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Nationwide Salmonella Sushi Outbreak Brewing

NMHEALTHThe New Mexico Department of Health, the City of Albuquerque Environmental Health Department, and the New Mexico Environment Department are jointly investigating a cluster of illness caused by Salmonella paratyphi. There have been six confirmed cases reported in New Mexico residents, with onsets of illness from April 4 to May 1, 2015. Five individuals reside in Bernalillo County and one resides in Sandoval County. The cases range in age from 23 to 68 years, and one individual was hospitalized as a result of the illness.

At this time, the investigation is still ongoing regarding the source of the outbreak. Five out of the six people reported eating sushi containing raw fish. The City of Albuquerque Environmental Health Department and the New Mexico Environment Department are investigating possible exposures linked to sushi. Federal agencies including the CDC and other states are also involved in the investigation following additional illnesses associated with the same Salmonella paratyphi strain in their respective jurisdictions.

“People at risk of severe illness associated with Salmonella paratyphi, including the elderly and very young and anyone who is immunocompromised, are urged to not consume any raw seafood product,” advises Department of Health Cabinet Secretary Retta Ward, MPH. “Anyone with nausea, diarrhea (with or without blood), abdominal cramping and fever, especially after recently eating raw fish, should seek medical attention. Healthcare providers are advised to get stool cultures from patients presenting with diarrhea and fever.”

The most common sources of Salmonella infection are undercooked poultry, eggs, and meat. Pet birds and reptiles as well as other pets with diarrhea can transmit Salmonella. To prevent illness, thorough hand washing with soap and water prior to food preparation or consumption is recommended. Salmonella can be killed by cooking foods to an internal temperature of 165°F. Therefore, consumers of raw or undercooked fish and meat products may be at increased risk of illness.

Any provider who suspects a patient is ill with Salmonella can contact the New Mexico Department of Health’s on call epidemiologist at 505-827-0006 24 hours a day, seven days a week.

Salmonella:  Marler Clark, The Food Safety Law Firm, is the nation’s leading law firm representing victims of Salmonella outbreaks. The Salmonella lawyers of Marler Clark have represented thousands of victims of Salmonella and other foodborne illness outbreaks and have recovered over $600 million for clients.  Marler Clark is the only law firm in the nation with a practice focused exclusively on foodborne illness litigation.  Our Salmonella lawyers have litigated Salmonella cases stemming from outbreaks traced to a variety of foods, such as cantaloupe, tomatoes, ground turkey, salami, sprouts, cereal, peanut butter, and food served in restaurants.  The law firm has brought Salmonella lawsuits against such companies as Cargill, ConAgra, Peanut Corporation of America, Sheetz, Taco Bell, Subway and Wal-Mart.

Sen. Gillibrand Introduces the Meat and Poultry Recall Notification Act

U.S. Sen. Kirsten Gillibrand, who introduced legislation earlier this year to bolster food safety standards, has now unveiled a bill that would improve the recall process for meat and poultry products.

The measure, the Meat and Poultry Recall Notification Act, would give the U.S. Department of Agriculture authority to request a voluntary recall of contaminated meat, poultry and some egg products. If a distributor, importer, manufacturer or retailer refuses to comply with the request, the agency’s Food Safety and Inspection Service may issue a mandatory recall.

The bill would also encourage retailers to use shopper reward cards that monitor purchases to inform customers who may have purchased recalled meat and poultry products. And it calls for the creation of a one-page recall summary notice, which would be posted at cash registers or on shelves in stores that sold a recalled product.

Gillibrand, D-N.Y., said Wednesday that the current food safety system is “failing to protect Americans.”

“Poultry and meat known to be contaminated should never end up in market fridges and freezes or our kitchens,” she said. “The USDA must have the authority to recall products that test positive for contaminants, and consumers need to know when food has been recalled.”

Gillibrand’s announcement comes one day after Frontline, a PBS program, aired its report on the dangers posed by salmonella. According to the investigation, the bacteria is found in one of four pieces of raw chicken.

A Consumer Reports study cited by Gillibrand’s office found one-third of chicken breast contaminated with salmonella carry a drug-resistant strain of the bacteria.

Bill Marler, a foodborne illness attorney, said all bacteria and viruses that cause illness should receive equal attention.

“They should be banned from both imports and from food produced in the U.S.,” Marler said. “Banning these bugs from our food supply would save both consumers and the food industry billions of dollars in medical and recall costs.”

According to Gillibrand’s office, approximately 3 million New York residents and one in six Americans contract a foodborne illness each year.

Why Paul Kruse, President and CEO of Blue Bell Needs a Criminal Lawyer

622x350-300x200After watching the Blue Bell Listeria Outbreak unfold over the last months – especially after reading the FDA’s 483’s, I think it is time for the President and CEO of Blue Bell to consult with criminal counsel.  True, perhaps he did not know that his Broken Arrow Plant had Listeria positives going back over years, but knowledge is not necessary for the FDA and a US Attorney to prosecute – just ask the Jensens and DeCosters.

Congress passed the Federal Food, Drug, and Cosmetic Act in 1938 in reaction to growing public safety demands.  The primary goal of the Act was to protect the health and safety of the public by preventing deleterious, adulterated or misbranded articles from entering interstate commerce.  Under section 402(a)(4) of the Act, a food product is deemed “adulterated” if the food was “prepared, packed, or held under insanitary conditions whereby it may have become contaminated with filth, or whereby it may have been rendered injurious to health.” A food product is also considered “adulterated” if it bears or contains any poisonous or deleterious substance, which may render it injurious to health.  The 1938 Act, and the recently signed Food Safety Modernization Act, stand today as the primary means by which the federal government enforces food safety standards.

