Letters to the Editor

Cookouts and the Seasonal Peak of Escherichia coli Infection


Am Fam Physician. 1998 Apr 1;57(7):1494.

to the editor: Upon reading the article on Escherichia coli,1 I was a bit surprised when the authors stated, “For unknown reasons, the rate of infection follows a seasonal pattern, with a peak incidence from June through September.”

Out here in the Midwest, a lot of folks cook out from June through September. Not surprisingly, many of them cook hamburgers, a wonderful reservoir for E. coli. Since folks at cookouts tend to be impatient, many of them eat hamburger meat that is undercooked. This is, to my simplistic view, a logical explanation for the seasonal peak from June through September.


1. Koutkia P, Mylonakis E, Flanigan T. Entero-hemorrhagic Escherichia coli O157:H7—an emerging pathogen. Am Fam Physician. 1997;56:853–6.

in reply: We appreciate Dr. Walbroehl's comments on our article. The importance of undercooked hamburgers in the epidemiology for E. coli O157:H7 infection is well-described in the literature and has been referred to as “barbecue syndrome.”1 This association was actually noted two paragraphs after the phrase that Dr. Walbroehl mentioned; it was also noted in the patient information handout accompanying the article.2

We believe that the epidemiology of E. coli O157:H7 is very important. However, little is known about the actual risk factors. The observation regarding cookouts has been tested in a large and well-documented epidemiologic study,1 and there was no statistical significance noted with barbecued hamburgers. Although there are studies explaining the epidemiology of E. coli O157:H7-associated gastroenteritis, it is still not fully explained why this infection peaks during the summer.1,35 Also, it was recently noted that the “seasonal variation of E. coli O157:H7 infection may reflect the ecology of the organism, variation in the consumption of ground beef or some other factor.”6

More studies are needed to evaluate the seasonal pattern of this disease.


show all references

1. Bryant HE, Athar MA, Pai CH. Risk factors for Escherichia coli O157:H7 infection in an urban community. J Infect Dis. 1989;160:858–64....

2. Koutkia P, Mylonakis E, Flanigan T. Escherichia coli O157:H7 infection [Patient information handout]. Am Fam Physician. 1997;56:859–61.

3. Pai CH, Ahmed N, Lior H, Johnson WM, Sims HV, Woods DE. Epidemiology of sporadic diarrhea due to verocytoxin-producing Escherichia coli: a two-year prospective study. J Infect Dis. 1988;157:1054–7.

4. Su C, Brandt LJ. Escherichia coli O157:H7 infection in humans. Ann Intern Med. 1995;123:698–714.

5. Griffin PM, Ostroff SM, Tauxe RV, Greene KD, Wells JG, Lewis JH, et al. Illnesses associated with Escherichia coli O157:H7 infections. A broad clinical spectrum. Ann Intern Med. 1988;109:705–12.

6. Boyce TG, Swerdlow DL, Griffin PM. Escherichia coli O157:H7 and the hemolytic-uremic syndrome. N Engl J Med. 1995;333:364–8.

Send letters to afplet@aafp.org, or 11400 Tomahawk Creek Pkwy., Leawood, KS 66211-2680. Include your complete address, e-mail address, and telephone number. Letters should be fewer than 400 words and limited to six references, one table or figure, and three authors.

Letters submitted for publication in AFP must not be submitted to any other publication. Possible conflicts of interest must be disclosed at time of submission. Submission of a letter will be construed as granting the AAFP permission to publish the letter in any of its publications in any form. The editors may edit letters to meet style and space requirements.

This series is coordinated by Kenny Lin, MD, MPH, Associate Deputy Editor for AFP Online.



Copyright © 1998 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact afpserv@aafp.org for copyright questions and/or permission requests.

Want to use this article elsewhere? Get Permissions


Oct 2021

Access the latest issue of American Family Physician

Read the Issue

Email Alerts

Don't miss a single issue. Sign up for the free AFP email table of contents.

Sign Up Now

Navigate this Article