The following is from a list of outbreak investigations being managed by FDA’s CORE Response Teams. The investigations are in a variety of stages, meaning that some outbreaks have limited information, and others may be near completion.
A public health advisory will be issued for outbreak investigations that have resulted in specific, actionable steps for consumers to take to protect themselves. Please direct your attention to those pages for the most up to date information on the investigation and for consumer protection information.
Outbreak investigations that do not result in specific, actionable steps for consumers may or may not conclusively identify a source or reveal any contributing factors. If a source and/or contributing factors are identified that could inform future prevention, the FDA commits to providing a summary of those findings.
Date Posted – 14 Jul 2021 Reference No – 1010 Pathogen – _E. coli_ O121 Product(s) Linked to Illnesses – Not Yet Identified Total Case Count – 15 Investigation Status – Active Outbreak Status – Ongoing
Harri Evans of Lancaster Live writes a toddler was left fighting for his life at a North West hospital and suffering kidney failure after eating seagull poo as he played in the garden.
Jaydon Pritchard, who is just 18 months old, is now doing much better after his ordeal, but is still “not out of the woods” according to his grandparents Arwel and Christine, who look after him along with his mother Tiffany at their home in Amlwch in Anglesey, off the north west coast of Wales.
Jaydon started to feel unwell in early April but was discharged by doctor after they thought he was suffering from a virus.
But Jaydon (below) continued to be sick and sleep lots and then his grandfather said they heard a “horrible noise coming from his cot”.
Mr Pritchard said: “He was having a fit, so we called for an ambulance straight away.
“He had another fit before the ambulance arrived and another three fits on the way to the hospital. It was like he was looking through you. He didn’t recognise anyone.
“There was a point where we really thought we were going to lose him. It was horrific.”
After being rushed to Ysbyty Gwynedd for the second time, a team from Alder Hey Children’s Hospital in Liverpool was sent to pick up Jaydon within a few hours – reports North Wales Live.
He was hooked up to a dialysis machine and received three blood transfusions during his 19-day stay at the children’s hospital.
Mr Pritchard said: “The doctors diagnosed him with kidney failure and told us that he had E. coli poisoning from having ingested the seagull faeces.
“We were fearing the worst at the time, seeing his little body hooked up to the dialysis machine and his face turned yellow.”
Verotoxigenic E. coli (VTec) is a powerful strain of E.coli bacterium that lives in the gut of healthy cattle and sheep and can cause serious illness in the elderly and in children aged under five.
The Mid-West public health department said the outbreak was under control but the incidence highlights the importance of hand hygiene and proper water treatment.
VTec can be a source of food poisoning and can cause bowel inflammation leading to bloody diarrhea and severe stomach cramps.
A specialist in public health said Ireland had one of the highest incidence rates of VTec in Europe and that the Mid-West region has one of the highest reported rates in the country.
It underpins the importance of hand hygiene before and after preparing food, after contact with farm animals and their environment, and effective treatment and rehabilitation of private wells.
One of my best friends used to be a dairy farmer, and he would always say, I’m not eating at McDonald’s, could be one of my former cows.
Shiga toxin-producing Escherichia coli (STEC) are foodborne bacterial pathogens, with cattle a significant reservoir for human infection. This study evaluated environmental reservoirs, intermediate hosts and key pathways that could drive the presence of Top 7 STEC (O157:H7, O26, O45, O103, O111, O121 and O145) on pasture-based dairy herds, using molecular and culture-based methods.
A total of 235 composite environmental samples (including soil, bedding, pasture, stock drinking water, bird droppings and flies and faecal samples of dairy animals) were collected from two dairy farms, with four sampling events on each farm. Molecular detection revealed O26, O45, O103 and O121 as the most common O-serogroups, with the greatest occurrence in dairy animal faeces (> 91%), environments freshly contaminated with faeces (> 73%) and birds and flies (> 71%). STEC (79 isolates) were a minor population within the target O-serogroups in all sample types but were widespread in the farm environment in the summer samplings.
Phylogenetic analysis of whole genome sequence data targeting single nucleotide polymorphisms revealed the presence of several clonal strains on a farm; a single STEC clonal strain could be found in several sample types concurrently, indicating the existence of more than one possible route for transmission to dairy animals and a high rate of transmission of STEC between dairy animals and wildlife.
