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

A study published in the British Medical Journal revealed that of 88 children who had contracted hemolytic uremic syndrome (HUS) between 1966 and 1985:

•    31% had protein in their urine (proteinuria)
•    18% had decreased glomerular filtration rate (GFR)
•    10% had proteinuria, decreased GFR, and hypertension
•    3% had end stage renal disease without ever recovering kidney function.
 

In addition, the study found that those patients on dialysis longer resulted in reduced GFR. A study published in The Journal of Pediatrics discussed the long-term outcome and prognostic indicators in HUS. In this study, 61 children with HUS prior to 1983 were studied. The study determined that the duration of nonpassage of urine dictated whether or not the patient would develop HUS. Patients with decreased production of urine (oliguria) that lasted for more than 2 weeks developed HUS. In addition, patients with absent production of urine (anuria) for more than 1 week developed HUS.

A study published in Pediatric Nephrology revealed that anuria for more than 1 week and hypertension during that phase would result in loss of nephrons (responsible for filtering blood in the kidneys). Loss of nephrons would cause hyperfiltration in the parts of the kidney that still did work, resulting in progressive renal disease and kidney failure.

1. Tonshoff B., Sammet A., Sanden I., Mehls O., Waldherr R., Scharer K., Outcome and prognostic determinants in the hemolytic uremic syndrome of children.

"The rate of recovery correlated with the degree of oligoanuria.... The proportion of patients who recovered was lower in the presence of severe hypertension during the acute phase...."

2. De Jong M., Monnens L. Haemolytic-uremic syndrome: A 10 year follow-up study of 73 patients.

"All six patients belonging to the third group (oliguria for more than 14 days or anuria for more than 7 days) had late sequelae: two started dialysis more than 10 years after the initial phase; three had decreased GFR and concentrating capacity."

3. Gagnadoux MF., Habib R. Long-term prognosis of childhood HUS.

"after follow up of 15 to 20 years, about 25% of patients affected with typical HUS in their childhood present with some degree of renal impairment. 10% being in advanced renal failure."

4. Kelles A., VanDyck M., Proesman W. Childhood HUS: long-term outcome and prognostic features.

"severe hypertension, anuria lasting more than 7 days and central nervous system involvment have all been said to be associated with poor outcome that means early death and end-stage renal failure."

According to the Associated Press, a researcher at Texas Tech University applied a mixture of four different lactic acid bacterium to ground beef and found the combination reduced the presence of salmonella and a harmful E. coli strain by as much as 99.99 percent.

Researcher Mindy Brashears said the mixture is the first post-production treatment that continues to work. It was effective for up to 60 days in frozen ground beef and about a week in refrigerated beef, Brashears said.

The study also showed the mixture doesn't affect how meat tastes.

Brashears' study was published in the Journal of Food Safety. The mixture will be marketed by Indianapolis-based Nutrition Physiology Corp.

The Food and Drug Administration said the mixture was safe for beef and poultry products. It isn't known when the treated meat carrying special labels will hit the market, and basic food safety practices will not be changing for the time being.

A preliminary investigation report released by the Ohio Department of Health pointed to contaminated fruit served at seven catered events in the Toledo area as the source of an E. coli O157:H7 outbreak that sickened 14 people and killed one woman last September. Two people developed hemolytic uremic syndrome, a complication of E. coli infection that can lead to organ failure, central nervous system impairment, and death.

The Centers for Disease Control and Prevention (CDC) continues to investigate the outbreak, but Ohio health officials note in the preliminary report that, "Although other possibilities exist, findings suggest that the fruit may have been contaminated during preparation." In fact, two people in Wisconsin who tested positive for a genetically indistinguishable strain of E. coli as that isolated from outbreak case-patients in Toledo reported consuming undercooked ground beef before becoming ill.

Courtney Duquette wrote a strong letter to The Ontarion at the University of Guelph, regarding the actions of restaurant workers at the Grill House on the University campus.

She witnessed one worker use her bare hands to handle raw hamburger meat, and then, without washing her hands, handling the hamburger buns. The students were then given the assembled hamburger and sent on their way.

Duquette felt as though the restaurant worker had no understanding of the possibility of E. coli contamination that could have happened from handling the hamburger buns after touching raw meat.

She ends her letter, "In my opinion, I should not even have to be writing this letter. It is common sense... that one should wash one's hands after having touched raw beef, or any other raw meat for that matter." She hopes that the University feels the same way, and keeps the health of their students and employees in mind.

Foodservice.com's Lacie Thrall posted a great quiz about food safety in regards to beef preparation on the website. The beef industry has been making strong steps to protect our beef supply, although we still have some foodborne outbreaks from bacteria such as Salmonella, E. coli, and Listeria.