Chapter III of the Act addresses prohibited acts, subjecting violators to both civil and criminal liability. Provisions for criminal sanctions are clear:

Felony violations include adulterating or misbranding a food, drug, or device, and putting an adulterated or misbranded food, drug, or device into interstate commerce.  Any person who commits a prohibited act violates the FDCA.  A person committing a prohibited act “with the intent to defraud or mislead” is guilty of a felony punishable by years in jail and millions in fines or both.

A misdemeanor conviction under the FDCA, unlike a felony conviction, does not require proof of fraudulent intent, or even of knowing or willful conduct.  Rather, a person may be convicted if he or she held a position of responsibility or authority in a firm such that the person could have prevented the violation.  Convictions under the misdemeanor provisions are punishable by not more than one year or fined not more than $250,000, or both.

The legal jargon aside, if you are a producer of food and knowingly or not sell adulterated food, you can (and should) face fines and jail time.  Mr. Kruse, I know you are a lawyer, but you should get another one.

The inspection observations of the most recent completed FDA inspections at the Blue Bell production facilities in Brenham, Texas, Broken Arrow, Okla., and Sylacauga, Ala. are available:

Listeria: Marler Clark, The Food Safety Law Firm, is the nation’s leading law firm representing victims of Listeria outbreaks. The Listeria lawyers of Marler Clark have represented thousands of victims of Listeria and other foodborne illness outbreaks and have recovered over $600 million for clients. Marler Clark is the only law firm in the nation with a practice focused exclusively on foodborne illness litigation. Our Listeria lawyers have litigated Listeria cases stemming from outbreaks traced to a variety of foods, such as caramel apples, cantaloupe, cheese, celery and milk.

Bill Marler: A Week Talking To The Media About Listeria And Ice Cream

Neither agencies nor Blue Bell tested products for Listeria

The Blue Bell recall underscores how Listeria outbreaks can occur without being traced to a specific product, said Bill Marler, a Seattle food-safety lawyer. Blue Bell’s Listeria strains have been matched to 10 illnesses in four states, dating to 2010.

The Centers for Disease Control and Prevention said the Listeria strains found in Blue Bell products were matched to human illnesses using a national computer database, called PulseNet. About 800 listeriosis cases are added to the list annually.

“It shows that the outbreak was going on with no knowledge by Blue Bell, no knowledge by the CDC and no knowledge by health departments,” Marler said. “And the people who had gotten sick had no knowledge that it was the Blue Bell ice cream that made them sick.”

Blue Bell outbreak dates to 2010

“It has evolved with human refrigeration,” said Seattle attorney Bill Marler. “In a sense, we’ve created this monster by our desire to have mass-produced food in cool, wet environments.”

Marler, who built a career on major verdicts for food-borne illness victims, and who may take on clients in this outbreak, said he thinks Blue Bell runs pretty clean plants. But listeria can lurk in crevices of equipment even with aggressive cleaning.

“That doesn’t mean Blue Bell gets a pass legally or morally on this,” he said. “But listeria is a hard thing.”

For Blue Bell, a Drastic Move to Recall Ice Cream as Listeria Findings Rose

Bill Marler, a personal injury lawyer and food safety advocate who is now working with Snoqualmie to make changes at its factory, said that the company had since overhauled its production processes, installing new flooring and sanitizing equipment, and adopting third-party sample testing for all batches of ice cream before they are shipped.Outside experts brought in to track down the source of the listeria infection discovered traces of the bacteria on pallets used by a supplier to deliver milk to the plant, Mr. Marler said. Snoqualmie now keeps pallets out of the production room, and it has also strengthened rules on cleaning uniforms, boots and strip curtains in production zones. Snoqualmie was cleared to start shipping ice cream again after 60 days.Mr. Marler stressed that Snoqualmie had immediately decided to recall all its products even though only a certain line of small-tub ice creams had been linked to the listeria case.“Limiting the recall might seem like a good idea,” he said. “But then if you keep expanding your recall, it’s a death by a thousand cuts. You look like you’re dragging your feet.”

Blue Bell Recalls Entire Line; CEO Vows To ‘Get It Right’

“Once the bacteria gets into a plant, it can grow very rapidly and is really difficult to eradicate,” Bill Marler, a Seattle lawyer who specializes in food-safety cases, tells them.

More listeria illnesses linked to Blue Bell products after recall

More Blue Bell-related listeria cases are likely on the horizon, according to Seattle-based foodborne-illness attorney Bill Marler.

Marler said he has been contacted by “dozens” of people who have been ill with gastrointestinal symptoms and have eaten Blue Bell products — “but there is no way to link them legally. The only sure test is a blood test (or spinal fluid), and you need to be very sick for that usually.” He said he has also heard from several who have listeria infections “but have not yet been linked to Blue Bell genetically,” and that “there are a number of background listeria cases that may or may not be linked.”

“Listeria is an environmental pathogen that loves a cool, wet environment and grows very well at refrigerator temperatures,” Marler said. “That is why it’s such a problem in manufacturing facilities like meat, cheese, cantaloupe and now ice cream. Once it gets into a plant, it is very hard to get rid of.”

“What we know is that the problem has been going on in these [Blue Bell] plants for some time,” he said. “But for South Carolina doing an apparently random test on product in February, no one would have known about this at all.”

