Outbreak of Shiga Toxin–ProducingEscherichia coliO111:H8 Infections among Attendees of a High School Cheerleading Camp

Abstract

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; P < .01), consuming ice provided in barrels on the camp's final day (HR, 3.41; P < .01), eating cob corn (HR, 3.22; P < .01), and eating a dinner roll (HR, 2.82; P < .01). 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.