Centers for Disease Control and Prevention, Atlanta, Georgia;
Caitta, Inc, Herndon, Virginia.
Pediatrics. 2019 Oct;144(4). doi: 10.1542/peds.2018-3978. Epub 2019 Sep 13.
In 2017, we conducted a multistate investigation to determine the source of an outbreak of Shiga toxin-producing (STEC) O157:H7 infections, which occurred primarily in children.
We defined a case as infection with an outbreak strain of STEC O157:H7 with illness onset between January 1, 2017, and April 30, 2017. Case patients were interviewed to identify common exposures. Traceback and facility investigations were conducted; food samples were tested for STEC.
We identified 32 cases from 12 states. Twenty-six (81%) cases occurred in children <18 years old; 8 children developed hemolytic uremic syndrome. Twenty-five (78%) case patients ate the same brand of soy nut butter or attended facilities that served it. We identified 3 illness subclusters, including a child care center where person-to-person transmission may have occurred. Testing isolated an outbreak strain from 11 soy nut butter samples. Investigations identified violations of good manufacturing practices at the soy nut butter manufacturing facility with opportunities for product contamination, although the specific route of contamination was undetermined.
This investigation identified soy nut butter as the source of a multistate outbreak of STEC infections affecting mainly children. The ensuing recall of all soy nut butter products the facility manufactured, totaling >1.2 million lb, likely prevented additional illnesses. Prompt diagnosis of STEC infections and appropriate specimen collection aids in outbreak detection. Child care providers should follow appropriate hygiene practices to prevent secondary spread of enteric illness in child care settings. Firms should manufacture ready-to-eat foods in a manner that minimizes the risk of contamination.
2017 年，我们开展了一项多州调查，以确定主要发生在儿童中的产志贺毒素大肠杆菌（STEC）O157：H7 感染暴发的源头。
我们将感染具有暴发株 STEC O157：H7 且发病时间在 2017 年 1 月 1 日至 4 月 30 日之间的病例定义为病例。对病例患者进行访谈以确定共同暴露源。开展溯源和设施调查；检测食品样本是否含有 STEC。
我们从 12 个州确定了 32 例病例。26 例（81%）病例发生在<18 岁的儿童中；8 例儿童发展为溶血尿毒综合征。25 例（78%）病例患者食用了同一品牌的大豆坚果黄油或在供应该食品的设施就餐。我们发现了 3 个疾病亚群，包括一个儿童保健中心，可能在那里发生了人际传播。检测从 11 份大豆坚果黄油样本中分离出了暴发菌株。调查发现，大豆坚果黄油生产厂违反了良好生产规范，存在产品污染的机会，尽管具体的污染途径尚未确定。
这项调查确定了大豆坚果黄油是一起主要影响儿童的产志贺毒素大肠杆菌感染的多州暴发的源头。该设施随后召回了所有生产的大豆坚果黄油产品，总计超过 120 万磅，可能防止了更多的疾病发生。及时诊断 STEC 感染并适当采集标本有助于发现暴发。儿童保健提供者应遵循适当的卫生规范，以防止在儿童保健环境中发生肠道疾病的二次传播。企业应采用将污染风险降至最低的方式生产即食食品。
