In Dec. 2014, an outbreak of E. coli O55 was identified in Dorset, UK with at least 31 sickened. Public Health England (PHE) and local environmental health officials investigated and found nothing, other than cats were also being affected.
There was a protracted battle between local residents affected by the outbreak, and the lack of disclosure by PHE, documented in June, 2017.
But now, the health-types have gone public, in a report in the current issue of Eurosurveillance.
The first documented British outbreak of Shiga toxin-producing Escherichia coli (STEC) O55:H7 began in the county of Dorset, England, in July 2014. Since then, there have been a total of 31 cases of which 13 presented with haemolytic uraemic syndrome (HUS). The outbreak strain had Shiga toxin (Stx) subtype 2a associated with an elevated risk of HUS. This strain had not previously been isolated from humans or animals in England. The only epidemiological link was living in or having close links to two areas in Dorset.
Extensive investigations included testing of animals and household pets. Control measures included extended screening, iterative interviewing and exclusion of cases and high-risk contacts. Whole genome sequencing (WGS) confirmed that all the cases were infected with similar strains. A specific source could not be identified. The combination of epidemiological investigation and WGS indicated, however, that this outbreak was possibly caused by recurrent introductions from a local endemic zoonotic source, that a highly similar endemic reservoir appears to exist in the Republic of Ireland but has not been identified elsewhere, and that a subset of cases was associated with human-to-human transmission in a nursery.
Recurrent seasonal outbreak of an emerging serotype of shiga toxin producing Escherichia coli (STEC O55:H7 STX2A) in the South West of England, July 2014 to September 2015
Eurosurveillance, vol 22, issue 36, 07 September 2017, N McFarland, N Bundle, C Jenkins, G Godbole, A Mikhail, T Dallman, C O’Connor, N McCarthy, E O’Connell, J Treacy, G Dabke, J Mapstone, Y Landy, J Moore, R Partridge, F Jorgensen, C Willis, P Mook, C Rawlings, R Acornley, C Featherstone, S Gayle, J Edge, E McNamara, J Hawker, Balasegaram, DOI: http://dx.doi.org/10.2807/1560-7917.ES.2017.22.36.30610,
Often during an outbreak of foodborne illness, there are health officials who have data indicating that there is a risk prior to notifying the public. During the lag period between the first public health signal and some release of public information, there are decision makers who are weighing evidence with the impacts of going public. Multiple agencies and analysts have lamented that there is not a common playbook or decision tree for how public health agencies determine what information to release and when. Regularly, health authorities suggest that how and when public information is released is evaluated on a case-by-case basis without sharing the steps and criteria used to make decisions. Information provision on its own is not enough.
Risk communication, to be effective and grounded in behavior theory, should provide control measure options for risk management decisions. There is no indication in the literature that consumers benefit from paternalistic protection decisions to guard against information overload. A review of the risk communication literature related to outbreaks, as well as case studies of actual incidents, are explored and a blueprint for health authorities to follow is provided.
Tara Russell of Bournemouth Echo reports again this week that a review into the outbreak in Dorset was carried out, health chiefs have insisted – but the report is not available to the public.
Public Health England (PHE) says the public can only request to see the report detailing exactly what happened when 31 people contracted the O55 strain between July 2014 and November 2015 through a Freedom of Information request.
Families including some whose children have been left with lifelong health complications say they did not know the review existed and have branded it ‘disappointing and disgusting’ they have been kept in the dark.
The Daily Echo has lodged an official FOI request on behalf of the affected families and will receive a response in July.
Nurse Jessica Archer, who today suffers crippling head pains, fatigue and depression while her nephew Isaac Mortlock (right) endures severe seizures, must be peg fed every night and will need a kidney transplant as a result of the outbreak, said: “Without the Daily Echo we wouldn’t even know this report even existed and we are very interested to see it and we have the right to know. The families affected have so many unanswered questions and have to live with the effects of this outbreak forever but yet again we feel Public Health England are trying to sweep it under the carpet and hope that it will just go away.
