A little over a week ago, health officials in Green County, Wisconsin announced to the public that they were investigating an E. coli O157:H7 outbreak that began in mid-August. The outbreak claimed the life of a 20-month-old girl and sickened at least 8 others. Today, health officials report that they are still struggling to find the source.

Steven Elbow of The Capital Times, who has been following the health department’s investigation of the outbreak, reported:

“We’re continuing to work with the Division of Public Health at the state and trying to find some common source through any of the risks: food, water, person-to-person via activities or common sites,” said RoAnn Warden, director of the Green County Health Department.

Most of those who were infected with E. coli were children under the age of 6, Warden said. Some of the cases occurred in the same household, and investigators think person-to-person transmission may have played a part.

Most of the cases were in Monroe, but some were in outlying areas of the county, Warden said. It’s been two weeks since officials confirmed any new E. coli infections, all of which were diagnosed between mid-August and the first week of September.

“At this point it’s looking good, and we’re encouraged,” Warden said. But she said that health clinics in the county continue to be on high alert and are testing stool samples of anyone who shows up with gastrointestinal illness.

Escherichia coli (E. coli) are bacteria that live in human and animal intestines. Shiga toxin-producing strains of E. coli, or STECs, are responsible for most food-related E. coli infections. In fact, in 2011 the Centers for Disease Control and Prevention (CDC) estimated that E. coli infections account for over 2,000 hospitalizations in the United States each year.

E. coli symptoms change as the infection progresses. Symptoms usually begin two to five days after infection. The initial symptoms include the sudden onset of cramps and abdominal pain, followed by diarrhea within 24 hours. Diarrhea will become increasingly watery, and then noticeably bloody. You can learn more about E. coli infection at www.about-ecoli.com.

walnuts.jpgThe Canadian Food Inspection Agency (CFIA) and Johnvince Foods announced a recall on Thursday, September 1, 2011, of some President’s Choice and Reddi Snack walnuts because the products may be contaminated with E. coli O157:H7. The raw, shelled walnuts products were imported from the United States and later packaged and distributed in Canada. The products were distributed across Canada.

Yesterday, September 6, 2011, CFIA expanded the recall to include raw shelled walnuts sold from bulk and additional prepackaged raw shelled walnuts and walnut containing products. CFIA and Johnvince Foods are warning the public not to consume certain bulk and prepackaged raw shelled walnut products described below because these products may also be contaminated with E. coli O157:H7:

  • Bulk walnuts distributed by Johnvince Foods and sold at retail from bulk bins** 11.34 kg sold from April 27 to August 6, 2011, inclusive
  • President’s Choice Raw California Walnut Halves Unsalted (250g) UPC 0 60383 and 87185 7
  • President’s Choice Deluxe Trail Mix (220g) UPC 0 60383 and 87201 4
  • No Frills Natural Walnut Halves and Pieces (175g) UPC 0 64777 and 37773 4
  • Longo’s California Walnuts (240g) UPC 7 72468 and 10107 9
  • Compliments California Walnut Halves & Pieces (225g) UPC 0 68820 and 12395 8
  • Compliments Walnut Halves (100g) UPC 0 55742 and 35977 0
  • FreshCo California Natural Walnut Halves & Pieces (200g) UPC 7 70974 and 80188 9
  • Marketplace Co-op “Halt” The Salt Walnut Halves & Pieces (250g) UPC 0 64777 and 44085 8
  • Johnvince Foods Caramel Toffee Walnuts (11.34 kg)
  • Stock & Barrel Caramel Toffee Walnuts (300g) UPC 0 64777 and 37906 6
  • Joe’s Tasty Travels California Select Walnuts Mostly Halves (350g) UPC 6 64989 and 60689 1
  • Selection Walnut Halves (250g) UPC 0 59749 and 90882 5  
  • Planters Vitality Mix 100 Calories per bag (240g) UPC 0 58716 98972 0 16881
  • Marketplace Co-op Vitality Mix (375g) UPC 0 64777 and 44131 2

**The bulk walnuts listed above were imported and distributed in Canada by Johnvince Foods in 25 lb cardboard cases bearing Lot code W1866 and the name Andersen and Sons Shelling, Vina, California, USA. Consumers who may have purchased unlabelled walnuts from bulk and are unsure if they have the affected product are advised to contact the place of purchase to determine if it is affected by this recall.

Although there have been no reported illnesses associated with the consumption of these products, Johnvince Foods of Downsview, Ontario is voluntarily recalling the affected products from the marketplace as a precautionary measure.

In another walnut recall in January, one person in Quebec died and 13 other Canadians fell sick with an E. coli bacterial infection with the same genetic fingerprint. Of the 14 reported cases of E. coli infection, nine people consumed walnuts and seven ate walnuts from the same distributor, the CFIA said at the time.

Tri State Beef, a Cincinnati, Ohio establishment, is recalling approximately 228,596 pounds of beef products that may be contaminated with E. coli O157:H7, according to a press release from the U.S. Department of Agriculture’s (USDA) Food Safety and Inspection Service (FSIS) issued today.