Overall, the findings improved the understanding of the ecology of the Top 7 STEC in open farm environments, which is required to develop on-farm intervention strategies controlling these zoonoses.
Investigation of on-farm transmission routes for contamination of dairy cows with top 7 Escherichia coli O-serogroups
Environmental Microbiology
Rapp & C. M. Ross & P. Maclean & V. M. Cave & G. Brightwell
Chris Koger of The Packer writes the U.S. Centers for Disease Control and Prevention has added 16 more people to an E. coli outbreak investigation of unknown origin, bringing the total to 39. Cases have been reported in 18 states; there have been no deaths.
According to the CDC’s Nov. 23 update, “Of the 22 ill people interviewed to date, all reported eating a variety of leafy greens, like spinach (16), romaine lettuce (15), iceberg lettuce (12), and mixed bag lettuce (8). No single type or brand of leafy greens or other food item has been identified as the source of this outbreak. CDC is not advising people avoid any particular food at this time.
Dole Fresh Vegetables, Inc. is voluntarily recalling a limited number of cases of organic romaine hearts. The products being recalled are Dole™ Organic Romaine Hearts 3pk (UPC 0-71430-90061-1), combined English/French packaging, with Harvested-On dates of 10-23-20 and 10-26-20, and Wild Harvest Organic Romaine Hearts (UPC 7-11535-50201-2), with Harvested-On dates of 10-23-20 and 10-26-20. The recall is being conducted due to a possible health risk from E. coli in the two products. Dole Fresh Vegetables is coordinating closely with regulatory officials. No illnesses have been reported to date in association with the recall.
Pathogenic E. coli can cause diarrhea, severe stomach cramps and vomiting. Most people recover within a week, but some illnesses can last longer and can be more severe.
This precautionary recall notification is being issued due to an isolated instance in which a package of Dole™ Organic Romaine Hearts – 3pk yielded a positive result for pathogenic non-O157 E.coli STEC in a routine sample collected at a retail store by the Michigan Department of Agriculture and Rural Development. There is no indication at this time that this positive result is related to any illnesses nor consumer complaints and it is not associated with the strains connected to the ongoing outbreaks currently under regulatory investigation.
I tell people that spices like cilantro are a significant source of dangerous E. coli and they look at me like I just fell off the turnip truck.
This study sought to model the growth and die-off of Escherichia coli (E. coli) O157:H7 along the cilantro supply chain from farm-to-fork to investigate its risk to public health. Contributing factors included in the model were on farm contamination from irrigation water and soil, solar radiation, harvesting, and transportation and storage times and temperatures.
The developed risk model estimated the microbiological risks associated with E. coli O157:H7 in cilantro and determined parameters with the most effect on the final concentration per serving for future mitigation strategies. Results showed a similar decrease in the E. coli O157:H7 (median values) concentrations along the supply chain for cilantro grown in both winter and summer weather conditions. With an estimated 0.1% prevalence of E. coli O157:H7 contamination for cilantro post-harvest used for illustration, the model predicted the probability of illness from consuming fresh cilantro as very low with fewer than two illnesses per every one billion servings of cilantro (1.6 x 10-9; 95th percentile). Although rare, 3.7% and 1.6% of scenarios run in this model for summer and winter grown cilantro, respectively, result in over 10 cases per year in the United States.
This is reflected in real life where illnesses from cilantro are seen rarely but outbreaks have occurred. Sensitivity analysis and scenario testing demonstrated that ensuring clean and high quality irrigation water and preventing temperature abuse during transportation from farm to retail, are key to reducing overall risk of illness.
Evaluation of public health risk for Escherichia coli O157:H7 in cilantro, 16 July 2020
In this study, the persistence of toxigenic Escherichia coli (E. coli ) on dried chamomile, peppermint, ginger, cinnamon, black and green teas stored under 4, 10, and 25°C was determined.
