A Multistate Outbreak of Gastrointestinal Illness Caused by Enterotoxigenic Escherichia coli in Imported Semisoft Cheese

In September 1983, three clusters of gastrointestinal illness with similar symptoms affected 45 persons in Washington, D.C., after office parties. The illness lasted a mean of 4.4 days and was characterized by watery diarrhea (91%), abdominal cramps (80%), headache (38%), nausea (38%), and subjective fever (20%). Illness was strongly associated with having eaten imported French Brie cheese one to six days before onset of illness (P < .0001 by Fisher's two-tailed exact test). After publicity about these outbreaks, additional cheese-associated cases were identified over an eight-week period in Illinois, Wisconsin, Georgia, and Colorado. Stool specimens from ill persons in four states yielded Escherichia coli serotype O27:H20. These organisms produced heat-stable enterotoxin and had similar plasmid profiles. When commercially distributed foods are contaminated, enterotoxigenic E. coli can cause widespread disease even in a developed country, and the disease can easily escape correct diagnosis.