Raw sprouts and sausage: There’s some hot STECs out there

Posted on October 15, 2016 by Douglas Powell

In 2011, one of the world’s largest outbreaks of hemolytic-uremic syndrome (HUS) occurred, caused by a rare Escherichia coli serotype, O104:H4, that shared the virulence profiles of Shiga toxin-producing E. coli (STEC)/enterohemorrhagic E. coli (EHEC) and enteroaggregative E. coli (EAEC).

The persistence and fitness factors of the highly virulent EHEC/EAEC O104:H4 strain, grown either in food or in vitro, were compared with those of E. coli O157 outbreak-associated strains.

The log reduction rates of the different EHEC strains during the maturation of fermented sausages were not significantly different. Both the O157:NM and O104:H4 serotypes could be shown by qualitative enrichment to be present after 60 days of sausage storage. Moreover, the EHEC/EAEC O104:H4 strain appeared to be more viable than E. coli O157:H7 under conditions of decreased pH and in the presence of sodium nitrite. Analysis of specific EHEC strains in experiments with an EHEC inoculation cocktail showed a dominance of EHEC/EAEC O104:H4, which could be isolated from fermented sausages for 60 days. Inhibitory activities of EHEC/EAEC O104:H4 toward several E. coli strains, including serotype O157 strains, could be determined. Our study suggests that EHEC/EAEC O104:H4 is well adapted to the multiple adverse conditions occurring in fermented raw sausages. Therefore, it is strongly recommended that STEC strain cocktails composed of several serotypes, instead of E. coli O157:H7 alone, be used in food risk assessments.

The enhanced persistence of EHEC/EAEC O104:H4 as a result of its robustness, as well as the production of bacteriocins, may account for its extraordinary virulence potential.

IMPORTANCE In 2011, a severe outbreak caused by an EHEC/EAEC serovar O104:H4 strain led to many HUS sequelae. In this study, the persistence of the O104:H4 strain was compared with those of other outbreak-relevant STEC strains under conditions of fermented raw sausage production. Both O157:NM and O104:H4 strains could survive longer during the production of fermented sausages than E. coli O157:H7 strains. E. coli O104:H4 was also shown to be well adapted to the multiple adverse conditions encountered in fermented sausages, and the secretion of a bacteriocin may explain the competitive advantage of this strain in an EHEC strain cocktail.

Consequently, this study strongly suggests that enhanced survival and persistence, and the presumptive production of a bacteriocin, may explain the increased virulence of the O104:H4 outbreak strain. Furthermore, this strain appears to be capable of surviving in a meat product, suggesting that meat should not be excluded as a source of potential E. coli O104:H4 infection.

Fitness of Enterohemorrhagic Escherichia coli (EHEC)/Enteroaggregative E. coli O104:H4 in comparison to that of EHEC O157: Survival studies in food and in vitro

Applied and Environmental Microbiology; November 2016 vol. 82 no. 21 6326-6334

Christina Böhnlein, Jan Kabisch, Diana Meske, Charles M. A. P. Franz and Rohtraud Pichner

http://aem.asm.org/content/82/21/6326.abstract?etoc

E. coli O104 in sprouts, 2011: Natural, accidental or deliberate

Posted on March 22, 2016 by Douglas Powell

In 2011, Germany was hit by one of its largest outbreaks of acute gastroenteritis and haemolytic uraemic syndrome caused by a new emerging enterohaemorrhagic Escherichia coli O104:H4 strain.

The German Haemolytic Uraemic Syndrome/Enterohaemorrhagic E. coli (GHUSEC) outbreak had unusual microbiological, infectiological and epidemiological features and its origin is still only partially solved. The aim of this article is to contribute to the clarification of the origin of the epidemic.

Methods: To retrospectively assess whether the GHUSEC outbreak was natural, accidental or a deliberate one, we analysed it according to three published scoring and differentiation models. Data for application of these models were obtained by literature review in the database Medline for the period 2011–13.

Results: The analysis of the unusual GHUSEC outbreak shows that the present official assumption of its natural origin is questionable and pointed out to a probability that the pathogen could have also been introduced accidentally or intentionally in the food chain.

Conclusion: The possibility of an accidental or deliberate epidemic should not be discarded. Further epidemiological, microbiological and forensic analyses are needed to clarify the GHUSEC outbreak.

