Lettuce is overrated: STEC in Finland

Escherichia coli are Gram-negative rod-shaped bacteria and part of the normal bacterial flora in the gastrointestinal tract, while diarrhoeagenic E. colipathotypes such as Shiga toxin-producing E. coli (STEC) and enteropathogenic E. coli (EPEC) are able to cause gastrointestinal infections [1]. STEC can lead to a severe disease, such as haemolytic-uraemic syndrome (HUS) [2]. The risk of HUS has been related especially to children under 5 years and to elderly people. HUS is characterised by acute onset of microangiopathic haemolytic anaemia, renal injury and low platelet count.

More than 400 STEC serotypes have been recognised, of which the best-known serotype is O157:H7 [1]. The most common non-O157:H7 serotypes causing human infections are O26, O103, O111 and O145 [3]. The virulence of STEC is largely based on the production of Shiga toxin 1 or 2 and is identified by detecting the presence of stx1 or stx2 genes [1,4]. The virulence of EPEC is caused by its capability to form attaching and effacing (A/E) lesions in the small intestine. This capability requires the presence of virulence genes called the locus of enterocyte effacement (LEE) in a pathogenity island (PAI) that encodes intimin [4]. Unlike STEC, EPEC do not produce Shiga toxin. EPEC are divided into two distinct groups by the presence of EPEC adherence factor plasmid (pEAF) expressing bundle-forming pili (BFP), which is a virulence determinant of typical EPEC (tEPEC) [5]. Thus atypical EPEC (aEPEC) are defined as E. coli that produce A/E lesions but do not express BFP. Typical EPEC are best known as a cause of infantile diarrhoea, especially in developing countries [6]. Diarrhoea-causing aEPEC have been shown to be separate group without a close relation to tEPEC, but some serotypes are genetically related to STEC [5]. The pathogenity of aEPEC has been questioned but their involvement with diarrhoeal outbreaks supports the idea that certain strains are diarrhoeagenic [1,7].

Both STEC and EPEC are transmitted through the faecal-oral route, and outbreaks caused by STEC and aEPEC have been described after ingestion of contaminated food or water [7,8]. STEC is common in ruminants and can be found in foods contaminated by ruminant faeces [9]. Most studies on STEC have focused on the serotype O157:H7, but infections and outbreaks caused by non-O157 strains are increasingly reported in Europe and elsewhere [1013]. Atypical EPEC strains are found in animals used for food production, such as cattle, sheep, goat, pig and poultry, in contrast to tEPEC that has been found only in humans [1,14].

Since 1995, clinicians and clinical microbiology laboratories have been obliged to report culture-confirmed STEC infections to the Finnish Infectious Disease Registry (FIDR) maintained by the National Institute for Health and Welfare (THL) in Finland. EPEC infections are not reportable. Since PCR instead of culture became the standard for screening of diarrhoeal patients in 2013, the incidence of reported STEC infections has increased in Finland to 1.2–1.8 per 100,000 population between 2013 and 2015 compared with 0.2–0.6 per 100,000 between 2000 and 2012. From 1997 to 2015, six food- or waterborne STEC outbreaks were detected in Finland (Table 1).

Outbreak of multiple strains of non-O157 Shiga toxin-producing and enteropathogenic Escherichia coli associated with rocket salad, Finland, autumn 2016

15.may.18

Eurosurvelliance, Volume 23, Issue 35, https://doi.org/10.2807/1560-7917.ES.2018.23.35.1700666

Sohvi KinnulaKaisa HemminkiHannele KotilainenEeva RuotsalainenEveliina Tarkka,Saara SalmenlinnaSaija HallanvuoElina LeinonenOllgren JukkaRuska Rimhanen-Finne

https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2018.23.35.170066

UK disease detectives: Supermarket loyalty cards to trace an E coli outbreak

Kathie Grant and Lisa Byrne write in Public Health Matters that in November 2017, supermarket loyalty cards were used to trace the source of a large E coli outbreak affecting mainly men in England. Dr Lisa Byrne leads Public Health England’s surveillance of two key bacteria that lead to food poisoning – E Coli and Listeria. Dr Kathie Grant heads the PHE Gastrointestinal Bacteria Reference Laboratory. The two work together as part of a larger team dedicated to reducing foodborne illness and below tell us how they put the pieces of this puzzle together to find the source.