CDC expands Blue Bell-related illnesses to 10 people in four states

Food safety attorney Bill Marler said he was “not particularly surprised” by the announcement.

Once tests show Listeria is in a finished product it is likely it is in the manufacturing facility, which is tough to combat, he said.

“Now that it’s expanded, it shows that Listeria is endemic in their plants,” he said.

“What is sad about the Blue Bell situation, had it had more thorough testing of product and more thorough cleaning of its plant and equipment beforehand, an outbreak could have been avoided. The devastation to Blue Bell’s customers and its reputation could have been avoided,” he said.

Marler said other companies have launched broad recalls, including Peter Pan peanut butter, which had years’ worth of products recalled.

“It’s a big hit, but there are a lot of companies that have taken a big hit and come back,” Marler said.

Blue Bell recall shows difficulty of controlling Listeria

“Once the bacteria gets into a plant, it can grow very rapidly and is really difficult to eradicate,” said Bill Marler, a Seattle lawyer who specializes in food-safety cases.

Blue Bell can capitalize on loyalty, industry woes

Frozen desserts have never been a usual suspect for listeria outbreaks, a fact that baffles Seattle attorney Bill Marler, who is helping Snoqualmie through its crisis and who routinely sues food manufacturers. He won a major verdict for one of the Jack in the Box victims.

Listeria thrives in cold, damp places. Ice cream companies and regulators could have been testing for listeria all along, Marler said. He predicts more illnesses and more ice creams linked to listeria before industry catches on – just as costs, tests and safety in ground beef ramped up in the 1990s and early 2000s after E. coli poisonings.

“In six months, instead of having no testing … on ice cream, everybody except tiny companies are going to be testing and swabbing in their facilities looking for listeria,” Marler said. “You won’t see as many recalls, and you won’t see as many illnesses, and that’s exactly what happened with hamburger.”

Marler Clark, The Food Safety Law Firm, is the nation’s leading law firm representing victims of Listeria outbreaks. The Listeria lawyers of Marler Clark have represented thousands of victims of Listeria and other foodborne illness outbreaks and have recovered over $600 million for clients. Marler Clark is the only law firm in the nation with a practice focused exclusively on foodborne illness litigation. Our Listeria lawyers have litigated Listeria cases stemming from outbreaks traced to a variety of foods, such as caramel apples, cantaloupe, cheese, celery and milk.

1 dead, Over 20 Sick After Eating At Church Supper In Ohio

Botulism.jpg-550x0One person is dead, and 19 others are being treated for botulism at Fairfield Medical Center.

Health officials say all of the people who are ill attended a potluck at Cross Pointe Free Will Baptist Church Sunday.

Health officials report 50 to 60 people attended the potluck.

Botulism is a rare paralytic illness caused by a nerve toxin, and can be foodborne. The hospital says a neurologist determined a patient had botulism Tuesday morning, and a short time later, two other cases were identified. All of the patients came in to the Emergency Department at Fairfield Medical Center, but the hospital says several have been transferred to other medical facilities.

All of the people affected had symptoms that included double vision, blurred vision, difficulty swallowing, and blurred vision. Doctors are working on getting an anti-toxin from the Centers for Disease Control to treat the patients.

The Fairfield Medical Center is reminding the community that botulism is not contagious, so there is no threat to the community. But medical officials are encouraging anyone who was at the potluck to come to the emergency department. The medical center has also set up an emergency hotline to answer questions at 740-687-8053.

Marler Clark, The Food Safety Law Firm, is the nation’s leading law firm representing victims of Botulism outbreaks. The Botulism lawyers of Marler Clark have represented thousands of victims of Botulism and other foodborne illness outbreaks and have recovered over $600 million for clients. Marler Clark is the only law firm in the nation with a practice focused exclusively on foodborne illness litigation. Our Botulism lawyers have litigated Botulism cases stemming from outbreaks traced to carrot juice and chili.

CIDRAP: US offers mixed news on drug resistance in foodborne pathogens

A pair of annual federal reports on antimicrobial resistance in pathogens found in poultry and meat brought a mix of good and not-so-good news this week.

The government’s National Antimicrobial Resistance Monitoring System (NARMS) issued its retail meat report for 2012 and an interim report for 2013 that covers only Salmonella.

NARMS is a collaborative program of the Food and Drug Administration (FDA), the Centers for Disease Control and Prevention, and state and local health departments in 11 states. The annual reports focus primarily on Salmonella and Campylobacter.

On the Salmonella front, testing showed that multidrug-resistant strains decreased from 2011 to 2013. In 2012, 33% of retail chicken Salmonella isolates were resistant to three or more classes of antibiotics, which was lower than in 2011. The number dropped to 26% in the 2013 interim report.

There was good news on quinolone resistance: all Salmonella isolates from poultry and meat were susceptible to nalidixic acid and ciprofloxacin in 2012, and in 2013 all were susceptible to ciprofloxacin. (The 2013 report does not mention nalidixic acid.)

The 2012 report shows that third-generation cephalosporin resistance in retail chicken Salmonella isolates increased from 10% to 28% between 2002 and 2012, but the 2013 report shows it dropped to 19.7%.

As for Campylobacter, nearly half of C jejuni and C coli isolates from retail chicken were resistant to tetracycline in 2012, making tetracycline resistance the most common type among Campylobacter.

The report also said that monitoring has revealed no consistent changes in ciprofloxacin resistance among retail chicken C jejuni and C coli isolates since the FDA banned fluoroquinolone use in poultry production in 2005.

