{"id":212,"date":"2014-07-29T11:29:36","date_gmt":"2014-07-29T11:29:36","guid":{"rendered":"http:\/\/209.151.87.121\/~fomes\/iom\/?p=212"},"modified":"2016-03-16T20:06:13","modified_gmt":"2016-03-16T20:06:13","slug":"berry-stand-strawberries","status":"publish","type":"post","link":"https:\/\/www.outbreakmuseum.com\/mobile\/e-coli-o157h7\/berry-stand-strawberries\/","title":{"rendered":"Berry Stand Strawberries"},"content":{"rendered":"\n<table id=\"tablepress-11\" class=\"tablepress tablepress-id-11\">\n<thead>\n<tr class=\"row-1\">\n\t<th class=\"column-1\"><b>Outbreak:<\/b> Berry Stand Strawberries<\/th>\n<\/tr>\n<\/thead>\n<tbody class=\"row-striping\">\n<tr class=\"row-2\">\n\t<td class=\"column-1\"><b>Product:<\/b> Strawberries<\/td>\n<\/tr>\n<tr class=\"row-3\">\n\t<td class=\"column-1\"><b>Investigation Start Date:<\/b> 08\/03\/2011<\/td>\n<\/tr>\n<tr class=\"row-4\">\n\t<td class=\"column-1\"><b>Location:<\/b> Clackamas, Multnomah, Washington, Clatsop &amp; Yamhill Counties, Oregon<\/td>\n<\/tr>\n<tr class=\"row-5\">\n\t<td class=\"column-1\"><b>Etiology:<\/b> <i>E. coli<\/i> (STEC) O157:H7<\/td>\n<\/tr>\n<tr class=\"row-6\">\n\t<td class=\"column-1\"><b>Earliest known case onset date:<\/b> 07\/01\/2011<\/td>\n<\/tr>\n<tr class=\"row-7\">\n\t<td class=\"column-1\"><b>Latest case onset date:<\/b> 07\/29\/2011<\/td>\n<\/tr>\n<tr class=\"row-8\">\n\t<td class=\"column-1\"><b>Confirmed \/ Presumptive Case Counts:<\/b> 14 \/ 11<\/td>\n<\/tr>\n<tr class=\"row-9\">\n\t<td class=\"column-1\"><b>Positive Samples (Food \/ Environmental):<\/b> 4 \/ 100<\/td>\n<\/tr>\n<tr class=\"row-10\">\n\t<td class=\"column-1\"><b>Hospitalizations:<\/b> 6<\/td>\n<\/tr>\n<tr class=\"row-11\">\n\t<td class=\"column-1\"><b>Deaths:<\/b> 2<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<!-- #tablepress-11 from cache -->\n<div id=\"metaslider-id-240\" style=\"width: 100%;\" class=\"ml-slider-3-99-0 metaslider metaslider-flex metaslider-240 ml-slider ms-theme-default\" role=\"region\" aria-label=\"Berry 2011-2163\" data-width=\"400\">\n    <div id=\"metaslider_container_240\">\n        <div id=\"metaslider_240\">\n            <ul class='slides'>\n                <li style=\"display: none; width: 100%;\" class=\"slide-623 ms-image \" aria-roledescription=\"slide\" data-date=\"2014-08-25 10:18:42\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.outbreakmuseum.com\/mobile\/wp-content\/uploads\/2014\/08\/1-e1425546598245-400x200.jpg\" height=\"200\" width=\"400\" alt=\"The team visits a local berry stand.\" class=\"slider-240 slide-623 msDefaultImage\" \/><div class=\"caption-wrap\"><div class=\"caption\">The team visits a local berry stand.<\/div><\/div><\/li>\n                <li style=\"display: none; width: 100%;\" class=\"slide-624 ms-image \" aria-roledescription=\"slide\" data-date=\"2014-08-25 10:19:00\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.outbreakmuseum.com\/mobile\/wp-content\/uploads\/2014\/08\/2-e1425548076111-400x200.jpg\" height=\"200\" width=\"400\" alt=\"&quot;Farm A&quot;\" class=\"slider-240 slide-624 msDefaultImage\" \/><div class=\"caption-wrap\"><div class=\"caption\">\"Farm A\"<\/div><\/div><\/li>\n                <li style=\"display: none; width: 100%;\" class=\"slide-625 ms-image \" aria-roledescription=\"slide\" data-date=\"2014-08-25 10:19:06\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.outbreakmuseum.com\/mobile\/wp-content\/uploads\/2014\/08\/3-e1425546584154-400x200.jpg\" height=\"200\" width=\"400\" alt=\"Specimen collection\" class=\"slider-240 slide-625 msDefaultImage\" \/><div class=\"caption-wrap\"><div class=\"caption\">Specimen collection<\/div><\/div><\/li>\n                <li style=\"display: none; width: 100%;\" class=\"slide-626 ms-image \" aria-roledescription=\"slide\" data-date=\"2014-08-25 10:19:12\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.outbreakmuseum.com\/mobile\/wp-content\/uploads\/2014\/08\/4-e1425546577561-400x200.jpg\" height=\"200\" width=\"400\" alt=\"Deer feces among strawberry plants.