Escherichia coli O157:H7 Outbreak Linked to Raw Milk Cheese in Quebec, Canada: Use of Exact Probability Calculation and Case-Case Study Approaches to Foodborne Outbreak Investigation

The analytical studies used to investigate foodborne outbreak are mostly case-control or retrospective cohort studies. However, these studies can be complex to perform and susceptible to biases. This article addresses basic principles of epidemiology, probability, and the use of case-case design to identify the source of an Escherichia coli O157:H7 outbreak linked to raw milk cheese consumption in Quebec, Canada; a small number of cases with the same pulsed-field gel electrophoresis (PFGE) profile were involved. Between 4 December 2008 and 15 January 2009, a cumulative total of 16 E. coli O157:H7 cases with the same PFGE profile were reported to Quebec public health authorities. Among the first six cases reported, three had consumed raw milk cheese from the same producer (cheese A). Raw milk cheese is consumed by about 2% of the Quebec population. By using the exact probability calculation, it was found that a significantly higher proportion of E. coli O157:H7 cases (with the specific PFGE profile) than e...