Crowe Samuel J, Bottichio Lyndsay, Shade Lauren N, Whitney Brooke M, Corral Nereida, Melius Beth, Arends Katherine D, Donovan Danielle, Stone Jolianne, Allen Krisandra, Rosner Jessica, Beal Jennifer, Whitlock Laura, Blackstock Anna, Wetherington June, Newberry Lisa A, Schroeder Morgan N, Wagner Darlene, Trees Eija, Viazis Stelios, Wise Matthew E, Neil Karen P
From the Centers for Disease Control and Prevention (S.J.C., L.B., L.W., A.B., M.N.S., D.W., E.T., M.E.W., K.P.N.), and IHRC (L.B., D.W.), Atlanta; Food and Drug Administration, College Park, MD (L.N.S., B.M.W., J.B., S.V.); Colorado Department of Public Health and Environment, Denver (N.C.); Washington State Department of Health, Shoreline (B.M.), and Food and Drug Administration, Bothell (J.W., L.A.N.) - both in Washington; Michigan Department of Health and Human Services, Lansing (K.D.A., D.D.); Oklahoma State Department of Health, Oklahoma City (J.S.); and Virginia Department of Health, Richmond (K.A., J.R.).
N Engl J Med. 2017 Nov 23;377(21):2036-2043. doi: 10.1056/NEJMoa1615910.
In 2016, a multijurisdictional team investigated an outbreak of Shiga toxin-producing Escherichia coli (STEC) serogroup O121 and O26 infections linked to contaminated flour from a large domestic producer.
A case was defined as infection with an outbreak strain in which illness onset was between December 21, 2015, and September 5, 2016. To identify exposures associated with the outbreak, outbreak cases were compared with non-STEC enteric illness cases, matched according to age group, sex, and state of residence. Products suspected to be related to the outbreak were collected for STEC testing, and a common point of contamination was sought. Whole-genome sequencing was performed on isolates from clinical and food samples.
A total of 56 cases were identified in 24 states. Univariable exact conditional logistic-regression models of 22 matched sets showed that infection was significantly associated with the use of one brand of flour (odds ratio, 21.04; 95% confidence interval [CI], 4.69 to 94.37) and with tasting unbaked homemade dough or batter (odds ratio, 36.02; 95% CI, 4.63 to 280.17). Laboratory testing isolated the outbreak strains from flour samples, and whole-genome sequencing revealed that the isolates from clinical and food samples were closely related to one another genetically. Trace-back investigation identified a common flour-production facility.
This investigation implicated raw flour as the source of an outbreak of STEC infections. Although it is a low-moisture food, raw flour can be a vehicle for foodborne pathogens.
2016年，一个多辖区团队调查了一起与一家大型国内生产商受污染面粉相关的产志贺毒素大肠杆菌（STEC）血清型O121和O26感染暴发事件。
病例定义为感染暴发菌株，发病时间在2015年12月21日至2016年9月5日之间。为确定与此次暴发相关的暴露因素，将暴发病例与非STEC肠道疾病病例进行比较，并根据年龄组、性别和居住州进行匹配。收集疑似与暴发相关的产品进行STEC检测，并寻找共同污染点。对临床和食品样本中的分离株进行全基因组测序。
在24个州共确定了56例病例。对22组匹配病例进行的单变量精确条件逻辑回归模型显示，感染与使用某一品牌面粉（比值比，21.04；95%置信区间[CI]，4.69至94.37）以及品尝未烘焙的自制面团或面糊（比值比，36.02；95%CI，4.63至280.17）显著相关。实验室检测从面粉样本中分离出暴发菌株，全基因组测序显示临床和食品样本中的分离株在基因上彼此密切相关。追溯调查确定了一个共同的面粉生产设施。
本次调查表明生面粉是STEC感染暴发的源头。尽管生面粉是低水分食品，但它可能是食源性病原体的传播媒介。
