Only four outbreaks in the U.S. have been documented, one resulting from consumption of water contaminated with human sewage, another from consumption of Mexican food prepared by an infected food handler. In two others, one in a hospital cafeteria and one aboard a cruise ship, food was the probable cause. The disease among travelers to foreign countries, however, is common. (Source: FDA Bad Bug Book)
MMWR 43(5):1994 Outbreaks of ETEC in Rhode Island and New Hampshire are reported.
In the last decade, four major common-source outbreaks of ETEC gastroenteritis occurred in the U.S. In late 1975 one-third of the passengers on two successive cruises of a Miami-based ship experienced diarrheal illness. A CDC investigation found ETEC to be the cause, presumably linked to consumption of crabmeat cocktail. In early 1980, 415 persons eating at a Mexican restaurant experienced diarrhea. The source of the causative organism was an ill food handler. In 1981, 282 of 3,000 personnel at a Texas hospital acquired ETEC gastroenteritis after eating in the hospital cafeteria. No single food was identified by CDC. Morbidity and Mortality Weekly Reports For more information on recent outbreaks see the CDC. (Source: FDA Bad Bug Book)
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Although some strains of E. coli exist as part of the normal GI flora, infection usually results from certain nonindigenous strains. For example, noninvasive diarrhea results from two toxins produced by strains called enterotoxic or enteropathogenic E. coli. Enteropathogenic E. coli serotype 0157:H7 is the most well-known strain in the United States. These toxins interact with intestinal juices and promote excessive loss of chloride and water. In the invasive form, E. coli directly invades the intestinal mucosa without producing enterotoxins, thereby causing local irritation, inflammation, and diarrhea. Normal strains can cause infection in immunocompromised patients.
Transmission can occur directly from an infected person or indirectly by ingestion of contaminated food or water or contact with contaminated utensils. Incubation takes 12 to 72 hours.
Incidence of E. coli infection is highest among travelers returning from other countries, particularly Mexico, Southeast Asia, and South America. E. coli infection also induces other diseases, especially in people whose resistance is low. The strain E. coli 0157:H7 has been associated with undercooked hamburger and with animals and petting zoos.
Source: Professional Guide to Diseases (Eighth Edition), 2005
The term 'prevalence' of Enterotoxigenic Escherichia coli usually refers to the estimated population of people who are managing Enterotoxigenic Escherichia coli at any given time. The term 'incidence' of Enterotoxigenic Escherichia coli refers to the annual diagnosis rate, or the number of new cases of Enterotoxigenic Escherichia coli diagnosed each year. Hence, these two statistics types can differ: a short-lived disease like flu can have high annual incidence but low prevalence, but a life-long disease like diabetes has a low annual incidence but high prevalence. For more information see about prevalence and incidence statistics.
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