CDC, several states, and the U.S. Food and Drug Administration are investigating a multistate outbreak of Shiga toxin-producing E. coli O157:H7
infections (STEC O157:H7) in 13 states. The CDC’s Laboratory Outreach Communication System (LOCS) has provided information regarding the outbreak specifically for clinical laboratories. Review the information below to learn more about the outbreak and implications for laboratory professionals.
Audience: Clinical and public health laboratories
Subject: CDC Investigating Multistate Outbreak of E. coli O157:H7 Infections
Region: CDC, several states, and the U.S. Food and Drug Administration are investigating a multistate outbreak of Shiga toxin-producing E. coli O157:H7 infections (STEC O157:H7) in 13 states. Seventeen illnesses have been reported from California (3), Connecticut (2), Illinois (1), Indiana (1), Michigan (1), Nebraska (1), New Hampshire (2), New York (1), Ohio (1), Pennsylvania (1), Virginia (1), Vermont (1) and Washington (1). Illnesses started on dates from November 15 through December 8, 2017. The Public Health Agency of Canada also is investigating an outbreak of STEC O157:H7 infections in several provinces.
Level: Laboratory Advisory - provides important information for a specific incident or situation; contains recommendations or actionable items to be performed by public health officials, laboratorians, and/or clinicians; may not require immediate action.
Highlights for Laboratory Professionals
Action for laboratorians if they suspect food borne illness diagnosis
Diagnostic laboratorians and clinical microbiologists are typically asked to report all cases of certain infections to their local health department and to submit at least the first strain isolated from each patient to the local or state public health laboratory. This process is routine in almost all states for infections with Salmonella, Shigella, Listeria, and E. coli O157:H7, all of which are transmitted commonly by food.
When Shiga toxin is detected by use of an enzyme immunoassay (EIA), but a Shiga toxin-producing E. coli has not been isolated, the diagnostic laboratory should submit the EIA-positive broth to the public health laboratory for isolation and identification. Isolates submitted to the public health laboratory are essential for surveillance of foodborne infections in the United States. Public health laboratories routinely serotype Salmonella and Shigella isolates, and routinely subtype all isolates of Listeria and Shiga toxin-producing E. coli (STEC) by pulsed-field gel electrophoresis (PFGE). Many also subtype representative samples of Salmonella and Shigella isolates with PFGE, among other foodborne pathogens. For more information on the national network of public health and food regulatory agency laboratories conducting molecular surveillance, visit the PulseNet website.
Guidance on E.coli to Healthcare Providers and Clinical Laboratories
Guidelines to ensure as complete as possible detection and characterization of STEC infections include the following: