An outbreak of Escherichia coli O157[ratio ]H7 infections and haemolytic uraemic syndrome associated with consumption of unpasteurized apple cider

During October 1996, an outbreak of Escherichia coli O157[ratio ]H7 infections among Connecticut residents occurred. An epidemiologic investigation included enhanced surveillance and a case-control study. Clinical isolates of Escherichia coli O157[ratio ]H7 were typed by pulsed-field gel electrophoresis (PFGE). Implicated cider samples were analysed by culture and polymerase chain reaction (PCR). Consumption of implicated cider was associated with illness; (matched odds ratio = undefined, 95% confidence interval = 3·5–infinity). Ultimately, a total of 14 outbreak-associated patients were identified. All isolates analysed by PFGE yielded the outbreak-associated subtype. Escherichia coli O157[ratio ]H7 was not cultured from three cider samples; PCR analysis detected DNA fragments consistent with Escherichia coli O157[ratio ]H7 in one. This outbreak was associated with drinking one brand of unpasteurized apple cider. PFGE subtyping supported the epidemiologic association. PCR analysis detected microbial contaminants in the absence of live organisms. Washing and brushing apples did not prevent cider contamination.