On the other hand, Campylobacter rarely shows resistance to multiple drugs, as only 26 of 620 poultry isolates were resistant to three or more antibiotic classes in 2012.

NARMS 2012 Retail Meat Report

NARMS 2013 interim report on Salmonella

With the DeCosters Heading to Jail, The Park Doctrine Remembered

business-man-in-handcuffs-300x205This week two former egg industry executives received three month long jail sentences for their roles in a major 2010 Salmonella outbreak. Austin “Jack” DeCoster and his son, Peter DeCoster’s Quality Egg company will pay a $6.8 million fine as part of a plea agreement, and the DeCosters individually paid $100,000.

The U.S. Centers for Disease Control and Prevention linked 1,939 illnesses to the outbreak, but officials estimate that up to 56,000 people may have been sickened. The three-month sentences handed down by U.S. District Judge Mark Bennett are noteworthy because only a handful of cases of corporate misconduct end with executives behind bars. The extent of harm caused by the outbreak and the pattern of problems led to the decision for jail time.

In the past 18 months, two Colorado cantaloupe farmers were convicted and received probation in a deadly 2011 listeria outbreak, and the former owner of Peanut Corporation of America was convicted in a 2008 salmonella outbreak. The peanut executive, Stewart Parnell, also could face jail time when sentenced.

United States v. Park 421 U.S. 658 (U.S. Sup. Ct. 1975) was decided just a few months after I graduated from High School, and long before I decided (as one food pundit coined), to become the “the Assassin in Armani” – at least to the food industry.

Park is an interesting (and seldom used) case where the Court ruled that Mr. Park, the CEO of Acme International (Acme Markets, Inc., was a national retail food chain with approximately 36,000 employees, 874 retail outlets, 12 general warehouses, and four special warehouses), had failed to comply with the Federal Food, Drugs, and Cosmetics Act (FDCA), to keep conditions within his warehouses sanitary. Rats and rat feces were found in two of the company’s warehouses (on more that one occasion) and the FDA had warned Acme to clean it up. There appears to have been no reported illnesses. At trial Acme pled guilty, but Park claimed he was not personally responsible for the violations. The jury disagreed and he was ultimately fined $50 per violation. The case eventually made its way to the Supreme Court.

In part, the focus of the Court’s opinion was whether “the manager of a corporation, as well as the corporation itself, may be prosecuted under the FDCA for the introduction of misbranded and adulterated articles into interstate commerce.” The Court concluded the answer to be yes. In fact, the Court found that “[t]he Act imposes upon persons exercising authority and supervisory responsibility reposed in them by a business organization not only a positive duty to seek out and remedy violations but also, and primarily, a duty to implement measures that will insure that violations will not occur, … [I]n order to make food distributors the strictest censors of their merchandise, … the Act punishes “neglect where the law requires care, or inaction where it imposes a duty.”

The Court further looked to the purposes of the Act and noted that they “touch phases of the lives and health of people which, in the circumstances of modern industrialism, are largely beyond self-protection.” It observed that the Act is of “a now familiar type, “which” dispenses with the conventional requirement for criminal conduct – awareness of some wrongdoing. In the interest of the larger good it puts the burden of acting at hazard upon a person otherwise innocent but standing in responsible relation to a public danger.”

Thus, the Court reaffirmed the proposition that “the public interest in the purity of its food is so great as to warrant the imposition of the highest standard of care on distributors.”

Today a misdemeanor conviction under the FDCA still, unlike a felony conviction, does not require proof of fraudulent intent, or even of knowing or willful conduct. Rather, a person may be convicted if he or she held a position of responsibility or authority in a firm such that the person could have prevented the violation. Convictions under the misdemeanor provisions are punishable by not more than one year or fined not more than $250,000, or both.

My strong suspicion is that those that produce and sell food are now paying a bit more attention.

Baby Food With Glass Recalled

Screen Shot 2015-04-15 at 10.14.33 PMBeech-Nut Nutrition, an Amsterdam, N.Y. establishment, is recalling approximately 1,920 pounds of baby food products that may be contaminated with small pieces of glass, the U.S. Department of Agriculture’s Food Safety and Inspection Service (FSIS) announced today.

The baby food product was produced on December 12, 2014. The following product is subject to recall:
4-oz. glass jars containing “Stage 2 Beech-Nut CLASSICS sweet potato & chicken”

The product subject to recall bears the establishment number “P-68A” inside the USDA mark of inspection. The affected product expires in “DEC 2016” and includes product numbers “12395750815” through “12395750821”. These items were shipped to retail locations nationwide.

The problem was discovered after the firm received a complaint from a consumer who found a small piece of glass in the product.

The company has received a report of an oral injury associated with consumption of these products. FSIS has received no additional reports of injury or illness from consumption of these products. Anyone concerned about an injury or illness should contact a healthcare provider.

Subway – Think Hepatitis

subwayindexThe Arkansas Department of Health (ADH) is warning of a possible Hepatitis A Virus (Hep A) exposure after a Subway employee in Morrilton tested positive for the virus. The Subway is located at 1812 State Highway 9 Business, just off of Exit 108 on Interstate 40 in Morrilton.

Any individual, who has eaten food from the Morrilton Subway between March 25 and April 5 and is experiencing symptoms should contact their primary care provider immediately. Typical symptoms of Hep A include, but are not limited to: fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, dark urine, clay-colored bowel movements, joint pain or jaundice (yellowing of the skin or eyes).

