E. coli Blog - Surveillance & analysis on e. coli news & outbreaks

As the Register-Guard reported yesterday, I've advised my clients to drop their lawsuits regarding the E. coli outbreak at the 2002 Lane County Fair. Not an easy decision, for me or for my clients, but after doing a lot of research and taking dozens of depositions of Lane County officials, family members of those affected by the outbreak and field experts, I saw no other choice.

From the article:

In 2002, when the Lane County outbreak happened, "airborne or dustborne transmission of E. coli was still a novel concept," Marler said. "Whether that's exactly how these people got the infection, we just don't know. Some washed their hands, others didn't. Some touched animals, others didn't. Some of the children walked through the barns, some never got out of their strollers. We just couldn't pinpoint, `This is what the fair didn't do, this is what they should have done.' Without that, we couldn't win a lawsuit."

He and the families wanted more than just a financial settlement.

"Most state, county and local entities are either immune from lawsuits or have caps on awards," Marler said. "There's very little economic incentive for them to change. I'm not suggesting that all award caps should be removed, but I think government officials should look at these situations as if it were their grandkids who had the problem."

If they did, Kevin Closson believes, it might cut E. coli outbreaks in the future. Closson's daughter, Madeline, then 3, spent two weeks in Legacy Emanuel Hospital in Portland, undergoing daily dialysis treatments for a week and requiring blood transfusions.

"During dialysis ... they suck the blood out, clean it up, cool it down and put it back in," Closson said. "It takes several hours, which is one thing for an adult but way too much for a little child, so they have to put them under anesthesia to do it. At one point, in one day, Maddy was under three times. The money wasn't as big a thing to us as witnessing what all that did to our 3-year-old's body."

Another 4-year-old has been struck with E. coli 0157:H7. Drew's mother thought he had the stomach flu when he started vomiting on Oct. 23. When bloody diarrhea followed, samples tested were negative for E. coli 0157:H7.

When he vomited several times in a 24-hour period with continued diarrhea that contained bloody mucus, Lisa took her son to a local physician's assistant who sent him to Gothenburg Memorial Hospital for intravenous saline solution to combat dehydration and for blood samples.

Once E. coli was diagnosed, Drew began receiving intravenous fluids followed by the insertion of a catheter on Oct. 29 as his kidneys started to fail.

During this time, Drew also received two blood transfusions which boosted his hemoglobin levels. Hemoglobin is the respiratory pigment in red blood cells.

The preschooler was finally released from Good Samaritan on Nov. 5 when there was no more E. coli 0157:H7 evident in his stools. After arriving home, Lisa said Drew battled urinary tract infection from the catheter that was inserted when his kidneys started to shut down.

No one knows what caused the infection.

The News-Observer's recent story on Matthew Baldwin said he was popular among the baby goats and sheep in the petting zoo at the N.C. State Fair.

As the critters nudged and licked his hands, the 3-year-old Lee County boy squealed for more pellets. He'd have been happy to spend the whole day feeding the animals, forgoing the rides and fried goodies and midway games.

But a 45-minute visit to the petting zoo on an October Sunday may have been all the exposure Matthew needed to pick up the E. coli bacterium, turning the Baldwins' happy afternoon celebrating the state's agricultural heritage into a monthlong medical horror.

A few days after the fair excursion, Matthew doubled over with stomach cramps and bloody diarrhea. He was the first of more than 100 people who apparently got sick from E. coli last month in the days after the State Fair, giving rise to a mystery that has yet to be solved.

From the article:

William D. Marler, a personal injury lawyer in Seattle who specializes in contamination cases, said petting zoos are increasingly being identified as sources of E. coli outbreaks. He said the Centers for Disease Control and Prevention has published suggestions to cut exposure, such as providing hand-washing stations with running water and soap -- an amenity that wasn't offered at the State Fair's petting zoos.

Exhibits that fail to take such measures, Marler said, may carry some legal liability, and four North Carolina families have contacted him.

