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

E. coli bacteria: what are they, where did they come from, and why are some so dangerous?

Escherichia coli (E. coli) are members of a large group of bacterial germs that inhabit the intestinal tract of humans and other warm blooded animals (mammals, birds). Newborns have a sterile alimentary tract which within two days becomes colonized with E. coli.

More than 700 serotypes of E. coli have been identified.  The different E. coli serotypes are distinguished by their “O” and “H” antigens on their bodies and flagella, respectively.  The E. coli serotypes that are responsible for the numerous reports of contaminated foods and beverages are those that produce Shiga toxin (Stx), so called because the toxin is virtually identical to that produced by another bacteria known as Shigella dysenteria type 1 (that also causes bloody diarrhea and hemolytic uremic syndrome [HUS] in emerging countries like Bangladesh) (Griffin & Tauxe, 1991, p. 60, 73). 

The best known and most notorious Stx-producing E. coli is E. coli O157:H7.  It is important to remember that most kinds of E. coli bacteria do not cause disease in humans, indeed, some are beneficial, and some cause infections other than gastrointestinal infections, such urinary tract infections.  This section deals specifically with Stx-producing E. coli, including specifically E. coli O157:H7.

Shiga toxin is one of the most potent toxins known to man, so much so that the Centers for Disease Control and Prevention (CDC) lists it as a potential bioterrorist agent (CDC, n.d.).  It seems likely that DNA from Shiga toxin-producing Shigella bacteria was transferred by a bacteriophage (a virus that infects bacteria) to otherwise harmless E. coli bacteria, thereby providing them with the genetic material to produce Shiga toxin.

You cannot see it, taste it, or smell it. 250,000 E. coli O157:H7 (E. coli) bacteria will fit on the head of a pin.  Ten to 50 will kill your child or your grandmother.

More likely due the expertise of Children’s Hospitals, and other top medical centers around the country, deaths at times are avoided, however, often not before Hemolytic Uremic Syndrome (HUS) nearly kills.  HUS, a complication from an E. coli infection, can cause severe damage to kidneys, intestines, and pancreas.  Falling into a coma and suffering further from cognitive impairment are all too common.

I’ve seen the inside of too many of those Intensive Care Units with families who are scared senseless as they watch their children or mother shutdown.  For 15 years, this has been my world.   When I was an undergraduate, I read Upton Sinclair’s, The Jungle.  That book took the American public on a tour of the contaminated underbelly of the meat industry and they were sickened.  It led to the Pure Food & Drug Act and the Federal Meat Inspection Act, versions of which are still in place today.

Until 1993, I thought—because of those laws—that the United States had a safe and secure food supply. But, then came the Jack-in-the-Box E. coli outbreak.  It killed four, and sickened hundreds, including many who were gravely ill with HUS and related complications.  Many of those victims became my clients.

Once again, there was a public outcry for safe meat.  The Food Safety & Inspection Service responded by creating and aggressively enforcing the Mandatory Risk Management System.  Based on research and practices of the U.S. Space Program, the risk management system established checkpoints at every phase of meat processing.

The presence of E. coli was defined as an adulterant under the Federal Meat Inspection Act.  I continued to sue “Big Meat” as most of my clients up to 2002 were children who were made sick by eating E. coli contaminated meat.  I recovered over $350 million during this period from the meat industry and the restaurants they supplied in verdicts and settlements on behalf of those clients.  In 2003 recalls of meat laced with E. coli began to decline.  After 24 million pounds of contaminated beef were recalled in 34 separate incidents in 2002, recalls dropped off to just over a million pounds a year for the next three years, and then to just 181,900 pounds in 2006.  The Centers of Disease Control and Prevention saw E. coli – related illnesses drop 48%.

But then came Spring 2007. E. coli, which begins its life in the hindgut of a cow, mounted a surge on its home court.  And, it came back with a vengeance.  Thirty-three million pounds of beef would be recalled in 22 incidents.  All over the country, slaughterhouses, packing and distribution centers, retail outlets, and restaurants were once again testing positive for E. coli and people-mostly children-were getting seriously sick.

The American meat supply, which had again been touted as safest in the world, tumbled back into disarray.  But, why?