If you’ve ever had food poisoning you’ll know that feeling of mentally going through everything you ate recently, trying to pinpoint what it was that might have made you ill. It’s our job to do that at a national scale.  We bring together lots of different pieces of  information from the community and the lab to try to find  the source of a food poisoning outbreak and then, working alongside other government agencies,  ensure that more people don’t get sick.

We study and monitor many different stomach bugs – some of which you may never have heard of! While stomach bugs are a part of life, PHE works with organisations such as the Food Standards Agency and the Animal and Plant Health Agency to try and prevent them.

Every so often we see a spike in the number of cases.  When this happens it is important that we find the link between the cases and the cause of their illness.  To do this we need to identify the exact strain of a bug to understand if people have got ill from the exact same source.

Whole Genome Sequencing (WGS) ‒ a relatively new process for showing us the makeup of a bacterium or virus’s genes ‒ has changed the way we can find the cause of an outbreak and stop more people getting ill. You can learn more about the process and how it works in our explainer blog.

Before WGS it could take weeks to identify bacteria and sometimes the bacteria could be missed. This slowed down any investigations  as we could not be sure that all the case histories we were taking could be linked to an outbreak – there was a lot of ‘noise’ and false lines of enquiry. With WGS, we can rapidly and accurately identify if bacteria of cases are the same strain and rule out people from our investigation who just happened to be ill at the same time, but with a different illness.

It has also expanded what the word ‘outbreak’ means as we can link cases across several years and different countries, meaning we can more accurately piece together a picture of how something in the food supply chain impacts human health.

Scientists working in the Gastrointestinal Bacteria reference laboratory at Public Health England. The team are processing samples from people who have reported gastrointestinal symptoms, to understand the exact cause of their illness.

Identifying the source of an outbreak is a lot like putting together a jigsaw puzzle, combining multiple pieces of evidence to get the full picture. Sometimes, a common source is obvious, such as when a group of people get ill after eating the same meal, at the same restaurant, on the same day. But other times, we need to use an arsenal of investigative tools, as was the case in a recent E coli outbreak.

In November 2017 our surveillance system alerted us to 12 cases of E coli O157 – (a particular form of E coli), over a six week window. E coliO157 is a relatively rare cause of food poisoning, with only about 700 cases a year, but it can cause a very severe illness. Because of this, any case of E coli O157 identified by doctors and laboratories must be reported to Public Health England.  We monitor the number of cases with our surveillance systems to find any patterns.

Very quickly our reference laboratory used WGS which showed that the cases had the identical genetic “fingerprint” and the work began to trace the source of infection. The majority of people who became ill were men, which was unusual as E coli outbreaks are often linked to salad items ‒ traditionally more likely to be eaten by women.

It took a few rounds of interviews – carried out by colleagues in local authorities – to zero in on the potential source of food poisoning, and a picture started to emerge that implicated burgers from a particular retailer.

We asked the supermarket to analyse the loyalty card records of those who had become ill, to help identify the particular burger product the cases had eaten.  As you can imagine, there were many different types of burgers supplied by the supermarket and it’s often difficult for people to remember exactly what they ate.

Working with the Food Standards Agency we were able to identify that all the cases had bought a particular brand of burger, leading to a product recall to ensure others didn’t get sick. The recall involved removing all the suspected batches of burgers from the supermarket shelves. The supermarket also contacted people who had bought the burgers, advising them not to eat them and return them for a refund.

Sometimes, as in this case, we can rapidly find what is making people ill and quickly remove it from sale. It’s an exciting role and we get a real sense of satisfaction out of using our skills to help people in this way. Other times it can be more frustrating – some outbreaks remain unsolved and it’s a real worry that people will get sick because we can’t eliminate a threat from food distribution.

