An Outbreak of E. coli O157:H7 Hemorrhagic Colitis Associated with Unpasteurized Gouda Cheese
Background: A cluster of E. coli O157:H7 hemorrhagic colitis was identified in metro Edmonton, Alberta through notifiable disease surveillance in late 2002. Methods: Environmental health officers collected food histories and clinical information from cases in the cluster. The provincial public healt...
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| Veröffentlicht in: | Canadian journal of public health 2005-05, Vol.96 (3), p.182-184 |
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| creator | Honish, Lance Predy, Gerry Hislop, Nyall Chui, Linda Kowalewska-Grochowska, Kinga Trottier, Larry Kreplin, Cornelia Zazulak, Ingrid |
| description | Background: A cluster of E. coli O157:H7 hemorrhagic colitis was identified in metro Edmonton, Alberta through notifiable disease surveillance in late 2002. Methods: Environmental health officers collected food histories and clinical information from cases in the cluster. The provincial public health laboratory conducted pulsed field gel electrophoresis (PFGE) analysis on E. coli O157:H7 isolates from cluster cases. Public health and food regulatory agencies conducted an investigation when a food source (unpasteurized gouda cheese) was implicated. Results: PFGE analysis revealed an "outbreak" profile in 13 cases. Onset dates for the outbreak cases ranged between October 2002 and February 2003. Two cases, aged 22 months and 4 years, developed hemolytic uremic syndrome as a result of their infection. Consumption of unpasteurized gouda cheese produced at a local dairy farm was reported by 12 of 13 outbreak cases in the 2 to 8 days prior to illness. E. coli O157:H7 was isolated from 2 of 26 cheese samples manufactured by the implicated producer. The cheese isolates had indistinguishable PFGE profiles as compared with outbreak case isolates.Implicated cheese was found to be contaminated with E. coli O157:H7 104 days after production, despite having met regulated microbiological and aging requirements. Conclusion: To our knowledge, this is the first confirmed outbreak of E. coli O157:H7 infection in Canada associated with raw milk hard cheese. A review of federal legislation vis-à-vis raw milk hard cheese may be in order. Contexte : Vers la fin de 2002, le système de surveillance des maladies à déclaration obligatoire a relevé une concentration de cas de colite hémorragique causés par Escherichia coli O157:H7 dans le Grand Edmonton, en Alberta. Méthode : Des hygiénistes du milieu ont recueilli les antécédents alimentaires et cliniques des cas relevés. Le laboratoire provincial de dépistage sanitaire a analysé par électrophorèse sur gel en champs puisé (EGCP) des isolats de E. coli O157:H7 parmi ces cas. Les organismes de santé publique et de réglementation des aliments ont fait enquête lorsqu'une source de nourriture (du gouda non pasteurisé) a été mise en cause. Résultats : L'EGCP a révélé une séquence apparentée à une eclosión dans 13 cas. Les dates d'apparition des cas liés à l'éclosion se situaient entre octobre 2002 et février 2003. Deux cas, l'un âgé de 22 mois et l'autre de quatre ans, ont présenté un syndrome hémolytique et urémique dû à l'infection. Dou |
| doi_str_mv | 10.1007/BF03403686 |
| format | Article |
