The bloody diarrhea gives it away: UK family of boy hit by E. coli after Turkish holiday takes legal action

Julie Gilmartin, 39, said her son Matthew Bennett, 10, started to develop symptoms including diarrhea on the plane home from a week-long stay at the Bone Club Sunset Hotel & Spa, Antalya, at the start of July.

Stacey Mullen of the Herald Scotland writes the youngster, from Penilee, Glasgow, was then seen by a GP, who requested a stool sample after the boy experienced further symptoms, including severe abdominal pains and passing blood.

His health deteriorated and he was taken to A&E, where he was admitted to the Royal Hospital for Children in Glasgow for more than three days.

Following several tests, his mother was advised Matthew had been diagnosed with E.coli O157, a serious bacterial infection that can cause serious long-term complications and sometimes even death.

Ms Gilmartin, a customer assistant at Sainsbury’s, said: “Matthew went to the toilet a few times on the plane journey home, which seemed odd for him.

 “Then, as the days passed, there was clearly something wrong. He didn’t eat well and started to suffer from further issues, like stomach cramps.

“I ended up calling the NHS 24-hour helpline and was told straight away to take him to hospital. It was awful to see how the illness affected him and they [doctors] felt they had no choice to admit him. It was horrendous.”

Ms Gilmartin and Matthew, along with his father Henry and younger brother Ollie, arrived at the Turkish resort on July 6, after booking the break through Jet2. She added: “I was stunned to get the news that Matthew’s illness was E.coli.

“I’m just so frustrated we went away for what should have been a nice, family break, only for this to happen.

“It is awful and we deserve some answers as to how Matthew’s illness emerged and whether it could have been prevented.

“Although I had seen some concerning issues in relation to the cleanliness and hygiene in the restaurant, such as roaming cats and food sometimes being served lukewarm, I never thought I was at serious risk of illness. I dread to think that other children might be running the risk of also being affected.”

E. coli O157: Which typing is better?

Due to the potential of enterohemorrhagic Escherichia coli (EHEC) serogroup O157 to cause large food borne outbreaks, national and international surveillance is necessary.

For developing an effective method of molecular surveillance, a conventional method, multilocus variable-number tandem-repeat analysis (MLVA), and whole-genome sequencing (WGS) analysis were compared. WGS of 369 isolates of EHEC O157 belonging to 7 major MLVA types and their relatives were subjected to comprehensive in silico typing, core genome single nucleotide polymorphism (cgSNP), and core genome multilocus sequence typing (cgMLST) analyses. The typing resolution was the highest in cgSNP analysis. However, determination of the sequence of the mismatch repair protein gene mutS is necessary because spontaneous deletion of the gene could lead to a hypermutator phenotype. MLVA had sufficient typing resolution for a short-term outbreak investigation and had advantages in rapidity and high throughput. cgMLST showed less typing resolution than cgSNP, but it is less time-consuming and does not require as much computer power. Therefore, cgMLST is suitable for comparisons using large data sets (e.g., international comparison using public databases). In conclusion, screening using MLVA followed by cgMLST and cgSNP analyses would provide the highest typing resolution and improve the accuracy and cost-effectiveness of EHEC O157 surveillance.

IMPORTANCE Intensive surveillance for enterohemorrhagic Escherichia coli (EHEC) serogroup O157 is important to detect outbreaks and to prevent the spread of the bacterium. Recent advances in sequencing technology made molecular surveillance using whole-genome sequence (WGS) realistic. To develop rapid, high-throughput, and cost-effective typing methods for real-time surveillance, typing resolution of WGS and a conventional typing method, multilocus variable-number tandem-repeat analysis (MLVA), was evaluated. Nation-level systematic comparison of MLVA, core genome single nucleotide polymorphism (cgSNP), and core genome multilocus sequence typing (cgMLST) indicated that a combination of WGS and MLVA is a realistic approach to improve EHEC O157 surveillance.

Effective surveillance using multilocus variable-number tandem-repeat analysis and whole-genome sequencing for enterohemorrhagic Escherichia coli O157

Applied and Environmental Microbiology

Kenichi Lee, Hidemasa Izumiya, Sunao Iyoda, Makoto Ohnishi and EHEC Working Group

DOI: 10.1128/AEM.00728-19

https://aem.asm.org/content/85/17/e00728-19.abstract?etoc

E. coli O157, England and Wales

I am fascinated with viruses, and we’re all hosts on a viral planet.

We used whole-genome sequencing to investigate the evolutionary context of an emerging highly pathogenic strain of Shiga toxin–producing Escherichia coli (STEC) O157:H7 in England and Wales.

A timed phylogeny of sublineage IIb revealed that the emerging clone evolved from a STEC O157:H7 stx-negative ancestor ≈10 years ago after acquisition of a bacteriophage encoding Shiga toxin (stx) 2a, which in turn had evolved from a stx2c progenitor ≈20 years ago. Infection with the stx2a clone was a significant risk factor for bloody diarrhea (OR 4.61, 95% CI 2.24–9.48; p<0.001), compared with infection with other strains within sublineage IIb. Clinical symptoms of cases infected with sublineage IIb stx2c and stx-negative clones were comparable, despite the loss of stx2c. Our analysis highlighted the highly dynamic nature of STEC O157:H7 Stx-encoding bacteriophages and revealed the evolutionary history of a highly pathogenic clone emerging within sublineage IIb, a sublineage not previously associated with severe clinical symptoms.

