A Multistate Outbreak of E Coli O157:H7 Infections Linked to Soy Nut Butter

Abstract

BACKGROUND:In 2017, we conducted a multistate investigation to determine the source of an outbreak of Shiga toxin-producing Escherichia coli (STEC) O157:H7 infections, which occurred primarily in children. METHODS:We defined a case as infection with an outbreak strain of STEC O157:H7 with illness onset between January 1, 2017, and April 30, 2017. Case patients were interviewed to identify common exposures. Traceback and facility investigations were conducted; food samples were tested for STEC. RESULTS:We identified 32 cases from 12 states. Twenty-six (81%) cases occurred in children ,18 years old; 8 children developed hemolytic uremic syndrome. Twenty-five (78%) case patients ate the same brand of soy nut butter or attended facilities that served it. We identified 3 illness subclusters, including a child care center where person-to-person transmission may have occurred. Testing isolated an outbreak strain from 11 soy nut butter samples. Investigations identified violations of good manufacturing practices at the soy nut butter manufacturing facility with opportunities for product contamination, although the specific route of contamination was undetermined.CONCLUSIONS: This investigation identified soy nut butter as the source of a multistate outbreak of STEC infections affecting mainly children. The ensuing recall of all soy nut butter products the facility manufactured, totaling .1.2 million lb, likely prevented additional illnesses. Prompt diagnosis of STEC infections and appropriate specimen collection aids in outbreak detection. Child care providers should follow appropriate hygiene practices to prevent secondary spread of enteric illness in child care settings. Firms should manufacture ready-toeat foods in a manner that minimizes the risk of contamination.WHAT'S KNOWN ON THIS SUBJECT: Shiga toxin-producing Escherichia coli (STEC) O157 causes ∼63 000 illnesses annually in the United States. The highest incidence is among young children, who are at higher risk of severe infection. Foodborne STEC outbreaks are often associated with beef and leafy greens.WHAT THIS STUDY ADDS: We identified soy nut butter as the source of a multistate outbreak of STEC infections affecting mainly children. This outbreak highlights the risk of STEC infection among young children and the critical role health care providers play in outbreak detection.

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