The Emergence of Escherichia coli O157:H7 Infection in the United States

In this issue ofThe Journal, Besser et al present findings from an outbreak ofEscherichia coliO157:H7 that occurred in southeastern Massachusetts in the fall of 1991.1Twenty-three cases ofE coliO157:H7 infection were identified; four had a diagnosis of hemolytic uremic syndrome (HUS), which is a well-recognized complication ofE coliO157:H7 infection. The outbreak was identified because the cases of HUS clustered in time at one hospital. A well-conducted case-control study implicated apple cider as the vehicle of transmission. While this is an unusual vehicle for a foodborne pathogen, the authors offer data from inoculation studies showing thatE coliO157:H7 organisms can survive for many days in refrigerated cider. In addition, the authors cite two previously reported outbreaks of illness associated with drinking apple cider. Interestingly enough, one was an outbreak of HUS and was probably caused byE coliO157:H7 organisms. See also