The E. coli survival rate in ginger and cinnamon teas decreased below 0 on Day 5. In the other tested teas, E. coli survivability showed a downward trend over time, but never dropped to 0. Chamomile tea retained the greatest population of viable E. coli . Meanwhile, die‐off of E. coli was higher at 25°C compared to lower temperatures. Additionally, fate of E. coli during brewing at 60, 70 and 80°C was evaluated.
The E. coli population was reduced to below 2 Log colony forming units (CFU)/g after 1 min at 80°C, At the same time, the E. coli survival at 60°C was higher than that at 70°C in all tested teas. The data indicated that if E. coli survives after storage of prepared teas, it may also survive and grow after the brewing process, especially if performed using temperatures <80°C. Finally, we analyzed the correlations between temperature, time, tea varieties and E. coli survival, and successfully constructed a random forest regression model. The results of this study can be used to predict changes in E. coli during storage and fate during the brewing process. Results will form the basis of undertaking a risk assessment.
Survival of toxigenic Escherichia coli on chamomile, peppermint, green, black, ginger, and cinnamon teas during storage and brewing, 23 June 2020
In this study, the persistence of toxigenic Escherichia coli (E. coli ) on dried chamomile, peppermint, ginger, cinnamon, black and green teas stored under 4, 10, and 25°C was determined.
The E. coli survival rate in ginger and cinnamon teas decreased below 0 on Day 5. In the other tested teas, E. coli survivability showed a downward trend over time, but never dropped to 0. Chamomile tea retained the greatest population of viable E. coli . Meanwhile, die‐off of E. coli was higher at 25°C compared to lower temperatures. Additionally, fate of E. coli during brewing at 60, 70 and 80°C was evaluated.
The E. coli population was reduced to below 2 Log colony forming units (CFU)/g after 1 min at 80°C, At the same time, the E. coli survival at 60°C was higher than that at 70°C in all tested teas. The data indicated that if E. coli survives after storage of prepared teas, it may also survive and grow after the brewing process, especially if performed using temperatures <80°C. Finally, we analyzed the correlations between temperature, time, tea varieties and E. coli survival, and successfully constructed a random forest regression model. The results of this study can be used to predict changes in E. coli during storage and fate during the brewing process. Results will form the basis of undertaking a risk assessment.
Survival of toxigenic Escherichia coli on chamomile, peppermint, green, black, ginger, and cinnamon teas during storage and brewing, 23 June 2020
In late 2014, three children in the Australian state of Victoria developed hemolytic uremic syndrome linked to Shiga-toxin toxin producing E. coli in unpasteurized bath milk produced by Mountain View Dairy Farm. One child died, and two others developed cryptosporidiosis.
The Victorian government quickly banned the sale of so-called bath milk, which although labeled as not fit for human consumption, was a widely recognized way for Australian consumers to access raw milk.
What followed was a despicable whisper campaign that the child who died had an underlying medical condition, it wasn’t Shiga-toxin producing E. coli (STEC), farmers were losing access to lucrative markets – anything but the basic and sometimes deadly biology of STECs and everything involving fantasy and fairytales.
Victorian Dairy farmer Vicki Jones was told in 2014 by the coroner that raw milk was the likely cause of death of a three-year-old boy in 2014.
The milk was ‘raw’, or unpasteurised, and Ms Jones’ Mountain View Dairy Farm had been selling it as bath milk — a cosmetic product labelled ‘not fit for drinking’.
Ms Jones said she told the officer she would immediately remove the milk from the shelves of local stores.
“And he said to me, ‘No, no, no, don’t do that. You’ve done nothing wrong and all your labelling is right’.”
In hindsight, Ms Jones said this response “was really bizarre” — as was the decision to wait months before telling her about the cases.
But then the health officer told her a three-year-old boy had died after drinking the bath milk.
“It was the most devastating news that you could possibly imagine ever getting,” she said.
“I was mortified, we were doing the raw milk because people wanted it.”
Or because you contributed to promoting BS.
A Gippsland MP, the father of the child who died, and evidence presented to the coroner have all questioned how the cases were managed and suggested other contributing factors were overlooked.
Mark Wahlqvist, an Emeritus professor of medicine at Monash University and former president of the international union of nutrition sciences, said, “Raw milk, unpasteurised milk, is not safe enough to be in the public domain.”
