Published Date: 2004-05-13 23:50:00
Subject: PRO/EDR> E. coli O157, pasteurized milk - Denmark (Copenhagen)
Archive Number: 20040513.1297
E. COLI O157, PASTEURIZED MILK DENMARK (COPENHAGEN)
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Date: 13 May 2004
From: ProMED-mail <promed@promedmail.org>
Source: Eurosurveillance Weekly Vol 8 / Issue 20 13 May 2004 [edited]
<http://www.eurosurveillance.org/ew/2004/040513.asp>
Outbreak of Vero cytotoxin-producing _E.coli_ O157 linked to milk in Denmark
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In an outbreak which lasted from Sep 2003 to Mar 2004 in Denmark, 25 people
became ill with disease caused by Vero cytotoxin-producing _E.coli_ (VTEC)
O157. The outbreak was limited to the Greater Copenhagen area. Cases in 18
children and 7 adults were reported: 6 males and 19 females.
The dominant symptoms experienced were abdominal cramps and diarrhea: there
were no cases with renal failure. The isolates cultured from stool samples
had the same unique genetic fingerprint. 11 patients who became ill after
15 Jan 2004 and 55 controls were interviewed. 8 of the 11 patients were
probably primary cases, while 3 might have been secondary cases. Of the 8
primary patients, 7 had bought goods from a certain supermarket chain
(matched odds ratio (mOR) 7.7; 95 percent Confidence Interval (CI):
0.9-65). No other chain of shops was associated with increased risk of
infection. On the basis of the interviews, milk from a certain dairy was
the only foodstuff that was linked with an increased risk of infection. 5
of the 8 primary patients had drunk milk from the dairy in question,
compared with 5 of 39 control persons, (mOR 8.7; 95 percent CI: 1.6-48).
The last 3 primary patients did not remember that they had drunk milk from
this dairy.
The outbreak was likely to have been caused by a foodstuff that was sold in
a certain supermarket chain, which sells a large amount of milk products
from the dairy mentioned. It is suspected that the milk from this dairy was
contaminated with very low levels of VTEC O157. Following a press release
by the Danish Veterinary and Food
Administration (<http://www.uk.foedevaredirektoratet.dk/forside.htm> 3) on
26 Mar 2004, the production of milk from the dairy mentioned was
temporarily stopped, the plant was cleaned and the pasteurization
temperature raised. Since then, there have been no further cases. The dairy
has been investigated for VTEC O157 contamination, but these results have
been negative. A further investigation of the herds supplying the dairy is
planned [4].
Physicians in the Copenhagen area are still being officially advised to
request a laboratory investigation for VTEC O157 when requesting cultures
of stool samples for enteropathogenic bacteria from patients presenting
with abdominal cramps and diarrhea.
This outbreak caused by VTEC O157 is the first general one recorded in
Denmark. Previous outbreaks of VTEC O157 linked to milk and dairy products
have been reported in the United Kingdom [5,6].
1. Gerner-Smidt P, Molbak K. Outbreak of VTEC O157. EPI-NEWS 2004; 12: 17
Mar. (<http://www.ssi.dk/sw9606.asp>)
2.Molbak K. VTEC Outbreak-update. EPI-NEWS 2004; 14:31 March 2004.
(<http://www.ssi.dk/sw10275.asp>)
3. Danish Veterinary and Food Association. Mistanke om colibakterier i
maelk fra Thise Mejeri. Press release. 26 March 2004
(<http://www.foedevaredirektoratet.dk/Presserum/Pressemeddelelser/Mistanke+om+colibakterier+i+maelk.htm>)
4. Gerner-Smidt P. Personal correspondence. 13 May 2004.
5. PHLS. Cases of Escherichia coli O157 infection associated with
unpasteurised cream in England. Eurosurveillance Weekly 1998; 2(44):
29/10/98 (<http://www.eurosurveillance.org/ew/1998/981029.asp#5>)
6. O Brien S, Smith H, Lighton L, Mellanby A. Outbreaks of VTEC O157
infection linked to consumption of unpasteurised milk. Eurosurveillance
Weekly 2000; 4(23): 8/6/2004
(<http://www.eurosurveillance.org/ew/2000/000608.asp#4>)
[By: [Editorial team (Eurosurveillance.weekly@hpa.org.uk), Eurosurveillance
editorial office]
--
ProMED-mail
<promed@promedmail.org>
[As can be noted when pasteurized milk 'spoils' in the refrigerator, this
product is not sterile. It is uncommon for pathogenic bacteria to survive
in clinically relevant numbers, but it may occur. This cluster illustrates
once again that transmission of _E. coli_ O157 to humans does not have to
be from undercooking hamburger. - Mod.LL]
See Also
2003----
E. coli O157, aerosol route susp. - USA (OH) 2001 20031128.2945
E. coli O157, retirement home - USA (CA) 20031017.2615
E. 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) 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
----
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
----
E. coli, O157, county fair - USA (Ohio) 20010923.2301
E. coli O157?, county fair - USA (Wisconsin) 20010816.1937
2000
----
E. coli, petting zoo - USA (Pennsylvania) 20001105.1929
E. coli O157, petting zoo (Washington) 20000609.0925
......................mpp/ll/pg/mpp
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