"I don't think we, as the public and people in positions of authority, have taken this seriously," Marler said. "Maybe five years ago nobody really knew about this, and it was novel. But it's far more than novel at this point. There are dozens of outbreaks that have occurred in petting zoos and fairs.

Institute of Food Science & Technology 19.11.2004

Summary

Foodborne illness caused by verocytotoxin-producing E.coli (VTEC) - sometimes referred to as enterohaemorrhagic E.coli (EHEC) - was first recognised in the early 1980s. Although the illness does not appear to be very common, VTEC is now regarded as an important pathogen because serious complications may follow infection. The O157:H7 serotype is the predominant cause in the UK and USA of human infections but other serotypes have also been implicated. In comparison with, for example, Salmonella, numbers of cases appear to be low but they seem to be increasing. Infection may produce a mild diarrhoea, or a severe or fatal illness. The infective dose may be very low.

The main reservoir for VTEC is the bovine intestine. More than half of all the cases in the UK follow environmental transmission, which is particularly important in respect of sporadic cases. Food vectors linked to outbreaks include milk and milk products and ground beef. In recent years apple juice and sprouting seeds have become more frequently implicated particularly in the USA. Water has been responsible for many of the largest outbreaks.

Agricultural fairs and petting zoos pose an inherent public health hazard by bringing the general public into direct contact with various animals, which can carry a host of human pathogens, including E. coli O157:H7.

There's nothing more American than the state fair. Countless millions visit them each year for some up close and personal--sometimes even hands on--time with farm animals. What fair-goers are finding out though, is that petting zoos and livestock exhibitions often harbor the lethal bacteria E. coli O157:H7.

Most people associate E. coli O157:H7 with undercooked hamburgers from fast food restaurants. The problem is not so confined. Infection can occur in a variety of ways, including attendance at a petting zoo, and those most prone to serious illness are our children.

Any place where people come into contact with farm animals must be considered high risk for exposure to E. coli and other pathogens. The track record speaks for itself. Since 1995, fifteen outbreaks of E. coli O157:H7 have been reported at fairs and petting zoos in the United States (see http://www.fair-safety.com).

Hundreds have been sickened. Some, mostly kids, suffer permanent kidney damage due to a complication of E. coli infection called Hemolytic Uremic Syndrome. Some have even died.

New questions are being raised about the source of the E. coli outbreak that has been linked to this year's State Fair. While most of the focus has been on petting zoos, some are questioning whether food vendors could be a possible source.

An anonymous viewer sent pictures to Eyewitness News claiming they show boxes of frozen turkey drumsticks sitting outside on a wooden pallet during the State Fair.

If the pictures are legitimate, and the drumsticks sat out long enough to be warmer than 45-degress, Wake County environmental health specialist, Rebecca Robbins says she would be concerned. "The concerns would definitely be food borne illnesses bacteria such as E. coli, salmonella... it's an important health concern because they do have a severe effect on people such as bloody stool etc."

No new cases of E. coli have been reported to state health officials since Friday, so a command center set up to coordinate the response to the disease outbreak is closing, officials said Monday.

State health officials are investigating 106 suspected cases of E. coli, 41 of which have been confirmed. Nineteen of the confirmed cases are in Wake County.

The North Carolina State Fair has been identified as the source of the outbreak, with almost all of the confirmed cases in people who attended the fair last month in Raleigh.

Although officials continue to investigate where at the State Fair the outbreak may have originated, they said active surveillance for suspected cases of illness related to the outbreak has been discontinued.

The Herald-Sun reports that as of Thursday, 43 people people had tested positive for the bacterial infection, including the three in Chatham County, two in Durham County and one in Person County. At least 27 victims had visited the State Fair in Raleigh Oct. 15 through 24. Officials believe most of the victims came into contact with fecal material from one or more sheep, goats or cattle at the fair.