Highly pathogenic clone of shiga toxin-producing Escherichia coli O157:H7, England and Wales, December 2018

Emerging Infectious Diseases vol. 24 no. 12

Lisa Byrne, Timothy Dallman, Natalie Adams, Amy Mikhail, Noel McCarthy, and Claire Jenkins

https://wwwnc.cdc.gov/eid/article/24/12/18-0409_article

Harvard Biz: How Wegmans became a leader in improving food safety

Notes from a podcast by Ray Goldberg of the Harvard Business School drawn from his case study, Wegmans and Listeria: Developing a Proactive Food Safety System for Produce

The agribusiness program Goldberg developed in 1955 continues to bring business leaders and policy makers from around the world together each year. Throughout his tenure, Ray has written over 100 articles and 24 books on the business of agriculture, including his very latest, Food Citizenship: Food System Advocates in an Era of Distrust.

He was interviewed by podcast host, Brian Kenny: Did you coin the term agribusiness?

Ray Goldberg: I did, together with John Davis. He was the Assistant Secretary of Agriculture under Eisenhower, and he became the first head of the (HBS) Agribusiness Program.

Brian Kenny: The case cites examples of foodborne illness outbreaks in the US. We’re coming on the heels of the recent romaine lettuce issue in the US, which has now occurred, I think, twice in the last few months.

Ray Goldberg: I can describe the romaine lettuce [event], because I talked to the produce manager this morning, and he tells me the cost to the industry was $100 million dollars.

The problem is that romaine lettuce itself, when cold temperatures occur, begins to blister, which make it more susceptible to listeria. When they tried to find the location of that listeria, it came from a dairy herd about 2,000 feet away from where that lettuce was grown. We have a rule that 1,200 feet is far enough, but they actually found listeria a mile away from where that lettuce was concerned, so he feels very strongly that they have to change the rules.

(They seem to be confusing Listeria with E.coli O157 in Romaine, but that’s Haaaaaaaaarvard.)

Brian Kenny: Which gets to another issue that the case raises, which is has the industry done well enough trying to regulate itself? What are some of the things the industry has tried to do?

Ray Goldberg: Under Danny Wegman’s leadership—he was the person in charge of food safety of the Food Marketing Institute that really looked at the whole industry—he got several members of the industry to sit down and create new rules with the FDA, the EPA, the USDA, and CDC, all of them saying we have to have better rules. Produce, as you know in the case, is the most valuable part of a supermarket but also the most susceptible to problems.

Brian Kenny: This gets a little bit to the topic of your book, Food System Advocates in an Era of Distrust. [What[ are the big ideas coming out of your book?

Ray Goldberg: The big ideas are two-fold, that the kind of men and women in the industry have changed from commodity handlers and bargaining as to how cheap they can buy something, or how expensive they can make something, to finally realizing that they have to be trusted. And because they have to be trusted, they have to start working together to create that trust. In addition to that, they realize that the private, public and not-for-profit sectors really need to work together. That’s why I tried to write a book to give people an inkling of the kind of men and women in this industry who really are the change-makers, who are changing it to a consumer-oriented, health-oriented, environmentally-oriented, economic development-oriented industry.

Les Nessman explains how to talk about continuing leafy green outbreaks

A romaine lettuce task force was organized by the industry in December to help prevent future outbreaks, said Jennifer McEntire, vice president of food safety and technology for the United Fresh Produce Association.

The task force has representation from all types of growing operations from different growing regions, she said.

One primary focus of the task force is preventing outbreaks by looking at root cause analysis, she said.

A table of leafy green-related outbreaks – at least 80 since 1995 – is available here.

But Les Nessman gets to the heart of this political process — in 1978:

UK family still waiting for answers one year after E. coli poisoning

The Yorkshire Post reports parents of two boys who be­came se­ri­ously ill af­ter con­tract­ing E.coli 0157 sus­pected to be from beef burg­ers are still wait­ing for an­swers from su­per­mar­ket gi­ant Sains­bury’s more than a year later.

Al­fie and Oliver Maude, then seven and three, from Rich­mond, North York­shire, came down with up­set stom­achs two days af­ter eat­ing the Taste the Dif­fer­ence Aberdeen An­gus burg­ers in Oc­to­ber 2017. Al­fie was ad­mit­ted to Dar­ling­ton hos­pi­tal two days later with ex­cru­ci­at­ing stom­ach pain and se­vere de­hy­dra­tion.

He was then rushed to New­cas­tle hos­pi­tal for dial­y­sis be­cause his kid­neys were fail­ing. Both boys had de­vel­oped a se­ri­ous con­di­tion, hae­molytic uremic syn­drome, al­though Oliver did not re­quire dial­y­sis.

