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15 January 2004

Volume 38, Number 2
Clinical Infectious Diseases 2004;38:190–198
This article is in the public domain, and no copyright is claimed.
1058-4838/2004/3802-0002
DOI: 10.1086/380634
MAJOR ARTICLE

Outbreak of Shiga Toxin–Producing Escherichia coli O111:H8 Infections among Attendees of a High School Cheerleading Camp

John T. Brooks,1,3

David Bergmire‐Sweat,4

Malinda Kennedy,1

Kate Hendricks,4

Marianne Garcia,5

Lisa Marengo,4

Joy Wells,1

Michelle Ying,1

William Bibb,1

Patricia M. Griffin,1

Robert M. Hoekstra,2 and

Cindy R. Friedman1

1Foodborne and Diarrheal Diseases Branch and 2Biostatistics and Information Management Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, and 3Epidemic Intelligence Service, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia; and 4Infectious Disease Epidemiology and Surveillance Division and 5Bureau of Laboratories, Microbiological Services Division, Texas Department of Health, Austin

Few US clinical laboratories screen stool specimens for Shiga toxin–producing Escherichia coli (STEC) other than E. coli O157. An outbreak of STEC O111:H8 infections indistinguishable from E. coli O157:H7 at a youth camp highlights the need to improve non‐O157 STEC surveillance. Interviews of 521 (80%) of 650 attendees revealed 55 (11%) were ill; 2 developed hemolytic‐uremic syndrome. Illness was associated with consuming salad during the camp’s first lunch meal (hazard ratio [HR], 4.68; ), consuming ice provided in barrels on the camp's final day (HR, 3.41; ), eating cob corn (HR, 3.22; ), and eating a dinner roll (HR, 2.82; ). Cultures of 2 of 11 stools yielded E. coli O111:H8. Results of serologic testing and additional stool cultures demonstrated no evidence of infection with other bacterial pathogens, including E. coli O157, and supported infection with E. coli O111. Clinical laboratories should routinely screen suspect specimens for non‐O157 STEC and should serotype and report Shiga‐positive isolates.

Received 25 April 2003; accepted 26 August 2003; electronically published 22 December 2003.

Reprints or correspondence: Dr. John T. Brooks, Centers for Disease Control and Prevention, National Center for HIV, STD, and TB Prevention, 1600 Clifton Rd. NE, Atlanta, GA 30333 ().

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  • Presented in part: 37th Annual Meeting of the Infectious Disease Society of America, Philadelphia, PA, 18–21 November 1999 (abstract 727); and 49th Annual Epidemic Intelligence Service Conference, Atlanta, GA, 24–28 April 2001.

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