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Euro Surveill. 2018 Aug;23(35). doi: 10.2807/1560-7917.ES.2018.23.35.1700666.

Outbreak of multiple strains of non-O157 Shiga toxin-producing and enteropathogenic Escherichia coli associated with rocket salad, Finland, autumn 2016.

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National Institute for Health and Welfare, Health Security Department, Helsinki, Finland.
Environmental Health, Social and Health Services Espoo, Espoo, Finland.
City of Helsinki, Communicable Diseases, Epidemiology Unit, Social Services and Health Care Sector, Helsinki, Finland.
Division of Infectious Diseases, Inflammation Center, Helsinki University Central Hospital, Helsinki, Finland.
Department of Clinical Microbiology, University of Helsinki and Helsinki University Hospital, HUSLAB, Helsinki, Finland.
Finnish Food Safety Authority Evira, Research and Laboratory Services Department, Microbiology Research Unit, Helsinki, Finland.
Finnish Food Safety Authority Evira, Food Safety Department, Microbiological Food Safety Unit, Helsinki, Finland.


In August 2016, an outbreak of Shiga toxin-producing Escherichia coli (STEC) and enteropathogenic E. coli (EPEC) with 237 cases occurred in the Helsinki metropolitan area, Finland. Gastroenteritis cases were reported at 11 events served by one catering company. Microbiological and epidemiological investigations suggested rocket salad as the cause of the outbreak.


H11 and EPEC O111:H8 strains isolated from food samples containing rocket were identical to the patient isolates. In this outbreak, the reported symptoms were milder than considered before for STEC infection, and the guidelines for STEC control measures need to be updated based on the severity of the illness. Based on our experience in this outbreak, national surveillance criteria for STEC have been updated to meet the practice in reporting laboratories covering both PCR-positive and culture-confirmed findings. We suggest that EPEC could be added to the national surveillance since diagnostics for EPEC are routinely done in clinical laboratories.


EPEC; STEC; Shiga toxin-producing E. coli; enteropathogenic E. coli; epidemiology; food-borne infections; gastrointestinal disease; outbreaks

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