Health

Update

MULTI-STATE OUTBREAK OF E.COLI 0157 INFECTIONS

Delaware Division of Public Health (DPH) epidemiologists identified two confirmed cases and one suspect case associated with the

Taco Bell outbreak.  Pulse field (“fingerprinting”) analysis conducted by the DPH Laboratory matched the

confirmed cases to the Taco Bell outbreak Pulse field pattern.

Taco Bell restaurants are now open after the following actions were taken under the supervision of the DPH Office of Food Protection:

All Taco Bell Restaurants in Delaware (15):

• Restaurants completely cleaned and sanitized;
• Foods in restaurants discarded and resupplied;

Taco Bell Restaurants with an associated case (2), in addition to above:

• All food workers cultured for E. coli O157 prior to returning to work.
• Food workers provided enhanced training in proper food handling and hygiene.

No food workers were culture positive for E. coli 0157.

This is an official

CDC Health Update

Distributed via Health Alert Network

December 14, 2006, 20:10 EST (8:10 PM EST)

CDCHAN-00256-06-12-14-UPD-N

Corrected: Multistate Outbreak of E. coli 0157 Infections, November-December 2006

This message is being sent to correct the information within CDC Health Update (CDCHAN-00255-06-12-14-UPD-N).

As of 12:00 PM (EST) Wednesday, December 13, 2006, 71 persons with illness associated with the Taco Bell restaurant E. coli 0157

outbreak have been reported to CDC from 5 states: New Jersey (33), New York (22), Pennsylvania (13), Delaware (2), and South Carolina

(1). States with Taco Bell restaurants where persons confirmed to have the outbreak strain have eaten are New Jersey, New York,

Pennsylvania, and Delaware. (The patient from South Carolina ate at a Taco Bell restaurant in Pennsylvania). Other cases of illness are

under investigation by state public health officials. Among these 71 ill persons, 53 (75%) were hospitalized and 8 (11%) developed a type

of kidney failure called hemolytic-uremic syndrome (HUS). Illness onset dates have ranged from November 20 to December 6. The number of

cases peaked in the last week of November. No illnesses were reported with onset within the past week, so the outbreak is over.

Cases in 48 of the 71 patients are confirmed, meaning that the patients’ E. coli strains have the outbreak “DNA

fingerprint.” E. coli O157 strains are routinely “DNA fingerprinted” at public health laboratories in all

states as part of PulseNet (the network of public health laboratories that sub-type bacteria). E. coli O157 strains from other

cases are being tested by PulseNet. As a result of testing by PulseNet, cases with the outbreak strain “fingerprint” pattern

are being re-classified as confirmed cases, and cases with an unrelated “fingerprint” pattern are being dropped from the

outbreak case count.

CDC is working with state and local health officials, the Food and Drug Administration (FDA), the Department of Agriculture (USDA), and

the restaurant chain to determine what food caused the outbreak. Public health investigators have identified a few ingredients that were

consumed more often by ill persons than well persons and were statistically linked with illness: lettuce, cheddar cheese, and ground

beef. This analysis also indicates that onions of any type are not linked to this outbreak. Evaluation of additional information about

the locations of involved restaurants, the patterns of distribution of food ingredients, and the characteristics and preparation of food

ingredients indicates that shredded lettuce consumed at Taco Bell restaurants in the northeastern United States was the most likely

source of the outbreak. Because multiple Taco Bell restaurants were involved during the same time period, contamination of lettuce likely

occurred before reaching the restaurants. Health officials and the restaurant chain are working collaboratively to learn more about the

shredded lettuce to determine how it may have become contaminated.

Health officials in Minnesota and Iowa are investigating a separate outbreak of E. coli O157 infections associated with another

fast food restaurant chain. They are reporting 27 and 50 associated illnesses, respectively. E. coli O157 strains isolated from

patients in both states have indistinguishable “DNA fingerprint” patterns, confirming that the Iowa and Minnesota clusters

are linked. This pattern is distinct from the Taco Bell restaurant outbreak pattern. A strain that matches that of patients in this new

outbreak has also been isolated from an ill person in Wisconsin. Investigators in Minnesota and Iowa have independently identified

lettuce as the contaminated food vehicle. Traceback efforts are underway. The most recent onset of illness from a confirmed case in this

outbreak is December 8, and this outbreak is not considered over.

E. coli O157 causes diarrhea that is often bloody and accompanied by severe abdominal cramps, but fever is typically absent or

mild. Persons who have developed such symptoms are advised to consult a physician to request that a stool sample be tested for E.

coli, and to inform their local health department.

For more information on E. coli infection and this outbreak, please refer to the following website: http://www.cdc.gov/ecoli/

NOTE:  The CDC HAN web site has been relocated. The link to the new site location is: http://www2a.cdc.gov/HAN/. If you maintain or contribute to a web site that links to the CDC HAN web site

you should update the link. Also, to ensure the widest dissemination of this change, it would be appreciated if you would distribute this

notification as appropriate. Thank you!