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E. coli O157:H7 Infection in Michigan (CB3075)

These Epidemiologic Case Studies are based on historical events and include epidemiologic methods that were practiced at the time. Given the historical nature of this content, the methods that are referenced in this site may be outdated practices in some settings. As some of the practices are still used, they continue to offer educational value.

Target Audience

Public health practitioners with knowledge of basic epidemiologic and public health concepts including public health nurses, epidemiologists, infectious disease investigators, environmental health specialists, sanitarians, and MPH students.

Learning Objectives

After completing this case study, the student should be able to:

  • Determine whether an increase in reports of a disease represents an outbreak.
  • Write a case definition for an epidemiologic investigation.
  • Summarize the descriptive epidemiology of cases in an outbreak.
  • List questions for in-depth interviews of cases to generate hypotheses about the source of an outbreak.
  • Outline key considerations in designing a case-control study.
  • Analyze the results of a case-control study.
  • List detailed product information that will facilitate traceback of a food implicated in an outbreak.
  • Describe the unique role the laboratory can play in an outbreak investigation.
  • Describe infection with E. coli O157:H7.


Successful completion of training in descriptive epidemiology, study design, and data analysis.






3 – 4 hours

Developed By

This product stems from a collaboration within the Centers for Disease Control and Prevention (CDC) with individuals from the:

  • National Center for Infectious Diseases (Division of Bacterial and Mycotic Diseases/Foodborne and Diarrheal Diseases Branch and Food Safety Office)
  • Epidemiology Program Office (Division of International Health)
  • Public Health Practice Program Office (Division of Professional Development and Evaluation)
  • Public Health Training Network

The development team included Jeanette K. Stehr-Green, MD and Nancy Gathany, MEd with Erick Emde, MM.

Available for Download

  • Complete Package (41 MB)

    System Requirements:
    • Microsoft® Windows® 95, Windows® 98, Windows® NT® 4.0 with service pack 3 or higher, or Windows® 2000
    • Intel® Pentium® III Processor or equivalent
    • Available hard disk space:
      • 48MB, if installing the case study from the CD or downloading the Complete Package from the Internet.
      • 19 MB, if downloading the Alternative Package from the Internet.
    • 16 MB of memory
    • 4x speed (NOTE: Only needed with CD format of program)
    • Monitor resolution of 800 x 600 with 16-bit color
    • Display font size set to “Small Fonts”
    • Mouse
  • Alternative Package (15 MB)

    Minimum files needed to run case study program.

Original Investigation Team

The following individuals investigated the original outbreak of E. coli O157:H7 infection in Michigan and Virginia: Thomas Breuer, Denise H. Benkel, Roger L. Shapiro, William N. Hall, Mary M. Winnett, Mary Jean Linn, Jakob Neimann, Timothy Barrett, Stephen Dietrich, Francis P. Downes, Denise M. Toney, James L. Pearson, Henry Rolka, Laurence Slutsker, and Patricia M. Griffin.