Outbreak of Shiga toxin-producing Escherichia coli O157 linked with consumption of a fast-food product containing imported cucumbers, United Kingdom, August 2020

Ranya Mulchandani; Clare Brehmer; Saira Butt; Bhavita Vishram; Melissa Harrison; Elizabeth Marchant; Simon Ferris; Frieda Jorgensen; Robert Smith; Gauri Godbole; Claire Jenkins; Tim Dallman; Neville Verlander; Nicholas Phin; Daniel Todkill; Saheer Gharbia; Jeremy Hawker

doi:10.1016/j.ijid.2021.04.001

Outbreak of Shiga toxin-producing Escherichia coli O157 linked with consumption of a fast-food product containing imported cucumbers, United Kingdom, August 2020

Ranya Mulchandani^*, Clare Brehmer, Saira Butt, Bhavita Vishram, Melissa Harrison, Elizabeth Marchant, Simon Ferris, Frieda Jorgensen, Robert Smith, Gauri Godbole, Claire Jenkins, Tim Dallman, Neville Verlander, Nicholas Phin, Daniel Todkill, Saheer Gharbia, Jeremy Hawker

^*Corresponding author for this work

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Abstract

Background: In August 2020, an outbreak of Shiga toxin-producing Escherichia coli (STEC) O157:H7 occurred in the United Kingdom. Whole genome sequencing revealed that these cases formed a genetically distinct cluster.

Methods: Hypotheses generated from case interviews were tested in analytical studies, and results informed environmental sampling and food chain analysis. A case–case study used non-outbreak ‘comparison’ STEC cases; a case–control study used a market research panel to recruit controls.

Results: A total of 36 cases were identified; all cases reported symptom onset between August 3 and August 16, 2020. The majority of cases (83%) resided in the Midlands region of England and in Wales. A high proportion of cases reported eating out, with one fast-food restaurant chain mentioned by 64% (n = 23) of cases. Both the case–case study (adjusted odds ratio (aOR) 31.8, 95% confidence interval (CI) 1.6–624.9) and the case–control study (aOR 9.19, 95% CI 1.0–82.8) revealed statistically significant results, showing that the consumption of a specific fast-food product was independently associated with infection.

Conclusions: Consumption of a specific fast-food product was a likely cause of this outbreak. The only ingredient specific to the product was cucumbers. The supply of cucumbers was immediately halted, and no further cases have been identified.

Original language	English
Pages (from-to)	S62-S68
Journal	International Journal of Infectious Diseases
Volume	110
Early online date	22 Apr 2021
DOIs	https://doi.org/10.1016/j.ijid.2021.04.001
Publication status	Published - Oct 2021

Bibliographical note

Funding Information: This article is published as part of a supplement entitled ‘Field Epidemiology: The Complex Science Behind Battling Acute Health Threats’ which was supported by Cooperative Agreement number NU2HGH000044, managed by TEPHINET and funded by the Centers for Disease Control and Prevention.

Open Access: . This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/

Publisher Copyright: © 2021 The Author(s). Published by Elsevier Ltd on behalf of International Society for Infectious Diseases.

Citation: Ranya Mulchandani, Clare Brehmer, Saira Butt, Bhavita Vishram, Melissa Harrison, Elizabeth Marchant, Simon Ferris, Frieda Jorgensen, Robert Smith, Gauri Godbole, Claire Jenkins, Timothy J. Dallman, Neville Q. Verlander, Nick Phin, Dan Todkill, Saheer Gharbia, Jeremy Hawker, Outbreak of Shiga toxin-producing Escherichia coli O157 linked with consumption of a fast-food product containing imported cucumbers, United Kingdom, August 2020, International Journal of Infectious Diseases, Volume 110, Supplement 1, 2021, Pages S62-S68, ISSN 1201-9712.

