HOW CAN WE BE SURE THAT THE TOXIC "GERMAN" E.COLI IS NEW IN THE U.S.?

The outbreak of toxic E.coli continues to create illnesses and panic in Europe. The latest genetic testing by a collaborating Chinese laboratory shows it to be a new strain - or, at least, a previously unidentified strain of E.coli. Yes, it is related to E.coli 0104 (about 80%) but the other 20% of the genetic composition comes from another very toxic bacterium. The closest thing we know to it is apparently a strain known as EAEC 55989 that causes very serious illness in the Central African Republic.

The experts are saying this strain of E.coli has never caused any illness in the United States. I think that conclusion is premature. How can we know we haven't had such incidents if laboratories do not test for them? Most laboratories only do serological typing for the more common E.coli 0157:H7, which crops up with some regularity in the North American food supply, with no testing for the other 2000 or so E.coli strains.

Remember the case of E.coli 0145 in a bag of Dole Baby Spinach in 2006 (and in Safeway lettuce in 2010)? The New York laboratory that found it was one of the few in the U.S. which tested for this strain. If the sample had been sent to another U.S. laboratory, the chances are that it would not have been identified. And if you were ill with E.coli 0104 and the sample was sent to a U.S. laboratory, the chances are that it would not have been identified either.

Let's not say the bacterium has never occurred in the U.S. Let's just say it hasn't been identified. It could have turned up, but simply been relegated to the cold case files of food borne illness.

To your good health.
TSF

WE MAY NEVER KNOW THE SOURCE OF THE GERMANY-CENTERED E.COLI OUTBREAK

The E.coli outbreak that originated in Germany, and is spreading across Europe and beyond, is much worse than anyone initially expected. In fact, it is worse than any recent outbreak of food borne illness anywhere in the world. I am calling it "food borne" because that is how it has been classified from the beginning. But I am still keeping an open mind until there is conclusive proof. And there isn't yet.

True, food is indeed the source of illness from enterohemorrhagic E.coli like this one. But it is not the only possibility. You can also get it from contact with sick people, from animals (who may carry disease-causing bacteria but not show any symptoms), from a swimming pool, from oral contact with a contaminated spoon or fork (or, anything else), or from drinking water.

Even if it is food - and, it probably is, given the large number of people becoming ill, we may never find out which food item is involved. It wouldn't be the first time that an investigation of food borne illness came up blank. Not all crimes are solved either. And, as in the case of this outbreak, under pressure to come up with a solution, the wrong culprit is sometimes initially identified. Even if traceback efforts and laboratory testing never find the source, the outbreak usually just fizzles out. But, of course, it would end faster if we knew where it started.

Research institutes all over the world are becoming involved in trying to solve the mystery. Let's hope they succeed before it spreads any further.

To your good health!

TSF

CATCHING E.COLI BACTERIA FROM SOMEONE ELSE INSTEAD OF FOOD

There is nothing new to report on the ongoing outbreak of the deadly E.coli bacteria in Europe. Some experts believe that the number of new illnesses and life-threatening HUS complications (in about 30% of cases) might be slowing down a bit, but opinions seem to differ. So do the statistics. We still don't know the source of the outbreak (now that cucumbers are no longer the definite suspect), but the focus remains on vegetables.

And now everyone is talking about how rare and infectious and deadly this particular strain of E.coli is.

What no one seems to be mentioning is the risk of catching it, not from food, but from someone who is ill. I am talking about person-to-person transmission, or "secondary" illnesses. They can be just as bad. A study published by the U.S. Centers for Disease Control (CDC) in March, 2011, on an outbreak of the better-known and more common E.coli 0157:H7 in Scotland, found that about 11% of cases were secondary. Another study of a 2006 U.S. outbreak of the bacteria associated with spinach estimated that 12% were secondary. So, conservatively, let's say at least around 10% of cases of these deadly illnesses are likely to occur as a result of contact with someone who is ill - usually a relative or close friend. Since this particular E.coli bacterium is especially virulent, the rate of secondary infections could well be much higher. Well, what are we doing to prevent these cases? And, is the public being warned to be careful?

Of course, the basics of preventing person-to-person transmission of this bacteria, as with any other, are pretty simple. The usual route for infection is fecal-oral. Most of it boils down to using good personal hygiene. But remember too that care should be applied to touching the clothing or bedding of someone who is ill, and in cleaning the bathroom they have used. Disposable rubber gloves, which are available in most urban areas, can be very useful.

What most people don't know is that someone can have an infection and not show symptoms, and, that someone who is ill can be contagious for a few days after all symptoms have disappeared. In some cases, much longer.

Be careful.