\" class=\"slider-240 slide-626 msDefaultImage\" \/><div class=\"caption-wrap\"><div class=\"caption\">Deer feces among strawberry plants.<\/div><\/div><\/li>\n                <li style=\"display: none; width: 100%;\" class=\"slide-639 ms-image \" aria-roledescription=\"slide\" data-date=\"2014-09-03 14:12:21\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.outbreakmuseum.com\/mobile\/wp-content\/uploads\/2014\/09\/5-e1425546433652-400x200.jpg\" height=\"200\" width=\"400\" alt=\"Deer are observed grazing the fields.\" class=\"slider-240 slide-639 msDefaultImage\" \/><div class=\"caption-wrap\"><div class=\"caption\">Deer are observed grazing the fields.<\/div><\/div><\/li>\n                <li style=\"display: none; width: 100%;\" class=\"slide-628 ms-image \" aria-roledescription=\"slide\" data-date=\"2014-08-25 10:19:19\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.outbreakmuseum.com\/mobile\/wp-content\/uploads\/2014\/08\/6-e1425546556392-400x200.jpg\" height=\"200\" width=\"400\" alt=\"Deer feces\" class=\"slider-240 slide-628 msDefaultImage\" \/><div class=\"caption-wrap\"><div class=\"caption\">Deer feces<\/div><\/div><\/li>\n                <li style=\"display: none; width: 100%;\" class=\"slide-629 ms-image \" aria-roledescription=\"slide\" data-date=\"2014-08-25 10:19:29\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.outbreakmuseum.com\/mobile\/wp-content\/uploads\/2014\/08\/7-e1425546502395-400x200.jpg\" height=\"200\" width=\"400\" alt=\"Dr. Keene gets into the weeds.\" class=\"slider-240 slide-629 msDefaultImage\" \/><div class=\"caption-wrap\"><div class=\"caption\">Dr. Keene gets into the weeds.<\/div><\/div><\/li>\n                <li style=\"display: none; width: 100%;\" class=\"slide-630 ms-image \" aria-roledescription=\"slide\" data-date=\"2014-08-25 10:19:35\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.outbreakmuseum.com\/mobile\/wp-content\/uploads\/2014\/08\/8-e1425546484379-400x200.jpg\" height=\"200\" width=\"400\" alt=\"Some of the crew.\" class=\"slider-240 slide-630 msDefaultImage\" \/><div class=\"caption-wrap\"><div class=\"caption\">Some of the crew.<\/div><\/div><\/li>\n                <li style=\"display: none; width: 100%;\" class=\"slide-631 ms-image \" aria-roledescription=\"slide\" data-date=\"2014-08-25 10:19:41\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.outbreakmuseum.com\/mobile\/wp-content\/uploads\/2014\/08\/9-e1425546471222-400x200.jpg\" height=\"200\" width=\"400\" alt=\"Samples seized from cases.\" class=\"slider-240 slide-631 msDefaultImage\" \/><div class=\"caption-wrap\"><div class=\"caption\">Samples seized from cases.<\/div><\/div><\/li>\n                <li style=\"display: none; width: 100%;\" class=\"slide-632 ms-image \" aria-roledescription=\"slide\" data-date=\"2014-08-25 10:19:49\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.outbreakmuseum.com\/mobile\/wp-content\/uploads\/2014\/08\/10-e1425546463491-400x200.jpg\" height=\"200\" width=\"400\" alt=\"Preparing specimens to send to the lab.\" class=\"slider-240 slide-632 msDefaultImage\" \/><div class=\"caption-wrap\"><div class=\"caption\">Preparing specimens to send to the lab.<\/div><\/div><\/li>\n                <li style=\"display: none; width: 100%;\" class=\"slide-633 ms-image \" aria-roledescription=\"slide\" data-date=\"2014-08-25 10:19:55\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.outbreakmuseum.com\/mobile\/wp-content\/uploads\/2014\/08\/11-e1425546454814-400x200.jpg\" height=\"200\" width=\"400\" alt=\"Vacuum bag containing O157\" class=\"slider-240 slide-633 msDefaultImage\" \/><div class=\"caption-wrap\"><div class=\"caption\">Vacuum bag containing O157<\/div><\/div><\/li>\n                <li style=\"display: none; width: 100%;\" class=\"slide-640 ms-image \" aria-roledescription=\"slide\" data-date=\"2014-09-03 14:49:39\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.outbreakmuseum.com\/mobile\/wp-content\/uploads\/2014\/09\/2011-2163C-e1425546424497-400x200.jpg\" height=\"200\" width=\"400\" alt=\"The deer head came from a resale shop.