Restaurants and consumers are the last step in the safety chain of events for our food supply, so the quiz is a great way to educate yourself:

Question: The muscle tissue of healthy cattle is sterile. True or false?
Answer: True. Muscle tissue of healthy cattle is virtually sterile, so the main way bacteria invade is during processing, handling and preparation.

Question: Beef must stay cold to help prevent spoilage and bacterial growth. Beef freezes at 28 degrees F. If we refrigerate beef, will bacteria grow on it? Yes or no.
Answer: Yes. Bacteria still grows in refrigeration, but a much slower rate. Bacteria double every 6 hours at 40 degrees F and every hour at 50 degrees F. For beef, store it very cold (optimum 35 to 28 degrees F) to extend the shelf life and slow spoilage bacteria.

Question: US Dept. of Agriculture inspects and grades the domestic meat supply. USDA beef inspection is mandatory for wholesomeness. Grading of beef is for palatability (tenderness, juiciness, and flavor when cooked.) Is USDA grading of beef mandatory in the U.S? Yes or no.
Answer: No. USDA inspection of beef is mandatory, but grading is a voluntary program paid for by the meat packers and ultimately the consumer for the better cuts. Grading sets standards of quality and yield used in the buying and selling of beef.

Question: Selection of quality cuts of beef is an important factor. According to USDA, how many "grades" of beef are there? (3, 5, or 8 grades.)
Answer: There are 8 USDA quality grades -- Prime, Choice, Select, Standard, Commercial, Utility, Cutter, and Canner. Muscle firmness, color and texture, maturity and marbling are the factors that determine quality grades. The top three quality grades (Prime, Choice and Select) are the ones most familiar to consumers. Prime is typically sold to restaurants, although some specialty markets may carry it. Choice is the most widely available grade in the market followed by Select.

Question: E. coli is a bacteria known for foodborne outbreaks associated with beef via cross-contamination. It is commonly found in the intestines of warm blooded animals (cattle, pigs, etc.) and humans. There are about 600 types or strains of E. coli. Do all strains of E. coli bacteria cause foodborne illness? Yes or no.
Answer: No. Most are harmless. Only 4 of the 600 E. coli strains are known to be pathogenic (disease causing), including E. coli 0157:H7 in beef. The concern is that E. coli 0157:H7 is a very low dose pathogen, meaning it takes very few (10-100) to cause illness, compared to other types of bacteria. It has been the cause of serious health complications and even death in victims.

Question: Which cut(s) of beef are more susceptible to E.coli contamination? (steak / roasts / prime rib / ground beef / or all cuts.)
Answer:All can be contaminated on the outer surface in processing, but whole cuts such as steak and roasts are safer because proper cooking temperatures kill all forms of E. coli on the surface. Ground beef is at the greatest risk because surface bacteria are transferred to the interior of the meat during grinding and must get to a higher internal temperature to kill the bacteria.

Question: A stem thermometer is recommended for checking the internal temperature of cooked beef. According to the FDA Food Code, what safe minimum temperature(s) do we cook steak and ground beef to? (125 degrees F / 145 degrees F / 155 degrees F.)
Answer: Minimum internal cooking temperature for beef steak is 145 degrees F for 15 seconds and ground beef is 155 degrees F for 15 seconds. A-8. No -- not unless the tray and tong is washed and sanitized between the raw and cooked steps. In a food service establishment or home kitchen, educate yourself and your crew about cross-contamination prevention.

An abstract in the April 2006 Journal of Food Protection discussed a Spanish study that investigated the presence of E. coli O157:H7 in raw ewe's milk collected from several cheese factories over a period of one year.

Of all the ewe's milk samples studied, three were positive for E. coli O157:H7.

The E. coli O157:H7 strains that were positive were then analyzed for the presence of virulent genes. All E. coli O157:H7 isolates were Shiga toxigenic and harbored additional genes related to virulence.

The results demonstrate that raw ewe's milk used in cheesemaking may be sporadically contaminated with E. coli O157:H7 strains that are potentially pathogenic for humans.

An abstract in the April 2006 Journal of Food Protection discussed the effects of whey protein isolate coatings incorporating a lactoperoxidase system on the inhibition of Salmonella and E. coli O157:H7 on roasted turkey.

Initial inhibition as well as inhibition during storage were tested. The antimicrobial effect was observed regardless of whether the turkey was inoculated before or after coating.

LPOS-WPI coatings inhibited the growth of both Salmonella and E. coli O157:H7 in turkey at both 4 and 10 degrees C for 42 days. The inhibition was more pronounced when the coating was formed on the surface of the turkey prior to inoculation. LPOS-WPI coatings also retarded the growth of total aerobes during storage.