Escherichia coli O104:H4 outbreak in Germany—clarification of the origin of the epidemic

European Journal of Public Health, vol 25, issue 1, p. 125-129

Vladan Radosavljevic, Ernst-Jürgen Finke, Goran Belojevic

http://eurpub.oxfordjournals.org/content/25/1/125.abstract

Horizontal gene transfer in E. coli O104

Posted on May 19, 2015 by Douglas Powell

Escherichia coli O104 is an emergent disease-causing bacterium various strains of which are becoming increasingly well known and troublesome.

The pathogen causes bloody diarrhea as well as and potentially fatal kidney damage, hemolytic uremic syndrome. Infection is usually through inadvertent ingestion of contaminated and incompletely cooked food or other materials, such as animals feces.

Escherichia coli is a gram negative bacterium, commonly found in the intestine of humans and other mammals. Entero-hemorrhagic strains including O157, O26, O103 and O111 and specifically the sub-strain O157:H7 is an important cause of foodborne illness in North America, the UK and Japan.

One particular strain, highlighted by Indian researchers in the International Journal of Bioinformatics Research and Applications, O104:H4, causes serious complications and has developed significant multiple-drug resistance to antibiotics. Moreover, it has acquired genes through horizontal transfer from other strains that make it even more virulent than others.

The team from Madurai Kamaraj University in Madurai, Tamil Nadu, working with colleagues at Genotypic Technology Pvt Ltd in Karnataka, have used the tools of computational molecular biology to identify 38 such horizontal gene transfer elements, prophage elements. These elements the team explains are genetic weapons that protect the bacteria from antibiotics and have been acquired from viruses, known as bacteriophages, that usually infect bacteria.

More than a quarter of the genome of this strain of E. coli comprises prophage elements, the team explains. These elements are also involved in the production of lethal compounds such as Shiga toxin, which give rise to many of the symptoms of infection. As such, they might represent new diagnostic markers or even targets for the development of novel antibiotics that circumvent the protective measures acquired by the bacteria.

Stealth ingredient; E. coli threat prompts EU sprouted seeds measures

Posted on October 16, 2012 by Douglas Powell

EU Member States have endorsed strict hygiene measures for readytoeat sprouted seeds to prevent incidents such as the deadly E. coli O104 outbreak in Germany and France last year.

But will these strict measures be enforced?

Food Quality magazine says the actions include tightening traceability requirements for seeds intended for sprouts and sprout production and approval by Member States of all sprouts producing plants after hygiene compliance checks by competent authorities.

The EC has also called for testing for the absence of pathogenic E. coli in sprouts on the market for each batch of seeds intended for sprouting.

Uh huh.

After the German E. coli O104 outbreak that killed 53 people last year and sickened over 4,000, along with the ridiculous public statements and blatant disregard for public safety taken by sandwich artist Jimmy John’s in the U.S., we reviewed the sprout-related literature and concluded:

• raw sprouts are a well-documented source of foodborne illness;

• risk communication about raw sprouts has been inconsistent; and,

• continued outbreaks question effectiveness of risk management strategies and producer compliance.

We document at least 55 sprout-associated outbreaks occurring worldwide affecting a total of 15,233 people since 1988. A comprehensive table of sprout-related outbreaks can be found at http://bites.ksu.edu/sprouts-associated-outbreaks.

Sprouts present a unique food safety challenge compared to other fresh produce, as the sprouting process provides optimal conditions for the growth and proliferation of pathogenic bacteria. The sprout industry, regulatory agencies, and the academic community have been collaborating to improve the microbiological safety of raw sprouts, including the implementation of Good Manufacturing Practices (GMP), establishing guidelines for safe sprout production, and chemical disinfection of seed prior to sprouting. However, guidelines and best practices are only as good as their implementation. The consumption of raw sprouts is considered high-risk, especially for young, elderly and immuno-compromised persons.

From November 2010 into 2011, an outbreak linked to raw sprouts in the U.S. and involving sandwich franchise Jimmy John’s sickened 140 people. This was the third sprout related outbreak involving this franchise, yet the owner of the Montana Jimmy John’s outlet, Dan Stevens, expressed confidence in his sprouts claiming that because the sprouts were locally grown they would not be contaminated. By the end of December 2010 a sprout supplier, Tiny Greens Farm, was implicated in the outbreak. Jimmy John’s owner, John Liautaud, responded by stating the sandwich chain would replace alfalfa sprouts with clover sprouts since they were allegedly easier to clean. However, a week earlier a separate outbreak had been identified in Washington and Oregon in which eight people were infected with Salmonella after eating sandwiches containing clover sprouts from a Jimmy John’s restaurant. This retailer was apparently not aware of the risks associated with sprouts, or even outbreaks associated with his franchisees.