To your good health!
TSF

THE LATEST ON THE DEADLY E.COLI OUTBREAK

The current outbreak of - presumably - food borne illness, is continuing in Europe. It has been declared to be the worst such outbreak in modern times. This is not only because of the numbers of people who are becoming ill, and the multi-country scope, but because of the severity of the illness. It is caused by a particularly deadly and rare strain of E.coli bacteria. While some E.coli live normally in our digestive system and serve a useful function in processing food, others are pathogenic and can cause very serious illness, including hemolytic uremic syndrome (HUS). This is one of the latter group. In fact, it may be the worst E.coli bacterium known because of the very high percentage of victims who develop HUS complications.

Since the outbreak is still ongoing, statistics are changing on a daily basis. Remember too that some people may be asymptomatic, and others have such mild cases that they don't see a doctor, and therefore do not get added to the list. As mentioned in earlier posts (see May 31), the real numbers in any foodborne illness are usually many times higher than the reported ones. By the time I post this, the below numbers will have increased again. But they give you some idea of where we are.

 In Germany: 1,534 people in the country have been confirmed as infected. The Robert Koch Institute in Germany has reported that out of these fully 470 are suffering from HUS (about 30%, which is in the range of my earlier guesstimate - see post of May 31 - of a quarter to a third). Seventeen deaths have been reported so far.

 In other countries: The World Health Organization said cases have been reported in nine European countries: Austria, Denmark, Germany, the Netherlands, Norway, Spain, Sweden, Switzerland and the U.K. But other reports also note two cases in the United States, and one in the Czech Republic (an American travelling from Germany, who is hospitalized in Prague). All but a few illness in other countries are among people who have recently travelled to Northern Germany, or among German residents who are have become ill while travelling abroad (There is a time-delay between getting infected and developing symptoms). The few instances that do not fit this patterns could be secondary infections caught from friends or relatives who are ill.

As of time of writing, the source of the outbreak is still unknown. Although cucumbers from Spain have now been dismissed as the cause, people in many countries are still being advised not to eat them. They are being fed to goats instead!

It seems that the focus of the investigation is still on vegetables which are eaten raw. But could it be something else?

To your good health!

TSF

YOU CAN MAKE THOSE CUCUMBERS SAFER TO EAT

I have just enjoyed a delicious cucumber salad, prepared the way I prefer it: with non-fat yogurt and fresh dill. It was left over from a party on the weekend, but still delicious.

Yes, I am continuing to eat raw cucumbers in spite of that outbreak of "cucumber illness" in Europe, mainly centered in Germany. But I live in North America, not in Europe. True, a couple of Americans returning home from travel to Germany have become ill with similar symptoms, but as far as we know at present, none of the suspect cucumbers from Spain are actually being sold in the U.S. or in Canada.

But I do take some precautions, not just to avoid any pathogenic E.coli, but also those common Salmonella bacteria, and parasites.

First, I buy carefully, not just checking to see how the cucumbers were grown (organic/conventional) but also where they came from. This information should be available. Mandatory "Country-of-Origin" (COOL) for fresh produce went into effect in the U.S. in 2008. If it's not actually on the cucumber, I look for information on the crate.

Secondly, I make sure the cucumbers I pick are firm and the skin is undamaged, which would allow easier entry of contaminants.

Thirdly, once in my home and before I let a knife anywhere near them, I wash the cucumbers well. Unless you are buying cucumbers in a farmers' market, these days most are covered with a layer of wax rather than dust or dirt, but I do it anyway.

Thirdly, I peel the cucumbers. Years ago, I used to eat them with the peel on, but now I remove it - pleasanter to eat with any waxed produce, and safer, although I am aware that I am losing some of the nutritional value.

Will this avoid any dangerous bacteria in my cucumbers, including those deadly E.coli 0104 that are popping up in Europe? No, but it is likely to reduce how many are present in what I eat. Realistically, some may be left in the actual flesh of the cucumber, and so may the toxins they produce.

Let's face it, as I stress in The Safe Food Handbook, raw is always riskier than cooked - including in the case of vegetables such as cucumbers. But at least you can reduce your risks a bit by making some smart decisions and actions.

To your good health!
TSF

THE "CUCUMBER BUG" COMES TO THE U.S.

It was simply a matter of time before it happened. Many of the illnesses from the very dangerous E.coli bacteria sweeping through Europe have been among visitors to Germany. And, Americans also travel, including to Germany. And there we have it - now the first two possible cases among Americans who have just returned from a trip there.

Notice that I said "possible." To my knowledge the tests haven't yet been finished. And there must be a lot of hysteria out there, particularly among people who have been in the Hamburg region eating salads. Secondly, notice that I said "first two." After all the correct predictions I made about radiation-contamination of food in the Fukushima area of Japan, I am on a bit of a roll. So let me make another "food safety prophecy." There will be more cases reported in the US in the next few days.