Hep A is a contagious liver disease that results from infection with the Hepatitis A virus. It can range in severity from a mild illness lasting a few weeks to a severe illness lasting several months. A person can transmit the virus to others up to 2 weeks before and one week after symptoms appear.

There are no specific treatments once a person gets Hep A. However, it can be prevented through vaccination or through receipt of a medicine called immune globulin. This medicine contains antibodies from other people who are immune to Hep A.

People without symptoms who have eaten at this Subway between March 25 and April 5 and are:

  • under 1 year of age, are too young to be vaccinated and may wish to seek out immune globulin from a health care provider.
  • between 1 year to 40 years of age, and if never vaccinated for Hep A, may wish to seek out vaccination from a health care provider.
  • 41 years old and older, and never vaccinated for Hep A, may wish to seek out immune globulin. Vaccine is not known to be effective in this group post-exposure.

As a matter of policy, employees at Subway use disposable gloves between customers and while preparing food. These behaviors have likely reduced the risk of illness to the public. Nevertheless, individuals who have eaten at this Subway between March 25 and April 5, who are pregnant or have severe chronic illness, in particular, liver-related disease, are encouraged to consult with their doctor and consider the above treatment.

The Conway County Health Unit, located at 100 Hospital Drive in Morrilton, will have immune globulin and Hep A vaccine, which can be administered upon request with an appointment on or after Wednesday, April 15. If you wish to get one of these medicines from the health department, call (501) 354-4652 to make an appointment.

At this time, no other Hep A illnesses have been reported to ADH; however, the virus can cause illness anytime from 2-7 weeks after exposure. If infected, most people will develop symptoms 3-4 weeks after exposure.

Hep A is usually spread when a person ingests fecal matter – even in microscopic amounts – from contact with objects, food or drinks contaminated by the feces, or stool, of an infected person.

Many people, especially children, may have no symptoms. The older a person is when they get Hep A, typically the more severe symptoms they have.

Almost all people who get Hep A recover completely and do not have any lasting liver damage, although they may feel sick for months.

Hepatitis A is preventable through vaccination. Hepatitis A vaccine has been recommended for school children for many years and one dose of Hep A vaccine is required for entry into kindergarten and first grade as of 2014. Most adults are likely not vaccinated, but may have been if they received vaccinations prior to traveling internationally.

Marler Clark, The Food Safety Law Firm, is the nation’s leading law firm representing victims of Hepatitis A outbreaks. The Hepatitis A lawyers of Marler Clark have represented thousands of victims of Hepatitis A and other foodborne illness outbreaks and have recovered over $600 million for clients. Marler Clark is the only law firm in the nation with a practice focused exclusively on foodborne illness litigation. Our Hepatitis A lawyers have litigated Hepatitis A cases stemming from outbreaks traced to a variety of sources, such as green onions, lettuce and restaurant food. The law firm has brought Hepatitis A lawsuits against such companies as Subway, McDonald’s, Chipotle, Quiznos and Carl’s Jr.

All You Need To Know About E. coli

ecoli-1184pxWhat is E. coli?

Escherichia coli (or E. coli) is the most prevalent infecting organism in the family of gram-negative bacteria known as enterobacteriaceae. E. coli bacteria were discovered in the human colon in 1885 by German bacteriologist Theodor Escherich. Dr. Escherich also showed that certain strains of the bacterium were responsible for infant diarrhea and gastroenteritis, an important public health discovery. Although E. coli bacteria were initially called Bacterium coli, the name was later changed to Escherichia coli to honor its discoverer.

E. coli is often referred to as the best or most-studied free-living organism. More than 700 serotypes of E. coli have been identified. The “O” and “H” antigens on the bacteria and their flagella distinguish the different serotypes. It is important to remember that most kinds of E. coli bacteria do not cause disease in humans. Indeed, some E. coli are beneficial, while some cause infections other than gastrointestinal infections, such as urinary tract infections.

The E. coli that are responsible for the numerous reports of contaminated foods and beverages are those that produce Shiga toxin, so called because the toxin is virtually identical to that produced by Shigella dysenteria type 1. The best-known and also most notorious E. coli bacteria that produce Shiga toxin is E. coli O157:H7. The Centers for Disease Control and Prevention (CDC) has estimated that every year at least 2,000 Americans are hospitalized, and about 60 die as a result of E. coli infection and its complications. A study published in 2005 estimated the annual cost of E. coli O157:H7 illnesses to be $405 million (in 2003 dollars), which included $370 million for premature deaths, $30 million for medical care, and $5 million for lost productivity.

E. coli O157:H7—a foodborne pathogen

E. coli O157:H7 is one of thousands of serotypes of Escherichia coli. The testing done to distinguish E. coli O157:H7 from its other E. coli counterparts is called serotyping.

Pulsed-field gel electrophoresis (PFGE), sometimes also referred to as genetic fingerprinting, is used to compare E. coli O157:H7 isolates to determine if the strains are distinguishable. A technique called multilocus variable number of tandem repeats analysis (MLVA) is used to determine precise classification when it is difficult to differentiate between isolates with indistinguishable or very similar PFGE patterns. 

E. coli O157:H7 was first recognized as a pathogen in 1982 during an investigation into an outbreak of hemorrhagic colitis associated with consumption of hamburgers from a fast food chain restaurant. Retrospective examination of more than three thousand E. coli cultures obtained between 1973 and 1982 found only one isolate with serotype O157:H7, and that was a case in 1975. In the ten years that followed, there were approximately thirty outbreaks recorded in the United States. This number is likely misleading, however, because E. coli O157:H7 infections did not become a reportable disease in any state until 1987, when Washington became the first state to mandate its reporting to public health authorities. Consequently, an outbreak would not be detected if it was not large enough to prompt investigation.