In late December, 2011, less than one year after making the switch to clover sprouts, Jimmy John’s was linked to another sprout related outbreak, this time it was E.coli O26 in clover sprouts. In February 2012, sandwich franchise Jimmy John’s announced they were permanently removing raw clover sprouts from their menus. As of April 2012, the outbreak had affected 29 people across 11 states. Founder and chief executive, John Liautaud, attempted to appease upset customers through Facebook stating, “a lot of folks dig my sprouts, but I will only serve the best of the best. Sprouts were inconsistent and inconsistency does not equal the best.” He also informed them the franchise was testing snow pea shoots in a Campaign, Illinois store, although there is no mention regarding the “consistency” or safety of this choice.

Despite the frequent need for sprout-based risk communication, messaging with industry and public stakeholders has been limited in effectiveness. In spite of widespread media coverage of sprout-related outbreaks, improved production guidelines, and public health enforcement actions, awareness of risk remains low. Producers, food service and government agencies need to provide consistent, evidence-based messages and, more importantly, actions. Information regarding sprout-related risks and food safety concerns should be available and accurately presented to producers, retailers and consumers in a manner that relies on scientific data and clear communications.

Erdozain, M.S., Allen, K.J., Morley, K.A. and Powell, D.A. 2012. Failures in sprouts-related risk communication. Food Control. 10.1016/j.foodcont.2012.08.022

http://www.sciencedirect.com/science/article/pii/S0956713512004707?v=s5

Abstract

Nutritional and perceived health benefits have contributed to the increasing popularity of raw sprouted seed products. In the past two decades, sprouted seeds have been a recurring food safety concern, with at least 55 documented foodborne outbreaks affecting more than 15,000 people. A compilation of selected publications was used to yield an analysis of the evolving safety and risk communication related to raw sprouts, including microbiological safety, efforts to improve production practices, and effectiveness of communication prior to, during, and after sprout-related outbreaks. Scientific investigation and media coverage of sprout-related outbreaks has led to improved production guidelines and public health enforcement actions, yet continued outbreaks call into question the effectiveness of risk management strategies and producer compliance. Raw sprouts remain a high-risk product and avoidance or thorough cooking are the only ways that consumers can reduce risk; even thorough cooking messages fail to acknowledge the risk of cross-contamination. Risk communication messages have been inconsistent over time with Canadian and U.S. governments finally aligning their messages in the past five years, telling consumers to avoid sprouts. Yet consumer and industry awareness of risk remains low. To minimize health risks linked to the consumption of sprout products, local and national public health agencies, restaurants, retailers and producers need validated, consistent and repeated risk messaging through a variety of sources.

E. coli O104 in Germany, 2011, and E. coli O103 in Norway, 2006, highly similar

Posted on March 7, 2012 by Douglas Powell

In 2006, a severe foodborne EHEC outbreak occured in Norway. Seventeen cases were recorded and the HUS frequency was 60%. The causative strain, Esherichia coli O103:H25, is considered to be particularly virulent.

Researchers at the School of Veterinary Science in Oslo, Norway, report in PLoS One that sequencing of the outbreak strain revealed resemblance to the 2011 German outbreak strain E. coli O104:H4, both in genome and Shiga toxin 2-encoding (Stx2) phage sequence.

The nucleotide identity between the Stx2 phages from the Norwegian and German outbreak strains was 90%. During the 2006 outbreak, stx2-positive O103:H25 E. coli was isolated from two patients. All the other outbreak associated isolates, including all food isolates, were stx-negative, and carried a different phage replacing the Stx2 phage. This phage was of similar size to the Stx2 phage, but had a distinctive early phage region and no stx gene. The sequence of the early region of this phage was not retrieved from the bacterial host genome, and the origin of the phage is unknown. The contaminated food most likely contained a mixture of E. coli O103:H25 cells with either one of the phages.

The complete report is available at http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0031413;jsessionid=4E2DA8292226636D48D1FDE0291324D4.

