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

The Bakersfield Californian reports that California State Senator Dean Florez will introduce controversial food safety legislation in the California legislature tomorrow. The legislation, which is being proposed in three separate bills, would:

1. Allow the Department of Health Services to assess fees on all growers of leafy green vegetables.
2. Require the Department of Health Services to set standards for members of the produce supply chain, such as growers, shippers, and processors, to minimize the danger of contamination with E. coli and other foodborne pathogens, and would outlaw the use of unprocessed manure as fertilizer on food crops.
3. Require the food industry to implement a trace-back system so that individual packages of fresh produce can be traced back to the fields they were grown in.
    

"This will start a real conversation about the food safety rules that we have to have in California," said the senator.

Senator Florez will hold a press conference tomorrow, where Marler Clark clients Ken and Pauline Costello will add their remarks on the new legislation.  Pauline Costello's mother, Ruby Trautz, passed away after eating contaminated spinach in September.
 

With absolute certainty, another E. coli outbreak will explode, a visiting lecturer said Thursday.

John Besser, a clinical laboratory manager for the Minnesota Department of Health, was recently the guest lecturer a the University of Iowa. The MDH investigated an E. coli outbreak that had been traced to lettuce served at Taco John's restaurants in Austin and Albert Lea, Minnesota, as well as in Cedar Falls, Iowa.

Though a recent outbreak was traced back to spinach grown in California, E. coli is not limited to the leafy plant. It is becoming prominent in a number of substances, said Besser. Last fall, an E. coli outbreak ripped across the United States, killing three and causing 31 cases of hemolytic uremic syndrome, which shuts down the kidneys.

Since there has been an increase in E. coli outbreaks traced to leafy greens and other produce, experts are predicting future outbreaks. Consumer advocacy groups have stepped into the debate over what can better be done to protect the public from E. coli and other harmful pathogens.  The Consumer Reports blog posted the Consumers Union opinion about California produce growers' intent to publish marketing guidelines for crops:

Costco now requires suppliers to random test spinach at the processing plant, including for E. coli 0157:H7 and salmonella, another bacteria that can cause serious infections in some people. Within weeks, Costco expects similar testing for other bagged and ready-to-eat products, such as lettuce salads and baby carrots.

Shortly after the spinach outbreak, Natural Selection Foods, which processed the implicated spinach, started random testing of raw product for E. coli and salmonella. This month, it started testing finished product, too.

The United Fresh Produce Association has asked for federal oversight of the produce industry. Now, the FDA regulates processing plants but only gives growers guidelines.
 

Fresh spinach contaminated with E. coli bacteria led to the death of Elizabeth "Betty" Howard of Richland, said her attorney, William Marler of Seattle.

Howard, 83, contracted E. coli O157:H7 from eating bagged spinach in September, the state Department of Health said.

The Tri-City Herald reports that Benton County Coroner Rick Corson said the cause of death still was under investigation. He said it was premature to say the E. coli infection caused her death, but it is a possibility that's being investigated. Corson said there were other age-related health issues that may have been contributing circumstances.

The elderly are far more susceptible to the lethal complications of disease, particularly E. coli O157:H7, than most.  Death rates for infectious diarrheal disease alone are five times higher in people over 74 years of age than in the next highest group, children under four years of age, and fifteen times higher than the rates seen in younger adults.

Published studies attribute the elderly’s heightened risks, both of infection and mortality due to infectious disease, to several factors:  the aging of the gastrointestinal tract (reduced gastric acidity/mobility), a higher prevalence of underlying medical disorders (co-morbidity factors), and immune system changes that leave the host less able to defend itself against infectious agents.
 

The Moose Jaw Times Herald reports that fair organizers are increasingly addressing issues related to human-animal interaction.

The Western Fair that year had 61 cases of E. coli traced back to fair barns with seven confirmed cases, one leading to severe kidney illness. Since 2004, at least seven U.S. fairs have been sued over E. coli outbreaks traced to livestock events at fairs.