The U.S. Department of Agriculture's Food Safety and Inspection Service has issued a public health alert to remind consumers to ensure that meat products are fully cooked and properly handled before they are consumed.

Safe steps in food handling, cooking, and storage are essential to prevent foodborne illness. There have recently been reports of E. coli-related illnesses in California, Iowa, New York, Ohio, Michigan, Rhode Island and Wisconsin.

Consumers should follow the four "Fight BAC!" guidelines to keep food safe:

CLEAN: Wash hands and surfaces often

Wash your hands with warm, soapy water for 20 seconds before and after handling food. Wash your cutting boards, dishes, etc., with hot, soapy water after preparing each food item. Wash fruits and vegetables with cold water before using. There is no need to wash or rinse meat or poultry.

SEPARATE: Don't cross-contaminate

Separate raw, cooked, and ready-to-eat foods while shopping, preparing, or storing. Never place cooked food on a plate which previously held raw meat, poultry, or seafood.

COOK: Cook food to proper temperatures

To be sure bacteria and pathogens are destroyed, cook ground beef products to 160 degrees F. Use a food thermometer to be sure!

CHILL: Refrigerate Promptly

Refrigerate or freeze perishables, prepared foods, and leftovers within 2 hours or sooner.

A rapid method for detecting and identifying very small numbers of diverse bacteria, from anthrax to E. coli, has been developed by scientists from the National Cancer Institute and National Institute of Standards and Technology.

MyDNANews of Maryland reports that the work was published in the March 28 issue of Proceedings of the National Academy of Sciences. The new method may lead to the development of handheld devices to be used for faster identification of biological weapons as well as antibiotic-resistant or virulent strains of bacteria.

Traditional methods could take hours or even days. The new method can detect and identify cells in only about an hour.

A provisional patent application has been filed originally through NIST, and a non-provisional patent application was filed more recently through the National Institutes of Health, the parent agency of NCI.

In September 2005, Hercules Tsirovakas tested positive for E. coli infection. Questions posed to his uncle resulted in the information that Tsirovakas has purchased two packages of 75% lean ground beef at the Stop & Shop Grocery Store in Manchester, New Hampshire.

Since there were leftover hamburger meat still at the residence, Tsirovakas' uncle delivered the product to the New Hampshire Department of Health and Human Services for testing. In addition, the City of Manchester Department of Health sent a specialist to the Stop & Shop.

Investigators found all seven samples submitted tested positive for E. coli O157:H7.
The Stop & Shop issued a Public Health Advisory and recall regarding the ground beef sold at their grocery store.

Because the Stop & Shop did not keep records of what pieces of meat were ground and added to its hamburger meat, the USDA was unable to trace back the source of the E. coli contamination to a single beef source. No additional cases of E. coli infection was reported, and the case was closed in October 2005.

In September 2005, a large number of E. coli O157:H7 infections in King and Pierce Counties in Washington revealed contaminated parsley used at an Olive Garden restaurant.

Later that same month, more infections surfaced, from parsley used at three other Olive Garden restaurants and The Boat Shed restaurant.

In October, more than 20 customers at McGrath's Fish House also reported incidents of E. coli poisoning. Parsley was again determined to be the source of the outbreak.

Investigators initiated a trace-back of produce suppliers to determine which supplier provided the parsley to the restaurants. The investigation lead to a single grower in Oregon. The Washington Department of Health as well as the Oregon Department of Agriculture were notified.

In September of 2003, a report of several male patients testing positive for E. coli O157:H7 was reported to the St Clair County Health Department. All patients had eaten at a Habaneros Mexican Restaurant located in the St Claire Square Mall.

The SCCHD also received other reports of people having similar symptoms after having eaten at the same restaurant, and a foodborne outbreak investigation was conducted. The restaurant agreed to voluntarily cease operations while the foodborne outbreak investigation was underway.

On-site investigations of the restaurant revealed that the temperature of ground beef hot held on the steam table was acceptable, but inadequate cooling of ground beef cooked two days earlier was noted. The walk-in cooler was also so crowded that air could not circulate around meat containers.

Employees were instructed to cook meat in smaller batches, which would allow for more rapid cooling.

Three days after several people reported having E. coli poisoning, the Salem, Oregon, Wendy's was voluntarily closed for being the source of the outbreak. Additional testing confirmed an additional case at a Wendy's restaurant in Tualatin, Oregon.

A health department investigation revealed that cross contamination from contaminated ground beef was the outbreak source, where meats and multiple salad bar items were prepared in close proximity to each other. Whereas the meats may have been cooked to health specifications, any contaminated salad bar items were not.