The role really keeps us on our toes. Our surveillance systems mean that we have a good sense of patterns of illness across the year and how we can intervene to stop people getting unwell – but changes to food habits can catch us by surprise. For instance, raw milk has become more popular recently, bringing with it all the disease risks you would expect from a product that has come straight from a cow without any treatment to kill off bacteria!

In another case, eight people in the UK were affected while on holiday in Germany that was related to seeds.  The seeds were decoratively used as a garnish on salads and were difficult for cases to remember eating. Nearly 1,000 people in Germany got ill in that outbreak and one of the approaches by authorities was to use tourist photos of food to try and identify the common item in meals that could be making people sick.

Solving food borne illness outbreaks can be a real challenge, but by using a variety of the different tools available to us we can quickly intervene to stop people getting ill.

UK toddler, 3, fighting for life after catching E. coli on holiday

Martin Coulter of the  Star reports that Harper Davis, 3, has been taking to intensive care and put on dialysis at Nottingham Children’s Hospital.

The youngster was described as being a “normal, healthy girl” before she picked up the lethal bug.

Harper is understood to have suffered acute kidney failure, seizures, peritonitis and developed diabetes as a result of her illness.

My 3 grandsons are pictured below, from a Canadian Thanksgiving feast put on by daughter Jaucelynn, on Monday.

My kids all know food safety, but sometimes knowing is never enough. 

19-year-old sickened with E. coli at same Egyptian resort linked to E. coli deaths of 2 British tourists

Anna Doherty, 19, spent 11 days in intensive care after being struck down with an E. coli infection at the same Egyptian resort where two British tourists died because of E. coli.

Halfway into her stay at the all-inclusive hotel, Anna recalled how she began to feel extremely unwell, suffering symptoms of vomiting and diarrhoea.

After visiting the on-site doctors’ clinic, Anna said she was told she had a water infection and was given an injection and antibiotics.

She began to feel better, but when she returned home to the UK, her condition rapidly deteriorated.

Anna said her family rushed to the Royal Oldham Hospital and she was quickly transferred to The Royal Liverpool Hospital with suspected jaundice.

Doctors in Liverpool originally suspected Anna was suffering from ‘hemolytic uremic syndrome,’ which is commonly caused by a complication from an infection with E coli O157.

They were unable to give a final diagnosis, she said, but believe the previously healthy teenager was struck by a bacterial infection.

Anna told the Manchester Evening News: “It was really scary. I never expected to go away and get this ill.

Tests showed that E. coli was behind the death of two British tourists in a hotel in Egypt’s Red Sea resort of Hurghada, the country’s chief prosecutor said in Sept.

The statement by Prosecutor Nabil Sadek came a week after travel company Thomas Cook said that there was a “high level of E. coli and staphylococcus bacteria” at the Steigenberger Aqua Magic Hotel where John and Susan Cooper died Aug. 21 after falling ill in their room in the five-star hotel.

Forensic tests showed that John Cooper, 69, suffered acute intestinal dysentery caused by E. coli, and Susan Cooper, 64, suffered hemolytic-uremic syndrome (HUS), likely because of E. coli, Sadek said.

2 children from same UK family die from E. coli

Two children from the same UK family have died after contracting shiga-toxin producing E. coli, health officials have confirmed.

The children, whose ages have not yet been released, were from the Charnwood area of Leicestershire and had been treated for the infection in the last 2 weeks.

Public Health England confirmed the deaths and said it is working with
environmental health officers after 2 cases of hemolytic uremic
syndrome were confirmed in the siblings.

It is not yet known how the children contracted E. coli.

PHE East Midlands said E coli is a relatively rare infection, adding that good hand hygiene and supervised hand hygiene for small children are essential to minimise the risk of developing an infection such as E coli.

Not rare enough for this family and handwashing is never enough.

 

244 Marines sickened with shiga-toxin producing E. coli

One of the proudest things I’ve done is help train U.S. military veterinarians in food safety each year I was at Kansas State University.

