Epidemic Intelligence Service, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Clin Infect Dis. 2012 Feb 15;54(4):511-8. doi: 10.1093/cid/cir831. Epub 2011 Dec 8.
Escherichia coli O157:H7 is a Shiga toxin-producing E. coli (STEC) associated with numerous foodborne outbreaks in the United States and is an important cause of bacterial gastrointestinal illness. In May 2009, we investigated a multistate outbreak of E. coli O157:H7 infections.
Outbreak-associated cases were identified using serotyping and molecular subtyping procedures. Traceback investigation and product testing were performed. A matched case-control study was conducted to identify exposures associated with illness using age-, sex-, and state-matched controls.
Seventy-seven patients with illnesses during the period 16 March-8 July 2009 were identified from 30 states; 35 were hospitalized, 10 developed hemolytic-uremic syndrome, and none died. Sixty-six percent of patients were <19 years; 71% were female. In the case-control study, 33 of 35 case patients (94%) consumed ready-to-bake commercial prepackaged cookie dough, compared with 4 of 36 controls (11%) (matched odds ratio = 41.3; P < .001); no other reported exposures were significantly associated with illness. Among case patients consuming cookie dough, 94% reported brand A. Three nonoutbreak STEC strains were isolated from brand A cookie dough. The investigation led to a recall of 3.6 million packages of brand A cookie dough and a product reformulation.
This is the first reported STEC outbreak associated with consuming ready-to-bake commercial prepackaged cookie dough. Despite instructions to bake brand A cookie dough before eating, case patients consumed the product uncooked. Manufacturers should consider formulating ready-to-bake commercial prepackaged cookie dough to be as safe as a ready-to-eat product. More effective consumer education about the risks of eating unbaked cookie dough is needed.
产志贺毒素大肠杆菌 O157:H7 是一种与美国多起食源性暴发有关的大肠杆菌，也是细菌性胃肠道疾病的重要病因。2009 年 5 月，我们调查了一起产志贺毒素大肠杆菌 O157:H7 感染的多州暴发疫情。
通过血清分型和分子亚型分析确定暴发相关病例。开展溯源调查和产品检测。采用年龄、性别和州匹配对照的病例对照研究，确定与发病相关的暴露因素。
2009 年 3 月 16 日至 7 月 8 日期间，从 30 个州共发现 77 例发病病例；35 例住院，10 例发生溶血尿毒综合征，无死亡病例。66%的患者年龄<19 岁；71%为女性。在病例对照研究中，35 例病例患者中有 33 例（94%）食用了现成可烘焙的商业预包装曲奇面团，而 36 例对照者中有 4 例（11%）（匹配比值比=41.3；P<.001）；没有其他报告的暴露因素与发病显著相关。食用曲奇面团的病例患者中，94%报告食用的是品牌 A。从品牌 A 曲奇面团中分离出 3 株非暴发相关的产志贺毒素大肠杆菌。该调查导致 360 万包品牌 A 曲奇面团被召回，并进行了产品配方更改。
这是首例报告的与食用现成可烘焙的商业预包装曲奇面团有关的产志贺毒素大肠杆菌暴发疫情。尽管食用说明要求先烘烤品牌 A 曲奇面团，但病例患者仍食用了生面团。制造商应考虑将现成可烘焙的商业预包装曲奇面团配方设计成与即食产品一样安全。需要对消费者进行更有效的关于食用未烘焙曲奇面团风险的教育。