“It is disappointing and disgusting this report has not already been made public let alone having to wait and wait still. We feel there have been a series of failures and this is the latest.”
The news comes after Jessica last month called for PHE to be held to account telling how her and her five-year-old nephew’s Isaac Mortlock’s lives have changed irreversibly, and accused the organisation of ‘a cover up.’
In response, PHE told the Daily Echo it carries out ‘routine outbreak reviews once investigations have ended’, adding it is ‘a learning organisation and reflects on outbreaks to identify lessons learnt and to continually improve our response.’
However at the time, the organisation refused to tell the Daily Echo exactly which lessons were learned.
It was only following a further request from this newspaper, PHE said a report was compiled however it has not been available to the public.
A spokesman said: “This report was not intended for external publication – it’s not standard procedure to publish outbreak reports externally due to patient confidentiality – however if interested parties would like to request a copy they can do this via our Freedom of Information portal.”
Outbreak investigations are routinely published while ensuring patient confidentiality.
Families say it is the latest in a string of ‘failures’ by Public Health England.
A spokesman from PHE added: “As with all outbreaks, PHE Health Protection Team ensured throughout their investigation that those affected were kept informed of any information that was uncovered at that time.”
That’s also bullshit.
And why UK health types feature prominently in our paper on when to go public for the benefit of public health.
Three years seems a bit long.
Going public: Early disclosure of food risks for the benefit of public health
NEHA, Volume 79.7, Pages 8-14
Benjamin Chapman, Maria Sol Erdozaim, Douglas Powell
Often during an outbreak of foodborne illness, there are health officials who have data indicating that there is a risk prior to notifying the public. During the lag period between the first public health signal and some release of public information, there are decision makers who are weighing evidence with the impacts of going public.
Multiple agencies and analysts have lamented that there is not a common playbook or decision tree for how public health agencies determine what information to release and when. Regularly, health authorities suggest that how and when public information is released is evaluated on a case-by-case basis without sharing the steps and criteria used to make decisions.
Information provision on its own is not enough. Risk communication, to be effective and grounded in behavior theory, should provide control measure options for risk management decisions. There is no indication in the literature that consumers benefit from paternalistic protection decisions to guard against information overload. A review of the risk communication literature related to outbreaks, as well as case studies of actual incidents, are explored and a blueprint for health authorities to follow is provided.
In Dec. 2014, an outbreak of E. coli 055 was identified in Dorset, U.K. with at least 31 sickened. Public Health England (PHE) and local environmental health officials investigated and found nothing, other than cats were also being affected.
Tara Russell of the Bournemouth Echo reports a nurse who fears her family’s lives will never be the same again after contracting the deadly E. coli bug has accused health officials of a ‘cover up.’
Three years on, Isaac suffers with severe seizures, must be peg fed for 10 hours each night and will need a kidney transplant and Jessica endures crippling head pains, fatigue and depression as a result of the bug.
But though the families’ lives have changed irreversibly, they feel let down by the Public Health England (PHE) investigation.
Jessica, who completed the London Marathon to raise awareness of her family’s plight, said: “This illness has robbed us. We are no longer the same people. It’s very frightening how life can suddenly change in an instant and I’m sure if all the other families were sat around the table they would say exactly the same.
“If someone attempts to murder someone, that is taken very seriously. We have been close to death through whatever reason that may be, yet we feel it was not taken at all seriously and more and more and more people suffered.
“It feels like a cover up and we just believe there are too many questions that have been left unanswered.”
Isaac and Jessica became ill after the family had eaten together at a restaurant. Medics originally put symptoms down to gastroenteritis but they were later diagnosed with a severe life-threatening complication which attacked their kidneys, liver and brain and fought for life. Today Jessica said they face a daily battle for recovery.
“We were discharged within a day of each other and we were so naïve. We thought we’d get our lives back together. How wrong were we.
“I used to be fit and active, now there’s not a day I can say ‘I feel well today.’”