I still carry the warrant officer badge in my knapsack.

 Steven M. Sellers of BNA writes that Sodexo Inc. is facing a surge of foodborne illness lawsuits over undercooked beef its employees allegedly served at two Marine Corps bases in California.

Tristan Abbott’s Aug. 24 complaint, the most recent of three suits filed in the U.S. District Court for the Southern District of California, alleges he suffered kidney and brain damage from beef contaminated with a virulent strain of E. coli bacteria.

Sodexo, the food and facilities management giant that serves corporations, schools, and the military, says it provides “quality of life” food and other services at 13,000 sites across the U.S. and Canada. The suits questions whether it lived up to its mission at the Marine Corps Recruit Depot and Camp Pendleton in San Diego.

At least 244 Marine recruits were sickened in the outbreak of Shiga toxin-producing E. coli last year. Thirty were hospitalized, 15 with life-threatening kidney failure, according to researchers from the U.S. Centers for Disease Control and Prevention.

The bacteria, known as E. coli O157:H7, can cause severe abdominal cramps, diarrhea, vomiting, and life-threatening complications in some cases.

Abbott was placed on dialysis and developed neurological symptoms from the infection, for which he received a medical discharge from the Marines in April, he says.

Investigators from the CDC and the Department of Defense found a “statistically significant association” between ill recruits and undercooked ground beef, for which Sodexo employees only intermittently checked temperatures, the complaint states.

“We recommended the Navy and Marine Corps retain lot information, address food handling concerns, and improve hygiene among recruits,” CDC researchers reported at an Epidemic Intelligence Service conference in April. The investigators also noted “poor hygiene practices among recruits.”

Sodexo told Bloomberg Law Aug. 27 that the source the outbreak remains uncertain.

1 dead, 17 sick from E. coli O26 in Cargill ground beef

The U.S. Centers for Disease Control (CDC), public health and regulatory officials in several states, and the U.S. Department of Agriculture’s Food Safety and Inspection Service (USDA-FSIS) investigated a multistate outbreak of Shiga toxin-producing Escherichia coli O26 (E. coli O26) infections linked to ground beef from Cargill Meat Solutions. This outbreak appears to be over.

On September 19, 2018, Cargill Meat Solutions in Fort Morgan, Colorado recalled ground beef products.

Recalled ground beef products were produced and packaged on June 21, 2018 and were shipped to retailers nationwide.

Products are labeled with the establishment number “EST. 86R” inside the USDA mark of inspection.

Restaurants and retailers should not serve or sell recalled ground beef and should check freezers and storage for recalled products.

If possible, retailers who received recalled ground beef should contact their customers to alert them of the recall.

When available, the retail distribution list will be posted on the USDA-FSIS website.

Consumers with questions regarding the recall can call 1-844-419-1574. Consumers with ground beef in their freezers can contact the store where it was purchased to determine if it is recalled ground beef.

Final Outbreak Information

At A Glance

Reported Cases: 18

States: 4

Hospitalizations: 6

Deaths: 1

Illnesses started on dates ranging from July 5, 2018 to July 25, 2018.

Six people were hospitalized, including one person who developed hemolytic uremic syndrome, a type of kidney failure. One person in Florida died.

Epidemiologic, laboratory, and traceback evidence indicates that ground beef from Cargill Meat Solutions is a likely source of the outbreak.

On September 19, 2018, Cargill Meat Solutions recalled ground beef products that were produced and packaged on June 21, 2018 and shipped to retailers nationwide. Visit the USDA-FSIS website for a full list of recalled products[PDF – 40.2 KB].

Laboratory testing identified the outbreak strain of E. coli O26 in leftover ground beef collected from the home of one ill person in Florida. WGS analysis showed that the E. coli O26 strain identified in the leftover ground beef was highly related genetically to the E. coli O26 strain isolated from ill people.

28 sick with E. coli O121 in Japan, because they like their burgers rare

The Mainichi – great newspaper name – reports a total of 28 people have suffered food poisoning after dining at MOS Burger restaurants in Tokyo and other locations in Japan, the operator and other sources said.