Professor Wahlqvist said he was open to new research but at present, found campaigners for raw milk to be more than unconvincing.
“When people for conspiratorial reasons rather than scientific reasons, think that vaccination is a problem or that pasteurisation is a problem,” he said.
“We have a science communication problem in this country and it needs science leaders.”
On March 16, 2020, Chicago Indoor Garden recalled external icon all products containing red clover sprouts. More information about this recall is available on the FDA website.external icon
Jimmy John’s LLC reported that all of its restaurants stopped serving clover sprouts on February 24, 2020.
People usually get sick from Shiga toxin-producing E. coli (STEC) 1 to 10 days (average of 3 to 4 days) after swallowing the germ.
Symptoms vary, but often include severe stomach cramps, diarrhea (often bloody), and vomiting. Some people may have a fever, which usually is not very high (less than 101˚F/38.5˚C).
Some people with a STEC infection may get a type of kidney failure called hemolytic uremic syndrome (HUS).
Antibiotics are not recommended for patients with suspected E. coli infections until diagnostic testing can be performed and E. coli infection is ruled out. Some studies have shown that administering antibiotics to patients with E. coli infections might increase their risk of developing HUS, and a benefit of treatment has not been clearly demonstrated.
CDC, public health and regulatory officials in several states, and the U.S. Food and Drug Administration (FDA) investigated a multistate outbreak of E. coli O103 infections linked to clover sprouts.
Public health investigators used the PulseNet system to identify illnesses that were part of this outbreak. PulseNet is the national subtyping network of public health and food regulatory agency laboratories coordinated by CDC. DNA fingerprinting is performed on E. coli bacteria isolated from ill people by using a standardized laboratory and data analysis method called whole genome sequencing (WGS). CDC PulseNet manages a national database of these sequences that are used to identify possible outbreaks. WGS gives investigators detailed information about the bacteria causing illness. In this investigation, WGS showed that bacteria isolated from ill people were closely related genetically. This means that people in this outbreak were likely to share a common source of infection.
A total of 51 people infected with the outbreak strain of E. coli O103 were reported from 10 states. A list of the states and the number of cases in each can be found on the Map of Reported Cases.
Illnesses started on dates ranging from January 6, 2020, to March 15, 2020. Ill people ranged in age from 1 to 79 years, with a median age of 29 years. Fifty-five percent of ill people were female. Of 41 ill people with information available, 3 were hospitalized and no deaths were reported.
WGS analysis of isolates from 39 ill people was performed; the isolate from 1 ill person predicted antibiotic resistance to streptomycin, sulfisoxazole, tetracycline, and trimethoprim-sulfamethoxazole, and 38 isolates from ill people did not show evidence of antibiotic resistance. Standard antibiotic susceptibility testing by CDC’s National Antimicrobial Resistance Monitoring System (NARMS) laboratory is currently underway. These findings do not affect treatment guidance since antibiotics are not recommended for patients with STEC O103 infections.
In interviews, ill people answered questions about the foods they ate and other exposures they had in the week before their illness started. Eighteen (56%) of 32 people interviewed reported eating sprouts. This percentage is significantly higher than results from a survey pdf icon[PDF – 787 KB] of healthy people in which 8% reported eating sprouts in the week before they were interviewed.
Seventeen (63%) of 27 people interviewed reported eating sprouts at a Jimmy John’s restaurant. Jimmy John’s LLC reported that all of their restaurants stopped serving clover sprouts on February 24, 2020. Clover sprouts are no longer available at Jimmy John’s restaurants.
Additionally, FDA identified the outbreak strain of E. coli O103 in samples of Chicago Indoor Garden products that contain sprouts. On March 16, 2020, Chicago Indoor Garden recalledexternal icon all products containing red clover sprouts.
FDA’s traceback investigationexternal icon showed that a common seed lot was used to grow both the sprouts recalled by Chicago Indoor Garden and sprouts that were served at some Jimmy John’s locations. The same seed lot was also used to grow sprouts linked to an outbreakexternal icon of the same strain of E. coli O103 infections in 2019.
As of April 22, 2020, this outbreak appears to be over.
A public health advisory will be issued for outbreak investigations
