TWO WAYS THE FRENCH AND GERMAN E.COLI OUTBREAKS COULD BE LINKED

There is more and more conjecture that the huge German outbreak of food borne illness and the more recent French one could be linked. Both have been traced to sprouted seeds. Both involve an unusually toxic strain of the bacterium, E.coli. In the case of the German outbreak, centered around Hamburg and hopefully winding down, it is now reported that 47 people have died, almost all in Germany. In the case of the French one, no fatalities have been reported as yet, but seven people are still seriously ill and hospitalized, one of them in intensive care and one having treatment for kidney problems.

It is highly unlikely that these geographically separated outbreaks are linked through means such as contaminated irrigation or rinsing water, wildlife, improperly cleaned equipment, or improperly composted manure. But there are two ways that they could be linked (note: the link has not yet been proven). The possibility being focused on by the French authorities is that both the German and the French growers used contaminated seeds, probably from the same British seed company (see 3 posts for June 25). If so, that would follow a pattern that has caused nationwide sprout-linked outbreaks in the U.S. where several sprout growers with contamination problems had all used contaminated seeds from the same source.

However, there is also at least one more possibility: a worker at the French grower's could have had a case of the German E.coli 0104, and become a carrier, later contaminating the French sprouts. This can happen. People may no longer have symptoms of illness (or, may never have been really ill - "asymptomatic carriage") but continue to shed the E.coli bacteria for several weeks, or even months afterwards and pass it to others directly, or indirectly through surfaces or food - such as sprouts.

So if the two outbreaks are linked, which is it? We'll find out soon..

To your good health,
TSF

HAVE DEADLY E.COLI 0104 NOW SPREAD TO SPROUTS IN FRANCE?

It was bound to happen. No sooner do you think an outbreak is over, when it isn't over. It looks like the super-toxic strain of E.coli bacteria that was traced to sprouts grown in Germany, may also have cropped up in sprouts grown in France.

But the French (who saw what slow action did in Germany) are acting much more quickly than the Germans did - and hopefully not fingering the wrong culprit. Not only have sprouted seeds been identified as the suspect food item, but investigators have found that all but one of the people who are ill attended a charity event at a children's play center in a suburb of Bordeaux at which they ate gazpacho garnished with sprouts.

True, the German and French E.coli strains haven't been conclusively matched as yet (it takes a while), and other less-lethal E.coli have been known to turn up in sprouted seeds (as well as other foods) as well. In fact, there were at least 3,500 cases of E.coli reported last year in the EU, with some 93 of these in France (though not all may be linked to food). And there was a case of E.coli contaminated frozen hamburger meat in northern France just about a week ago (investigators say the two cases are not linked).

But what makes one suspect that this French outbreak and the German one might be linked is the high incidence of Hemolytic Uremic Syndrome (HUS) complications with kidney failure among adults who are ill. Only 8 illnesses have been reported in France so far, but of these, apparently 5 (or, 7 - depending on which news report you read) are hospitalized with life-threatening HUS. Even if we assume that the actual number of illnesses is much greater, this is clearly an unusually toxic E.coli - like the E.coli 0104:H4 that turned up in Northern Germany this spring. I hope not.

But if it is, what does this mean? It means that the bacteria was/is most likely in seeds themselves (although they are different kinds of sprouts). That is, the contamination did not come from water used by sprout growers for irrigation or washing, and the cause was not some bacteria-carrying worker or unsanitary conditions at the sprout grower's in Germany. I imagine that this grower is very relieved.

But it can also mean that there is more to come...We have not heard the end of this yet. Until the next post..

To your good health,
TSF

ARE SPROUTS THE DEADLIEST FOOD IN THE WORLD?

Sprouts (sprouted seeds) have now caused the two largest known outbreaks of E.coli food borne illness. You could say that they are the deadliest food in the world. And, unfortunately, a little goes a long way in terms of making you ill.

In the summer of 1996, in Sakai, Japan, an estimated 12,680 were sickened and at least 11 people died from eating radish sprouts. Many where school-age children.

In the early summer of 2011, in northern Germany, at least 3100 people have been sickened and so far 31 have died, from eating bean sprouts. Hundreds remain critically ill, as the outbreak winds down. Although sprouts were the second suspect, and then dismissed, the authorities have now concluded that the outbreak did after all originate in organic sprouts grown on a farm in the northern German village of Bienenbuettel.

Just a few days ago, the Dutch recalled exported beet sprouts from three countries, because E.coli was found, but not by the vicious Hamburg strain. It was another pathogenic E.coli bacterium.

There have also been numerous sprout-linked outbreaks in the United States and Canada over the years, many of them in alfalfa sprouts which are the most popular in the U.S. Sprouts are commonly contaminated with not just various E.coli, but also Salmonella and even Listeria (see earlier post). The government-recommended treatment of seeds (not obligatory), is not used by all growers, and even when used, does not always work. Organically grown sprouts appear to be no safer than conventionally grown ones.