Twelve of the 28 were infected with the same O-121 strain of E. coli bacteria, the Ministry of Health, Labor and Welfare said Friday.

Those affected had dined at 19 restaurants in eight prefectures in eastern and central Japan between Aug. 10 and 23, the operator, MOS Food Services Inc., said.

One of the restaurants in Ueda, Nagano Prefecture, suspended operations for three days through last Wednesday following an order from a local public health office, the company said.

“It is highly likely that (the illness) was caused by foodstuffs supplied (to the restaurants) by the headquarters of the chain,” it said.

18 sick: E. coli O26 linked to Publix ground chuck products

Publix Super Markets Inc., a Lakeland, Fla., retail grocery store chain is voluntarily recalling an undetermined amount of ground beef products made from chuck that may be contaminated with Escherichia coli O26, the U.S. Department of Agriculture’s Food Safety and Inspection Service (FSIS) announced today.

The ground chuck items were purchased by consumers from June 25, 2018, through July 31, 2018. The following products are subject to recall: https://www.fsis.usda.gov/wps/wcm/connect/330436d0-f5bb-4ee3-a3eb-cca6459bf014/072-2018-List-Products.pdf?MOD=AJPERES&useDefaultText=0&useDefaultDesc=0   

These items were shipped to Publix Super Market retail locations in the following Florida counties: https://www.fsis.usda.gov/wps/wcm/connect/68f37b9e-2b95-45c9-8ba7-36500f13a6ac/072-2018-Affected-Counties-Florida.pdf?MOD=AJPERES&useDefaultText=0&useDefaultDesc=0

On Aug. 16, 2018, FSIS was notified of an investigation of E. coli O26 illnesses. FSIS, the Centers for Disease Control and Prevention, and state public health and agriculture partners determined that raw ground chuck was the probable source of the reported illnesses. The epidemiological investigation identified 18 case-patients, predominantly from Florida, with illness onset dates ranging from July 5 to July 25, 2018. Traceback information indicated that case-patients consumed ground chuck products purchased at various Publix Super Markets that was supplied by a yet-to-be determined source. As this investigation further develops, FSIS will continue to work with the supermarket, suppliers and public health partners, and will provide updated information should it become available.

  1. coli O26, like the more common E. coli O157:H7, is a serovar of Shiga toxin-producing E. coli (STEC). People can become ill from STECs 2–8 days (average of 3–4 days) after exposure to the organism.

Most people infected with STEC O26 develop diarrhea (often bloody) and vomiting. Some illnesses last longer and can be more severe. Infection is usually diagnosed by testing of a stool sample. Vigorous rehydration and other supportive care is the usual treatment; antibiotic treatment is generally not recommended. Most people recover within a week, but rarely, some develop a more severe infection. Hemolytic uremic syndrome (HUS), a type of kidney failure, is uncommon with STEC O26 infection. HUS can occur in people of any age but is most common in children under 5 years old, older adults and persons with weakened immune systems. It is marked by easy bruising, pallor and decreased urine output. Persons who experience these symptoms should seek emergency medical care immediately

FSIS is concerned that some product may be frozen and in consumers’ freezers. Consumers who have purchased these products are urged not to consume them. These products should be thrown away or returned to the place of purchase.

FSIS routinely conducts recall effectiveness checks to verify recalling firms notify their customers of the recall and that steps are taken to make certain that the product is no longer available to consumers. When available, the retail distribution list(s) will be posted on the FSIS website at www.fsis.usda.gov/recalls.

Always tragic: Iowa student dies from complications of E. coli

Southeast Polk Community School District officials say a student has died as a result of complications of E. coli.

No mention in early media reports is made of what kind of E coli was involved.

Willowbrook Elementary officials confirm Natalie Baker, a second grade student, died unexpectedly on Friday. Natalie’s mother said the death was very sudden, and urges parents to be on the lookout for signs of illness in their children, especially if they complain of a stomachache.