ANOTHER U-TURN IN THE E.COLI OUTBREAK INVESTIGATION?

So the culprit vegetable for the huge toxic E.coli outbreak was declared to be (Spanish, imported) cucumbers. And then it wasn't cucumbers. Next it was (German-Saxony, organic) bean sprouts. And now doubt is being cast too on this being the criminal food. Talk of a mess! And talk of an embarrassing situation for German officials. And, a very frustrating situation for all the people living or visiting Northern Germany who are trying to not starve to death or ruin their health, but not knowing what to eat.

But I am a little sympathetic, because of the pressures and challenges involved in solving this mystery. If you have "been in the business" - as I have (among other things, having done bacteriology in public health laboratories), you tend to be more aware of the barriers and pitfalls. For one thing, particularly in the case of food, sufficient numbers of bacteria rarely turn up in every single sample. So you may get some negatives as well as positives. In this case, the news reports 23 out of 40 samples from the farm had turned out negative so far. There are still 17 to go. Let's see...

But there is also the chance - although less likely - that the bacteria entered at a later point. There are still other possibilities as well. I don't have the details on when the sprout samples were taken, but conceivably, it might be possible that the contamination was temporary, in that it only affected sprout crops at a certain period of time (around end of April to early May). This could have been a rainy period, with more runoff from fields where cattle were grazing. Or, perhaps wild animals (which can also carry such bacteria) were running around then, and are now gone. Sprouts do spoil rather quickly, so there may have been none of the original samples left on which to do tests.

Investigating the cause of a food outbreak is always a challenge, particularly with perishable produce or perishable legumes, unless you just happen to get lucky (for instance, finding the contaminated food sitting in the refrigerator of someone who has become ill). But, admittedly, this is one for the history books.

To your good health,

TSF

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

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

SPANISH CUCUMBERS NOT THE CAUSE OF OUTBREAK

So we are back to the beginning. The Hamburg Institute for Hygiene and the Environment now says that it may not be Spanish cucumbers after all that are causing the deadly E.coli bacteria outbreak in Europe. Here we go again - another botched up case of investigating a food borne illness. It happens, particularly when researchers and authorities are under pressure. As we said in earlier blogs, it wasn't a conclusive link yet.

Apparently the testing found that the E.coli bacteria isolated from the stools of sick people don't quite match the bacteria in those suspect Spanish cucumbers.

That leaves us with several questions which have not been answered.

First, are they sure that food is really the cause of the outbreak? Conceivably, it could be contaminated water, or beer or coke or ice or something else. Did interviews with victims ask what they drank recently?

Secondly, if it is food, what is it? Yes, we seem to be back to the beginning on that one as well. Some of the alternatives that have been tossed out over the past week or so are tomatoes, lettuce and eggplant. Who knows, maybe it isn't even one of these. Maybe it's cabbage.

Thirdly, what are those E.coli 0104 bacteria doing in those Spanish cucumbers? Or, was that laboratory finding a mistake too, and they weren't really there?

The mystery deepens. And unfortunately, this one had better be solved quickly. Illnesses and deaths are increasing. And so are political tensions.

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

MORE WOMEN THAN MEN ARE BECOMING ILL AND DYING FROM CONTAMINATED CUCUMBERS

The bacteria causing the outbreak of cucumber-linked foodborne illness in Europe is E.coli 0104:H4. It is relatively rare. In fact, to my knowledge there has never before been a large outbreak caused by this particular E.coli. But E.coli 0104:H4 is one of the more deadly ones, since an illness can progress to Hemolytic Uremic Syndrome (HUS). This complication can be fatal, particularly for the elderly or the very young.

Usually it is children who are most likely to develop complications of HUS when they have one of these types of E.coli infections. The odd thing is that in the case of the currently ongoing outbreak in Europe, especially in Germany, most of those being hospitalized with HUS are adults. And, there are many more women than men. The reported illnesses change from day to day, but one analysis I did showed 78% to be female. Other earlier estimates were slightly lower. Of the ten people that have died to date in this outbreak, nine were women.

Why are more women becoming seriously ill than men? I doubt the explanation is very complicated. Women probably eat more raw vegetables such as cucumbers and are therefore statistically more likely to ingest the bacteria.

To your good health!
TSF

NOROVIRUS FROM CONTAMINATED ICE

The problem is that Norovirus is very infectious. You only need to be exposed to about 100 particles to catch it, whereas in the case of seasonal flu it's around 10,000 - quite a difference. It's also a survivor. Norovirus can live outside the body much better and longer than many other viruses.

Virus-contaminated food is only one of the vehicles for catching it, but an important one. You can also inhale the virus from the air where someone has vomited, or

get sick from touching an infected surface, or a sick person. You can even catch Norovirus from contaminated ice, as occurred a few decades ago at a football game between University of Pennsylvania (where I went to graduate school) and Cornell, or, at a museum fundraiser for that matter.

Here's what happened (my source is the Centers for Disease Control - CDC report on the incidents). Within 48 hours of the University of Pennsylvania-Cornell football game in Philadelphia in 1987, a large number of band members from both universities, Cornell football players, and spectators, including visiting students and university staff and faculty, all started having symptoms of gastrointestinal illness, especially projectile vomiting and nausea. A smaller percentage had diarrhea, headaches, chills and additional symptoms. These were typical of Norovirus. Almost all had bought soda with ice from the stadium vendor.

Oddly, many of the Pennsylvania football team members became ill several days later. Apparently this team had used ice from a different source at the September 19 game, but had used the contaminated ice at practice a few days later.

