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Am Fam Physician. 1998;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.

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.

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This series is coordinated by Kenny Lin, MD, MPH, deputy editor.

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