Citation: L’Abée-Lund TM, Jørgensen HJ, O’Sullivan K, Bohlin J, Ligård G, et al. (2012) The Highly Virulent 2006 Norwegian EHEC O103:H25 Outbreak Strain Is Related to the 2011 German O104:H4 Outbreak Strain. PLoS ONE 7(3): e31413. doi:10.1371/journal.pone.0031413
Editor: Niyaz Ahmed, University of Hyderabad, India

Magic man defends sprouts, another chain pulls the wonder food

Posted on February 18, 2012 by Douglas Powell

Beginning in Dec. 2010, people started getting sick from eating raw sprouts on Jimmy John’s sandwiches, primarily in Indiana. After some 140 confirmed cases, the sprouts were linked to Tiny Greens Organic Farms, a producer based in Urbana, Illinois.

The U.S. Food and Drug Administration released a 6-page inspection report of Tiny Greens in Feb. 2011, and found the company grew sprouts in “soil from the organic material decomposed outside” without using any monitored “kill step” on it.

Other findings included:

• An “amphibian/reptile” was kept in the reception room of the firm, which adjoined the production area.?* The firm couldn’t show that its antimicrobial treatment for seeds, which was not specifically described in the report, was equivalent to the recommended treatment with a bleach solution.

• Employees stored their lunches, including such items as raw bacon, in the same cooler where finished sprouts were stored.?* Organic matter was seen on a table where sprouts were packaged, and a “biofilm-like buildup” was seen on sprouting trays after they were cleaned.?* What looked like mold was seen on walls and ceiling in a mung-bean sprouting room.?*

• Condensation dripped from the ceiling in production areas throughout the inspection period, which lasted close to a month.?* An outside lab that the firm used to test its water and sprouts used a method that was not validated for detecting Salmonella in those items.?

• FDA found a Salmonella isolate matching the outbreak strain, known as I 4,[5],12:i:-, in a sample of runoff water from the company.

In the midst of the German-centered E. coli O104-in-sprouts outbreak in May 2011, Tiny Greens owner Bill Bagby, said the nutritional benefits outweigh the risk.

“Sprouts are kind of a magical thing.”

“That’s why I would advise people to only buy sprouts from someone who has a (foodsafety) program in place” that includes outside auditors, Bagby said. “We did not have (independent auditors) for about one year and that was the time the problems happened. The FDA determined that unsanitary conditions could have been a potential source of cross-contamination and so we have made a lot of changes since then.”

Independent auditors? Like the ones who said everything was cool, everything was OK, at Peanut Corporation of America (7 dead, 700 sick) and DeCoster eggs (2,000 sick)?

Auditors aren’t going to do much for sprout safety. But the optimism of the Magic Man is shared by the International Sprout Growers Association, which launched a campaign earlier this year to “make sprouts part of your healthy eating in 2012” and promoted the idea of sprouts as a “wonder food.”

Then another Jimmy John’s outbreak – E. coli O26 linked to raw sprouts in sandwiches favored by college kids – and the same actors surface on the social stage.

Bagby said this week, “We are not involved in any way, nor are we associated in any way with this current outbreak.”

The CDC website said the clover spouts used at the affected restaurants all came from two sprouting facilities using the same lot of clover seeds provided by International Specialty Supply, also known as ISS, in Cookeville, Tenn.

Bagby said, “I don’t buy from that company because it doesn’t have a sufficient decontamination procedure for the seeds.”

Bagby said Tiny Greens gets all its seeds from the Caudill Seed Co. in Louisville, Ky., because it uses a system to decontaminate the sprouting seeds.

“They use a process involving heat and a vacuum,” Bagby said.

Bagby said he was notified that Jimmy John’s has removed sprouts from its menu following this week’s finding by the CDC.

“It is ironic because sprouts have a high vitamin content, are rich in enzymes and phyto nutrients and strengthen one’s immune system.”

Not so much ironic as a painfully delayed recognition by Jimmy John’s that after 5 outbreaks related to sprouts on their sandwiches since 2008, maybe something should be done. A table of sprout-related outbreaks is available at http://bites.ksu.edu/sprouts-associated-outbreaks.

Jimmy John’s spokeswoman Mary Trader said on Thursday that the company is not releasing a statement at this time.

Others, however, aren’t waiting.

