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E. coli Outbreak: What Have We Learned Since 1993?

They say, “Those who cannot remember the past are condemned to repeat it.”
And that is the very thing the Centers for Disease Control and Prevention (CDC) is hoping to remind public health specialists—and, likely, state and federal legislators as well as the media—through its “We Were There” series, which includes events featuring speakers and multimedia presentations highlighting the agency’s role during several key disease outbreaks in the 20th and 21st centuries. The CDC launched the series in 2016.
The latest “We Were There” program, held at the CDC’s Atlanta headquarters on May 25th, focused on the agency’s work on the infamous Escherichia coli (E. coli) outbreak of 1993. The outbreak, which was traced to hamburgers sold by the fast-food chain Jack-in-the-Box, yielded 744 cases, most of them children. Of these, 193 were hospitalized as a result of their illnesses; 56 developed kidney failure as a result of hemolytic uremic syndrome (HUS)—linked with the specific E. coli strain implicated in the outbreak; and 4 deaths.
Speakers at the event included Rima Khabbaz, MD, CDC Deputy Director for Infectious Diseases; Beth P. Bell, MD, MPH, former director, National Center for Emerging and Zoonotic Infectious Diseases; Bala Swaminathan, PhD, Executive Vice-President, IHRC and a former CDC lab scientist; Robert Tauxe, MD, Director, Division of Foodborne, Waterborne and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases; and Patricia M. Griffin, MD, Chief, CDC Enteric Diseases Epidemiology Branch. These and other clinicians and researchers working for the CDC at the time were involved in the publication of several landmark studies associated with the outbreak, including the case-control study published in the Journal of the American Medical Association and the article that highlighted the need for improved lab testing, published in the American Journal of Public Health.
What made the 1993 initially difficult to identify and control, of course, was the fact that its cause was a relatively little known strain of E. coli called 0157. At the time of the outbreak, which was first reported in Seattle on January 12, 1993, Dr. Griffin noted that only 6% of US labs were able to test for, and identify, 0157, and food safety standards governing both production and preparation were insufficient to protect the public from illness.

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