RT Journal
T1 Notes from the field: Escherichia coli o157:h7 gastroenteritis associated with a state fair—north carolina, 2011
JF JAMA
JO JAMA
YR 2012
FD February 22
VO 307
IS 8
SP 779
OP 780
DO 
UL http://dx.doi.org/
AB 
NCDPH conducted a case-control study to identify the source of transmission. A case was defined as laboratory evidence of STEC, hemolytic uremic syndrome (HUS), or acute bloody diarrhea with no other identified etiology in a person who attended the fair 1-10 days before illness onset. Active case finding was performed by using a network of hospital-based public health epidemiologists.* Passive surveillance was enhanced through notifications to public health officials, health-care providers, laboratory directors, and the public. Control subjects were recruited by contacting 11,000 randomly selected advanced ticket purchasers by e-mail with a request to participate in the investigation. Three control subjects were matched to each case by age (<18 years or ≥18 years) and date of fair attendance. A stool specimen was requested of all case-patients for laboratory confirmation of E. coli. Pulsed-field gel electrophoresis (PFGE) patterns were compared with known strains in the national PulseNet database.† Case-patients' exposures to food, animals, and fair activities were assessed by using a scripted questionnaire administered to case-patients and control subjects.