As with any unexplained mystery, theories abound.  Could it really just be meat industry complacency?  Did everyone respond to the good numbers in 2006 by taking a long nap?  Did meat processors slack off—consciously or unconsciously—and relax their testing procedures?

Or could it be better reporting?  Doctors are more aware of E. coli now, and perhaps when patients present symptoms of food poisoning; tests are more likely to be ordered.  When the presence of E coli is found and reported, a recall is triggered.

There’s always global warming.  Seriously though – very smart people have posited that droughts in the southeast and southwest have launched more fecal dust into the air, which then finds its way into beef slaughtering plants.  It has also been suggested that the deluging rainfall in other areas created muddy pens—an ideal environment for E. coli.

While we’re at it, why not blame high oil prices?  High gas prices have fueled (sorry) the growth of ethanol plants.  These plants are often built next to feedlots, and a byproduct of the ethanol production process—distiller’s grains—is considered an excellent (and cheap) alternative to corn for cattle feed.  Unfortunately, research at Kansas State University associates the use of distiller’s grains as feed with an increase in the incidence of E. coli in the hindguts of cattle.

Another controversial issue may affect the meat supply.  The New York Times reported that immigration officials began a crackdown at slaughterhouses across the country in the fall of 2006.  Experienced—albeit undocumented—workers have been cleared out and replaced with unskilled, inexperienced labor.

And then there’s Darwin.  Another theory holds that interventions have caused the wily E. coli microbes to adapt, selecting pathogens that are more resistant to detection or intervention.  E. coli back in our meat cannot be tolerated.  We’ve got a lot of summer of 2008 left. Summer has always been kind to the E. coli bug.  More than 5.6 million pounds of E. coli contaminated beef has been recalled so far in 2008, most supplied by Nebraska Beef Ltd., via the Kroger Grocery chain.  All of which is responsible for a multi-state outbreak of E. coli that again is filling up the ICU’s in Hospitals in the seven states.

What is being done?  Not much.

Congress has held some hearings, but the only new reform is that the names of retail stores that received meat and poultry involved in recalls with high health risk will be made public.  Good as far as it goes.

However, despite 76,000,000 American’s being sickened, 325,000 hospitalized and 5,000 deaths each year, food safety has not made it as a Presidential campaign issue.  Congress, Democrats and Republicans, have about run out its clock.  But E. coli is back in our meat and we better care.

Solutions?

State departments of health and agriculture in several states, collaborating local health jurisdictions, CDC, and the United States Department of Agriculture’s Food Safety and Inspection Service (USDA-FSIS) are investigating a multi-state outbreak of Escherichia coli O157:H7 infections.

States with cases of E. coli 0157:H7 infections with the outbreak strain

Based on this investigation, as of 5pm EST, July 14, 2008, 44 confirmed cases have
been linked both epidemiologically and by molecular fingerprinting to this outbreak. The number of cases in each state are as follows: Indiana (1), Kentucky (1), Michigan (20), New York (1), and Ohio (21). Their illnesses began between May 30 and June 24, 2008.

Twenty-one ill persons have been hospitalized. One patient has developed a type of kidney failure called hemolytic-uremic syndrome (HUS). No deaths linked to the outbreak have yet been reported. Twenty-five (57 percent) patients are female. Patients range in age from 4 to 78 years with a median age of 20 years.

CDC and public health agencies across the United States are continuing surveillance activities to detect additional cases related to this outbreak. CDC and state laboratories are using advanced molecular testing techniques to help determine the extent of this outbreak.

State health and agriculture departments tested ground beef recovered from several patient residences that was purchased at Kroger® retail stores in Michigan and Ohio. Molecular fingerprinting testing conducted by the Ohio and Michigan Departments of Health and Agriculture Laboratories, in collaboration with PulseNet, the national molecular subtyping network for foodborne disease surveillance, on E. coli O157 isolates isolated from these ground beef samples have confirmed the isolates to be the outbreak strain of E. coli O157.

CDC's OutbreakNet Team conducted a multi-state case-control study in collaboration with health authorities in Ohio and Michigan to epidemiologically examine exposures that would be related to illness. The data indicate a significant association between illness and eating ground beef purchased at one of several Kroger® Company stores in Michigan and Ohio. CDC has provided these results to the USDA-FSIS and public health agencies in Michigan and Ohio.

