This month’s issue of Clinical Infectious Diseases has an excellent article recounting the State of Wisconsin’s investigation into the 2006 E. coli O157:H7 outbreak linked to Dole spinach. You can see the article here. For reasons that are still not entirely clear, Wisconsin was something of a "ground zero" for the outbreak with 49 of the 204 cases reported nationwide. Strong work by health officials in Wisconsin (and elsewhere) helped recognize the outbreak and put a stop to it.
Despite this excellent effort in cataloging the illnesses in order to end the outbreak and draw conclusions, the count is still incomplete. I have spent the day working on the case of a retirement aged woman from Wisconsin who developed HUS after consuming Dole Spinach from the same lot associated with the outbreak. She spent 7 weeks in the hospital. She only survived through the receipt of donated blood, mechanical ventilation and dialysis. Yet because she was not tested for E. coli O157:H7 until well into her hospitalization she is not one of the 49.