Both will have to un­dergo reg­u­lar check-ups well into adult­hood to keep an eye on their kid­neys.

Mother Vicci Maude said she and hus­band Steve were be­sides them­selves with worry as their boys “puffed up and turned yel­low”. She said: “When the con­sul­tant came in she said some chil­dren don’t sur­vive this – ob­vi­ously it was the hard­est thing I’ve ever had to hear. They still find it very stress­ful hav­ing to go back to hos­pi­tal and hav­ing blood tests. I just feel they (Sains­bury’s) need to take some re­spon­sibiity.”

It’s explained by shit in irrigation water: Santa Barbara farm first fingered with outbreak strain of E coli O157 in Romaine lettuce that sickened 59 in US, 28 in Canada: Tumble those dice

Welcome to Washington, D.C., Frank, and government PR.

On Nov. 20, the U.S. Food and Drug Administration and the Centers for Disease Control and Prevention warned the American public of a multi-state outbreak of E. coli O157:H7 linked to romaine lettuce and advised against eating any romaine lettuce on the market at that time.

According to FDA Commissioner Scott Gottlieb, M.D. and FDA Deputy Commissioner Frank Yiannas, we  have new results to report from this investigation tracing the source of the contamination to at least one specific farm. Based on these and other new findings, we’re updating our recommendations for the romaine lettuce industry and consumers.
Today, we’re announcing that we’ve identified a positive sample result for the outbreak strain in the sediment of a local irrigation reservoir used by a single farm owned and operated by Adam Bros. Farms in Santa Barbara County.

The FDA will be sending investigators back to this farm for further sampling. It’s important to note that although this is an important piece of information, the finding on this farm doesn’t explain all illnesses and our traceback investigation will continue as we narrow down what commonalities this farm may have with other farms that are part of our investigation. While the analysis of the strain found in the people who got ill and the sediment in one of this farm’s water sources is a genetic match, our traceback work suggests that additional romaine lettuce shipped from other farms could also likely be implicated in the outbreak. Therefore, the water from the reservoir on this single farm doesn’t fully explain what the common source of the contamination. We are continuing to investigate what commonalities there could be from multiple farms in the region that could explain this finding in the water, and potentially the ultimate source of the outbreak.

As of Dec. 13, our investigation yielded records from five restaurants in four different states that have identified 11 different distributors, nine different growers, and eight different farms as potential sources of contaminated romaine lettuce. Currently, no single establishment is in common across the investigated supply chains. This indicates that although we have identified a positive sample from one farm to date, the outbreak may not be explained by a single farm, grower, harvester, or distributor.

At the same time, the U.S. Centers for Disease Control updated its warning to advise U.S. consumers to not eat and retailers and restaurants not serve or sell any romaine lettuce harvested from certain counties in the Central Coastal growing regions of northern and central California. If you do not know where the romaine is from, do not eat it.

  • Some romaine lettuce products are now labeled with a harvest location by region. Consumers, restaurants, and retailers should check bags or boxes of romaine lettuce for a label indicating where the lettuce was harvested.
      • Do not buy, serve, sell, or eat romaine lettuce from the following California counties: Monterey, San Benito, and Santa Barbara.
      • If the romaine lettuce is not labeled with a harvest growing region and county, do not buy, serve, sell, or eat it.
      • The Public Health Agency of Canada has identified ill people infected with the same DNA fingerprint of E. coliO157:H7 bacteria in Canada.

Own it: Gossip goes away

I knew I wouldn’t get into rehab Friday morning because I had been drinking at 3 a.m. in a vain attempt to go back to sleep.

Gotta blow zero to get into rehab, which I’ll do Monday.

But, as I said to one of my rehab buddies, whose life has spun out of control, yet he got 90% in the law courses he has taken, own it. Don’t be ashamed.

He said, I read your blog and it seems you had a falling out with Ben.

I said I’ve had a falling out with my wife of 13 years every week (she’s at hockey practice, 6 a.m. in Brisbane).

Ben, about the same.

Bad wiring.

Or, the people you are closest with and feel vulnerable enough to share your fears, are the ones to lash out at.

The produce industry needs a similar self-reckoning.

Candice Choi of APwrites that after repeated food poisoning outbreaks linked to romaine lettuce, the produce industry is confronting the failure of its own safety measures in preventing contaminations.

The E. coli outbreak announced just before Thanksgiving follows one in the spring that sickened more than 200 people and killed five, and another last year that sickened 25 and killed one. No deaths have been reported in the latest outbreak, but the dozens of illnesses highlight the challenge of eliminating risk for vegetables grown in open fields and eaten raw, the role of nearby cattle operations that produce huge volumes of manure and the delay of stricter federal food safety regulations.

A contested aspect of the regulation, for example, would require testing irrigation water for E. coli. The Food and Drug Administration put the measure on hold when the produce industry said such tests wouldn’t necessarily help prevent outbreaks. Additional regulations on sanitation for workers and equipment — other potential sources of contamination — only recently started being implemented.

We’ve been saying the same thing for over 20 years.