678. Outbreak of Shiga toxin-producing Escherichia coli Infections at Marine Corps Recruit Depot (MCRD), San Diego and Camp Pendleton, California—October–November, 2017
Session: Poster Abstract Session: Public Health: Epidemiology and Outbreaks
Thursday, October 4, 2018
Room: S Poster Hall
Background: Shiga toxin-producing Escherichia coli (STEC) infections are a major cause of foodborne illness and the principal cause of hemolytic-uremic syndrome (HUS). In November 2017, CDC and the U.S. Navy responded to an outbreak of STEC illnesses in military recruits at the Marine Corps Recruit Depot in San Diego (MCRD). We investigated to determine the source of this outbreak and identify prevention and mitigation measures.

Methods: In October 2017, medical staff identified a high number of gastrointestinal (GI) illnesses at MCRD. Recruits with diarrhea submitted stool specimens for culture and/or culture-independent diagnostic testing (CIDT) for GI pathogens. We performed pulsed-field gel electrophoresis (PFGE) on culture isolates. Case-patients were defined as confirmed (PFGE-confirmed STEC infection matching outbreak strains), probable (diagnosis of HUS and/or CIDT evidence of STEC), or suspected (bloody diarrhea). We conducted environmental evaluations of dining facilities, training areas, and barracks. A case-control study was performed using PFGE-confirmed case-patients and platoon-matched controls. We performed product traceback for foods identified as exposure risks by interview or case-control study.

Results: We identified 64 confirmed, 105 probable, and 91 suspected case-patients. Thirty case-patients required hospitalization and 15 had HUS. Ages ranged from 17-28 years (median: 18 years). Poor hygiene practices among recruits and inconsistent cooking temperatures within dining facilities were noted. Forty-three case-patients and 135 controls were interviewed about food, hygiene, and environmental exposures. Consumption of undercooked beef was significantly associated with illness (mOR 2.40, CI 1.04-5.72, p=0.04). We identified a single ground beef supplier for MCRD, but dining facility records did not document the dates on which specific lots of ground beef were used.

Conclusion: Case-control analysis and environmental observations suggested undercooked ground beef as a potential source for this outbreak. We recommended the Navy and Marine Corps retain lot information, address food handling concerns, and improve hygiene among recruits.

Amelia Keaton, MD1, Rashida Hassan, MSPH1, Sarah Luna, PhD2, Isabell Lee, MPH3, Richelle Magalhaes, MPH3, Matthew Bidlack, MD4, Paul Graf, PhD, D(ABMM)5, Ryan Maves, MD, FCCP, FIDSA6, Linda Smith, MD7, Douglas Freer, MD, DPM, MPH4, Kimberly Flinn, RN, BSN4, Gregory Monk, PA-C4, Kelly Trinh, BS8, John Crandall, BS8, Douglas Noveroske, MPH9, Gamola Fortenberry, PhD, MPH9, Corey Peak, MS, ScD10,11, Eric McDonald, MD, MPH12, Thomas Waltz, BS13, Kane Patel, BS13, Darlene Wagner, PhD13, Jennifer Espiritu, MD, MPH14, Lori Christensen, MPH3 and Laura Gieraltowski, PhD, MPH1, (1)National Center for Emerging and Zoonotic Infectious Diseases, Division of Foodborne, Waterborne, and Environmental Diseases, Outbreak Response and Prevention Branch, Centers for Disease Control and Prevention, Atlanta, GA, (2)National Center for Emerging and Zoonotic Infectious Diseases, Division of Foodborne, Waterborne, and Environmental Diseases, Enteric Diseases Epidemiology Branch, Centers for Disease Control and Prevention, Atlanta, GA, (3)Preventive Medicine, Naval Medical Center San Diego, San Diego, CA, (4)Branch Health Clinic, Marine Corps Recruit Depot, San Diego, CA, (5)Division of Microbiology, Department of Laboratory Medicine, Naval Medical Center, San Diego, CA, (6)Infectious Diseases, Naval Medical Center San Diego, San Diego, CA, (7)Naval Hospital Camp Pendleton, Oceanside, CA, (8)California Department of Public Health, Richmond, CA, (9)United States Department of Agriculture-Food Safety and Inspection Services, Washington, DC, (10)Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA, (11)County of San Diego Health and Human Services Agency, San Diego, CA, (12)Epidemiology and Immunization Services, County of San Diego Health and Human Services Agency, San Diego, CA, (13)National Center for Emerging and Zoonotic Diseases, Division of Foodborne, Waterborne, and Environmental Diseases, Enteric Diseases Laboratory Branch, Centers for Disease Control and Prevention, Atlanta, GA, (14)Navy Environmental and Preventive Medicine Unit 6, Honolulu, HI

Disclosures:

A. Keaton, None

R. Hassan, None

S. Luna, None

I. Lee, None

R. Magalhaes, None

M. Bidlack, None

P. Graf, None

R. Maves, None

L. Smith, None

D. Freer, None

K. Flinn, None

G. Monk, None

K. Trinh, None

J. Crandall, None

D. Noveroske, None

G. Fortenberry, None

C. Peak, None

E. McDonald, None

T. Waltz, None

K. Patel, None

D. Wagner, None

J. Espiritu, None

L. Christensen, None

L. Gieraltowski, None

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