Erbert and Gerbert’s Sandwich Shops, based in Eau Claire, Wis., has taken alfalfa sprouts off its menus at all outlets. The company has 53 locations.

“The decision to pull the sprouts from our menu system-wide is being made to protect the health of our guests,” Eric Wolfe, chief executive officer at E&G Franchise Systems, Inc., said in the release. “We value the well-being of our customers and felt removing all sprouts from our menu and sandwich line was the best way to eliminate the risk.”

WalMart stopped selling sprouts in North America in Oct. 2010.

NPR’s Nancy Shute chatted with Bob Sanderson, president of the International Sprout Growers Association, who talked about a number of possible sanitary treatments while concluding, “I’m hoping that the new rules [that are part of the Food Safety Modernization Act] will say, here’s what you have to do to be acceptable. That would free up the industry to come up with solutions.”

With repeated outbreaks, acceptable is a long way off.

Credit card payments helped track German E. coli O104 outbreak in sprouts

Posted on January 4, 2012 by Douglas Powell

Why bother editing; it’s all below in this letter from the current issue of Emerging Infectious Diseases, Identifying risk factors for shiga toxin–producing Escherichia coli by payment information.

During May and June 2011, a large outbreak of hemolytic uremic syndrome (HUS) and diarrhea caused by Shiga toxin–producing Escherichia coli (STEC) occurred, centered on northern Germany (1,2). Early on, salads and raw vegetables were suspected to be food vehicles (3). Also in May, the staff department of a local company informed the Health Protection Authority in Frankfurt in southwestern Germany about the rapidly increasing number of patients with bloody diarrhea and HUS among employees at 2 company office sites. Both sites were served by cafeterias run by the same caterer. Main dishes were prepared in the cafeterias’ kitchens and differed between the 2 sites. However, in both cafeterias various fresh foods from a salad bar and fruits, desserts, and daily asparagus dishes originated from the caterer’s main kitchen. The salad bar included 30 items. Suspecting that this outbreak was linked to the one in northern Germany, we conducted an outbreak investigation to confirm the epidemiologic link to focus epidemiologic and traceback investigations.

A face-to-face survey among hospitalized employees and by email among all other employees was conducted, which included personal details, symptoms, and information about general food eaten at the cafeterias. We defined outbreak cases as infections in employees of the company at 1 of the 2 sites who by May 23, 2011, were either hospitalized with bloody diarrhea or HUS or who self-reported onset of bloody diarrhea from May 8 through May 23. A total of 320 persons responded to the survey, and 285 (89%) of 320 of the responders stated they used the cafeterias; 60 employees fulfilled our case definition. Case-patients’ median age was 33 years (range 22–60 years); 36 (60%) of 60 were female. Thirty case-patients were hospitalized; HUS developed in 18 (30%) (Figure A1). Disease onsets occurred over 9 days. Beginning and magnitude of the outbreak were not different between cafeteria locations. Bacteriologic diagnostics for 11 patients yielded results that are compatible with the outbreak strain (4).

We used billing data from the cafeterias’ obligatory cashless payment system to ascertain risk factors for disease. A nested case–control study design was chosen, limited to a fraction of the cohort to obtain rapid risk estimates. Exposures included were purchases of any fruit, salad bar item, dessert, or asparagus dish in either cafeteria from May 2 through May 13. On the basis of customer identification numbers, the caterer provided billing information for persons with early cases (n = 23). Controls were randomly chosen persons from the caterer’s database whose disease status was checked against the survey information (n = 30) and who did not report symptoms of diarrhea (nonbloody), vomiting, or nausea during the same period. Univariable logistic regression was performed.
In univariable analysis, salad bar purchases were highly associated with illness (odds ratio 5.19; 95% CI 1.28–21.03), and desserts, fruit, and asparagus dishes were not (Table). Three (9%) of the case-patients remained unexposed to salad bar items according to the payment system data. The analysis of main courses purchased in 1 cafeteria revealed that no such meal had been consumed by >5 (22%) of 23 case-patients. Beginning May 23, the cafeterias were closed for 1 week, and salad sales were suspended for a longer period. There were no additional cases.