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Methods: Environmental health officers collected food histories and clinical information from cases in the cluster. The provincial public health laboratory conducted pulsed field gel electrophoresis (PFGE) analysis on E. coli O157:H7 isolates from cluster cases. Public health and food regulatory agencies conducted an investigation when a food source (unpasteurized gouda cheese) was implicated. Results: PFGE analysis revealed an "outbreak" profile in 13 cases. Onset dates for the outbreak cases ranged between October 2002 and February 2003. Two cases, aged 22 months and 4 years, developed hemolytic uremic syndrome as a result of their infection. Consumption of unpasteurized gouda cheese produced at a local dairy farm was reported by 12 of 13 outbreak cases in the 2 to 8 days prior to illness. E. coli O157:H7 was isolated from 2 of 26 cheese samples manufactured by the implicated producer. The cheese isolates had indistinguishable PFGE profiles as compared with outbreak case isolates.Implicated cheese was found to be contaminated with E. coli O157:H7 104 days after production, despite having met regulated microbiological and aging requirements. Conclusion: To our knowledge, this is the first confirmed outbreak of E. coli O157:H7 infection in Canada associated with raw milk hard cheese. A review of federal legislation vis-à-vis raw milk hard cheese may be in order. Contexte : Vers la fin de 2002, le système de surveillance des maladies à déclaration obligatoire a relevé une concentration de cas de colite hémorragique causés par Escherichia coli O157:H7 dans le Grand Edmonton, en Alberta. Méthode : Des hygiénistes du milieu ont recueilli les antécédents alimentaires et cliniques des cas relevés. Le laboratoire provincial de dépistage sanitaire a analysé par électrophorèse sur gel en champs puisé (EGCP) des isolats de E. coli O157:H7 parmi ces cas. Les organismes de santé publique et de réglementation des aliments ont fait enquête lorsqu'une source de nourriture (du gouda non pasteurisé) a été mise en cause. Résultats : L'EGCP a révélé une séquence apparentée à une eclosión dans 13 cas. Les dates d'apparition des cas liés à l'éclosion se situaient entre octobre 2002 et février 2003. Deux cas, l'un âgé de 22 mois et l'autre de quatre ans, ont présenté un syndrome hémolytique et urémique dû à l'infection. Douze des 13 cas liés à l'éclosion ont dit avoir consommé du gouda non pasteurisé fabriqué dans une ferme laitière locale au cours d'une période de deux à huit jours avant leur maladie. On a isolé E. coli O157:H7 dans deux des 26 échantillons de fromage fabriqués par la ferme en question. Les séquences EGCP des isolats du fromage étaient identiques à ceux des isolats des cas liés à l'éclosion. Le fromage en question avait été contaminé, 104 jours après sa fabrication, par E. coli O157:H7, bien que la ferme ait respecté les exigences réglementaires en matière microbiologique et d'affinage. Conclusion : À notre connaissance, il s'agit de la première eclosión confirmée du colibacille O157:H7 au Canada associée à du fromage au lait cru à pâte dure. Un examen de la législation fédérale sur le fromage au lait cru à pâte dure pourrait être indiqué.</description><identifier>ISSN: 0008-4263</identifier><identifier>EISSN: 1920-7476</identifier><identifier>DOI: 10.1007/BF03403686</identifier><identifier>PMID: 15913080</identifier><identifier>CODEN: CJPEA4</identifier><language>eng</language><publisher>Ottawa, ON: Canadian Public Health Association</publisher><subject>Alberta - epidemiology ; Biological and medical sciences ; Bowel disease ; Cheese ; Cheese - microbiology ; Cheese industry ; Cluster Analysis ; Colitis - epidemiology ; Colitis - microbiology ; Disease Outbreaks ; Diseases ; Electrophoresis, Gel, Pulsed-Field ; Epidemics ; Escherichia coli ; Escherichia coli - isolation & purification ; Escherichia coli Infections - epidemiology ; Escherichia coli Infections - microbiology ; Food Handling ; Food law ; Food Microbiology ; Gastrointestinal Hemorrhage - epidemiology ; Gastrointestinal Hemorrhage - microbiology ; Gouda cheese ; Hard cheeses ; Humans ; Industrial plants ; Medical sciences ; Miscellaneous ; Pasteurization ; Pathogens ; Public health ; Public health. Hygiene ; Public health. Hygiene-occupational medicine ; Raw