Cows are not the only culprit.  Sheep, goats, and other animals also carry harmful E. coli in their intestinal tracts.
 

See www.about-ecoli.com

E. coli O157:H7 was identified for the first time at the CDC in 1975, but it was not until seven years later, in 1982, that E. coli O157:H7 was conclusively determined to be a cause of enteric disease. Following outbreaks of foodborne illness that involved several cases of bloody diarrhea, E. coli O157:H7 was firmly associated with hemorrhagic colitis.

The Centers for Disease Control and Prevention (CDC) estimated in 1999 that 73,000 cases of E. coli O157:H7 occur each year in the United States. Approximately 2,000 people are hospitalized, and 60 people die as a direct result of E. coli O157:H7 infections and complications. The majority of infections are thought to be foodborne-related, although E.coli O157:H7 accounts for less than 1% of all foodborne illness.

E. coli O157:H7 bacteria are believed to mostly live in the intestines of cattle but have also been found in the intestines of chickens, deer, sheep, goats, and pigs. E. coli O157:H7 does not make the animals that carry it ill; the animals are merely the reservoir for the bacteria.

While the majority of foodborne illness outbreaks associated with E. coli O157:H7 have involved ground beef, such outbreaks have also involved unpasteurized apple and orange juice, unpasteurized milk, alfalfa sprouts, and water. An outbreak can also be caused by person-to-person transmission of the bacteria in homes and in settings like daycare centers, hospitals, and nursing homes.

Symptoms of E. coli O157:H7 infection

E. coli O157:H7 infection is characterized by the sudden onset of abdominal pain and severe cramps, followed within 24 hours by diarrhea. As the disease progresses, the diarrhea becomes watery and then may become grossly bloody - bloody to naked eye. Vomiting can also occur, but there is usually no fever. The incubation period for the disease (the period from ingestion of the bacteria to the start of symptoms) is typically 3 to 9 days, although shorter and longer periods are not that unusual. An incubation period of less than 24 hours would be unusual, however. In most infected individuals, the intestinal illness lasts about a week and resolves without any long-term problems.

Hemolytic Uremic Syndrome (HUS) is a severe, life-threatening complication of an E. coli O157:H7 bacterial infection. Although most people recover from an E. coli O157:H7 infection, about 5-10% of infected individuals goes on to develop HUS. E. coli O157:H7 is responsible for over 90% of the cases of HUS that develop in North America. Some organs appear more susceptible than others to the damage caused by these toxins, possibly due to the presence of increased numbers of toxin-receptors. These organs include the kidney, pancreas, and brain. Visit the Marler Clark sponsored Web site about Hemolytic Uremic Syndrome for more information. www.about-hus.com

Thrombotic Thrombocytopenic Purpura (TTP) is a clinical syndrome defined by the presence of thrombocytopenia (low blood platelet counts) and microangiopathic hemolytic anemia. This has generally been recognized as ìadult HUS.î There are many possible causes, including E. coli O157:H7, all of which act through the common mechanism of inducing endothelial cell damage. The damage triggers a cascade of biochemical events that ultimately leads to the characteristic feature of TTP - widespread dissemination of hyaline thrombi, composed predominantly of platelets and fibrin, which block the terminal arterioles and capillaries (microcirculation) of most of the major body organs, commonly, the heart, brain, kidneys, pancreas and adrenals. Other organs are involved to a lesser degree. The pathophysiology of this disease results in multisystem abnormalities and the clinical manifestations of the syndrome. To learn more about Thrombotic Thrombocytopenic Purpura, visit the Marler Clark sponsored Web site about TTP. www.about-ttp.com

Detection and treatment of E. coli O157:H7

Infection with E. coli O157:H7 is usually confirmed by detecting the bacteria in the stool of the infected individual. Antibiotics do not improve the illness, and some medical researchers believe that medications can increase the risk of complications. Therefore, apart from good supportive care, such as close attention to hydration and nutrition, there is no specific therapy for E. coli O157:H7 infection. The recent finding that a toxin produced by E. coli O157:H7 initially greatly speeds up blood coagulation may lead to medical therapies in the future that could forestall the most serious consequences. Most individuals recover within two weeks.