Let's see if I am right.

But if you are just back from Europe, and were in fact eating salads or eating raw cucumbers, keep yourself healthy and keep a watch on your symptoms. If you have diarrhea and it goes on for more than a few days, or is bloody - go see a doctor or go to the emergency room. Also, make sure you do not pass on bacteria to any of your relatives and friends. Practice good hygiene.

To your good health!
TSF

UPDATE ON THE "KILLER CUCUMBER BUG."

There have now been 16 confirmed deaths from pathogenic E.coli 0104:H4 bacteria in food in Europe - probably raw contaminated organic cucumbers that were imported from Spain. We are still not 100% positive. The number of illnesses is reported to be around 1,200.

But remember two things. First, there is always a time delay in reporting of food borne illnesses, so, while an outbreak is still ongoing, they are always a bit behind the actual numbers. Secondly, only a fraction of food borne illnesses are actually ever reported. Some people, who have a milder case - and they do exist, even in this outbreak, may never go to a doctor or a hospital, and never enter the reporting system. Let's assume the number is actually double, triple - or even more.

It looks to me as though about a quarter to a third of the cases of this illness are resulting in complications of hemolytic uremic syndrome (HUS), which is very serious and can be fatal when the kidneys are badly affected. If true, that is a very high incidence - much higher than usual with outbreaks of the more common E.coli 0157:H7 (closer to 10%). In other words, this is a very, very virulent bacteria.

As mentioned, the definitive cause of the illness is still largely unknown, although stories and rumors are flying. It has also become a political battleground, with every country that is accused - not just Spain, but also the Netherlands and Denmark, loudly denying any guilt, issuing threats and demanding apologies.

What we do know is that this is one of the deadliest food borne outbreaks that has ever occurred. Quoting Dr. Robert Tauxe, Deputy Director of foodborne, waterborne and environmental diseases at the U.S. Centers for Disease Control (CDC): "There has not been such an outbreak before that we know of in the history of public health."

Please be careful. If you live in Europe, follow government advice and avoid raw cucumbers for a while - and raw tomatoes and lettuce as well. Don't even use raw cucumber slices on your eyes or your sunburn!

To your good health!
TSF

ARE U.S. CUCUMBERS SAFE TO EAT?

2011 seems to be the year of the cucumber. In food safety terms, that is. Three hazards have surfaced in cucumbers in just the past two months. Where does that leave us with eating raw cucumbers in the U.S.?

First there was the concern about radiation in cucumbers from the Fukushima area in Japan (see post of May 7). Yes, according to the latest government statistics I found (for 2009), Japan is eligible to export cucumber to the United States. But it is a very small player. Besides, as I said in the earlier blog, a small dose of radionuclides in a cucumber or two is not likely to cause permanent damage to your health. Although yes, pregnant women and young children should be extra careful.

The next cucumber-related safety issue that has surfaced this year is our old friend Salmonella bacteria. In early May there was a recall of cucumbers by the U.S. Food and Drug Administration (FDA) because of Salmonella contamination (see post for May 3). The infective dose for Salmonella bacteria is usually fairly low. Most likely you could just have eaten one of these Salmonella-infected cucumbers, or even a few slices and become ill. But in all, this seems to have been a fairly small outbreak.

Now there is the very frightening E.coli 0104:H4 outbreak in Europe, that appears to have originated in cucumbers exported from two growers in Spain. So is the U.S. importing cucumbers from Spain? The U.S. Department of Agriculture (USDA) data I found suggests that Spain is indeed eligible to export cucumbers to the U.S. But do we get them from the two cucumber producers in Spain that seem to be implicated in this outbreak? I don't know. But I am trying to find out.

In the meantime, if you are nervous about it, I would suggest that you buy local wherever possible. Personally, I have not stopped eating raw cucumbers. But until we know more, I check to make sure they are not imported from Spain. And as soon as mine are large enough to eat (if the squirrels don't get them first) I'll eat those.

To your good health!

TSF

ACTION TO STOP THE CUCUMBER-LINKED OUTBREAK

This cucumber-associated outbreak of food borne illnesses in multiple countries in Europe is really frightening, mainly, because of the virulence of the hemorrhagic E. coli involved. A large percentage of people - around three fourths women - are not just having a few miserable days with diarrhea, but actually developing complications of Haemolytic Uremic Syndrome (HUS) and ending up in the hospital. As of today, at least ten have died. There will be more.

