

@article {14001,
	title = {Factors contributing to the emergence of {Escherichia} coli {O}157 in {Africa}},
	journal = {Emerg Infect Dis},
	volume = {7},
	number = {5},
	year = {2001},
	pages = {812{\textendash}819},
	abstract = {In 1992, a large outbreak of bloody diarrhea caused by Escherichia coli O157 infections occurred in southern Africa. In Swaziland, 40,912 physician visits for diarrhea in persons ages {\textbackslash}textgreater5 years were reported during October through November 1992. This was a sevenfold increase over the same period during 1990-91. The attack rate was 42\% among 778 residents we surveyed. Female gender and consuming beef and untreated water were significant risks for illness. E. coli O157:NM was recovered from seven affected foci in Swaziland and South Africa; 27 of 31 patient and environmental isolates had indistinguishable pulsed-field gel electrophoresis patterns. Compared with previous years, a fivefold increase in cattle deaths occurred in October 1992. The first heavy rains fell that same month (36 mm), following 3 months of drought. Drought, carriage of E. coli O157 by cattle, and heavy rains with contamination of surface water appear to be important factors contributing to this outbreak.},
	doi = {10.3201/eid0705.017507},
	author = {Effler, E and Isaacson, M and Arntzen, L and Heenan, R and Canter, P and Barrett, T and Lee, L and Mambo, C and Levine, W and Zaidi, A and Griffin, P M}
}