DOI: https://doi.org/10.1016/j.ijid.2021.04.001

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Mulchandani2021OutbreakOfShigaToxin-ProducingEscherichiaColiO157IntJInfectDisFinal published version, 1.26 MBLicence: CC BY-NC-ND

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Mulchandani, R., Brehmer, C., Butt, S., Vishram, B., Harrison, M., Marchant, E., Ferris, S., Jorgensen, F., Smith, R., Godbole, G., Jenkins, C., Dallman, T., Verlander, N., Phin, N., Todkill, D., Gharbia, S., & Hawker, J. (2021). Outbreak of Shiga toxin-producing Escherichia coli O157 linked with consumption of a fast-food product containing imported cucumbers, United Kingdom, August 2020. International Journal of Infectious Diseases, 110, S62-S68. https://doi.org/10.1016/j.ijid.2021.04.001

@article{f50db47330724191895816dcdb230ef6,

title = "Outbreak of Shiga toxin-producing Escherichia coli O157 linked with consumption of a fast-food product containing imported cucumbers, United Kingdom, August 2020",

abstract = "Background: In August 2020, an outbreak of Shiga toxin-producing Escherichia coli (STEC) O157:H7 occurred in the United Kingdom. Whole genome sequencing revealed that these cases formed a genetically distinct cluster. Methods: Hypotheses generated from case interviews were tested in analytical studies, and results informed environmental sampling and food chain analysis. A case–case study used non-outbreak {\textquoteleft}comparison{\textquoteright} STEC cases; a case–control study used a market research panel to recruit controls. Results: A total of 36 cases were identified; all cases reported symptom onset between August 3 and August 16, 2020. The majority of cases (83%) resided in the Midlands region of England and in Wales. A high proportion of cases reported eating out, with one fast-food restaurant chain mentioned by 64% (n = 23) of cases. Both the case–case study (adjusted odds ratio (aOR) 31.8, 95% confidence interval (CI) 1.6–624.9) and the case–control study (aOR 9.19, 95% CI 1.0–82.8) revealed statistically significant results, showing that the consumption of a specific fast-food product was independently associated with infection. Conclusions: Consumption of a specific fast-food product was a likely cause of this outbreak. The only ingredient specific to the product was cucumbers. The supply of cucumbers was immediately halted, and no further cases have been identified.",

author = "Ranya Mulchandani and Clare Brehmer and Saira Butt and Bhavita Vishram and Melissa Harrison and Elizabeth Marchant and Simon Ferris and Frieda Jorgensen and Robert Smith and Gauri Godbole and Claire Jenkins and Tim Dallman and Neville Verlander and Nicholas Phin and Daniel Todkill and Saheer Gharbia and Jeremy Hawker",

note = "Funding Information: This article is published as part of a supplement entitled {\textquoteleft}Field Epidemiology: The Complex Science Behind Battling Acute Health Threats{\textquoteright} which was supported by Cooperative Agreement number NU2HGH000044, managed by TEPHINET and funded by the Centers for Disease Control and Prevention. Open Access: . This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/ Publisher Copyright: {\textcopyright} 2021 The Author(s). Published by Elsevier Ltd on behalf of International Society for Infectious Diseases. Citation: Ranya Mulchandani, Clare Brehmer, Saira Butt, Bhavita Vishram, Melissa Harrison, Elizabeth Marchant, Simon Ferris, Frieda Jorgensen, Robert Smith, Gauri Godbole, Claire Jenkins, Timothy J. Dallman, Neville Q. Verlander, Nick Phin, Dan Todkill, Saheer Gharbia, Jeremy Hawker, Outbreak of Shiga toxin-producing Escherichia coli O157 linked with consumption of a fast-food product containing imported cucumbers, United Kingdom, August 2020, International Journal of Infectious Diseases, Volume 110, Supplement 1, 2021, Pages S62-S68, ISSN 1201-9712. DOI: https://doi.org/10.1016/j.ijid.2021.04.001",

year = "2021",

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Mulchandani, R, Brehmer, C, Butt, S, Vishram, B, Harrison, M, Marchant, E, Ferris, S, Jorgensen, F, Smith, R, Godbole, G , Jenkins, C, Dallman, T, Verlander, N, Phin, N, Todkill, D , Gharbia, S & Hawker, J 2021, 'Outbreak of Shiga toxin-producing Escherichia coli O157 linked with consumption of a fast-food product containing imported cucumbers, United Kingdom, August 2020', International Journal of Infectious Diseases, vol. 110, pp. S62-S68. https://doi.org/10.1016/j.ijid.2021.04.001

TY - JOUR

T1 - Outbreak of Shiga toxin-producing Escherichia coli O157 linked with consumption of a fast-food product containing imported cucumbers, United Kingdom, August 2020

