E. coli Outbreak Tracked by Billing Data
Cafeteria billing information enabled a rapid investigation of an E. coli outbreak at a large company in Frankfurt, Germany, during last year's broader E. coli O104:H4 outbreak that killed 50 people and infected more than 4,000 others.
The Centers for Disease Control and Prevention (CDC) reported on the so-called "satellite outbreak'' in the January 2012 issue of Emerging Infectious Diseases. The investigation found fenugreek sprouts to be the cause of the illnesses at the company. The origin of the sprouts was traced back to the same supplier of sprout seeds as was common to the rest of the outbreak.
"Using data sources independent of individual memory is quite useful,'' the authors wrote in a synopsis of the investigation..jpg)
The multi-country sprouts E. coli outbreak in Europe last spring was the largest outbreak ever described worldwide in terms of hemolytic uremic syndrome (HUS), a complication of toxic E. coli infection that shuts down a person's kidneys and often leads to other severe illnesses, including stroke, invasion of the central nervous system and heart attack.
The company that was studied in the investigation operated two cafeteria sites that were both served with salad bar items from the same central kitchen. Using the employee billing card system, salad bar purchases were highly associated with illness. The study focused on 60 case patients who were either hospitalized with bloody diarrhea or HUS or who self-reported onset of bloody diarrhea from May 8 through May 23. Only three of the case patients remained unexposed to salad bar items according to the payment system data.
Beginning May 23, the cafeterias were closed for 1 week, and salad sales were suspended for a longer period. There were no additional cases.
The CDC report noted that sprout consumption throughout Frankfurt couldn't be studied effectively without billing data because of the intense media attention on the sprout hypothesis once it had been announced. "Also, it was thought that too much time had passed to successfully recall actually selected salad bar items consumed a few weeks previous,'' the report said.
This wasn't the first time that data sources were used in an investigation of an outbreak of foodborne illness. Credit card information and retail loyalty cards have been used in other investigations in Denmark, Iceland, Canada and the United States.
Participants in the Frankfurt, Germany, investigation included the Robert Koch Institute of Berlin and Wernigerode and Frankfurt's own Health Protection Authority.