Isaac today suffers severe health and behavioural problems.
The investigation closed in March 2016 without the affected families being made aware and failed to find the source. The outbreak was only confirmed by PHE in response to enquiries made by the Bournemouth Echo in November 2014 after it struck a children’s nursery in Blandford – months after the initial outbreak.
Jessica said: “We’ve been in the dark throughout with absolutely no communication about the outbreak, investigation or what has happened since. If they’d have thought we were important enough to find the cause, little babies and children may not have been put through the same hell.
“All we can hope for is that lessons have been learned so no other family ever has to go through the same horrendous ordeal we are living. For us, every morning is a constant reminder that life for us will never be the same.”
This is normal in the U.K. where science-based agencies recommend cooking food to the standard of piping hot, and where 252 people were sickened with E. coli O157 in 2010 – 80 hospitalized, one death, possibly linked to potatoes and leeks – and the Food Standards Agency reminded people to wash their produce.
This is some fucked up shit.
Maybe that’s why I like John Oliver so much.
He says he’s British and has no human emotion.
It’s buried way, way down.
Russell of the Bournemouth Echo writes public health officials carried out a review of the E. coli outbreak in Dorset to ‘identify lessons learnt.’
Public Health England said it is a ‘learning organisation’ and ‘reflects on outbreaks’ however refused to reveal what these lessons were.
Dr Sarah Harrison, consultant in health protection at Public Health England South West said: “Our colleagues in Public Health England worked closely with partners to try and identify a possible common source of infection, but the investigations did not identify a single common source. It is very good news that there have been no further cases of infection with this strain in Dorset since the end of the outbreak in 2015, however we remain vigilant.
“PHE is a learning organisation and reflects on outbreaks to identify lessons learnt and to continually improve our response. A review of this outbreak was conducted at the time by staff involved in line with standard procedures.
“E coli VTEC can be a very serious infection and can be passed easily from person to person and young children are particularly easily affected. We know that the bacteria causing the infection can survive in the environment, so good hand hygiene is important to prevent the spread. Wash hands thoroughly using soap and water after using the toilet, before and after handling food and after contact with animals including farm animals. Small children should be supervised in washing their hands. Remove any loose soil before storing vegetables and thoroughly wash all vegetables and fruit that will be eaten raw.”
PHE said the investigation at the time was extensive with involvement from many organisations.
A statement read: “Control measures included extended screening and exclusion of cases and high risk contacts. Public Health England and the Animal and Plant Health Agency put in place enhanced surveillance of faecal samples in Dorset laboratories and environmental sampling to help determine the extent of this organism in the community. The only link common to all the cases was that they either lived in or had close links to the county. The outbreak investigation closed in March 2016.”
As John Oliver would say, cool.
As Jessica Archer would say, fuck off you bureaucratic assholes who spend work time watching goats singing Taylor Swift songs on the the Intertubes.
Since the early 80’s E. coli O157:H7 had been public enemy number one in the pathogenic foodborne E. coli world. Sample and hold strategies that came out of the meat-related E. coli focus was based on O157.
According to Heart 102.3, a cluster of E. coli O55 has been identified Blanford UK.
Since July, ten people have been diagnosed with this infection which can cause bloody diarrhoea and seven of those affected have developed kidney problems – called haemolytic uraemic syndrome – a serious complication of an E. coli infection. There have been no deaths.
As some cases have occurred in people associated with a children’s nursery, letters have been sent to parents whose children attend the nursery and staff, informing them about E. Coli O55 and the ongoing investigation.
Noëleen McFarland, Consultant in Health Protection at PHE Wessex, said: “We are working closely with colleagues in the North Dorset Environmental Health Department to identify possible sources of infection. It is an infection that can be passed easily from person to person and young children are particularly easily affected.
“Any infection with E. coli can be very serious. We have interviewed all of those affected or their parents and their close contacts to look for possible causes in the days before they became ill. This information is being used in the ongoing investigation into these cases.”