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Escherichia coli O157 Outbreaks in the United States, 2003–2012 - Volume 21, Number 8—August 2015 - Emerging Infectious Disease journal - CDC

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Escherichia coli O157 Outbreaks in the United States, 2003–2012 - Volume 21, Number 8—August 2015 - Emerging Infectious Disease journal - CDC

Volume 21, Number 8—August 2015


Escherichia coli O157 Outbreaks in the United States, 2003–2012

Katherine E. HeimanComments to Author , Rajal K. Mody, Shacara D. Johnson, Patricia M. Griffin, and L. Hannah Gould
Author affiliations: Centers for Disease Control and Prevention, Atlanta, Georgia, USA


Infections with the Shiga toxin–producing bacterium Escherichia coli O157 can cause severe illness and death. We summarized reported outbreaks of E. coli O157 infections in the United States during 2003–2012, including demographic characteristics of patients and epidemiologic findings by transmission mode and food category. We identified 390 outbreaks, which included 4,928 illnesses, 1,272 hospitalizations, and 33 deaths. Transmission was through food (255 outbreaks, 65%), person-to-person contact (39, 10%), indirect or direct contact with animals (39, 10%), and water (15, 4%); 42 (11%) had a different or unknown mode of transmission. Beef and leafy vegetables, combined, were the source of >25% of all reported E. colioutbreaks and of >40% of related illnesses. Outbreaks attributed to foods generally consumed raw caused higher hospitalization rates than those attributed to foods generally consumed cooked (35% vs. 28%). Most (87%) waterborne E. coli outbreaks occurred in states bordering the Mississippi River.
Signs and symptoms of infection with Shiga toxin–producing Escherichia coli O157 can include diarrhea that is often bloody, severe stomach cramps, and vomiting; infection can progress to hemolytic uremic syndrome (HUS) and death (1). In the United States, these infections and related illnesses are estimated to cost >$405 million annually (2).
E. coli O157 can be transmitted to humans through contaminated food and water, directly between persons, and through contact with animals or their environment. The most common reservoir is cattle, and ground beef is the most frequently identified vehicle of transmission to humans. E. coli O157 was first recognized as a foodborne pathogen after outbreaks during 1982 were linked to ground beef consumption (1). Since then, many other sources have been identified (3), mostly through outbreak investigations. We describe the epidemiology of E. coliO157 outbreaks during 2003–2012.

Ms. Heiman is an epidemiologist in the Outbreak Response and Prevention Branch at the Centers for Disease Control and Prevention. Her primary research interests are in enteric disease surveillance, and outbreak investigation.


We thank Kristin Holt for input into the analysis and state and local public health officials for submitting outbreak reports to CDC.


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Suggested citation for this article: Heiman KE, Mody RK, Johnson SD, Griffin PM, Gould LH. Escherichia coli O157 outbreaks in the United States, 2003–2012. Emerg Infect Dis. 2015 Aug [date cited].
DOI: 10.3201/eid2108.141364

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