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Abstract

We investigated a large outbreak of O157 in the United Kingdom (UK) with 165 cases between 31 May and 29 July 2016. No linked cases were reported in other countries. Cases were predominately female (n = 128) and adult (n = 150), 66 attended hospital and nine had features of haemorrhagic uraemic syndrome. A series of epidemiological studies (case–control, case–case, ingredients-based and venue-based studies) and supply chain investigations implicated mixed salad leaves from Supplier A as the likely outbreak vehicle. Whole genome sequencing (WGS) indicated a link with strains from the Mediterranean and informed the outbreak control team to request that Supplier A cease distributing salad leaves imported from Italy. Microbiological tests of samples of salad leaves from Supplier A were negative. We were unable to confirm the source of contamination or the contaminated constituent leaf although our evidence pointed to red batavia received from Italy as the most likely vehicle. Variations in Shiga toxin-producing surveillance and diagnosis may have prevented detection of cases outside the UK and highlights a need for greater standardisation. WGS was useful in targeting investigations, but greater coverage across Europe is needed to maximise its potential.

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/content/10.2807/1560-7917.ES.2018.23.18.17-00197
2018-05-03
2024-11-21
http://instance.metastore.ingenta.com/content/10.2807/1560-7917.ES.2018.23.18.17-00197
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National outbreak of Shiga toxin-producing Escherichia coli O157:H7 linked to mixed salad leaves, United Kingdom, 2016
<p class="citation"> <span>Citation style for this article:</span> <span class="meta-value authors"> <a href="/search?value1=Maya+Gobin&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Gobin Maya</a>, <a href="/search?value1=Jeremy+Hawker&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Hawker Jeremy</a>, <a href="/search?value1=Paul+Cleary&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Cleary Paul</a>, <a href="/search?value1=Thomas+Inns&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Inns Thomas</a>, <a href="/search?value1=Daniel+Gardiner&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Gardiner Daniel</a>, <a href="/search?value1=Amy+Mikhail&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Mikhail Amy</a>, <a href="/search?value1=Jacquelyn+McCormick&option1=author&noRedirect=true" class="nonDisambigAuthorLink">McCormick Jacquelyn</a>, <a href="/search?value1=Richard+Elson&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Elson Richard</a>, <a href="/search?value1=Derren+Ready&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Ready Derren</a>, <a href="/search?value1=Tim+Dallman&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Dallman Tim</a>, <a href="/search?value1=Iain+Roddick&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Roddick Iain</a>, <a href="/search?value1=Ian+Hall&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Hall Ian</a>, <a href="/search?value1=Caroline+Willis&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Willis Caroline</a>, <a href="/search?value1=Paul+Crook&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Crook Paul</a>, <a href="/search?value1=Gauri+Godbole&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Godbole Gauri</a>, <a href="/search?value1=Drazenka+Tubin-Delic&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Tubin-Delic Drazenka</a>, <a href="/search?value1=Isabel+Oliver&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Oliver Isabel</a></span>. National outbreak of Shiga toxin-producing Escherichia coli O157:H7 linked to mixed salad leaves, United Kingdom, 2016. <a href="/content/ecdc">Euro Surveill.</a> 2018;23(18):pii=17-00197. <a href="https://doi.org/10.2807/1560-7917.ES.2018.23.18.17-00197" title="doi link" target="_blank">https://doi.org/10.2807/1560-7917.ES.2018.23.18.17-00197</a> <span class="ES_Article_citation"> <span class="generated">Received</span>: 13 Mar 2017;&nbsp;&nbsp; <span class="generated">Accepted</span>: 21 Sept 2017 </span> </p>
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