milk</subject><ispartof>Canadian journal of public health, 2005-05, Vol.96 (3), p.182-184</ispartof><rights>2005 INIST-CNRS</rights><rights>Copyright Canadian Public Health Association May/Jun 2005</rights><rights>The Canadian Public Health Association 2005</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3316-c87d7267d6135b59fa18e6277fb23d641e1c6b2cfc5a861933bccf30eeb9777e3</citedby><cites>FETCH-LOGICAL-c3316-c87d7267d6135b59fa18e6277fb23d641e1c6b2cfc5a861933bccf30eeb9777e3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.jstor.org/stable/pdf/41994536$$EPDF$$P50$$Gjstor$$H</linktopdf><linktohtml>$$Uhttps://www.jstor.org/stable/41994536$$EHTML$$P50$$Gjstor$$H</linktohtml><link.rule.ids>230,314,727,780,784,803,885,27922,27923,53789,53791,58015,58248</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=16776030$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/15913080$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Honish, Lance</creatorcontrib><creatorcontrib>Predy, Gerry</creatorcontrib><creatorcontrib>Hislop, Nyall</creatorcontrib><creatorcontrib>Chui, Linda</creatorcontrib><creatorcontrib>Kowalewska-Grochowska, Kinga</creatorcontrib><creatorcontrib>Trottier, Larry</creatorcontrib><creatorcontrib>Kreplin, Cornelia</creatorcontrib><creatorcontrib>Zazulak, Ingrid</creatorcontrib><title>An Outbreak of E. coli O157:H7 Hemorrhagic Colitis Associated with Unpasteurized Gouda Cheese</title><title>Canadian journal of public health</title><addtitle>Can J Public Health</addtitle><description>Background: A cluster of E. coli O157:H7 hemorrhagic colitis was identified in metro Edmonton, Alberta through notifiable disease surveillance in late 2002. Methods: Environmental health officers collected food histories and clinical information from cases in the cluster. The provincial public health laboratory conducted pulsed field gel electrophoresis (PFGE) analysis on E. coli O157:H7 isolates from cluster cases. Public health and food regulatory agencies conducted an investigation when a food source (unpasteurized gouda cheese) was implicated. Results: PFGE analysis revealed an "outbreak" profile in 13 cases. Onset dates for the outbreak cases ranged between October 2002 and February 2003. Two cases, aged 22 months and 4 years, developed hemolytic uremic syndrome as a result of their infection. Consumption of unpasteurized gouda cheese produced at a local dairy farm was reported by 12 of 13 outbreak cases in the 2 to 8 days prior to illness. E. coli O157:H7 was isolated from 2 of 26 cheese samples manufactured by the implicated producer. The cheese isolates had indistinguishable PFGE profiles as compared with outbreak case isolates.Implicated cheese was found to be contaminated with E. coli O157:H7 104 days after production, despite having met regulated microbiological and aging requirements. Conclusion: To our knowledge, this is the first confirmed outbreak of E. coli O157:H7 infection in Canada associated with raw milk hard cheese. A review of federal legislation vis-à-vis raw milk hard cheese may be in order. Contexte : Vers la fin de 2002, le système de surveillance des maladies à déclaration obligatoire a relevé une concentration de cas de colite hémorragique causés par Escherichia coli O157:H7 dans le Grand Edmonton, en Alberta. Méthode : Des hygiénistes du milieu ont recueilli les antécédents alimentaires et cliniques des cas relevés. Le laboratoire provincial de dépistage sanitaire a analysé par électrophorèse sur gel en champs puisé (EGCP) des isolats de E. coli O157:H7 parmi ces cas. Les organismes de santé publique et de réglementation des aliments ont fait enquête lorsqu'une source de nourriture (du gouda non pasteurisé) a été mise en cause. Résultats : L'EGCP a révélé une séquence apparentée à une eclosión dans 13 cas. Les dates d'apparition des cas