These results and the identification of the same rare serotype of O104:H4 renders this a satellite outbreak to the larger outbreak in northern Germany, which is the largest outbreak in terms of HUS ever described worldwide. Sprouts are believed to be the food vehicle (5). Sprouts available in the Frankfurt cafeteria salad bars were traced back to a producer of fenugreek sprouts, which appear to be the common source of primary cases in the entire outbreak (5). Sprout consumption could not be studied directly in Frankfurt because of the intense media attention on the sprout hypothesis once it had been announced. Also, it was thought that too much time had passed to successfully recall actually selected salad bar items consumed a few weeks previous.

Cafeteria billing information allowed for a rapid investigation while avoiding exposure misclassification attributable to ill-remembered food purchases (6). Using data sources independent of individual memory is quite useful. In previous studies, similar tools were successfully applied for the detection of outbreak vehicles. Credit card information was used during an investigation on STEC in beef sausages in Denmark (7), supermarket purchase records for STEC in Iceland (8), and grocery store loyalty card records for cyclosporiasis in Canada (9). Shopper card information was used in the United States in an outbreak of Salmonella enterica serovar Montevideo (10). However, billing information also could have introduced exposure misclassification, e.g., purchased food that was left uneaten or brought for colleagues. Analysis on ingredient level is often not possible. This study emphasizes the need for recall-independent investigation methods. In settings where such methods are available, they should be exploited early and relevant data saved from routine deletion.

Hendrik Wilking , Udo Götsch, Helma Meier, Detlef Thiele, Mona Askar, Manuel Dehnert, Christina Frank, Angelika Fruth, Gérard Krause, Rita Prager, Klaus Stark, Boris Böddinghaus, Oswald Bellinger, and René Gottschalk
Author affiliations: Robert Koch Institute, Berlin, Germany (H. Wilking, M. Askar, M. Dehnert, C. Frank, G. Krause, K. Stark); Health Protection Authority, Frankfurt am Main, Germany (U. Götsch, B. Böddinghaus, O. Bellinger, R. Gottschalk); Veterinary Service, Frankfurt am Main (H. Meier, D. Thiele); Robert Koch Institute, Wernigerode, Germany (A. Fruth, R. Prager)

Acknowledgment
We are grateful to the caterer, the employees, and the company management for their cooperation. We thank each member of the Robert Koch Institute HUS Investigation Team for their indispensable work and the coordinators of the German Postgraduate Training for Applied Epidemiology and the European Programme for Intervention Epidemiology Training for their help.

References
Frank C, Werber D, Cramer J, Askar M, Faber M, an der Heiden M, Epidemic profile of Shiga-toxin–producing Escherichia coli O104:H4 outbreak in Germany. N Engl J Med. 2011;365:1771–80. DOI PubMed
Wadl M, Rieck T, Nachtnebel M, Greutélaers B, An der Heiden M, Altmann D, Enhanced surveillance during a large outbreak of bloody diarrhoea and haemolytic uraemic syndrome caused by Shiga toxin/verotoxin–producing Escherichia coli in Germany, May to June 2011. Euro Surveill. 2011;16:pii:19893.
Frank C, Faber M, Askar M, Bernard H, Fruth A, Gilsdorf A, Large and ongoing outbreak of haemolytic uraemic syndrome, Germany, May 2011. Euro Surveill. 2011;16:pii:19878.
Bielaszewska M, Mellmann A, Zhang W, Köck R, Fruth A, Bauwens A, Characterisation of the Escherichia coli strain associated with an outbreak of haemolytic uraemic syndrome in Germany, 2011: a microbiological study. Lancet Infect Dis. 2011;11:671–6.PubMed
Buchholz U, Bernard H, Werber D, Böhmer MM, Remschmidt C, Wilking H, German outbreak of Escherichia coli O104:H4 associated with sprouts. N Engl J Med. 2011;365:1763–70. DOI PubMed
Decker MD, Booth AL, Dewey MJ, Fricker RS, Hutcheson RH, Schaffner W. Validity of food consumption histories in a foodborne outbreak investigation. Am J Epidemiol. 1986;124:859–63.PubMed
Ethelberg S, Smith B, Torpdahl M, Lisby M, Boel J, Jensen T, Outbreak of non-O157 Shiga toxin–producing Escherichia coli infection from consumption of beef sausage. Clin Infect Dis. 2009;48:e78–81. DOI PubMed
Sigmundsdottir G, Atladottir A, Hardardottir H, Gudmundsdottir E, Geirsdottir M, Briem H. STEC O157 outbreak in Iceland, September-October 2007. Euro Surveill. 2007;12(11):E071101.2.
Shah L, MacDougall L, Ellis A, Ong C, Shyng S, LeBlanc L. Challenges of investigating community outbreaks of cyclosporiasis, British Columbia, Canada. Emerg Infect Dis. 2009;15:1286–8. DOI PubMed
Centers for Disease Control and Prevention. Salmonella montevideo infections associated with salami products made with contaminated imported black and red pepper—United States, July 2009–April 2010. MMWR Morb Mortal Wkly Rep. 2010;59:1647–50.PubMed

