May 17, 2018
by Gary Pace M.D.
The situation with the E Coli outbreak at the time of this writing (mid-May) is that 172 people have been identified nationwide as being infected, with California reporting 24 cases and 1 death. The source appears to be romaine lettuce, probably cut and in bags, coming out of Yuma, Arizona. The growing season there for romaine has ended, so we are probably nearing the end of this cluster of cases. Let’s take this opportunity, though, to get informed about this and future outbreaks: What do we know about this illness, what steps are being taken to protect the public, and what things can we do as individuals to avoid getting sick?
Escherichia coli is a common bacteria found in the intestines, and it is usually considered a beneficial inhabitant. Certain virulent strains can lead to problems, which is generally gastroenteritis. The most dangerous varieties produce toxins, and the O157:H7 strain (the one involved in the current outbreak) produces Shiga toxin that can lead to the destruction of red blood cells, sometimes causing kidney failure, strokes, and even death.
This bacteria is usually spread by “oral-fecal contact,” which means that someone gets exposed through contaminated food or water, with an incubation period of 3-4 days. People infected with Shiga producing E Coli often come down with bloody diarrhea, crampy abdominal pain, vomiting and no fever. Hospitalization is required in 25-50% of these patients, with a mortality rate of 1-2%. Uncomplicated infections usually clear up in one week. Treatment generally involves supportive therapy since antibiotics have not proven to be helpful.
Outbreaks occur intermittently, and this current one is the largest in the US since 2006 when 199 people became ill from contaminated spinach. Cases of bloody diarrhea began appearing in March in many states around the country, and the numbers have been continuing at a fairly steady pace.
Most laboratories can identify the concerning type of E coli in the stool. In order to determine genotyping, the laboratory must send the specimen to regional Public Health labs, a necessary step for pinpointing the source.
To identify an outbreak, local public health officials receive notice from medical providers or labs when a cluster of unusual cases emerges. These findings will then be relayed to the California Department of Public Health (with a great website about different infectious diseases), and eventually, the information will make it to the Center for Disease Control, the federal agency monitoring these things.
As the investigation progresses, these larger agencies will give general advisories and then start communicating back down to the local agencies in areas where there is concern. For example, in 2016, frozen strawberries from Egypt were identified as being contaminated with Hepatitis A. Once the source was recognized, the CDC and state health departments traced where the strawberries had been shipped to. With the help of the local health departments, they then tracked down and recalled the contaminated products and warned consumers.
In the current outbreak, lettuce grown and shipped from Yuma is the likely source. They have not yet been able to identify a specific farm or distributor, so mounting an ongoing investigation and issuing general guidelines has been the public health strategy. In recent years, public health laws and databases have been rolled out to help prevent these outbreaks, but they are slow to be adopted.
A person can become ill with Shiga-producing E Coli after consuming food or water contaminated with the bacteria. Illnesses have been linked to:
• raw or undercooked beef products
• unpasteurized apple juice or raw milk
• raw produce, including lettuce, spinach, and sprouts
• contaminated water sources
• having direct contact with an infected person who hasn’t properly washed their hands
• contact with contaminated surfaces or animals ( e.g ., at agricultural fairs, petting zoos, etc).
Avoiding contact with potentially contaminated sources, washing produce, washing hands, and cooking meat adequately will all help prevent a person or their family from getting ill.
Hopefully, we are seeing the last of the cases in this outbreak, but through common-sense measures and good public health monitoring, we can hope to delay or prevent further recurrences.
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