liés à l'éclosion se situaient entre octobre 2002 et février 2003. Deux cas, l'un âgé de 22 mois et l'autre de quatre ans, ont présenté un syndrome hémolytique et urémique dû à l'infection. Douze des 13 cas liés à l'éclosion ont dit avoir consommé du gouda non pasteurisé fabriqué dans une ferme laitière locale au cours d'une période de deux à huit jours avant leur maladie. On a isolé E. coli O157:H7 dans deux des 26 échantillons de fromage fabriqués par la ferme en question. Les séquences EGCP des isolats du fromage étaient identiques à ceux des isolats des cas liés à l'éclosion. Le fromage en question avait été contaminé, 104 jours après sa fabrication, par E. coli O157:H7, bien que la ferme ait respecté les exigences réglementaires en matière microbiologique et d'affinage. Conclusion : À notre connaissance, il s'agit de la première eclosión confirmée du colibacille O157:H7 au Canada associée à du fromage au lait cru à pâte dure. Un examen de la législation fédérale sur le fromage au lait cru à pâte dure pourrait être indiqué.</description><subject>Alberta - epidemiology</subject><subject>Biological and medical sciences</subject><subject>Bowel disease</subject><subject>Cheese</subject><subject>Cheese - microbiology</subject><subject>Cheese industry</subject><subject>Cluster Analysis</subject><subject>Colitis - epidemiology</subject><subject>Colitis - microbiology</subject><subject>Disease Outbreaks</subject><subject>Diseases</subject><subject>Electrophoresis, Gel, Pulsed-Field</subject><subject>Epidemics</subject><subject>Escherichia coli</subject><subject>Escherichia coli - isolation & purification</subject><subject>Escherichia coli Infections - epidemiology</subject><subject>Escherichia coli Infections - microbiology</subject><subject>Food Handling</subject><subject>Food law</subject><subject>Food Microbiology</subject><subject>Gastrointestinal Hemorrhage - epidemiology</subject><subject>Gastrointestinal Hemorrhage - microbiology</subject><subject>Gouda cheese</subject><subject>Hard cheeses</subject><subject>Humans</subject><subject>Industrial plants</subject><subject>Medical sciences</subject><subject>Miscellaneous</subject><subject>Pasteurization</subject><subject>Pathogens</subject><subject>Public health</subject><subject>Public health. Hygiene</subject><subject>Public health. Hygiene-occupational medicine</subject><subject>Raw milk</subject><issn>0008-4263</issn><issn>1920-7476</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2005</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNpd0cFv0zAUBnALgVgZXLiDLKRxQMrwy4v9Eg5IpdpWpEm9sCOyHMdZXdK4sxMm-OvJ1GoFTpb9_fT0rI-x1yDOQQj6-OVSYCFQleoJm0GVi4wKUk_ZTAhRZkWu8IS9SGkzXREJn7MTkBWgKMWMfZ_3fDUOdXTmBw8tvzjnNnSer0DSpyXxpduGGNfm1lu-mILBJz5PKVhvBtfwez-s-U2_M2lwY_S_p6erMDaGL9bOJfeSPWtNl9yrw3nKbi4vvi2W2fXq6utifp1ZRFCZLamhXFGjAGUtq9ZA6VRO1NY5NqoAB1bVuW2tNKWCCrG2tkXhXF0RkcNT9nk_dzfWW9dY1w_RdHoX_dbEXzoYr_9Ner_Wt-GnVhUpADENeH8YEMPd6NKgtz5Z13Wmd2FMGghIQo4TfPcf3IQx9tPndI65ECBRTujDHtkYUoqufdwEhH6oTB8rm_Dbv3c_0kNHEzg7AJOs6dpoeuvT0SkiJfDBvdm7TRpCfMwLqKpCosI_Ij6l5Q</recordid><startdate>20050501</startdate><enddate>20050501</enddate><creator>Honish, Lance</creator><creator>Predy, Gerry</creator><creator>Hislop, Nyall</creator><creator>Chui, Linda</creator><creator>Kowalewska-Grochowska, Kinga</creator><creator>Trottier, Larry</creator><creator>Kreplin, Cornelia</creator><creator>Zazulak, Ingrid</creator><general>Canadian Public Health Association</general><general>Springer Nature B.V</general><general>Springer International Publishing</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>0-V</scope><scope>3V.