The following product is subject to recall:

  • Combo bins of “TRI-STATE BEEF CO., INC BONELESS BEEF.”

Each bin bears the establishment number “EST. 1750” inside the USDA mark of inspection. The products subject to recall were produced between July 19, 2011 and July 22, 2011, and sold to federally-inspected establishments for further processing and distribution in Chicago, Illinois, Cincinnati and Columbus, Ohio, Iowa and Virginia.

The problem was discovered through routine FSIS testing which confirmed a positive result for E. coli O157:H7. FSIS notes in its press release that “these products were distributed to facilities where they were cooked and as a result received full-lethality treatment, which would effectively kill the E. coli O157:H7 pathogen in the products.”

Despite that, E. coli O157:H7 is a potentially deadly bacterium that can cause bloody diarrhea, dehydration, and in the most severe cases, it can lead to the severe complication known as hemolytic uremic syndrome (HUS).

Consumers and media with questions regarding the recall should contact the company’s attorney, Mark Fitch, at (513) 731-8459.

The FDA has released their Form 483 (PDF), detailing several alarming and insanitary practices at Sally Jackson Cheese’s manufacturing facility that likely contributed to the current raw cheese E. coli O157:H7 outbreak among Washington, Oregon, Vermont, and Minnesota residents.

Among the more egregious findings:

  • The owner was observed throughout the day doing such things as stirring cheese curds with bare hands, wrapping cheese in grape leaves, and milking/feeding livestock, without hand washing between those activities.
  • The owner wore manure soiled clothing during production of cheese, handling of utensils and direct handling of finished product.  The owner was observed kneeling in fresh cow manure, while milking a cow outside, then brushed pants with a bare hand and was later observed standing over a bucket of drained curd in the cheese room with the soiled pants coming into direct contact with the edge of the bucket.
  • The hand washing sink’s drain pipe and water supply lines were disconnected.  Also, the two-compartment processing room sink was not set up for hand washing and there were no towels or soap available at either sink.
  • The well water supply for the facility indicated an elevated total coliform level.
  • Wood fixtures, walls and floors generally soiled and stained with grime and dirt.  The floors had accumulations of manure, mud, straw, wood chips, and other debris.  Several areas of the ceiling had black mold-like deposits.  Wood shelving, work tables and cheese storage boxes were noted throughout the facility with accumulated product, grime and black mold-like deposits.
  • Holes, open cracks, water damage and peeling paint/plaster in several ceiling and upper wall locations directly above exposed cheese on storage shelves.  A section of the cheese room ceiling is unfinished with exposed bolts and insulation above the sink and clean utensil storage.

The link between Bravo Farms’s Dutch Style Raw Milk Gouda Cheese and an outbreak of E. coli O157:H7 among at least 37 Southwest residents became even stronger today.  The New Mexico Department of Health has confirmed that an intact sample of the raw milk Gouda cheese sampled and sold at numerous Costco stores has cultured positive for the outbreak strain of E. coli O157:H7.

On Nov. 5, 2010, Bravo Farms voluntarily recalled all of its Dutch Style Gouda cheese because it is potentially contaminated with E. coli 0157:H7. The cheese was distributed primarily through Costco in Southern California, Nevada, Arizona, Utah, Colorado, and New Mexico in 1.5 lb. packages. It was also distributed through various retail stores within California in 8 oz. packages.

The number of ill persons identified in each state with this particular E. coli O157:H7 strain is presently as follows: AZ (19), CA (3), CO (10), NM (3) and NV (2). There have been 15 reported hospitalizations and 1 case of hemolytic uremic syndrome (HUS).  Thankfully no deaths have been reported thus far.

Officials with Grand Traverse County Health Department have reported three probable cases of  Shigatoxin-producing E.coli in the past week.  Information was not provided on the specific strain, but the most common pathogenic strain of the bacteria is E. coli O157:H7.   According to this report, "All cases were in children and all three attended the Northwestern Michigan Fair in Grand Traverse County between August 9 and August 13.  The onset of symptoms, including bloody diarrhea, were between August 15 and August 17.

It appears that the illnesses are linked to exposure to animals at the fair:

"Considering the number of animals in close proximity to people at that venue, it seems likely that their infections were contracted there", stated Dr. Michael Collins, Medical Director for the Grand Traverse County Health Department. "Though we will probably never know exactly which animal or animals were involved as sources".

E. coli O157:H7 is most often harbored by ruminants, including cattle, sheep, and goats.  Outbreaks of illness, and E. coli O157:H7, have been repeatedly linked to animal/child interaction at petting zoos and fairs.   For many years, the CDC and the National Association of State Public Health Veterinarians (NASPHV) has provided a list of guidelines and recommendations aimed at reducing or eliminating the risk of such transmission.

