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Epidemiological analysis of a large enterohaemorrhagic Escherichia coli O111 outbreak in Japan associated with haemolytic uraemic syndrome and acute encephalopathy

  • Y. YAHATA (a1), T. MISAKI (a1), Y. ISHIDA (a2), M. NAGIRA (a1), M. WATAHIKI (a3), J. ISOBE (a3), J. TERAJIMA (a1), S. IYODA (a1), J. MITOBE (a1), M. OHNISHI (a1), T. SATA (a3), K. TANIGUCHI (a1), Y. TADA (a1), N. OKABE (a1) and the E. coli O111 Outbreak Investigation Team...

Summary

A large outbreak of enterohaemorrhagic Escherichia coli (EHEC) O111 and O157 occurred in Japan in April 2011. We conducted an unmatched case-control study and trace-back investigation to determine the source of EHEC O111 infection and risk factors for severe complications. Pulsed-field gel electrophoresis was performed to help define cases. A total of 86 individuals met the case definition. Of these, 40% experienced haemolytic uraemic syndrome (HUS), 24% acute encephalopathy, and 6% died. Illness was significantly associated with eating the raw beef dish yukhoe (odds ratio 19·64, 95% confidence interval 7·03–54·83), the likely food vehicle. EHEC O111 and its closely related stx-negative variants were found in the beef. HUS occurred most frequently in individuals aged 5–9 years, and this age group was significantly associated with acute encephalopathy. The prevalence of HUS and acute encephalopathy was higher than in previous non-O157-related outbreaks, indicating a high risk of severe complications.

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Copyright

Corresponding author

* Author for correspondence: Dr Y. Yahata, Infectious Diseases Surveillance Center, National Institute of Infectious Diseases, 1–23–1 Toyama, Shinjuku-ku, Tokyo 162–8640, Japan. (Email: yahata@nih.go.jp)

Footnotes

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Additional members of the E. coli O111 Outbreak Investigation Team are listed in the Appendix. This paper has been presented previously in abstract form at the International Meeting on Emerging Diseases and Surveillance, February 2013, Vienna, Austria (Abstract No. 22.115).

Footnotes

References

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Epidemiological analysis of a large enterohaemorrhagic Escherichia coli O111 outbreak in Japan associated with haemolytic uraemic syndrome and acute encephalopathy

  • Y. YAHATA (a1), T. MISAKI (a1), Y. ISHIDA (a2), M. NAGIRA (a1), M. WATAHIKI (a3), J. ISOBE (a3), J. TERAJIMA (a1), S. IYODA (a1), J. MITOBE (a1), M. OHNISHI (a1), T. SATA (a3), K. TANIGUCHI (a1), Y. TADA (a1), N. OKABE (a1) and the E. coli O111 Outbreak Investigation Team...

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