</scope><scope>4S-</scope><scope>4U-</scope><scope>7QP</scope><scope>7QR</scope><scope>7RV</scope><scope>7T2</scope><scope>7TK</scope><scope>7U9</scope><scope>7X7</scope><scope>7XB</scope><scope>88C</scope><scope>88E</scope><scope>88J</scope><scope>8C1</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8FQ</scope><scope>8FV</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>ALSLI</scope><scope>AN0</scope><scope>ATCPS</scope><scope>AZQEC</scope><scope>BEC</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>DPSOV</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB0</scope><scope>KC-</scope><scope>M0S</scope><scope>M0T</scope><scope>M1P</scope><scope>M2L</scope><scope>M2O</scope><scope>M2R</scope><scope>M3G</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PATMY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PYCSY</scope><scope>Q9U</scope><scope>S0X</scope><scope>7QL</scope><scope>7U2</scope><scope>5PM</scope></search><sort><creationdate>20050501</creationdate><title>An Outbreak of E. coli O157:H7 Hemorrhagic Colitis Associated with Unpasteurized Gouda Cheese</title><author>Honish, Lance ; Predy, Gerry ; Hislop, Nyall ; Chui, Linda ; Kowalewska-Grochowska, Kinga ; Trottier, Larry ; Kreplin, Cornelia ; Zazulak, Ingrid</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3316-c87d7267d6135b59fa18e6277fb23d641e1c6b2cfc5a861933bccf30eeb9777e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2005</creationdate><topic>Alberta - epidemiology</topic><topic>Biological and medical sciences</topic><topic>Bowel disease</topic><topic>Cheese</topic><topic>Cheese - microbiology</topic><topic>Cheese industry</topic><topic>Cluster Analysis</topic><topic>Colitis - epidemiology</topic><topic>Colitis - microbiology</topic><topic>Disease Outbreaks</topic><topic>Diseases</topic><topic>Electrophoresis, Gel, Pulsed-Field</topic><topic>Epidemics</topic><topic>Escherichia coli</topic><topic>Escherichia coli - isolation & purification</topic><topic>Escherichia coli Infections - epidemiology</topic><topic>Escherichia coli Infections - microbiology</topic><topic>Food Handling</topic><topic>Food law</topic><topic>Food Microbiology</topic><topic>Gastrointestinal Hemorrhage - epidemiology</topic><topic>Gastrointestinal Hemorrhage - microbiology</topic><topic>Gouda cheese</topic><topic>Hard cheeses</topic><topic>Humans</topic><topic>Industrial plants</topic><topic>Medical sciences</topic><topic>Miscellaneous</topic><topic>Pasteurization</topic><topic>Pathogens</topic><topic>Public health</topic><topic>Public health. Hygiene</topic><topic>Public health. 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Ingrid</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>An Outbreak of E. coli O157:H7 Hemorrhagic Colitis Associated with Unpasteurized Gouda Cheese</atitle><jtitle>Canadian journal of public health</jtitle><addtitle>Can J Public Health</addtitle><date>2005-05-01</date><risdate>2005</risdate><volume>96</volume><issue>3</issue><spage>182</spage><epage>184</epage><pages>182-184</pages><issn>0008-4263</issn><eissn>1920-7476</eissn><coden>CJPEA4</coden><abstract>Background: A cluster of E. coli O157:H7 hemorrhagic colitis was identified in metro Edmonton, Alberta through notifiable disease surveillance in late 2002. Methods: Environmental health officers collected food histories and clinical information from cases in the cluster. The provincial public health laboratory conducted pulsed field gel electrophoresis (PFGE) analysis on E. coli O157:H7 isolates from cluster cases. Public health and food regulatory agencies conducted an investigation when a food source (unpasteurized gouda cheese) was implicated. Results: PFGE analysis revealed an "outbreak" profile in 13 cases. Onset dates for the outbreak cases ranged between October 2002 and February 2003. Two cases, aged 22 months and 4 years, developed hemolytic uremic syndrome as a result of their infection. Consumption of unpasteurized gouda cheese produced at a local dairy farm was reported by 12 of 13 outbreak cases in the 2 to 8 days prior