\" class=\"slider-240 slide-640 msDefaultImage\" \/><div class=\"caption-wrap\"><div class=\"caption\">The deer head came from a resale shop.<\/div><\/div><\/li>\n                <li style=\"display: none; width: 100%;\" class=\"slide-641 ms-image \" aria-roledescription=\"slide\" data-date=\"2014-09-03 14:49:51\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.outbreakmuseum.com\/mobile\/wp-content\/uploads\/2014\/09\/2011-2163B-e1425546413107-400x200.jpg\" height=\"200\" width=\"400\" alt=\"A box of berry-stand strawberries.\" class=\"slider-240 slide-641 msDefaultImage\" \/><div class=\"caption-wrap\"><div class=\"caption\">A box of berry-stand strawberries.<\/div><\/div><\/li>\n                <li style=\"display: none; width: 100%;\" class=\"slide-2095 ms-image \" aria-roledescription=\"slide\" data-date=\"2015-04-01 18:26:24\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.outbreakmuseum.com\/mobile\/wp-content\/uploads\/2015\/04\/strawberry-epi-curve-400x200.jpg\" height=\"200\" width=\"400\" alt=\"\" class=\"slider-240 slide-2095 msDefaultImage\" \/><div class=\"caption-wrap\"><div class=\"caption\">Epi curve.<\/div><\/div><\/li>\n            <\/ul>\n        <\/div>\n        \n    <\/div>\n<\/div>\n\n<table id=\"tablepress-56\" class=\"tablepress tablepress-id-56\">\n<thead>\n<tr class=\"row-1\">\n\t<th class=\"column-1\">Outbreak Summary:<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr class=\"row-2\">\n\t<td class=\"column-1\">This investigation implicated a novel vehicle\u2014strawberries\u2014as the cause of an outbreak of <i>E. coli<\/i> O157 infections. An association with locally produced strawberries quickly became apparent as cases were interviewed; but the fact that almost all had purchased them at roadside stands and farmer\u2019s markets led to concern about potential confounding of some overlooked item sold at similar venues. The concern was laid to rest by visits to the stands, a case-control study, and traceback of the strawberries to a single Oregon farmer. Learning how the strawberries became contaminated was the fruit of field work: epidemiologists investigated the strawberry fields and found them heavily contaminated with deer feces, with a herd of deer seen grazing in the area. Culture of 50 environmental samples that contained visible deer pellets yielded <i>E. coli<\/i>  O157 in 10 (20%), with PFGE patterns matching those of the cases.<br \/>\n<br \/>\nThis outbreak once again confirmed deer as key reservoirs for the pathogen. Interestingly, an additional PFGE-matched case was identified months later; the case hadn\u2019t eaten the commercial strawberries but lived in the area where they were grown. Culture of a sample from this case household\u2019s vacuum cleaning bag yielded a PFGE-matching strain of <i>E. coli<\/i>  O157:H7, a testimony to the pathogen\u2019s ability to survive for prolonged periods when dried.<br \/>\n<br \/>\n<ul><li>\u2022 <a href=\"http:\/\/www.outbreakmuseum.com\/mobile\/wp-content\/uploads\/2015\/03\/Strawberry-Questionnaire.pdf\" target=\"_blank\">Outbreak questionnaire (PDF)<\/a><\/li><li>\u2022 <a href=\"http:\/\/www.outbreakmuseum.com\/mobile\/wp-content\/uploads\/2015\/04\/CD-Summary-v61-no13.pdf\" target=\"_blank\">CD summary article (PDF)<\/a><\/li><\/ul><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<!-- #tablepress-56 from cache -->\n<p style=\"text-align: justify;\">\n<table id=\"tablepress-78\" class=\"tablepress tablepress-id-78\">\n<thead>\n<tr class=\"row-1\">\n\t<th class=\"column-1\">Details:<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr class=\"row-2\">\n\t<td class=\"column-1\">The following is the abstract from the published article <a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/23876397\" target=\"_blank\">found here.<\/a><br \/>\n<br \/>\nEditorial commentary can be <a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/23876394\" target=\"_blank\">found here.