

@article {2416,
	title = {{A large Escherichia coli O157 outbreak in Sweden associated with locally produced lettuce.}},
	journal = {Foodborne Pathogens and Disease},
	volume = {5},
	number = {3},
	year = {2008},
	month = {jun},
	pages = {339{\textendash}49},
	abstract = {<p>In 2005 a large outbreak of verotoxin-producing Escherichia coli (VTEC) occurred in Sweden. Cases were interviewed and cohort and case-control studies were conducted. Microbiological investigations were performed using polymerase chain reaction (PCR) to detect the Shiga-like toxin (Stx) genes followed by cultivation and pulsed-field gel electrophoresis. A total of 135 cases were recorded, including 11 cases of hemolytic uremic syndrome. The epidemiological investigations implicated lettuce as the most likely source of the outbreak, with an OR of 13.0 (CI 2.94-57.5) in the case-control study. The lettuce was irrigated by water from a small stream, and water samples were positive for Stx 2 by PCR. The identical VTEC O157 Stx 2 positive strain was isolated from the cases and in cattle at a farm upstream from the irrigation point. An active surveillance and reporting system was crucial and cooperation between all involved parties was essential for quickly identifying the cause of this outbreak. Handling of fresh greens from farm to table must be improved to minimize the risk of contamination.</p>
},
	keywords = {80 and over, Adolescent, Adult, Aged, Case-Control Studies, Child, Cohort Studies, Disease Outbreaks, Escherichia coli Infections, Escherichia coli Infections: epidemiology, Escherichia coli O157, Escherichia coli O157: isolation \& purification, Escherichia coli O157: pathogenicity, Female, Food Contamination, Food Contamination: analysis, Hemolytic-Uremic Syndrome, Hemolytic-Uremic Syndrome: epidemiology, Humans, Infant, Lettuce, Lettuce: microbiology, Male, Middle Aged, Newborn, Preschool, Sweden, Sweden: epidemiology, Young Adult},
	issn = {1556-7125},
	doi = {10.1089/fpd.2007.0065},
	url = {http://www.ncbi.nlm.nih.gov/pubmed/18767979},
	author = {S{\"o}derstr{\"o}m, A and Osterberg, P and Lindqvist, A and J{\"o}nsson, B and Lindberg, A and Blide S Ulander and Welinder-Olsson, C and L{\"o}fdahl, S and Kaijser, B and De Jong, B and K{\"u}hlmann-Berenzon, S and Boqvist, S and Eriksson, E and Szanto, E and Andersson, S and Allestam, G and Hedenstr{\"o}m, I and Ledet Muller, L and Andersson, Y}
}
