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. 2021 Jan 29;47(2):11-16.
doi: 10.14745/ccdr.v47i01a03.

Escherichia coli O121 outbreak associated with raw milk Gouda-like cheese in British Columbia, Canada, 2018

Eva Boyd  1 , Aljosa Trmcic  1 , Marsha Taylor  1 , Sion Shyng  1 , Paul Hasselback  2 , Stephanie Man  3 , Christine Tchao  3 , Jason Stone  4 , Loretta Janz  3 , Linda Hoang  1   3   5 , Eleni Galanis  1   6
Affiliations

Escherichia coli O121 outbreak associated with raw milk Gouda-like cheese in British Columbia, Canada, 2018

Eva Boyd et al. Can Commun Dis Rep. .

Abstract

Background: In 2018, a Shiga toxin-producing Escherichia coli O121 outbreak that affected seven individuals was associated with raw milk Gouda-like cheese produced in British Columbia, Canada.

Objectives: To describe the E. coli O121 outbreak investigation and recommend greater control measures for raw milk Gouda-like cheese.

Methods: Cases of E. coli O121 were identified through laboratory testing results and epidemiologic surveillance data. The cases were interviewed on exposures of interest, which were analyzed against Foodbook Report values for British Columbia. Environmental inspection of the dairy plant and the cheese products was conducted to ascertain a source of contamination. Whole genome multi-locus sequence typing (wgMLST) was performed on all positive E. coli O121 clinical and food isolates at the provincial laboratory.

Results: Four out of the seven cases consumed the same raw milk Gouda-like cheese between August and October 2018. The implicated cheese was aged longer than the required minimum of 60 days, and no production deficiencies were noted. One sample of the implicated cheese tested positive for E. coli O121. The seven clinical isolates and one cheese isolate matched by wgMLST within 6.5 alleles.

Conclusion: Raw milk Gouda and Gouda-like cheese has been implicated in three previous Shiga toxin-producing E. coli outbreaks in North America. It was recommended product labelling to increase consumer awareness and thermization of milk to decrease the risk of illness associated with raw milk Gouda and Gouda-like cheese.

Keywords: Escherichia coli O121; Gouda; cheese; disease outbreak; foodborne; raw milk.

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Conflict of interest statement

Competing interests: None.

Figures

Figure 1
Figure 1
Confirmed outbreak cases of Escherichia coli O121 infection by week of illness onset and dates of major outbreak investigations and control actions, British Columbia, 2018 Abbreviation: WGS, whole genome sequencing
Figure 2
Figure 2
Phylogenetic tree of Escherichia coli O121 outbreak cases and cheese A sample, British Columbia, 2018 Abbreviations: BCCDC, BC Centre for Disease Control; UPGMA, unweighted pair group method with arithmetic mean; wgMLST, whole genome multi-locus sequence typing
See this image and copyright information in PMC

References

    1. Valilis E, Ramsey A, Sidiq S, DuPont HL. Non-O157 Shiga toxin-producing Escherichia coli-A poorly appreciated enteric pathogen: systematic review. Int J Infect Dis 2018. Nov;76:82–7. 10.1016/j.ijid.2018.09.002 - DOI - PubMed
    1. Ochoa TJ, Cleary TG. Epidemiology and spectrum of disease of Escherichia coli O157. Curr Opin Infect Dis 2003. Jun;16(3):259–63. 10.1097/00001432-200306000-00013 - DOI - PubMed
    1. Noftall K, Taylor M, Hoang L, Galanis E. Shiga toxin-producing Escherichia coli in British Columbia, 2011-2017: analysis to inform exclusion guidelines. Can Commun Dis Rep 2019. Sep;45(9):238–43. 10.14745/ccdr.v45i09a03 - DOI - PMC - PubMed
    1. Johnson KE, Thorpe CM, Sears CL. The emerging clinical importance of non-O157 Shiga toxin-producing Escherichia coli. Clin Infect Dis 2006. Dec;43(12):1587–95. 10.1086/509573 - DOI - PubMed
    1. Morton V, Cheng JM, Sharma D, Kearney A. Notes from the field: an outbreak of Shiga toxin-producing Escherichia coli O121 infections associated with flour — Canada, 2016–2017. MMWR Morb Mortal Wkly Rep 2017. Jul;66(26):705–6. 10.15585/mmwr.mm6626a6 - DOI - PMC - PubMed