Preventing E. coli O157: H7 infection

Eating undercooked ground beef is the most important risk factor for acquiring E. coli O157:H7. Cook all ground beef and hamburger thoroughly. Because ground beef can turn brown before disease causing bacteria are killed, use a digital instant read meat thermometer to ensure thorough cooking. Hamburgers should be cooked until a thermometer inserted into several parts of the patty, including the thickest part, reads at least 160∫ F. Persons who cook ground beef without using a thermometer can decrease their risk of illness by not eating ground beef patties that are still pink in the middle. If you are served an undercooked hamburger or other ground beef product in a restaurant, send it back for further cooking.

Avoid spreading harmful bacteria in your kitchen. Keep raw meat separate from ready-to-eat foods. Wash hands, counters, and utensils with hot soapy water after they touch raw meat. Never place cooked hamburgers or ground beef on the unwashed plate that held raw patties. Wash meat thermometers in between tests of patties that require further cooking.

Drink only pasteurized milk, juice, or cider. Commercial juice with an extended shelf life that is sold at room temperature (such as juice in cardboard boxes or vacuum-sealed juice in glass containers) has been pasteurized, although this is generally not indicated on the label. Most juice concentrates are also heated sufficiently to kill pathogens.

Wash fruits and vegetables thoroughly, especially those that will not be cooked. Children younger than 5 years of age, immunocompromised persons, and the elderly should avoid eating alfalfa sprouts until their safety can be assured. Methods to decontaminate alfalfa seeds and sprouts are being investigated.

Drink municipal water that has been treated with chlorine or other effective disinfectants, or bottled water that has be sterilized with ozone or reverse osmosis (almost all major brands use one or the other method).

Avoid swallowing lake or pool water while swimming, especially pool water in public swimming facilities.

Avoid petting zoos and other animal exhibits unless there are good hand washing facilities available and other sanitation measures have been taken. Wash your hands and your childrenís hands after handling animals.

Make sure that persons with diarrhea, especially children, wash their hands carefully with soap after bowel movements to reduce the risk of spreading infection, and that persons wash hands after changing soiled diapers. Anyone with a diarrheal illness should avoid swimming in public pools or lakes, sharing baths with others, and preparing food for others.

Fresh Express has announced that the company will donate up to $2 million for E. coli research. According to the press release, which was posted at Infection Control Today, Fresh Express will help fund an independent advisory panel that has already been formed.

Members are respected scientists in the food safety community:

• Dr. Michael T. Osterholm, PhD, MPH, director of the Center for Infectious Disease Research and Policy, University of Minnesota
• Dr. Jeff Farrar, California Department of Health Services
• Dr. Bob Buchanan, U.S. Food and Drug Administration
• Dr. Robert Tauxe, Centers for Disease Control and Prevention
• Dr. Bob Gravani, Cornell University
• Dr. Craig Hedberg, University of Minnesota
   

The Food and Drug Administration has announced that it has moved closer to identifying the source of illness for the Taco John E. coli outbreak.

FDA and the state of California, working in conjunction with state health officials in Minnesota, Iowa, and Wisconsin, have DNA-matched the strain of E. coli O157:H7 bacteria associated with the outbreak with two environmental samples gathered from dairy farms near a lettuce growing area in California's Central Valley.

The outbreak sickened approximately 81 individuals in November and December of 2006. Illnesses were reported in Minnesota, Iowa, and Wisconsin. Twenty-six people were hospitalized, and two suffered hemolytic uremic syndrome, a serious complication of E. coli O157:H7 infection that can cause permanent kidney damage and death. No deaths have been associated with the outbreak. No new cases of illness are being reported and the outbreak is now considered over.