to illness. E. coli O157:H7 was isolated from 2 of 26 cheese samples manufactured by the implicated producer. The cheese isolates had indistinguishable PFGE profiles as compared with outbreak case isolates.Implicated cheese was found to be contaminated with E. coli O157:H7 104 days after production, despite having met regulated microbiological and aging requirements. Conclusion: To our knowledge, this is the first confirmed outbreak of E. coli O157:H7 infection in Canada associated with raw milk hard cheese. A review of federal legislation vis-à-vis raw milk hard cheese may be in order. Contexte : Vers la fin de 2002, le système de surveillance des maladies à déclaration obligatoire a relevé une concentration de cas de colite hémorragique causés par Escherichia coli O157:H7 dans le Grand Edmonton, en Alberta. Méthode : Des hygiénistes du milieu ont recueilli les antécédents alimentaires et cliniques des cas relevés. Le laboratoire provincial de dépistage sanitaire a analysé par électrophorèse sur gel en champs puisé (EGCP) des isolats de E. coli O157:H7 parmi ces cas. Les organismes de santé publique et de réglementation des aliments ont fait enquête lorsqu'une source de nourriture (du gouda non pasteurisé) a été mise en cause. Résultats : L'EGCP a révélé une séquence apparentée à une eclosión dans 13 cas. Les dates d'apparition des cas liés à l'éclosion se situaient entre octobre 2002 et février 2003. Deux cas, l'un âgé de 22 mois et l'autre de quatre ans, ont présenté un syndrome hémolytique et urémique dû à l'infection. Douze des 13 cas liés à l'éclosion ont dit avoir consommé du gouda non pasteurisé fabriqué dans une ferme laitière locale au cours d'une période de deux à huit jours avant leur maladie. On a isolé E. coli O157:H7 dans deux des 26 échantillons de fromage fabriqués par la ferme en question. Les séquences EGCP des isolats du fromage étaient identiques à ceux des isolats des cas liés à l'éclosion. Le fromage en question avait été contaminé, 104 jours après sa fabrication, par E. coli O157:H7, bien que la ferme ait respecté les exigences réglementaires en matière microbiologique et d'affinage. Conclusion : À notre connaissance, il s'agit de la première eclosión confirmée du colibacille O157:H7 au Canada associée à du fromage au lait cru à pâte dure. Un examen de la législation fédérale sur le fromage au lait cru à pâte dure pourrait être indiqué.</abstract><cop>Ottawa, ON</cop><pub>Canadian Public Health Association</pub><pmid>15913080</pmid><doi>10.1007/BF03403686</doi><tpages>3</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0008-4263 |
| ispartof | Canadian journal of public health, 2005-05, Vol.96 (3), p.182-184 |
| issn | 0008-4263 1920-7476 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_6976110 |
| source | MEDLINE; JSTOR Archive Collection A-Z Listing; EZB-FREE-00999 freely available EZB journals; PubMed Central; SpringerLink Journals - AutoHoldings |
| subjects | Alberta - epidemiology Biological and medical sciences Bowel disease Cheese Cheese - microbiology Cheese industry Cluster Analysis Colitis - epidemiology Colitis - microbiology Disease Outbreaks Diseases Electrophoresis, Gel, Pulsed-Field Epidemics Escherichia coli Escherichia coli - isolation & purification Escherichia coli Infections - epidemiology Escherichia coli Infections - microbiology Food Handling Food law Food Microbiology Gastrointestinal Hemorrhage - epidemiology Gastrointestinal Hemorrhage - microbiology Gouda cheese Hard cheeses Humans Industrial plants Medical sciences Miscellaneous Pasteurization Pathogens Public health Public health. Hygiene Public health. Hygiene-occupational medicine Raw milk |
| title | An Outbreak of E. coli O157:H7 Hemorrhagic Colitis Associated with Unpasteurized Gouda Cheese |
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