From the article:

"Although the illness is often associated with eating undercooked ground beef, we suspect these cases may have been contracted through direct contact with live animals," State Epidemiologist Jeffrey Engel said. "Outbreaks are often associated with fairs and petting farms, however we are still exploring every possible source."

As the state continues to track down the source of the disease, Dr. Engel said that residents can help themselves by practicing prevention measures, especially in schools and child day care facilities.

"The best way to reduce the risk of getting E. coli, especially if a friend or family member is sick with the disease, is careful and diligent hand-washing," he said. "Teachers and school officials will want to make sure they have plenty of soap and paper towels for their students. If teachers notice a student who appears to have any of the symptoms associated with E. coli, they should contact the parents as soon as possible."

E. coli is associated with petting zoos because animals carry the bacteria in their intestines. People pick up E. coli by eating contaminated meat or through contact with manure, animals or contaminated surfaces. A number of the cases identified so far have been in contact with farm animals, however public health disease investigators have not yet determined the exact source or sources of the human cases.

Katie Maness, 13, had been diagnosed with an E. coli infection and was a patient at FirstHealth Moore Regional Hospital in Pinehurst.

Nothing could have prepared her mother, Becky Maness, for the shocking news the doctor would deliver: Her daughter's kidneys were failing.

Katie had developed a condition called hemolytic uremic syndrome, a serious complication that occurs in high-risk people such as children and can cause kidney failure, seizures and in some cases death.

Katie is one of 41 people in North Carolina with confirmed cases of E. coli disease. An investigation by the N.C. Department of Health and Human Services has determined that the State Fair, Oct. 15-24, was the source of the outbreak. At least 107 suspected case are under investigation, according to the state.

Katie was discharged last Thursday but had to go back Friday for some lab work. It was determined that her hemoglobin was too low and that she would need a blood transfusion. Doctors re-admitted her to UNC Hospitals overnight. She was finally released Saturday.

Katie, who is an eighth-grader at The O'Neal School, returned to school Wednesday and is going to classes for half days for now.

Most of us have experienced a bout of food poisoning: an episode of stomach pain or upset often associated with diarrhea and in some cases vomiting. Such encounters are usually inconsequential, of limited duration and rarely do we think to bother our general practitioner with them. Most of us assume it's something we have eaten or drunk, shrug it off and get on with our lives. Minor bouts of upset stomachs have become so common as to be something we all expect to experience sooner or later, and we rarely question their origin.

Imagine the following scenario:

It's lunchtime and three customers enter a restaurant. The first eats some meat and has a very severe reaction four days later from a virulent form of salmonella. The second eats chicken and three days later comes down with a bad bout of campylobacteriosis, with diarrhea, fever and vomiting. The third only eats imported cheese and nearly dies a few days later of meningitis. Far-fetched? Not at all. Food poisoning is rampant and it's increasing at an alarming rate.

And the problem is not confined to fast foods.

Potentially lethal bacteria are turning up daily in a wide variety of foods. Salmonella has also been found in other products such as fruit juices, bread and even chocolate.

The Daytona Beach News-Journal did a story today on fairs, petting zoos, and caution in the wake of the E. coli outbreak in North Carolina. Health officials in North Carolina have confirmed 31 cases and are investigating 103 more, with some of the cases linked to a state fair petting zoo.

From the Daytona Beach News-Journal:

There have been no E. coli cases reported in connection with the Volusia County Fair, but Chris Campbell said he wasn't taking any chances. Campbell gave his children, ages 7 and 3, very specific instructions when he lets them loose at the Phillips Petting Zoo.
Jim Phillips, who owns the Missouri-based petting zoo, said a few people have asked him about E. coli since the North Carolina cases were reported, but it hasn't hurt his business in Volusia County. People are still coming in to feed several varieties of fuzzy goats, cattle, llamas and horses.

He sells wet-wipes for 25 cents so people can clean their hands and keeps a sign prominently posted reminding people to use "common sense" and wash their hands after feeding or petting the animals, and before eating.