The student newspaper at Penn State is reporting that an attendee to a tennis camp at PSU left early last week, and has been told that he had contracted E. coli.   There is no confirmation that the illness was contracted at the camp.   The report did not indicate the strain of E. coli to be E. coli O157:H7.  It is fairly likely that this is the strain involved however, as it is one of very few, and in some cases the only strain, that is tested for and reported.   According to the report:

Penn State spokeswoman Lisa Powers said Penn State officials couldn’t confirm that the camper contracted the illness while at Penn State. University officials will meet this afternoon to discuss the situation, she said.

A natural question is whether any other attendees of the camp were ill.  It does appear that other campers reported digestive problems, but there is not yet any indication of other reports of E. coli.  A single commons provides food for all attendees at the university’s sports camps.  

In 2002,  a number of attendees at a dance camp at Eastern Washington University developed E. coli O157:H7 infections eventually traced to lettuce served in the university kitchens. 

The number of those sickened by raw milk in Boulder County Colorado has grown to 24.  Earlier this week, health officials announced that 16 people were suffering from E. coli O157:H7 and campylobacter infections lined to unpasteurized goat’s milk from the Billy Goat Dairy in Longmont, Colorado.   Now 8 more illnesses have been identified.   This may not be the final tally:

Epidemiologists continued to contact the 43 households that participate in the dairy’s goat-share program to warn of potential health risks and check for symptoms Thursday. They were still waiting on responses from several households.  "As long as we continue to discover new cases, the investigation will continue," said Murielle Romine, of Boulder County Public Health.

Two children have been hospitalized in the outbreak, although one has now been released.  Both E. coli O157:H7 and campylobacter cause severe food poisoning symptoms, and both are associated with the risk of severe complications.   E. coli O157:H7 can cause hemolytic uremic syndrome (HUS), especially in children and the elderly.  HUS is a potentially fatal illness that can also cause permanent kidney injury, pancreatic damage, and brain damage.

Campylobacter is a known cause of Guillain Barre Syndrome (GBS).   GBS is a an autoimmune disorder affecting the peripheral nervous system, usually triggered by an acute infectious process.  It causes nerve paralysis, and can be permanently disabling.

In 2009, 93 people, mostly young children, were sickened in an outbreak of E. coli O157:H7 linked to the Godstone Farm in Surrey, U.K.  A year later, an independent inquiry into the matter has produced a report that concluded that dozens of cases of E. coli O157:H7 "could have been prevented if authorities had acted earlier and taken the outbreak more seriously" according to press reports.   Outbreaks of E. coli O157:H7 at petting zoos are not new.

Professor George Griffin, professor of infectious diseases at St George’s University London, chaired the inquiry.  He warned that "regulations governing petting or ‘open’ farms were not robust enough to prevent a similar outbreak occurring again." 

The report was critical of medical practitioners and government officials alike:

The 250-page report said some local GPs did not recognise the illness as a medical emergency, telling parents their children would get better on their own only for them to deteriorate rapidly.

There were ‘unacceptable delays’ by the Health Protection Agency in setting up an outbreak control team and a ‘failure in public health leadership’, the report said.

It added: "If action had been taken sooner to stop all contact with ruminants (cows and sheep), a substantial number of the E.coli 0157 cases could have been prevented."

8 of the ill persons developed cases of HUS serious enough to need dialysis to survive.   Some victims may need a kidney transplant in the future.  Because HUS is much more likely to develop among children exposed to E. coli O157:H7, outbreaks at petting zoos are particularly damaging.  Such a sudden spike in children needing kidney treatment stretches medical care thin as well:

The outbreak was so severe that every specialist hospital bed to treat children with serious kidney problems in London and the South East was filled with cases from Godstone Farm.

The report suggested that thousands were permitted to visit the farm after the local Health Protection Agency was aware of at least cases of illness linked to the farm.  The report did not call for a ban on human/animal contact at such fairs:

Prof. Griffin said the report was in favour of common sense approach and not draconian measures. He said it was perfectly possible for children to pet animals on a farm safely if the animals are kept clean, on fresh bedding and handwashing facilities are readily available and well supervised.

In the U.S. the CDC has published guidelines created by the National Association of State Public Health Veterinarians for public animal exhibits.

A report on last summer’s outbreak of E. coli O157:H7 , traced to the Godstone Farm in Surrey, U.K. is due shortly, according to the BBC.   Ninety-three people, mostly young children, were sickened in the outbreak.  

The inquiry was ordered by the Health Protection Agency.  The Agency was criticized for a slow response to the problem.  According to BBC:

The independent inquiry looked into how the outbreak occurred and the role of the regulatory agencies.  The farm was not closed until a month after the first case .During this time tens of thousands of people would have passed through it.  Some of the people affected are still ill with kidney damage and a group of parents are preparing to launch legal action for damages.

Outbreaks of zoonotic disease, generally, and E. coli O157:H7 in particular, has been a problem in both the U.K. and the U.S. that has been documented for over 20 years.