E. coli O157:H7’s ability to induce injury in humans is a result of its ability to produce numerous virulence factors, most notably Shiga toxin (Stx), which is one of the most potent toxins known to man.  Shiga toxin has multiple variants (e.g., Stx1, Stx2, Stx2c), and acts like the plant toxin ricin by inhibiting protein synthesis in endothelial and other cells.  Endothelial cells line the interior surface of blood vessels, and are known to be extremely sensitive to E. coli O157:H7, which is cytotoxigenic to these cells.

In addition to Shiga toxin, E. coli O157:H7 produces numerous other putative virulence factors, including proteins which aid in the attachment and colonization of the bacteria in the intestinal wall and which can lyse red blood cells and liberate iron to help support E. coli metabolism.

E. coli O157:H7 evolved from enteropathogenic E. coli serotype O55:H7, a cause of non-bloody diarrhea, through the sequential acquisition of phage-encoded Stx2, a large virulence plasmid, and additional chromosomal mutations. The rate of genetic mutation indicates that the common ancestor of current E. coli O157:H7 clades likely existed some 20,000 years ago. E. coli O157:H7 is a relentlessly evolving organism, constantly mutating and acquiring new characteristics, including virulence factors that make the emergence of more dangerous variants a constant threat. The prospect of emerging pathogens as a significant public health threat has been emphasized by the CDC for some time. As Robert Tauxe of the CDC notes:

After 15 years of research, we know a great deal about infections with E. coli O157:H7, but we still do not know how best to treat the infection, nor how the cattle (the principal source of infection for humans) themselves become infected.

Although foods of a bovine origin are the most common cause of both outbreaks and sporadic cases of E. coli O157:H7 infections, outbreaks of illnesses have been linked to a wide variety of food items. For example, produce has been the source of substantial numbers of outbreak-related E. coli O157:H7 infections since at least 1991.   Outbreaks have been linked to alfalfa, clover and radish sprouts, lettuce, and spinach. Other vehicles for outbreaks include unpasteurized juices, yogurt, dried salami, mayonnaise, raw milk, game meats, hazelnuts, and raw cookie dough.

Non-O157 Shiga Toxin-Producing E. coli

E. coli are classified by their O and H antigens (e.g., E. coli O157:H7, E. coli O26:H11) and broadly categorized as Shiga toxin-producing E. coli (STEC) O157 or non-O157 STEC.  For many years, most recognized STEC outbreaks were associated with STEC O157. Despite the dominance of STEC O157, at least 150 non-O157 strains of E. coli are known to cause human illness and have been associated with outbreaks.

In the US, documented outbreaks of non-O157 E. coli include 10 involving O111; 6 involving O26; 3 involving O45; 2 involving O145, O104, and O6; and, one each involving O51; O103; O27; and, O84. Non-O157 STEC outbreaks are rare, but tend to primarily be due to contaminated food and person-to-person transmission.

Non-O157 STEC infections are under-recognized and under-reported due to inadequate epidemiological and laboratory surveillance. In the United States, E. coli O157:H7 became nationally notifiable in 1994, whereas non-O157 STEC infections were not reportable until 2000. Screening for non-O157 STEC remains rare. This is no surprise since by 2007 only 66% of clinical labs screened all stool samples for E. coli O157:H7 and fewer than 10% of labs ever conducted on-site testing for non-O157 STEC. As with E. coli O157:H7, non-O157 STEC cases tend to occur during the summer months.

Non-O157 STEC can be difficult to identify in laboratory screening for E. coli O157 because they do not ferment sorbitol. Most stool cultures suspected to contain STEC are first screened for Shiga toxin; a positive test could be either E. coli O157:H7 or non-O157 STEC. Unfortunately, some labs will discard Shiga toxin-positive cultures after reporting to the referring doctor without identifying the strain. State laboratories can send STEC cultures to the CDC to determine the serotype. Some states, such as Minnesota and Connecticut have begun studies of their own to identify non-O157 STEC.

In recent years, improved diagnostic assays for non-O157 STEC have contributed to an increased appreciation of the severity of disease caused by these strains, including hemolytic uremic syndrome (HUS). Notably, the number of non-O157 STEC cases reported to CDC’s FoodNet has risen steadily each year; from 2000-2006, there was an overall 4-fold increase in incidence (0.12 cases per 100,000 to 0.42 cases per 100,000 population) at FoodNet sites. The most common serogroups reported to cause foodborne illness in the United States are O26, O111, O103, O121, O45, and O145. [56] These six serotypes account for 75% of human infections.

Worldwide, non-O157 STEC outbreaks emerged in the 1980s, and the first reported outbreaks in the United States occurred in the 1990s. The number of reported outbreaks due to non-O157 STECs remains relatively low in the United States, but experts agree that documented outbreaks probably represent the “tip of the iceberg.” From 1983-2002, seven non-O157 STEC outbreaks were reported in the United States. [55] During the following five-year period from 2003-2007, CDC documented an additional five non-O157 STEC outbreaks (CDC Outbreak Surveillance Data, http://www.cdc.gov/foodborneoutbreaks/outbreak_data.htm).

