Jpn. J. Infect. Dis., 54, 2001

Laboratory and Epidemiology Communications

Universal Questionnaire Needed for Investigations of Diffuse Outbreaks ofEnterohemorrhagic Escherichia coli in Japan
Takeshi Tanakal･2*, Hiroshi Takahashil, Makoto Komatsuzakil･2, Tamano Matsuil･2,
Koki KakuI･2, Takaaki Ohyama1 , Tsuyoshi Kishimoto3, Asao Honda4,

John M. Kobayashil and Nobuhiko Okabel
JInfectious Disease Surveillance Center and2Field Epidem iology Train ing Program, National Institute oflnfectious Diseases,Toyama 1‑23‑1, Shinjuku‑ku, Tokyo 162‑8640,
3saitama Prefectural Institute of Public Health,Kami‑okubo 639‑1, Saitama cio!, Saitama 338‑0824 and4Medical Service Division, Health and Welfare Bureau, Saitama Prefectural Government,
Takasago 3‑15‑1, Saitama ciO), Saitama 336‑8501

Communicated by Hamo Watanabe(Accepted December 5, 200 1 )implicated in past EHEC outbreaks. hterviewsuslnguniversal

Recent progress in molecular epidemiology has enhanced

questionnaires is found to be highly effective when PFGE

the efficiency ofpublic health measures. The pulsed‑field gelelectrophoresis (PFGE) teclmique, for e.xample, has played aresults are matched but the source of infection otherwise

crucial role in epidemiologlCal investlgation of infectious

remainsunknown(personal communication with Rob Tauxe,

diseases (1). Based upon the unique characteristics ofCDC). The universal questionnaire has been developed andEscherichia coli, whose DNA profile changes within a shortrevised for other infectious pathogens including Bacillus

period of time, applying PFGE to a cross sectional study is aceyleuS, CampyT10bacter, Salmonellaand so on (it is available

powerful tool for etiological investlgation of outbreaks ofwith thefull text of this article at h仕p://www.cdc.gov/ncidod/

disease induced by this pathogen (2). A PFGE database f♭r

曲md/outbreak/stand̲qu. htm) ( 6 ).

enterohemorrhagic Escherichia coli (EHEC) was thus estab‑

introducing the U.S. questionnaire without revision tolished in Japan in 1999. This database is maintained by theJapanese settings will be of limited value since the queried

Department of Bacteriology, National Institute of Infectious

food items are occasionally inapproprlate. We recognlZe theDiseases (NIID), and data results are routinely shared usingnecesslty Of making two major modificationsto the list of

the computer network, called "Pulse‑net", among prefectural

food items in thp present questionnaire. First, We have topublic health laboratories in the country (3).

replace the uncomon fわod items with those common toJapanese cuisine. Next, We have to add food items which have

From March to April 2001, several clusters of dia汀hea

patients infected with EHEC 0157:H7 were reported from
Chiba, Saitama, Tokyo, and Kanagawa Prefectures. Althoughbeen implicated in past EHEC outbreaks in J叩an.

these cases appeared to be epidemiologically unlinked, Pulse‑in the past 10 years in Japan (Fig. 1 ; published in Infectious

net data indicated that they were identical in PFGE pattem

Agents SuⅣeillance Report (lASR) and Japan Centra Revuo

The collaboration of public health physicians from theMedicina) indicates that the EHEC outbreaks are induced byvarietyof non‑beef items including hlits, vegetables, and even

The list of identified foods implicated in EHEC outbreaks

Prefectures, With the assistance of field epidemiologlStS inNIID, lead to the conclusion that the outbreak was caused byPea foods･ The brevityofthe list indicates that identifying theItems implicated in EHEC outbreaks was highly difficult.

contaminated roast beef manufactured in Tochigi Prefecture
where no case was reported (4). Meanwhile, in another di乱se

Field investlgation enhanced by uslng the integrated universal

outbreak in June 200l caused by EHEC probably of common
origin (suggested by the saTPe PFGE pattem), no implicatedquestionnaireand PFGE DNA typing will make the investiga‑
tlOn Of diffuse EHEC outbreaks more efficient and morefood was identified by actlVe field investigation (5)･ Thisthorough.

failure was caused mainly by the difficulties in obtaining
accurate and precise information regarding the food items

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Watanabe, H. (1999): Detection of a multi‑prefecturalcommonly consumed in the country, and/or have often been

E. coli. 0 1 57:H7 Outbreak caused by contaminated Ikura‑*Corresponding author: Fax: +8 1‑315285‑1 129, E‑mail: ttmhw@

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1 998

2000

2001

YearFig･ I. Food items implicated in EHEC outbreaks in Japan, 1996‑2001
Each rcctanglc indicates the implicated food, (number of cases), setting, and Prefecture where each incidence was recognized･Position of the rectangle showsthe month and year of the incidence･#l salad navored withdricd bonito Rake.
#2 Japancsc radish.

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198