Outbreak of Shiga Toxin-Producing Escherichia coli O104:H4 Associated With Organic Fenugreek Sprouts, France, June 2011

L. A. King (1) , F. Nogareda (1, 2) , F.-X. Weill (3) , P. Mariani-Kurkdjian (4) , Estelle Loukiadis (5) , G. Gault (6) , N. Jourdan-Dasilva (1) , E. Bingen (4) , M. Mace (3) , D. Thevenot (5) , N. Ong (6) , C. Castor (5) , H. Noel (1) , D. van Cauteren (1) , M. Charron (6) , V. Vaillant (1) , B. Aldabe (6) , V. Goulet (1) , G. Delmas (1) , E. Couturier (1) , Y. Le Strat (1) , C. Combe (7) , Y. Delmas (7) , François Terrier (8) , B. Vendrely (7) , P. Rolland (6) , H. de Valk (1)

1 Département des maladies infectieuses
2 EPIET - European Programme for Intervention Epidemiology Training
3 CNR-ESS - Centre National de Référence - National Reference Center Escherichia coli, Shigella et Salmonella
4 AP-HP Hôpital universitaire Robert-Debré [Paris]
5 VAS - VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement
6 INVS - Institut de Veille Sanitaire
7 CHU Bordeaux
8 Hôpital d'Instruction des Armées Robert Picqué

BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

Domaines: Santé publique et épidémiologie; Bactériologie

L. A. King, F. Nogareda, F.-X. Weill, P. Mariani-Kurkdjian, Estelle Loukiadis, et al.. Outbreak of Shiga Toxin-Producing Escherichia coli O104:H4 Associated With Organic Fenugreek Sprouts, France, June 2011. Clinical Infectious Diseases, 2012, 54 (11), pp.1588-94. ⟨10.1093/cid/cis255⟩. ⟨pasteur-01118497⟩