But don't panic. Action is being taken all over Europe to stop the outbreak of illnesses. Everywhere, the culprit food (that is, if it's only the Spanish cucumbers) is being withdrawn from the market - Germany, the Czech Republic, Luxemburg, Hungary and elsewhere. National authorities everywhere in Europe are checking what was imported, where it went, and trying to catch every vegetable before any more people eat them. The public is also being advised not to eat them and restaurants and consumers have been told to throw out any they might have bought.

Restrictions have been imposed on the two suspect Spanish cucumber growers, even before conclusive proof is available that the problem started with them. So, there won't be any more coming in from those sources. In parallel with these activities an investigation is ongoing. Interviews are being done with victims, laboratory testing is being performed on actual vegetables (including others, as well as cucumbers), and every point along the distribution line is being checked and examined for possible failures which could have resulted in contamination.

Assuming we have the right culprit vegetable (and that it's not eggplant or tomatoes or lettuce as well), and assuming that there is no other grower anywhere with the same problem, new illnesses should soon stop occurring since the incubation period for this bacterium is usually less than a week.

But then, there is the problem of secondary illnesses(people becoming ill from someone else - usually a family member - who did eat the food), or other indirect routes, as through swimming pool water (see previous post). Some studies have found around 10% of pathogenic E.coli illnesses to be secondary. But a few case studies I looked at had a higher incidence. Given the rarity of this particular E.coli 0104:H4, we don't really know what will happen.

To your good health!
TSF

CUCUMBER TRAVEL ADVICE FOR BRITONS - AND OTHERS

A couple of weeks ago, vacationing or business travel in Germany would have been considered very safe. Not any more. Particularly around Hamburg. This is the center of the "cucumber crisis." Most of the over-thousand hermorragic E.coli-related illnesses have been linked to eating food here. A considerable number have occurred among people from other countries such as Sweden, Denmark, France, visiting this area, or, residents of Germany who ingested the cucumbers and at home and then went abroad and became ill.

Britain is the latest country to be hit by cucumber fears. At least three cases among visiting Germans are suspected to be part of this outbreak, one of them confirmed. In fact, the advice to Britons now is not to eat raw cucumbers - or, raw lettuce or tomatoes (see earlier post) - when visiting Germany. And remember, washing or peeling is not guaranteed to solve the problem. If the cucumber has been sliced up or otherwise prepared in a restaurant or hotel, the risk could be even greater, as it could also be contaminated by a food worker who is a carrier of the bacteria (or others).

The "incubation" period for pathogenic E.coli (the time between ingesting it and developing symptoms of illness) can be as little as one day or a week or even longer. That means that you can feel perfectly well for a while after eating that deadly cucumber, keep working or vacationing and get on that plane and then become ill.

And yes, the bacteria are contagious. That is, they can be passed along not only in food or water, but also from person to person and even from the water in a swimming pool where it can survive for weeks, particularly if not well chlorinated. So I will add a bit more advice to travelers: don't let the water from a public swimming pool enter your mouth - not even a few drops. Don't dive in, don't dive under, and in fact, you may want to think twice about using the pool at all.

To your good health!
TSF

COULD TOMATOES OR LETTUCE ALSO BE CONTAMINATED?

The large outbreak of foodborne illness in Europe caused by Enterohemorrhagic E.coli 0104:H4 (EHEC) has been attributed to contaminated organic cucumbers imported from Spain. But keep an open mind. It could be another fresh vegetable as well, one such as tomatoes or lettuce.

In fact, German authorities have advised people to be careful when eating any of these vegetables raw. Why? Well, at least one study of women who had become ill (adult women are the main victims) found that a slightly higher percentage had eaten raw tomatoes than had eaten cucumbers in the preceding days. Lettuce also scored well in this survey.

So why were cucumbers pinpointed as the culprit vegetable? Actual testing did find the identical EHEC bacteria to be present in those imported whole cucumbers. To date, no testing has turned it up in tomatoes or in lettuce. But that doesn't mean it won't be found tomorrow, or in a week's time.

It wouldn't be the first time that the initial identification of a culprit food wasn't quite accurate. This happened with a large outbreak of Salmonella illnesses (Salmonellosis) in the United States in 2008. For weeks tomatoes were believed to be the cause, but later it was found that the culprit vegetable was Jalapeno and Serrano peppers (with "maybe" tomatoes as well). In other incidents strawberries have been blamed when it was actually raspberries. And so on. Nor is it impossible that more than one fresh vegetable is involved. This is quite likely if they came from the same farm or even the same area. The same improperly prepared organic fertilizer, E.coli 0104:H4 contaminated irrigation or processing water, or even packing ice could have been used.

So yes, if you live in Germany, and especially Northern Germany (where most of the illnesses have occurred) or are visiting there, I would avoid all three of these fresh vegetables for a little longer, until the investigation comes up with more answers. Washing may help a bit, but it may not work completely.

To your good health,
TSF