People who visit the Volusia County Fair can also come into contact with animals at the many agricultural displays, including farm animals at the Old Plantation building, but hand disinfectant is available, said spokesman John Owens.

Unfortunately, hand wipes and common sense aren't always enough. For children who come in contact with the animals, hand washing stations should be available in both the animal free area and the interaction area. An adequate number of hand washing facilities complete with soaps and disposable towels should be provided. The facilities should be accessible, sufficient for the maximum anticipated attendance, and designed for use by both children and adults. Communal basins should not be considered as adequate hand washing facilities.

The Raleigh News-Observer reported today on three sick children, all of whom visited the State Fair petting zoo. The three Orange County children have been added to the list of those sickened by an E. coli infection linked to the N.C. State Fair.

In addition to the three confirmed cases, the county lab is testing 13 other children who may have been infected and expects to have results by the end of the week. Two of the suspected cases are thought to be secondary infections spread among siblings within households, health officials said.

All three Orange County children with confirmed infections -- one elementary school student and two preschool children -- visited the petting zoo at the fair, said Judy Butler, a Health Department nurse. All three became ill within a few days.

State health officials announced Monday that they have collected enough information to identify the State Fair as the source of the E. coli outbreak but have not yet identified a specific exhibit or food vendor. State officials think the outbreak has sickened as many as 112 people statewide.

The First Coast News reports that the Duval County Health department has confirmed its third case of E coli 0157 in children this year. Four year old Emma Kee is the latest to be diagnosed on the First Coast. Her symptoms started with a fever, then bloody diarrhea. Her mom, Trisha Kee says she's concerned it took three days for a hospital to diagnose the particular strain.

Dr. Jeff Goldhagen of the Duval County Health Department says 0157 isn't typically tested for immediately because it's rare, though we've seen three cases in Northeast Florida. Goldhagen says it takes two cases where the patients are linked through one source for the county to declare an outbreak. In the three cases so far, there were no points of commonality. "Not where they ate, took field trips or even animals they touched."

Kee encourages parents to ask as many questions as possible and ask specifically for an E coli 0157 test.

Montanans, remember this name: John Munsell.

Munsell, owner of Montana Quality Foods meat packing plant in Miles City, has just dropped a bomb of a lawsuit on the United States Department of Agriculture (USDA) that, if successful, could bring about the most significant changes to America's meat-inspection system since the Federal Meat Inspection Act of 1906 tried to limit the amount of crap one could legally shovel into a sausage.

Munsell's family-owned operation was shipped beef contaminated with E. coli from the multinational ConAgra corporation as early as January 2002, but when Munsell notified the USDA's Food Safety and Inspection Service (FSIS), the government responded by making him rewrite his Hazard Analysis Critical Control Point plan 14 times and pay for additional testing while suspending him from grinding his own beef for four months.

Convinced he could prove the contamination originated at another source, Munsell even penned an e-mail to a USDA district office manager in Minneapolis in which he wrote, "If you and I, realizing all the details now, cover this up and do nothing about it and somebody gets sick as a result, then you and I need to share a cell in Alcatraz." (see "Watching the inspectors," Aug. 7, 2003). It later turned out that as Munsell had suspected, ConAgra's beef was indeed contaminated, and the end result was a 2002 recall of nearly 19 million pounds of ConAgra beef--one of the largest beef recalls in history--and plenty of red faces at the USDA.

State health officials today announced that they have collected enough information from the ongoing E. coli disease investigation to identify the state fair as the source of the outbreak. Health officials stressed that while a specific exhibit or concession within the state fair cannot yet be identified, the disease investigation can now focus on the most likely sources. In addition, state agriculture officials continue to assist with public health efforts.

"More than 90 percent of the E. coli cases we've investigated during this outbreak were contracted during the time period of the state fair," State Epidemiologist Jeffery Engel said. "We have also determined that a large majority of the people who tested positive for E. coli during this time period indicated that they had attended the state fair. As our investigation continues we will attempt to determine the exact source or sources of the outbreak."