At the beginning of this year, sprouts headed my list of 5 foods I would not eat in 2011 (see post of January 3). They are still there.

To your good health!

TSF

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

ARE SPROUTS SAFE TO EAT?

On January 4 of this year, I posted "Five Foods I Won't Eat in 2011." Sprouts was one of them. In fact, it was first on the list. I guess if all those unfortunate people who are very ill with the German E.coli had read this post, they would be much happier today. I wish they had. This outbreak is no joke. Nor is this new super-toxic strain of E.coli bacteria.

The Safe Food Handbook has identified sprouts as one of the riskiest foods to eat. The U.S. Food and Drug Administration does not like sprouted seeds either. In fact, it warns people who are elderly or with a weakened immune system, not to eat them. There have been certain periods of time, such as April, 2009, when the FDA has warned everyone - even healthy people - not to eat sprouts. That is what the German government is doing now. For thousands of people, it's too late.

The usual contaminant of sprouts in the United States is Salmonella bacteria, although E.coli 0157:H7 has also been involved in contaminated alfalfa sprouts in the U.S. , as has the bacterium Listeria monocytogenes. In the German outbreak, it is E.coli. Both in the case of the Salmonella and the E.coli bacteria, the original source is likely to be animal manure. In the case of Listeria contamination, the point of entry could be during processing.

Will washing sprouts help? Not always, because the contaminant can be right inside the seed itself.

Will cooking help? (Not that most of us like well-cooked sprouts) Sometimes. In the case of some E.coli bacteria, the enterotoxins they produce are heat-labile (meaning they are destroyed at high temperatures). But other E.coli enterotoxins can survive. That means that even cooking won't always solve the problem. And it is the toxins that really attack your body and continue to do so, even when the bacteria themselves have left the scene.

You may think twice about eating those sprouted seeds in the future.

To your good health!
TSF

E.COLI SPROUTS WERE GROWN IN GERMANY

It looks like imported food was not to blame after all. Bean sprouts are now suspected of causing this deadliest outbreak of food borne illness known. It has sickened over 2,000 people and caused at least 22 deaths. And, these sprouts originated right in northern Germany, where the outbreak centered.

The sprouts were in fact grown on a farm in lower Saxony. The ministry spokesman Gert Hahne told The Associated Press: "Bean sprouts have been identified as the product that likely caused the outbreak," Hahne added: "Many restaurants that suffered from an E.coli outbreak had those sprouts delivered."

Today, the Lower Saxony agriculture ministry sent out an alert, advising people not to eat the sprouts - on salads, in sandwiches, or in any form.

What we still don't know is exactly where and how the deadly E.coli entered the sprouts. The farm level is the obvious place to suspect, and most likely, the water used for irrigation, from improperly composted manure used as fertilizer or from grazing animals. Contaminants can also be in sprout seeds before they are even sent to the grower. Or, though less likely, contaminants can enter during processing.

Can you make sprouts safe? I'll deal with this in the next blog. In the meantime, if you have a copy, read about it in the book.

To your good health!

TSF

BREAKING NEWS : BEAN SPROUTS CAUSE OF E.COLI OUTBREAK

I have just returned from being interviewed on KRON 4 Television in San Francisco (my second time there this year). The topic was the European E.coli outbreak. Since this is an emerging situation, I made sure that I caught up with the latest news before I left the house for the studio. But wouldn't it. About 5 minutes before the interview aired the news came out. It is now suspected that the outbreak was caused by bean sprouts, served in Hamburg area restaurants. It wasn't the cucumbers, tomatoes or lettuce after all. It was a legume. At least I had blogged the possibility last night - and identified one of the restaurants (see previous blog). It helps to be a step ahead of the "breaking news."

Besides, I can't say I am surprised. What was that famous line is the movie Casablanca after Major Strasser has been shot? "Round up the usual suspects." We tend to go for the obvious first. In this case of deadly food borne illness, the usual suspects were cucumbers, lettuce and tomatoes. Most people eat them. So, if people who are ill are asked what they ate in the last few days, they are likely to mention these. Who is likely to say" "Oh, and there were these tiny sprouts in the salad..." That's why it took a while - far too long - to come up with the culprit food.

This is not the first time that a misidentification has happened in the investigation of a food-linked outbreak. Remember the case in the large Salmonella outbreak in the U.S. in 2008 when those poor tomatoes were blamed for everything, and it really turned out to be Jalapeno and Serrano peppers - and only "maybe" tomatoes as well? This isn't the only instance of the wrong food being identified.

To your good health!
TSF

RESTAURANT FOOD MAY BE INVOLVED IN E.COLI OUTBREAK

There is now some speculation that the huge outbreak of super-toxic E.coli in Europe may not have originated at the farm level after all. And, it may not be linked to imported produce - such as cucumbers. In fact, the outbreak could have been "home-grown" in Northern Germany itself, maybe originating at the Hamburg Port Festival. The beautiful festival took place at the beginning of May. That timing sounds just about right. It was attended by about 1.5 million people - both tourists and locals.

