli O157, summer camp - USA (Washington): alert 20020719.4807
2001
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E. coli, O157, county fair - USA (Ohio) 20010923.2301
E. coli O157?, county fair - USA (Wisconsin) 20010816.1937
2000
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E. coli, petting zoo - USA (Pennsylvania) 20001105.1929
E. coli O157, petting zoo (Washington) 20000609.0925
.......................ab/ll/pg/lm
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