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Article
May 5, 1993

The Emergence of Escherichia coli O157:H7 Infection in the United States: The Changing Epidemiology of Foodborne Disease

JAMA. 1993;269(17):2264-2266. doi:10.1001/jama.1993.03500170094040
Abstract

In this issue of The Journal, Besser et al present findings from an outbreak of Escherichia coli O157:H7 that occurred in southeastern Massachusetts in the fall of 1991.1 Twenty-three cases of E coli O157:H7 infection were identified; four had a diagnosis of hemolytic uremic syndrome (HUS), which is a well-recognized complication of E coli O157:H7 infection. The outbreak was identified because the cases of HUS clustered in time at one hospital. A well-conducted case-control study implicated apple cider as the vehicle of transmission. While this is an unusual vehicle for a foodborne pathogen, the authors offer data from inoculation studies showing that E coli O157:H7 organisms can survive for many days in refrigerated cider. In addition, the authors cite two previously reported outbreaks of illness associated with drinking apple cider. Interestingly enough, one was an outbreak of HUS and was probably caused by E coli O157:H7 organisms.

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