At the time this news release was written, health officials were investigating 112 cases. A number of cases reported earlier have been dropped from the investigation because genetic testing conducted by the State Laboratory of Public Health determined that those cases are not associated with this specific outbreak.

The Herald-Sun reports that three young children in Orange County now have been diagnosed with E. coli, and health officials are awaiting lab results on nearly a dozen more.

All three children, a 5-year-old who attends Glenwood Elementary School and two who are in preschool, are doing fine, said Rosemary Summers, the county's health director.

All three confirmed cases are linked to an E. coli outbreak at a petting zoo at the State Fair. Across the state, public health officials are investigating an outbreak of E. coli that has been confirmed in 35 people and is suspected to have infected 77 others in the state.

Along with the three cases in Orange County, there are 11 more people who were tested after exhibiting symptoms of the illness. Those test results should start trickling back in later this week, Summers said.

The Marler Clark-sponsored Web site about Fair Safety is a great resource for people who are researching how to prevent outbreaks at fairs, and for those who are researching previous fair outbreaks. It can be found at http://www.fair-safety.com.

The University of Alabama at Birmingham Children's Hospital is treating several children with E. coli bacterial infection.

Jeremiah McCord, 2, was at the hospital undergoing kidney dialysis because of HUS. It's his third treatment. Jeremiah is one of seven children in the last month, five in the last week, to be treated at the Children's Hospital for the infection.

No one knows how Jeremiah or the other six children contracted E. coli, but it's most commonly found in the intestines of cows and typically spreads in undercooked ground beef.

The Herald-Sun reports that a Glenwood Elementary School student has been infected with E. coli. The student is doing fine, and will return to the school as soon as laboratory tests have confirmed the infection is fully resolved, according to a news release issued by the district.

State officials, meanwhile, are investigating 20 confirmed cases of the infection that may be related to a petting zoo at the state fair last month. It was unclear Friday if the Glenwood student was one of those cases, or whether he or she had visited the fair.

The Associated Press reports that North Carolina has confirmed more cases of infection with the E. coli bacteria, raising the total to 24 victims and 14 suspected cases Thursday.

Health officials are awaiting genetic tests on some of the bacteria to see whether the cases are related. So far, the most common link among victims is that some visited the State Fair last month.

Of the 38 cases being examined, at least 15 have some link to the State Fair and one person attended the Cleveland County fair. Seven people did not go to the fair, and investigators are awaiting information from others.

"If it does turn out to be a petting zoo, there are thousands of people who were exposed, and they are widespread," said Dr. Jeffrey Engel, state epidemiologist. "People came to visit from other states."

Durham County Health Director Brian Letourneau confirmed Tuesday that the 2-year-old Durham child was infected with a virulent strain of the common Escherichia coli (E. coli) bacterium. There are various forms of the bacteria, often found in feces and the digestive tracts of mammals, including humans.

State and county health officials, however, are still trying to pinpoint the cause of the recent outbreak. A children's petting zoo at the N.C. State Fair is suspected in some cases, but Letourneau said it's possible there might be more than one source.

The Associated Press reported today that North Carolina health officials have confirmed that 17 people have been infected with E. coli, a highly contagious bacteria that commonly lives inside of animals. Ten additional cases are suspected, the state Department of Health and Human Services said Tuesday. At least 14 of the cases have ties to the State Fair petting zoo, health officials reported Monday.

That theory remains in question, though, because two people infected in Mecklenburg County got sick in early October, well before the Oct. 14 fair opening.

From the article:

"It's going to be tough" to trace the source, said state epidemiologist Dr. Jeffrey Engel.

The victims are mostly children from across the state: Chatham, Cleveland, Durham, Harnett, Lee, Mecklenburg, Wake, Wilson and Union counties. State officials have sent the stricken families a 14-page survey, asking where the victims had been, what they had eaten and with whom they had come in contact in the days before becoming sick.