An extraordinary non-O157 outbreak occurred in Germany beginning in May 2011. The STEC involved was extremely rare: E. coli O104:H4. It was also extremely virulent. Ultimately, the outbreak sickened nearly 4,000 people and killed more than 50. This strain was not only resistant to many antibiotics, it possessed a novel mechanism for sticking to intestinal cells. Other unusual aspects of this outbreak were that it affected a disproportionately large percentage of women. Further, nearly a quarter of those infected developed HUS and of those the vast majority was women. It appears that this non-O157 STEC acquired its particular virulence factors and antibiotic resistance through horizontal gene acquisition rather than point mutations or descent from prior generations of bacteria. The outbreak was ultimately traced to contaminated seeds of fenugreek from Egypt, sold as sprouts by an organic farm in Germany.

A study of non-O157 STEC concluded that these strains may account for up to 20 to 50% of all STEC infections in the United States. The prevalence of non-O157 STEC infections is placing an increasing burden on society and the health care system in the United States.

Prevalence

E. coli O157:H7 bacteria and other pathogenic E. coli mostly live in the intestines of cattle, but E. coli bacteria have also been found in the intestines of chickens, deer, sheep, and pigs.  A 2003 study on the prevalence of E. coli O157:H7 in livestock at 29 county and three large state agricultural fairs in the United States found that E. coli O157:H7 could be isolated from 13.8% of beef cattle, 5.9% of dairy cattle, 3.6% of pigs, 5.2% of sheep, and 2.8% of goats. [36] Over 7% of pest fly pools also tested positive for E. coli O157:H7. Shiga toxin-producing E. coli does not make the animals that carry it ill. The animals are merely the reservoir for the bacteria.

According to a study published in 2011, an estimated 93,094 illnesses are due to domestically acquired E. coli O157:H7 each year in the United States. Estimates of foodborne-acquired O157:H7 cases result in 2,138 hospitalizations and 20 deaths annually.

What makes E. coli O157:H7 remarkably dangerous is its very low infectious dose, and how relatively difficult it is to kill these bacteria.  “E. coli O157:H7 in ground beef that is only slightly undercooked can result in infection.” As few as 20 organisms may be sufficient to infect a person and, as a result, possibly kill them. And unlike generic E. coli, the O157:H7 serotype multiplies at temperatures up to 44° Fahrenheit, survives freezing and thawing, is heat-resistant, grows at temperatures up to 111 F, resists drying, and can survive exposure to acidic environments.   And, finally, to make it even more of a threat, E. coli O157:H7 bacteria are easily transmitted by person-to-person contact.

The colitis caused by E. coli O157:H7 is characterized by severe abdominal cramps, diarrhea that typically turns bloody within 24 hours, and sometimes fever. The incubation period—that is, the time from exposure to the onset of symptoms—in outbreaks is usually reported as 3 to 4 days, but may be as short as 1 day or as long as 10 days.  Infection can occur in people of all ages but is most common in children.

Unlike other E. coli pathogens, which remain on intestinal surfaces, Shiga toxin-producing bacteria, like O157:H7, are invasive. After ingestion, E. coli bacteria rapidly multiply in the large intestine and then bind tightly to cells in the intestinal lining.  This snug attachment facilitates absorption of the toxins into the small capillaries within the bowel wall.   Once in the systemic circulation, Shiga toxin becomes attached to weak receptors on white blood cells, thus allowing the toxin to “ride piggyback” to the kidneys where it is transferred to numerous avid (strong) Gb3 receptors that grasp and hold on to the toxin.

Inflammation caused by the toxins is believed to be the cause of hemorrhagic colitis, the first symptom of E. coli infection, which is characterized by the sudden onset of abdominal pain and severe cramps. Such symptoms are typically followed within 24 hours by diarrhea, sometimes fever.

As the infection progresses, diarrhea becomes watery and then may become grossly bloody; that is, bloody to the naked eye. E. coli symptoms also may include vomiting and fever, although fever is an uncommon symptom.

On rare occasions, E. coli infection can cause bowel necrosis (tissue death) and perforation without progressing to hemolytic uremic syndrome (HUS)—a complication of E. coli infection that is now recognized as the most common cause of acute kidney failure in infants and young children. In about 10 percent of E. coli cases, the Shiga toxin attachment to Gb3 receptors results in HUS.

The duration of an uncomplicated illness can range from one to twelve days.  In reported outbreaks, the rate of death is 0-2%, with rates running as high as 16-35% in outbreaks involving the elderly, like those that have occurred at nursing homes.

Shiga toxin–producing E. coli (STEC) cause approximately 100,000 illnesses, 3,000 hospitalizations, and 90 deaths annually in the United States.   As noted, most reported STEC infections in the United States are caused by E. coli O157:H7, with an estimated 73,000 cases occurring each year. According to the CDC:

Non-O157 STEC bacteria also are important causes of diarrheal illness in the United States; at least 150 STEC serotypes have been associated with outbreaks and sporadic illness. In the United States, six non-O157 serogroups (O26, O45, O103, O111, O121, and O145) account for the majority of reported non-O157 STEC infections.

Persons with non-O157 STEC tend to have less severe illness, but some non-O157 STEC members can cause very severe infections, including those that result in HUS and death. Non-O157 STEC that cause HUS overwhelmingly produce Shiga toxin 2 with or without Shiga toxin 1. As with E. coli O157:H7, more severe disease results from Shiga toxin 2 production by non-O157 STEC.

How is an E. coli Infection Diagnosed?