<\/a><br \/>\n<br \/>\n<strong>BACKGROUND:<\/strong><br \/>\nAn outbreak of <i>Escherichia <i>coli<\/i> O157:H7 was identified in Oregon through an increase in Shiga toxin-producing <i>E. coli<\/i> cases with an indistinguishable, novel pulsed-field gel electrophoresis (PFGE) subtyping pattern.<br \/>\n<br \/>\n<strong>METHODS:<\/strong><br \/>\nWe defined confirmed cases as persons from whom <i>E. coli<\/i> O157:H7 with the outbreak PFGE pattern was cultured during July\u2013August 2011, and presumptive cases as persons having a household relationship with a case testing positive for <i>E. coli<\/i> O157:H7 and coincident diarrheal illness. We conducted an investigation that included structured hypothesis-generating interviews, a matched case-control study, and environmental and traceback investigations.<br \/>\n<br \/>\n<strong>RESULTS:<\/strong><br \/>\nWe identified 15 cases. Six cases were hospitalized, including 4 with hemolytic uremic syndrome (HUS). Two cases with HUS died. Illness was significantly associated with strawberry consumption from roadside stands or farmers\u2019 markets (matched odds ratio, 19.6; 95% confidence interval, 2.9\u2013\u221e). A single farm was identified as the source of contaminated strawberries. Ten of 111 (9%) initial environmental samples from farm A were positive for <i>E. coli<\/i> O157:H7. All samples testing<br \/>\npositive for <i>E. coli<\/i> O157:H7 contained deer feces, and 5 tested farm fields had \u2265 1 sample positive with the outbreak PFGE pattern.<br \/>\n<br \/>\n<strong>CONCLUSIONS:<\/strong><br \/>\nThe investigation identified fresh strawberries as a novel vehicle for <i>E. coli<\/i> O157:H7 infection, implicated deer feces as the source of contamination, and highlights problems concerning produce contamination by wildlife and regulatory exemptions for locally grown produce. A comprehensive hypothesis-generating questionnaire enabled rapid identification of the implicated product. Good agricultural practices are key barriers to wildlife fecal contamination of produce.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<!-- #tablepress-78 from cache --><\/p>\n<p style=\"text-align: justify;\"><a href=\"https:\/\/www.outbreakmuseum.com\/mobile\/exhibits\/\"><strong>Back to Outbreak Exhibits<\/strong><\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Back to Outbreak Exhibits<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":true,"template":"","format":"standard","meta":{"footnotes":""},"categories":[9],"tags":[81,99,77,117,82,80,87,88,79,78],"class_list":["post-212","post","type-post","status-publish","format-standard","hentry","category-e-coli-o157h7","tag-acute-and-communicable-disease-prevention","tag-berry-stand-strawberries","tag-dr-bill-keene","tag-e-coli-o157h7","tag-fomes","tag-integrated-food-safety-center-of-excellence","tag-international-outbreak-museum","tag-iom","tag-oregon-health-authority","tag-tribute"],"_links":{"self":[{"href":"https:\/\/www.outbreakmuseum.com\/mobile\/wp-json\/wp\/v2\/posts\/212","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.outbreakmuseum.com\/mobile\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.outbreakmuseum.com\/mobile\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.outbreakmuseum.com\/mobile\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.outbreakmuseum.com\/mobile\/wp-json\/wp\/v2\/comments?post=212"}],"version-history":[{"count":6,"href":"https:\/\/www.outbreakmuseum.com\/mobile\/wp-json\/wp\/v2\/posts\/212\/revisions"}],"predecessor-version":[{"id":1776,"href":"https:\/\/www.outbreakmuseum.com\/mobile\/wp-json\/wp\/v2\/posts\/212\/revisions\/1776"}],"wp:attachment":[{"href":"https:\/\/www.outbreakmuseum.com\/mobile\/wp-json\/wp\/v2\/media?parent=212"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.outbreakmuseum.com\/mobile\/wp-json\/wp\/v2\/categories?post=212"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.outbreakmuseum.com\/mobile\/wp-json\/wp\/v2\/tags?post=212"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}