Marion County Inspectors found several food-handling problems that likely resulted in the cross-contamination:

• Food-preparation staff soaked lettuce in the first compartment of a three-compartment sink that was used to rinse bloody-meat-juice-covered pans in which raw hamburger patties had been held, without cleaning and sanitizing the sink between uses.

• Food-preparation staff used a cleaning and sanitizing "wet towel, dry towel" process, whereby a shelf above the grill that held raw hamburger patties was wiped clean first with a dry towel, then with a sanitized-soaked wet towel. The dry, bloody-meat-juice-soaked towel was used for hand wiping in both the grill area and the sandwich assembly area (where raw products are placed on cooked burgers).

• Poor hand washing was observed.

Prior to reopening, the restaurant was required to do the following:

• Hand wash Sink/Produce sink in Prep area to be switched to improve accessibility at back prep area hand washing.

• A new hand wash sink will be provided in the grill/sandwich prep area.

• All open foods/not sealed will be removed from the facility and replaced with new product.

• A new utensil washing system will be installed.

• A barrier will be provided to separate the grill from the sandwich assembling area.

• In the near future, a food preparation sink will be installed at the baked potato station.

• Prior to reopening, training and re-orientation will be provided to all staff over food preparation procedures.

• Increased monitoring of cooking hot/cold holding, sanitizer rotation and towel rotation.

In May of 2002, the Rockland County Health Department was alerted to a sudden increase in E. coli O157:H7 infections in their residents. A common denominator in all the cases was the purchase of ground beef products at area BJ's Wholesale Club stores.

Laboratory testing of purchased ground meat products confirmed the presence of E.coli O157:H7 in their ground beef. However, since the products that tested positive initially were handled by consumers prior to testing (handmade meatballs), there was no way to determine if the E. coli was present before handling.

Later, an unopened package of 90% lean ground beef from BJ's was submitted and tested for E. coli. A positive test result yielded a small recall effort by BJ's Wholesale Club, who mailed a notification letter only to those individuals who had purchased the ground beef at their West Nyack store between May 8 and May 13 of 2002.

From a cluster of cases reported by the City of Milwaukee Health Department, 64 confirmed cases of E. coli O157:H7 were linked to area Sizzler restaurants - 62 in Layton and 2 in Mayfair. Of those infected, 4 people developed hemolytic uremic syndrome and 1 person died. In addition, there were reports of 551 probable cases and 122 possible cases of infection.

Samples from both restaurants were matched to the strain of E. coli found in patients, notably from the chunky taco meat and sirloin tri-tips. The meat was manufactured by the Excel Corporation, but were remanufactured by Sizzler chefs at individual franchise restaurants as part of their food preparation.

Although cross-contamination events are difficult to confirm, the State Department of Health speculates that raw watermelon may have been the vehicle for infection. The watermelon was contaminated when cut with the same tools as the infected raw sirloin tri-tip. Whereas the tri-tip may have been cooked according to health guidelines, the watermelon remained infected.

Sizzler has had several other incidents of E. coli outbreak in its history, all with similar examples of cross-contamination, where raw meats and multiple salad bar items were prepared in close proximity to each other.

Since the outbreaks, Sizzler has started to utilize pre-cut meats rather than prepare them in their kitchens. However, this does not necessarily mean that measures to eliminate cross-contamination have been implemented.

The Minnesota Department of Health issued a press release in December 2000, regarding 17 residents who had been sicked with E. coli O157:H7.

MDH's final report on the outbreak linked the infections to contaminated ground beef that was sold at SuperValu/Cub Foods, who issued a recall on the products.

The contaminated ground beef was manufactured at American Food Group, who also issued a recall. The 1.1 million pounds of recalled beef was processed in Wisconsin.

Wisconsin Department of Public Health also linked three cases of E.coli infection in their state to the same beef.

The USDA Food Safety and Inspection Service also noted that AFG had been told to recall 1,000 pounds of beef two years earlier, when meat contaminated with E. coli was found at a Cub Foods store in Chicago, Illinois. AFG had also issued a recall for over a half a million pounds of ground beef in 2001.

Dungeness Valley Farm is the latest dairy to start providing raw milk to the public, according to Sequim-Dungeness Valley editor Diane Urbani de la Paz.

Since 1992, their milk had been processed by Darigold, which included homogenizing and pasteurizing the milk. With the cutting of ties with Darigold, the farm also changed their name to Dungeness Valley Creamery.

This week, the farm will undergo a series of US Department of Agriculture inspections, which is required prior to licensing. The license is required in order to sell raw milk.

Despite the recent E. coli outbreak at an unlicensed dairy that provided raw milk, the owners are optimistic about the demand for unpasteurized milk. Orders are already coming in as well as inquiries into their product.