The possibility is being investigated. Certainly at least some of the victims attended the event. And reportedly several of them ate at a popular local restaurant called the Kartoffel-Keller - "The Potato Cellar" in English. It is a charming Hamburg restaurant with outdoor tables and vines - straight out of a tourist brochure. The photo is of one of their potato pies. The owner is clearly upset, to put it mildly.

I assume that we'll find out in the next few days whether all of the victims ate there (except for those who caught it second-hand from other people). They are no doubt being questioned right now. But it's possible. And it may not have been the restaurant's fault. If you look at my post of earlier today on E.coli 0157:H7 recalls of the past few months in the U.S., you will see that at least two of the contaminated meat recalls were of ground meat distributed to restaurants only. That is, the distributor sent the restaurant contaminated food. As I say in The Safe Food Handbook, restaurant food tends to be less safe.

Was the source even salad? Or was it potatoes? Or meat? Or, sprouts?

To your good health!
TSF

SALADS ARE ONE OF THE RISKIEST FOODS TO EAT

The Safe Food Handbook calls salads one of the riskiest types of food we can eat. In fact, it could well be that more food borne illnesses originate in salads each year than in any other type of food. Why?

The main reason is that we eat them raw. Meat may carry more bacteria, but we can do something about it: we can cook it. But we do nothing about our salads, except wash each item, peel where we can, and hope for the best. Some of the time it works. But sometimes it doesn't. The reason is that the microbes have got under the skin, right into the flesh - the parts we eat. And, salads are so easy to contaminate in the kitchen, from unclean surfaces or contact with other raw foods that carry bacteria. Salads in a restaurant are particularly risky.

As reported by CNN World, Dr Nicola Holden, from Scotland's James Hutton Institute, noted that food poisoning cases linked to vegetables appeared to be on the increase. "We have seen a rise in the number of outbreaks associated instead with fresh fruit and vegetables; in particular foods that are eaten raw or lightly cooked, like salad vegetables, fresh fruit and sprouted beans," she said.

What is happening in Europe right now with the current outbreak could underline this point. That is, if it really turns out to be one of the salad items that is responsible. It is not proven yet.

To your good health!

TSF

E.COLI HAS US PASSING ON THE SALAD

There is still no solution to the mysterious E.coli bacteria outbreak in Europe. We don't know what the source was, but the main suspects are still cucumbers, lettuce and tomatoes.

People are getting nervous and forgoing their salad. First in Spain, now in other European countries as well, farmers are having to throw out their vegetable crops, or feed them to the goats and pigs. The market vendors are suffering too. The German government has advised people not to eat raw vegetables. That means no cucumber salad, no tomatoes on your sandwich, and no salads.

In Hamburg, the center of this deadly outbreak, the main market has few customers and sales have fallen. Even the U.S. military bases in Germany are pulling tomatoes, lettuce and cucumbers from the menus, salad bars and commissary shelves. And American Airlines has taken green salads off its menus on flights out of Europe.

But it's not just in Germany. People in other European countries are also being more cautious about fresh vegetables and especially the three main suspects. Even in Britain, farmers are having to discard tons of salad crops because of poor demand - not just of cucumbers, but also of lettuce, tomatoes - and even peppers. As of today, there have been at least 11 confirmed cases of this illness in the UK - four among visiting Germans, and the rest among Brits who recently visited Northern Germany, or, had close contact with someone from there.

Russia has gone so far as to ban import of all vegetables from Europe, which will also hit European farmers hard since it is a major market for their produce.

With all these bailouts and other problems, that's all the EU needed.
To your good health!

TSF

NUMBERS OF E.COLI ILLNESSES COULD BE TEN TIMES GREATER

Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, has said that the actual number of infections resulting from the very toxic E.coli outbreak centered in Germany, could be 10 or more times higher than those officially announced.

So let's say the official numbers are 2,000 illnesses from this very unusual bacteria (that's probably close to what they will be tomorrow). That would mean that it's really closer to 20,000. Is this possible?

Yes, not only possible, but probable. That is what I have been suggesting in previous posts, so I am glad someone agrees. In all outbreaks there are large numbers of affected people who are not included in the reporting system: because they don't go to the doctor, because laboratory tests are not performed, because the tests don't turn up the bacteria (numbers present in the stool will decrease after the first few days), because the cause is not correctly identified, because the doctor or hospital doesn't have time to send in a report.

In addition, there are reporting delays: not just a few days, but sometimes weeks, while the information works its way through the system. This means that the reported statistics are always behind the real ones. And, much lower than the real ones.

Based on a review of the U.S. experience, The Safe Food Handbook suggests that probably as few as 3% of actual cases of food borne illness actually enter the official reporting system. I would guess that it is better in Europe, where the regulatory agencies are not as underfinanced and overworked as they are here. But it is still only a fraction.

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