Figure
Figure A1. Patients with Shiga toxin–producing Escherichia coli/hemolytic uremic syndrome (STEC/HUS) by onset of diarrhea and cafeteria visit (location A or B) during STEC/HUS outbreak at a company in Frankfurt, Germany,…
Table
Table. Univariable analysis of risk factors for bloody diarrhea among users of 2 cafeterias in Frankfurt, Germany, 2011
Suggested citation for this article: Wilking H, Götsch U, Meier H, Thiele D, Askar M, Dehnert M, et al. Identifying risk factors for Shiga toxin–producing Escherichia coli by payment information [letter]. Emerg Infect Dis [serial on the Internet] 2012 Jan [date cited]. http://dx.doi.org/10.3201/eid1801.111044
DOI: 10.3201/eid1801.111044

Germany’s E. coli nightmare: Too often, politics trumps safety

Posted on August 20, 2011 by Douglas Powell

The Aug/Sept. issue of Food Quality magazine contains a package of articles about lessons learned from this year’s E. coli O104 outbreak in Germany linked to raw sprouts grown from seeds produced in Egypt.

My own contribution was an attempt, at the editor’s request, to capture the uncertainty and vagaries that characterize outbreaks of food- or waterborne illness.

My friend Jim called on a Friday afternoon. Jim is a dairy farmer located on the edge of a town in Ontario, Canada, called Walkerton, and he said a lot of people were getting sick. The community knew there was a problem several days before health types went public.

On Sunday, May 21, 2000, at 1:30 p.m., the Grey Bruce Health Unit in Owen Sound, Ontario posted a notice on its website to hospitals and physicians to make them aware of a boil water advisory and inform them that a suspected agent in the increase of diarrheal cases was E. coli O157:H7.

There had been a marked increase in illness in the town of about 5,000 people, and many were already saying the water was suspect. But because the first public announcement was also the Sunday of the Victoria Day long weekend, it received scant media coverage.

It wasn’t until Monday evening that local television and radio began reporting illnesses, stating that at least 300 people in Walkerton were ill.

At 11 a.m. on Tuesday, May 23, the Walkerton hospital held a media conference jointly with the health unit to inform the public of the outbreak, to make people aware of the potential complications of the E. coli O157:H7 infection, and to warn them to take the necessary precautions. This generated a print report in the local paper the next day, which was picked up by the national wire service Tuesday evening, and subsequently appeared in papers across Canada on May 24.

These public outreach efforts were neither speedy nor sufficient. Ultimately, 2,300 people were sickened and seven died—in a town of 5,000. All the gory details and mistakes and steps for improvement were outlined in the report of the Walkerton inquiry
(www.attorneygeneral.jus.gov.on.ca/english/about/pubs/walkerton).

The E. coli O157:H7 was thought to have originated on a farm owned by a veterinarian and his family at the edge of town, someone my friend Jim knew well, a cow-calf operation that was the poster farm for Environmental Farm Plans. Heavy rains washed cattle manure into a long abandoned well-head, which was apparently still connected to the municipal system. The brothers in charge of the municipal water system for Walkerton, who were found to have been adding chlorine based on smell rather than something minimally scientific like test strips, were criminally convicted.

But the government-mandated reports don’t capture the day-to-day drama and stress that people like my friend experienced. Jim and his family knew many of the sick and dead. This was a small community. News organizations from around the province descended on Walkerton for weeks. They had their own helicopters, but the worst was the medical helicopters flying patients with hemolytic uremic syndrome to the hospital in London. Every time Jim saw one of those, he wondered if it was someone he knew.

I’m not an epidemiologist, but as a scientist and journalist with 20 years of contacts, I usually find out when something is going on in the world of foodborne outbreaks.