Infection with E. coli O157:H7 or other Shiga toxin-producing E. coli is usually confirmed by the detection of the bacteria in a stool specimen from an infected individual. Most hospitals labs and physicians know to test for these particular bacteria, especially if the potentially infected person has bloody diarrhea.  Still, it remains a good idea to specifically request that a stool specimen be tested for the presence of Shiga toxin-producing E. coli.

Treatment for an E. coli Infection

In most infected individuals, symptoms of a Shiga toxin-producing E. coli infection last about a week and resolve without any long-term problems. Antibiotics do not improve the illness, and some medical researchers believe that these medications can increase the risk of developing HUS. Therefore, apart from supportive care, such as close attention to hydration and nutrition, there is no specific therapy to halt E. coli symptoms.   The recent finding that E. coli O157:H7 initially speeds up blood coagulation may lead to future medical therapies that could forestall the most serious consequences.  Most individuals who do not develop HUS recover within two weeks.

A Life-Threatening Complication—Hemolytic Uremic Syndrome

E. coli O157:H7 infections can lead to a severe, life-threatening complication called the hemolytic uremic syndrome (HUS). HUS accounts for the majority of the acute deaths and chronic injuries caused by the bacteria. HUS occurs in 2-7% of victims, primarily children, with onset five to ten days after diarrhea begins. “E. coli serotype O157:H7 infection has been recognized as the most common cause of HUS in the United States, with 6% of patients developing HUS within 2 to 14 days of onset of diarrhea.” And it is the most common cause of renal failure in children.

Approximately half of the children who suffer HUS require dialysis, and at least 5% of those who survive have long term renal impairment. The same number suffers severe brain damage.  While somewhat rare, serious injury to the pancreas, resulting in death or the development of diabetes, also occurs. There is no cure or effective treatment for HUS. And, tragically, children with HUS too often die, with a mortality rate of five to ten percent.

Once Shiga toxins attach to receptors on the inside surface of blood vessel cells (endothelial cells), a chemical cascade begins that results in the formation of tiny thrombi (blood clots) within these vessels.  Some organs seem more susceptible, perhaps due to the presence of increased numbers of receptors, and include the kidney, pancreas, and brain. Consequently, organ injury is primarily a function of receptor location and density.

Once they move into the interior of the cell (cytoplasm), Shiga toxins shut down protein machinery, causing cellular injury or death. This cellular injury activates blood platelets too, and the resulting “coagulation cascade” causes the formation of clots in the very small vessels of the kidney, leading to acute kidney failure.

The red blood cells are either directly destroyed by Shiga toxin (hemolytic destruction), or are damaged as cells attempt to pass through partially obstructed micro-vessels. Blood platelets become trapped in the tiny blood clots, or they are damaged and destroyed by the spleen.

By definition, when fully expressed, HUS presents with the triad of hemolytic anemia (destruction of red blood cells), thrombocytopenia (low platelet count), and renal failure (loss of kidney function). Although recognized in the medical community since at least the mid-1950s, HUS first captured the public’s widespread attention in 1993 following a large E. coli outbreak in Washington State that was linked to the consumption of contaminated hamburgers served at a fast-food chain.  Over 500 cases of E. coli were reported; 151 were hospitalized (31%), 45 persons (mostly children) developed HUS (9%), and three died.

Of those who survive HUS, at least five percent will suffer end stage renal disease (ESRD) with the resultant need for dialysis or transplantation.  But, “[b]ecause renal failure can progress slowly over decades, the eventual incidence of ESRD cannot yet be determined.”  Other long-term problems include the risk for hypertension, proteinuria (abnormal amounts of protein in the urine that can portend a decline in renal function), and reduced kidney filtration rate. Since the longest available follow-up studies of HUS victims are 25 years, an accurate lifetime prognosis is not really available and remains controversial.

Other Complications from Infection

IBS is a chronic disorder characterized by alternating bouts of constipation and diarrhea, both of which are generally accompanied by abdominal cramping and pain. Suffering an E. coli O157:H7 infection has been linked to the development of post-infectious irritable bowel syndrome (IBS). This link was demonstrated by the Walkerton Health Study (WHS), which followed one of the largest O157:H7 outbreaks in the history of North America. In this outbreak, contaminated drinking water caused over 2,300 people to be infected, resulting in 27 recognized cases of HUS, and 7 deaths. The WHS followed 2,069 eligible study participants. Among its findings, WHS noted that, “Between 5% and 30% of patients who suffer an acute episode of infectious gastroenteritis develop chronic gastrointestinal symptoms despite clearance of the inciting pathogens.”

Not surprisingly, E. coli O157:H7 infection is associated with long-term emotional disruption as well, not just for the victim, but for entire families.   A recent study reported that “parents experienced long-term emotional distress and substantive disruption to family and daily life” following an E. coli O157:H7 infection in the family.

Marler Clark, The Food Safety Law Firm, is the nation’s leading law firm representing victims of E. coli outbreaks and hemolytic uremic syndrome (HUS). The E. coli lawyers of Marler Clark have represented thousands of victims of E. coli and other foodborne illness infections and have recovered over $600 million for clients. Marler Clark is the only law firm in the nation with a practice focused exclusively on foodborne illness litigation. Our E. coli lawyers have litigated E. coli and HUS cases stemming from outbreaks traced to ground beef, raw milk, lettuce, spinach, sprouts, and other food products. The law firm has brought E. coli lawsuits against such companies as Jack in the Box, Dole, ConAgra, Cargill, and Jimmy John’s. We have proudly represented such victims as Brianne Kiner, Stephanie Smith and Linda Rivera.