On June 25, 2008, a recall was announced for ground beef sold at Kroger® Co. Stores in Michigan and Ohio. On July 3, the Kroger® Co. expanded the June 25th recall to include ground beef products from Kroger® establishments outside of Michigan and Ohio.

On June 30, 2008, a recall of 531,707 pounds of ground beef components from Nebraska Beef Ltd. was announced. On July 3, 2008, Nebraska Beef Ltd. expanded the June 30 recall to include all beef manufacturing trimmings and other products intended for use in raw ground beef produced between May 16 and June 26, 2008, totaling approximately 5.3 million pounds.

More information about these recalls can be found at the United States Department of Agriculture, Food Safety and Inspection Service’s (USDA/FSIS) web site at http://www.fsis.usda.gov/Fsis_Recalls/.

FSIS has confirmed that none of the affected products remain available for purchase at stores; however consumers are urged to check their refrigerators and freezers and discard or return the ground beef products for a refund. Consumers with questions about the recall should contact the Kroger Consumer Hotline at (800) 632-6900 or James Timmerman, Nebraska Beef Ltd. Vice President of Administration at (402) 397-7300.

The Moultrie Observer reported on the link between ill people in Ohio and Michigan to at least nine in Georgia – “E. coli: Ground beef may be culprit.”  The common denominator here is Nebraska Beef Ltd. (Remember, the guys who sue a church).  Here is the key:

Ground beef is used in some of the dishes served in the Barbecue Pit, a Moultrie restaurant that has voluntarily closed as disease investigators attempt to find the source of E. coli O157:H7 contamination. A common thread among patients with confirmed cases of the disease is that they ate at the restaurant.

The tally of confirmed E. coli cases has now climbed to six, with three more cases still considered probable. The three “probable” E. coli patients have hemolytic uremic syndrome (HUS).  Laura Hall Bannister of Moultrie was one of the first ill reported.  Hemolytic Uremic Syndrome (D+HUS) is a severe, life-threatening complication that occurs in about 10% of those infected with E. coli O157:H7 or other Shiga toxin (Stx) producing E. coli.  D+HUS was first described in 1955, but was not known to be secondary to E. coli infections until 1982. It is now recognized as the most common cause of acute kidney failure in infants and young children.  Adolescents and adults are also susceptible, as are the elderly who often succumb to the disease.  We are now involved with at least three suits against Nebraska Beef:

Kroger E coli Outbreak Litigation

An outbreak of E. coli O157:H7 in June, 2008 was traced to Kroger stores in Ohio and Michigan. Kroger began a voluntary recall of certain ground beef products on June 25.  On June 26, it was revealed that the meat was supplied by Nebraska Beef.   Marler Clark filed the first lawsuit stemming from the outbreak on behalf of an Ohio resident on June 30, 2008.

Nebraska Beef E. coli Litigation

In 2006, meat manufactured by Nebraska Beef, distributed by Interstate Meat, and sold by Tabaka’s Supervalu was identified as the source of an E. coli outbreak among residents of and visitors to Longville, Minnesota.  An outbreak investigation conducted by the Minnesota Department of Health and Minnesota Department of Agriculture led to the conclusion that 17 people who had eaten ground beef purchased at Tabaka’s Supervalu and consumed either in private homes or at a dinner prepared at the Salem Lutheran Church in Longville had become ill with E. coli infections.  Three people developed hemolytic uremic syndrome (HUS), and one person died.

And, several E. coli cases in Georgia:

Bauer Meat E. coli Litigation – Georgia

Excel E. coli Outbreak – Georgia

White Water Water Park E. coli Outbreak - Georgia

"It's on ground beef products in a Styrofoam tray with clear cellophane over it," Kroger spokeswoman Meghan Glynn said this morning. "It could have been purchased in cases or over the service counter.

• Kroger's Mid-Atlantic division, which includes stores in North Carolina, northeastern Tennessee, Virginia and West Virginia, with "sell by" dates of May 19-June 6.

• Fry's, Ralphs and Smiths stores ground beef with "sell by" dates of May 21-July 3.

• Baker's stores with "sell by" dates of May 17-June 4.

• King Soopers and City Market stores with "sell by" dates of June 20-July 3.