Epidemiological studies by Minnesota and Iowa health officials had previously identified shredded iceberg lettuce served in the restaurants as the likely vehicle of transmission in the outbreak. FDA was able to focus on specific lettuce growing regions based on the traceback from records obtained from the lettuce processor. The recent DNA match provides a clue as to one possible source of the contamination for the lettuce, although others may exist. It has yet to be determined how the E. coli contaminated the lettuce. The traceback investigation is ongoing and will hopefully yield further insight into how this contamination occurred.
 

Dr. Mike Osterholm, a nationally known food-safety and infectious-disease expert at the University of Minnesota, argues that the public has some misperceptions about irradiation.

Dr. Mike Osterholm, a nationally known food-safety and infectious-disease expert at the University of Minnesota, argues that the public has some misperceptions about irradiation.
 
“The food does not become radioactive, as many people seem to think,” says Osterholm. It's what NASA uses to sterilize astronauts' meals, he said, and is also widely used to decontaminate spices.

Osterholm says irradiation could prevent hundreds of thousands of cases of food-borne illness every year, and save hundreds of lives.

But opponents say that irradiation can harm food by killing nutrients and, in some circumstances, generate cancer-causing chemicals. They also argue that there are other ways to protect the food supply, such as better sanitation and inspections.

“I don't think irradiation is a solution,” said Dr. David Wallinga, director of the food and health program at the St. Paul, Minnesota-based Institute for Agriculture and Trade Policy. “It's at best a Band-Aid on a much bigger problem.”
 

In the last decade, lettuce and spinach grown in California's central coast region have caused at least nine outbreaks of illness associated with E. coli bacteria. Today, fresh produce outpaces even meat as a source of food-borne illness. The beef industry tightened its safety practices after Jack In the Box burgers contaminated with E. coli killed four children in 1993, but with vegetables, regulators and growers are still catching up.

As health officials have urged Americans to eat more green, leafy vegetables, the produce industry has responded to consumers' unrelenting demand for convenience by giving them salad that's pre-washed and packaged in plastic. Yet the convenience may have a price: Some steps in processing might actually contribute to the spread of contamination.

Even after one of the biggest food-safety investigations in U.S. history, officials can only guess at what exactly caused the recent outbreak involving bagged fresh spinach, which killed three people and sickened 201 in 26 states and Canada. Worse, they still can't guarantee that every salad will be safe to eat.
 

Work on safety guidelines that the FDA is ready to propose began in 2004 -- though it has been slowed because staff time has been devoted to finding the source of the most recent outbreaks of E coli.

Even when these guidelines are finished, the FDA says they will be voluntary, according to the Sheboygan Press.

Growers are ready to implement new procedures on how to prevent contamination in green leafy vegetables from the planting stage to the time they reach the dinner table.

Because produce grows outdoors in the dirt, there is little you can do that will make it 100 percent safe unless you cook it or irradiate it, and it is unlikely that consumers will begin cooking all fresh produce, while there is skepticism about the public's acceptance of irradiated product. Researchers at the University of Illinois expressed concerns about existing technologies - including irradiation - that can reduce or eliminate pathogenic bacteria from fresh produce.

Food science professors are testing ozone, high-intensity ultrasound, electrolyzed water, irradiation, and temperature, and they say no treatment singlehandedly can reduce the number of pathogens sufficiently to meet the standards set by the FDA.

 

Among the concerns outlined in the Monterey County Grand Jury's 2006 report was E. coli contamination in the Salinas Valley lettuce and spinach fields, which has plagued the area for years now, reports the Monterey County Herald.

As part of their investigation, grand jury members accompanied federal, state and local health officials on a survey of Santa Rita Creek last May. During the survey, the report said, the group observed land littered with cans, tires, bed frames and mattresses as well as animal feces.

Fecal material and samples of water samples from one parcel containing cattle and a llama with access to the creek were tested for E. coli 0157:H7. Although the results were negative, the grand jury report recommended that the county health department enforce state codes protecting waterways from animal contamination.