The uncertainties in any outbreak are enormous, and the pressures to get it right when going public are tremendous.

The public health folks in Walkerton may have been slow by a couple of days while piecing together the puzzle; what happened in Germany this summer in the sprout-related outbreak of E. coli O104, a relative of O157, was a travesty.
Worse, bureaucrats seemed more concerned about the fate of farmers than that of citizens. By at least one count, 53 have died, and more than 4,200 have been sickened.

Raw sprouts are one of the few foods I won’t eat, and as many epidemiologists have pointed out, sprouts top the list of any investigation involving foodborne illness.

We at bites count at least 55 outbreaks related to raw sprouts beginning in the U.K. in 1988, sickening thousands.

The first consumer warning about sprouts was issued by the U.S. Centers for Disease Control and Prevention (CDC) in 1997. By July 9, 1999, the U.S. Food and Drug Administration (FDA) had advised all Americans to be aware of the risks associated with eating raw sprouts. Consumers were informed that the best way to control the risk was to not eat raw sprouts. The FDA stated that it would monitor the situation and take any further actions required to protect consumers.

At the time, several Canadian media accounts depicted the U.S. response as panic, quoting Health Canada officials as saying that, while perhaps some were at risk, sprouts were generally a low-risk product.

That attitude changed in late 2005, as I was flying back to reunite with a girl I had met in Kansas and 750 people in Ontario became sick from eating raw bean sprouts.

Unfortunately, what food safety types think passes for common knowledge—don’t eat raw sprouts—barely registers as public knowledge. It’s hard to compete against food porn.

Sprouts present a special food safety challenge because the way they are grown, with high moisture at high temperature, also happens to be an ideal environment for bacterial growth.

Because of continued outbreaks, the sprout industry, regulatory agencies, and the academic community in the U.S. pooled their efforts in the late 1990s to improve the safety of the product, implementing good manufacturing practices, establishing guidelines for safe sprout production, and beginning chemical disinfection of seeds prior to sprouting.

But are such guidelines being followed? And is anyone checking?

Doubtful.

This was demonstrated by two sprout-related outbreaks earlier this year linked to sandwiches served by Jimmy John’s, a chain of gourmet sandwich shops based in Champaign, Ill.

Sprouts served on Jimmy John’s sandwiches supplied by a farm called Tiny Greens sickened 140 people with Salmonella, primarily in Indiana. In January, Jimmy John’s owner Jimmy John Liautaud said his restaurants would replace alfalfa sprouts, effective immediately, with allegedly easier-to-clean clover sprouts. This was one week after a separate outbreak of Salmonella sickened eight people in the U.S. Northwest who had eaten at a Jimmy John’s that used clover sprouts.

If the head of a national franchise is that clueless about food safety, can we really expect more from others?

Sprout grower Bill Bagby, who owns Tiny Greens Sprout Farm, said in the context of the German outbreak that, for many like him, the nutritional benefits outweigh the risk:

“Sprouts are kind of a magical thing. That’s why I would advise people to only buy sprouts from someone who has a (food safety) program in place (that includes outside auditors). We did not have (independent auditors) for about one year, and that was the time the problems happened. The FDA determined that unsanitary conditions could have been a potential source of cross-contamination and so we have made a lot of changes since then.”

Independent auditors? Like the ones who said everything was cool, everything was OK, at Peanut Corporation of America (nine dead, 700 sick in 2008-09) and Wright County Egg (2,000 sick in 2010)?

Like the Walkerton E. coli O157:H7 outbreak in 2000, too many are using the filters of their politics to advance their own causes and saying too many dumb things in light of the sprout outbreak of 2011.

It’s really about biology and paying attention to food safety basics—no matter how much that interferes with personal politics.

E. coli on Dutch sprouts is new; 39 dead in German E. coli O104 sprout outbreak

Posted on June 17, 2011 by Douglas Powell

Researchers say a strain of E. coli found last week on Dutch beet sprouts has not been seen before in the country and they have sent samples for further analysis at labs in Italy and Denmark.

The Dutch Food Safety Authority says nobody appears to have been sickened by the strain.

Friday’s announcement came a day after Germany’s disease control center said the death toll in Europe’s outbreak of a separate strain of E. coli had risen to 39 after one more patient died.

The killer strain has been traced to sprouts from an organic farm in a northern German village.

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