Just a couple of days later there was an outbreak of gastroenteritis among 750 people who attended a museum fund-raiser in Wilmington, Delaware, not far away. The ice was traced to the same Pennsylvania ice supplier. It turned out that its wells had been flooded by a creek (obviously contaminated) following a torrential downpour of rain. Probably, in all, about 5,000 people became ill from this Norovirus contaminated ice.

There is no reason why this kind of outbreak can't happen again anytime, anywhere. And there's no way to know that ice is contaminated. Opt for a warm soda?

TSF

HALF A BILLION SUSPECT EGGS

One thing we should never assume is that new food safety legislation is going to have an instant effect. Take eggs. Yes, the FDA has this year issued a new egg safety rule, meant to seriously reduce the chance that shell eggs could contain Salmonella bacteria - the main contamination risk in eggs. In fact, the majority of big U.S. egg producers and transporters are already doing most of the things proposed, and have been for years. Can they do better? Sure, there is always room for improvement, and hopefully, the legislation will help.

But if egg producers and egg transporters are being careful, how come more than half a billion eggs all over the U.S. have just been recalled because they could be contaminated with Salmonella bacteria? Everyone seems to be blaming the huge Iowa egg producers - Wright County Egg farms, and Hillandale Farms. Certainly, there is a chance that they slipped up. Let's face it, the violation record of Wright farms is not exactly great. If they break employment laws, maybe they have also been breaking the safety ones. And, there have been reports of rats...

But it could simply be that they were very unlucky. Maybe the chicks they bought were already ill, or the hen feed they bought was contaminated, or something else. The last think a food producer of any kind wants is a recall of their food products. The trouble is that bacteria are probably smarter at surviving than we are at catching them. Salmonella bacteria are proving to be one of the best. They are cropping up in almost every kind of food we eat - even in dry spices.

So, don't hold your breath and wait for things to get better. No matter what government does, or food producers and distributors do, things will never be perfect. There will always be a bad egg somewhere.

This is one type of food in which we consumers can really control our risks.

RAW IS RISKY.

COOK YOUR EGGS WELL.

Bon appetit

TSF

Ready and Risky Food

We Americans are eating more and more 'ready' foods - those nice-and-easy, no cooking items we can just eat straight out of the package, or slab onto a piece of bread or bagel in 30 seconds flat. These foods are also among the most risky to eat. Why?

One reason is that they have been touched by so many hands or pieces of equipment, any one of which could be contaminated. Another is that usually several different ingredients have been mixed in together, any which could spread microorganisms from one to another, where it might grow even better.

One presently ongoing outbreak (recall date, January 9, 2010) involves several different products from the same company - peanut butter, processed cheeses, several types and flavors of bagel spreads, several types of salsa......All of them in plastic tubs with snap-on lids. The company involved, Parkers Farm, Inc. of Coon Rapids, Minnesota, supplies such major retailers as Costco, Safeway, Whole Foods, Target and many more.

The bacterium Listeria monocytogenes is the culprit again, as it often is in these kinds of foods. This bug is the one that is so risky for pregnant women (very frequently causing miscarriages and stillbirths). It can also cause serious and sometimes fatal infection in young children, frail or elderly people, and others with weakened immune systems. If you don't fall into any of these categories and you get it, you are just likely to have a few days of high fever, severe headache, nausea, abdominal pain and diarrhea. Consider yourself lucky.

So how did the bacteria get into the food products? We don't know yet. The investigation is ongoing. But the chances are that it got in the usual way - through some contaminated piece of equipment, or a food plant worker that carried the bacteria (some estimate that 10% of workers may do so).

Yes, the products are all being recalled, but don't rely on the recall. For a list (which is likely to grow) link to the FDA recall site (see sidebar).

bon appetit!
TSF

NUTS TO YOU

Keeping up with frightening food events in our food supply is getting quite exhausting. One of the most annoying aspects is that just as you think you can forget about one of the outbreaks, you realize it is still out there. And contaminated products might still be out there too, waiting for us, innocent consumers, to pounce on them.

Take peanuts. The PCA incident that blanketed our country (and a few others) with salmonella-contaminated peanuts and peanut products should be well over by now. The plants have been shut down. More than 2,100 products in 17 categories have been voluntarily recalled by more than 200 companies, since January, 2009 (probably more, as the FDA information is at least a week or two out of date). Hundreds of people have become ill and some have died. But guess what, it's not over.

There have been more peanut product recalls in the last few days, including one yesterday. More or less ditto for pistachios. The most recent pistachio one - just four days ago. No wonder I could not get any at Trader Joe's on Wednesday when I wanted to make my usual favorite of herb cornish hen, stuffed with raisins and pistachios (I settled for pine nuts instead).

But back to peanuts. Yesterday's recall really illustrates the oddity of our so-called food safety system. Nuts for You of Preston ID is recalling Roasted and Salted Peanuts manufactured with peanuts bought from PCA. The product was distributed between March 15, 2008 and Jan 15, 2009.The sell-by date on the plastic bag of 'Nuts for You' was Feb 18, 2009 (more than four months ago) . Presumably the nuts were purchased sometime in 2007 from PCA's Texas plant to make these cute bags of salted peanuts sold at gift stores.

So here we are on June 25, asking consumers to send back products made of antique nuts (maybe two years old) that are well and truly expired and, are very likely to have also been well and truly eaten. The really bad news is that this type of pattern is not unusual.

Nuts to you, FDA. How are we supposed to escape bad food in America?

bon appetit!

TSF