Scientists at the state laboratory are running DNA tests of the bacteria that infected the victims to determine whether the cases are related. Results might be available later this week.

The petting zoo had goats and sheep, animals that carry E. coli in their intestines. The bacteria is passed to humans through feces.

Testing on the animals has not occurred, because the link to the petting zoos has not been confirmed.

Agriculture Department officials said they have contacted the two firms that ran the petting zoos during the 10-day fair. One company, Commerford and Sons, has headed to its next show in South Carolina. The other, Crossroads Farms, only does a few shows a year.

"I'm not sure what actions they are taking," said Brian Long, an Agriculture Department spokesman. "They are aware that there are cases in North Carolina, and that the State Fair is a commonality in some of those cases. We're waiting to hear some determination from public health at this point."

It's unclear what the state would do if the cases are linked to one of the petting zoos.

At least seven people, most of them children, have been infected by E. coli in an outbreak that may point to the North Carolina State Fair's petting zoo.

State health officials alerted local physicians, health departments and hospitals this weekend to be on the lookout for more cases. Doctors already are awaiting test results in several other suspected cases. Health officials are also urging parents to keep sick children at home.

E. coli -- a type of bacteria found in the intestines of otherwise healthy livestock -- are spread through feces and can cause severe nausea and bloody diarrhea. An infection can be particularly harmful to young children.

Nearly all of the confirmed cases are children, state officials said. Of the confirmed cases, two are in Wake County, two are in Lee County, one is in Wilson County and two are in Mecklenburg County.

State Fair officials have tried to alert the owners of the petting zoo animals, R.W. Commerford and Sons of Connecticut, of a potential problem. These animals -- goats, lambs, pigs and a few zebras and antelope -- travel the fair circuit up and down the East Coast, State Fair manager Wesley Wyatt said.

At least 2 suspected E. coli cases are linked to the state fair in Raleigh. State officials Sunday night said they have confirmed seven cases of E. coli in four counties, including two in Mecklenburg, the Charlotte Observer reports.

A spokeswoman said state health officials are investigating last month's fair in Raleigh as one possible cause of at least two confirmed Wake County cases, and a third suspected case.

From the article:

"There are three cases that seem to have that in common, but the investigation is not yet done," said Carol Schriber, a spokeswoman for the state Department of Health and Human Services.

The fair ran from Oct. 15 to 24, and drew more than 800,000 people.

Schriber said most of the confirmed cases were children, including the three Wake County cases.

Wake, Lee and Mecklenburg counties each have two confirmed cases, state officials said in a statement. Wilson County has one.

Lee County health officials are warning the public to take necessary precautions after two cases of E. Coli were discovered on the same day. The two cases were found in unrelated individuals - a small child and an adult, both of whom are recovering - whose paths have apparently not crossed in the past 10 days. That has stumped health officials trying to determine the cause of the bacterial disease.

Roy Warren, a county environmental health official, said investigators don't know if the cases are related. Although this is the first known E. Coli outbreak ever in Sanford or Lee County, Warren said investigators haven't found any commonalities in the places the two victims ate or even bought groceries.

Dangerous food potentially stays on shelves too long because of ineffective recalls, a congressional watchdog agency warns.

The McClatchy Washington Bureau reports less than half of the recalled food studied was actually returned or destroyed, the Government Accountability Office noted in its new study. Moreover, federal officials can't issue mandatory recall orders for food - a power other agencies have over dangerous toys or medical devices.

"Consumers may be vulnerable to serious illness, hospitalization, and even death, in part, because of weaknesses in (federal) programs for monitoring companies' recalls of unsafe food," the GAO said.

Even so, some of the proposed solutions might cause gagging among California's politically attuned food processors. In particular, the GAO is urging Congress to grant the Agriculture Department and Food and Drug Administration the authority to flat-out order food recalls.