{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2024,5,1]],"date-time":"2024-05-01T16:10:00Z","timestamp":1714579800816},"reference-count":19,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2011,4,6]],"date-time":"2011-04-06T00:00:00Z","timestamp":1302048000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Zoonoses and Public Health"],"published-print":{"date-parts":[[2011,12]]},"abstract":"<jats:title>Summary<\/jats:title><jats:p>Infection with sorbitol\u2010fermenting Shiga toxin\u2010producing <jats:italic>Escherichia coli<\/jats:italic> O157:H\u2010 (sf STEC O157:H\u2010) is rare, but emerging in Europe. The pathogen is typically isolated from paediatric patients with life\u2010threatening haemolytic uraemic syndrome (HUS). It is unclear whether this observation primarily reflects the pathogen\u2019s virulence or its complex laboratory diagnosis, not routinely conducted in diarrhoeal patients. In summer 2009, four boys living in the same suburb in Germany developed diarrhoea\u2010associated HUS: three were infected by sf STEC O157:H\u2010 and one died. We conducted two analytical epidemiological studies, an extensive search for diarrhoeal cases in potentially exposed groups, and an environmental investigation. Outbreak cases were residents of the suburb diagnosed with HUS, sf STEC O157:H\u2010 infection, or both between 24 July 2009 and 25 August 2009. Overall, we ascertained eight cases with a median age of 4\u2003years (range: from 8\u2003months to 9\u2003years). Stool screening of 220 persons led to the identification of only four additional cases: two asymptomatic carriers and two diarrhoeal cases. HUS was strongly associated with visiting a local playground in July, particularly on 16th July (odds ratio\u2003=\u200342.7, <jats:italic>P<\/jats:italic>\u2003=\u20030.002). No other commonality, including food, was identified, and all environmental samples (<jats:italic>n<\/jats:italic>\u2003=\u200324) were negative. In this localized non\u2010foodborne outbreak, the place of likely infection was a local playground. Sf STEC O157:H\u2010 infection apparently limits itself rarely to diarrhoeal illness and progresses frequently to HUS. Therefore, detection of and response to this hypervirulent pathogen primarily relies on HUS surveillance.<\/jats:p>","DOI":"10.1111\/j.1863-2378.2011.01405.x","type":"journal-article","created":{"date-parts":[[2011,4,6]],"date-time":"2011-04-06T07:30:28Z","timestamp":1302075028000},"page":"567-572","source":"Crossref","is-referenced-by-count":17,"title":["Desperately Seeking Diarrhoea: Outbreak of Haemolytic Uraemic Syndrome Caused by Emerging Sorbitol\u2010Fermenting Shiga Toxin\u2010Producing <i>Escherichia coli<\/i> O157:H\u2010, Germany, 2009"],"prefix":"10.1111","volume":"58","author":[{"given":"S.","family":"Nielsen","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C.","family":"Frank","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A.","family":"Fruth","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A.","family":"Spode","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"R.","family":"Prager","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A.","family":"Graff","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A.","family":"Plenge\u2010B\u00f6nig","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S.","family":"Loos","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M.","family":"L\u00fctgehetmann","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M. 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