Department of Infectious Disease, Institut de Veille Sanitaire, Saint Maurice, France.
Clin Infect Dis. 2012 Jun;54(11):1588-94. doi: 10.1093/cid/cis255. Epub 2012 Mar 28.
On 22 June 2011, 8 patients with hemolytic uremic syndrome (HUS) or bloody diarrhea were reported in France. All 8 were attendees of a community center event on 8 June near Bordeaux. Three Escherichia coli cases were confirmed by isolation of Shiga toxin-producing E. coli O104:H4 stx2 aggR producing a cefotaximase (CTX-M) β-lactamase (STEC O104:H4); the same rare serotype caused the outbreak in Germany in May-July 2011. An investigation was initiated to describe the outbreak, identify the vehicle for infection, and guide control measures.
We conducted a retrospective cohort study among all adults attending the event, including food handlers. A standardized questionnaire was administered to participants. A case was an attendee who developed HUS or diarrhea between 8 and 24 June. Cases were confirmed by isolation of STEC O104:H4 or O104 serology. Relative risks (RRs) and 95% confidence intervals (CIs) by exposure were calculated using a Poisson regression model.
Twenty-four cases were identified (14% attack rate). Of these, 18 (75%) were women, 22 (92%) were adults, 7 (29%) developed HUS, 5 (21%) developed bloody diarrhea, and 12 (50%) developed diarrhea. Ten (42%) cases were confirmed. Fenugreek was the only sprout type with an independent association to illness (RR, 5.1; 95% CI, 2.3-11.1) in multivariable analysis.
This investigation identified a point-source STEC O104:H4 outbreak associated with consumption of fenugreek sprouts. Comparison of results from French and German STEC O104:H4 outbreak investigations enabled identification of a common food vehicle, fenugreek sprouts, and resulted in implementation of Europe-wide control measures in July 2011.
2011 年 6 月 22 日，法国报告了 8 例溶血性尿毒症综合征（HUS）或血性腹泻病例。这 8 例均为 6 月 8 日在波尔多附近一个社区中心活动的参与者。通过分离产志贺毒素的大肠杆菌 O104：H4stx2aggR 株并产生头孢噻肟酶（CTX-M）β-内酰胺酶（STEC O104：H4），证实了 3 例大肠杆菌病例；2011 年 5 月至 7 月，德国爆发的疫情也是由同一罕见血清型引起的。开展了一项调查，以描述疫情，确定感染媒介，并指导控制措施。
我们对所有参加活动的成年人（包括食品处理人员）进行了回顾性队列研究。向参与者发放了一份标准化问卷。病例为 6 月 8 日至 24 日期间发生 HUS 或腹泻的参与者。通过分离 STEC O104：H4 或 O104 血清学确证病例。使用泊松回归模型计算按暴露因素计算的相对风险（RR）和 95%置信区间（CI）。
确定了 24 例病例（14%的发病率）。其中，18 例（75%）为女性，22 例（92%）为成年人，7 例（29%）发生 HUS，5 例（21%）发生血性腹泻，12 例（50%）发生腹泻。10 例（42%）病例得到了确认。在多变量分析中，胡芦巴芽是唯一与发病相关的芽菜类型（RR，5.1；95%CI，2.3-11.1）。
这项调查确定了一起与食用胡芦巴芽有关的产志贺毒素大肠杆菌 O104：H4 暴发事件。比较法国和德国产志贺毒素大肠杆菌 O104：H4 暴发调查的结果，确定了共同的食物媒介胡芦巴芽，并于 2011 年 7 月在欧洲实施了控制措施。
