Q Fever and the US Military

1320 Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 11, No. 8, August 2005 trophoresis (PFGE) analysis demonstrated these to be a unique clone distinct from Asian and American clinical strains (5). In July 2004, a V. parahaemolyticus outbreak of 80 illnesses occurred in A Coruña, Spain. All the casepatients attended weddings in the same restaurant. V. parahaemolyticus was isolated from stool samples of 3 patients. The outbreak isolates were characterized by serotyping, polymerase chain reaction (PCR) for species-specific genes (Vp-toxR and tlh), virulence-related genes (tdh and trh), and group specific (GS)-PCR (a PCR method to detect the pandemic clone). Two isolates belonged to the serotype O3:K6, while the remaining isolate was O3:K untypeable. All 3 isolates had the toxR, tlh, and tdh genes, lacked the trh gene, and were positive for the GS-PCR assay to detect pandemic strains. These results unequivocally linked the outbreak isolates to the O3:K6 pandemic clone of V. parahaemolyticus. To confirm the relationship with the pandemic clone, the outbreak isolates were additionally subjected to DNA fingerprinting analyses. PFGE and arbitrarily primed PCR analyses showed that these isolates exhibited a pattern indistinguishable from those of pandemic strains from Asia. The epidemiologic investigation associated with the outbreak identified the boiled crab eaten in the restaurant as the most probable source of the infection. Live crabs were imported to Spain from the United Kingdom, processed under unhealthy conditions, and stored at room temperature for several hours before they were eaten. All the seafood eaten at the weddings was harvested in Europe, and no imported food was eaten or handled in the restaurant. Pandemic O3:K6 clone of V. parahaemolyticus appeared in Asia around 1996 (6). Since its emergence, it has accounted for most V. parahaemolyticus infections in Asia. It spread to the United States in 1998 (7) and more recently to Chile (8), where it has caused hundreds of infections, resulting in the first V. parahaemolyticus pandemic in history (9). We report the first evidence that it has been introduced to Europe. The emergence of this virulent serotype in Europe is a public health concern and emphasizes the need to include V. parahaemolyticus in microbiologic surveillance and reexamine control programs for shellfish-harvesting areas and ready-to-eat seafood.