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Outbreak of Escherichia coli O157:H7 Infections Associated with Drinking Unpasteurized Commercial Apple Juice -- British Columbia, California, Colorado, and Washington, October 1996

On October 30, 1996, the Seattle-King County Department of Public Health and the Washington State Department of Health reported an outbreak of Escherichia coli O157:H7 infections epidemiologically associated with drinking Odwalla brand unpasteurized apple juice or Odwalla juice mixtures containing apple juice from a coffee shop chain, grocery stores, or other locations. A case was defined as hemolytic uremic syndrome (HUS) or a stool culture yielding E. coli O157:H7 in a person who became ill after September 30, 1996, and drank Odwalla juice within 10 days before illness onset. As of November 6, British Columbia, California, Colorado, and Washington had reported a total of 45 cases.

The median age of the 28 case-patients for whom information was reported was 5.0 years (range: 1-41 years); 15 (54%) were male. HUS was diagnosed in 12 persons; none have died. One case of E. coli O157:H7 infection occurred in a child who had onset of illness in Illinois after drinking implicated juice in Washington. Another patient with E. coli O157:H7 infection, not included in the total, acquired illness by secondary transmission from a patient with juice-associated infection. E. coli O157:H7 isolates cultured from a previously unopened container of Odwalla apple juice had a DNA "fingerprint" pattern (restriction fragment length polymorphism) indistinguishable from case-related isolates.

Odwalla, Inc., has completed a voluntary nationwide recall of all its products containing apple juice. Odwalla juice was distributed to British Columbia, California, Colorado, Idaho, Montana, Nevada, New Mexico, Oregon, Texas, and Washington.

Reported by: Dept of Environmental Health, Univ of Washington, Seattle; Seattle-King County Dept of Public Health, Seattle; Washington State Dept of Health. California State Dept of Health Svcs. Colorado Dept of Public Health and Environment. British Columbia Centre for Disease Control, Vancouver; Laboratory Centre for Disease Control, Health Canada, Ottawa, Ontario. Center for Food Safety and Applied Nutrition and Office of Regulatory Affairs, Food and Drug Administration. Foodborne and Diarrheal Diseases Br, Div of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, CDC.

Editorial Note

Editorial Note: Investigations are ongoing to determine the extent of the outbreak and the specific mechanisms of contamination. Health-care providers should consider infection with E. coli O157:H7 in patients with diarrheal illness who were residents of or travelers to British Columbia, California, Colorado, Idaho, Montana, Nevada, New Mexico, Oregon, Texas, or Washington during October and may have consumed Odwalla brand apple juice or Odwalla juice mixtures containing apple juice. Possible cases should be reported to local and state health departments.

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