AU - Mulchandani, Ranya

AU - Brehmer, Clare

AU - Butt, Saira

AU - Vishram, Bhavita

AU - Harrison, Melissa

AU - Marchant, Elizabeth

AU - Ferris, Simon

AU - Jorgensen, Frieda

AU - Smith, Robert

AU - Godbole, Gauri

AU - Jenkins, Claire

AU - Dallman, Tim

AU - Verlander, Neville

AU - Phin, Nicholas

AU - Todkill, Daniel

AU - Gharbia, Saheer

AU - Hawker, Jeremy

N1 - Funding Information: This article is published as part of a supplement entitled ‘Field Epidemiology: The Complex Science Behind Battling Acute Health Threats’ which was supported by Cooperative Agreement number NU2HGH000044, managed by TEPHINET and funded by the Centers for Disease Control and Prevention. Open Access: . This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/ Publisher Copyright: © 2021 The Author(s). Published by Elsevier Ltd on behalf of International Society for Infectious Diseases. Citation: Ranya Mulchandani, Clare Brehmer, Saira Butt, Bhavita Vishram, Melissa Harrison, Elizabeth Marchant, Simon Ferris, Frieda Jorgensen, Robert Smith, Gauri Godbole, Claire Jenkins, Timothy J. Dallman, Neville Q. Verlander, Nick Phin, Dan Todkill, Saheer Gharbia, Jeremy Hawker, Outbreak of Shiga toxin-producing Escherichia coli O157 linked with consumption of a fast-food product containing imported cucumbers, United Kingdom, August 2020, International Journal of Infectious Diseases, Volume 110, Supplement 1, 2021, Pages S62-S68, ISSN 1201-9712. DOI: https://doi.org/10.1016/j.ijid.2021.04.001

PY - 2021/10

Y1 - 2021/10

N2 - Background: In August 2020, an outbreak of Shiga toxin-producing Escherichia coli (STEC) O157:H7 occurred in the United Kingdom. Whole genome sequencing revealed that these cases formed a genetically distinct cluster. Methods: Hypotheses generated from case interviews were tested in analytical studies, and results informed environmental sampling and food chain analysis. A case–case study used non-outbreak ‘comparison’ STEC cases; a case–control study used a market research panel to recruit controls. Results: A total of 36 cases were identified; all cases reported symptom onset between August 3 and August 16, 2020. The majority of cases (83%) resided in the Midlands region of England and in Wales. A high proportion of cases reported eating out, with one fast-food restaurant chain mentioned by 64% (n = 23) of cases. Both the case–case study (adjusted odds ratio (aOR) 31.8, 95% confidence interval (CI) 1.6–624.9) and the case–control study (aOR 9.19, 95% CI 1.0–82.8) revealed statistically significant results, showing that the consumption of a specific fast-food product was independently associated with infection. Conclusions: Consumption of a specific fast-food product was a likely cause of this outbreak. The only ingredient specific to the product was cucumbers. The supply of cucumbers was immediately halted, and no further cases have been identified.

AB - Background: In August 2020, an outbreak of Shiga toxin-producing Escherichia coli (STEC) O157:H7 occurred in the United Kingdom. Whole genome sequencing revealed that these cases formed a genetically distinct cluster. Methods: Hypotheses generated from case interviews were tested in analytical studies, and results informed environmental sampling and food chain analysis. A case–case study used non-outbreak ‘comparison’ STEC cases; a case–control study used a market research panel to recruit controls. Results: A total of 36 cases were identified; all cases reported symptom onset between August 3 and August 16, 2020. The majority of cases (83%) resided in the Midlands region of England and in Wales. A high proportion of cases reported eating out, with one fast-food restaurant chain mentioned by 64% (n = 23) of cases. Both the case–case study (adjusted odds ratio (aOR) 31.8, 95% confidence interval (CI) 1.6–624.9) and the case–control study (aOR 9.19, 95% CI 1.0–82.8) revealed statistically significant results, showing that the consumption of a specific fast-food product was independently associated with infection. Conclusions: Consumption of a specific fast-food product was a likely cause of this outbreak. The only ingredient specific to the product was cucumbers. The supply of cucumbers was immediately halted, and no further cases have been identified.

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U2 - 10.1016/j.ijid.2021.04.001

DO - 10.1016/j.ijid.2021.04.001

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C2 - 33895409

AN - SCOPUS:85106238601

SN - 1201-9712

VL - 110

SP - S62-S68

JO - International Journal of Infectious Diseases

JF - International Journal of Infectious Diseases

ER -

Outbreak of Shiga toxin-producing Escherichia coli O157 linked with consumption of a fast-food product containing imported cucumbers, United Kingdom, August 2020

Abstract

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