Parry S M, Salmon R L, Willshaw G A, Cheasty T
Welsh Combined Centres for Public Health, Cardiff, UK.
Lancet. 1998 Apr 4;351(9108):1019-22. doi: 10.1016/s0140-6736(97)08376-1.
Recent outbreaks of vero cytotoxin (shiga toxin) producing Escherichia coli O157 (VTEC O157) infection have stimulated debate on food safety. However, 90% of cases in England and Wales are sporadic. We report a case-control study of sporadic VTEC O157 infection.
We compared 85 sporadic cases of VTEC O157 infection, identified through population surveillance, with 142 controls, randomly selected from general practitioners' lists. We matched cases and controls for age, sex, and family doctor's practice. Exposures to foods, water, animals, farms, and environmental factors were recorded. We visited the premises concerned when cases had eaten beefburgers or cooked sliced meats from caterers or had had contact with a farm.
Consumption of a beefburger from a catering premises other than from a fast-food chain A (a national chain) and consumption of cold cooked sliced meat (eg, in a salad or sandwich) from caterers, but not butchers, was associated with VTEC O157 infection (odds ratios 4.63 [95% CI 1.33-30.14] and 3.36 [1.04-12.74], respectively). Policies for ensuring thorough cooking of burgers by one national fast-food chain differed from the other catering premises we visited. There was evidence of person-to-person spread and transmission of VTEC O157 infection from animals.
Local inspection of catering establishments that serve cooked meats together with public education to prevent spread on farms and in houses would reduce the burden of VTEC O157 infection by about 10% for each risk factor.
近期产志贺毒素大肠杆菌O157（VTEC O157）感染的暴发引发了关于食品安全的讨论。然而，在英格兰和威尔士，90%的病例为散发病例。我们报告了一项关于散发性VTEC O157感染的病例对照研究。
我们将通过人群监测确定的85例散发性VTEC O157感染病例与从全科医生名单中随机选取的142名对照进行了比较。我们按照年龄、性别和家庭医生诊所对病例和对照进行了匹配。记录了对食物、水、动物、农场和环境因素的接触情况。当病例食用了来自餐饮场所（而非快餐连锁店A，一家全国性连锁店）的牛肉汉堡或熟食切片肉，或与农场有接触时，我们走访了相关场所。
食用来自非快餐连锁店A的餐饮场所的牛肉汉堡以及食用来自餐饮服务商（而非肉店）的冷熟食切片肉（如在沙拉或三明治中）与VTEC O157感染有关（比值比分别为4.63 [95%可信区间1.33 - 30.14]和3.36 [1.04 - 12.74]）。一家全国性快餐连锁店确保汉堡彻底烹饪的政策与我们走访的其他餐饮场所不同。有证据表明存在人传人传播以及VTEC O157从动物传播。
对提供熟肉的餐饮场所进行本地检查，同时开展公众教育以防止在农场和家庭中传播，对于每个风险因素，可将VTEC O157感染负担降低约10%。
