Officials now report that nine hospitalized children have been diagnosed with a complication that causes the kidneys to shut down.

Eleven daycare centers have been closed since Monday. Five of them may be allowed to reopen on Sept. 11 if no illnesses among attendees or staff have been confirmed. The five centers and six with known patients were closed as a cautionary move because they all use a central kitchen.

The Shiga toxin-producing E. Coli involved in the outbreak can also attack other organs and cause widespread organ failure. It is not unusual for children to appear to be recovering and then backslide into a much more severe infection.

Investigators have collected samples of leftovers and frozen food for testing, but those test results are not yet available.

About E. coli infections
Anyone who has developed symptoms of E. coli infection should seek medical attention and tell their doctor about their possible exposure to the bacteria. Specific tests are required to diagnose the infections, which can mimic other illnesses.

Alberta Health Services officials said the outbreak has peaked, though more patients could be identified. There is a chance of secondary infections where sick patients expose others in their families to the bacteria.

The symptoms of E. coli infections vary for each person but often include severe stomach cramps and diarrhea, which is often bloody. Some patients may also have a fever. Most patients recover within five to seven days. According to the Centers for Disease Control and Prevention (CDC), others can develop severe or life-threatening symptoms and complications.

Many people with HUS recover within a few weeks, but some suffer permanent injuries or death. This condition can occur among people of any age but is most common in children younger than five years old because of their immature immune systems, older adults because of deteriorating immune systems, and people with compromised immune systems such as cancer patients. 

About 5 to 10 percent of those diagnosed with E. coli infections develop a potentially life-threatening kidney failure complication known as a hemolytic uremic syndrome (HUS). Symptoms of HUS include fever, abdominal pain, tiredness, decreased frequency of urination, small unexplained bruises or bleeding, and pallor. 

People who experience HUS symptoms should immediately seek emergency medical care. People with HUS will likely be hospitalized because the condition can cause other serious and ongoing problems such as hypertension, chronic kidney disease, brain damage, and neurologic problems.

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The issue was reported to FSIS after the ground beef product was submitted to a third-party laboratory for microbiological analysis and the sample tested presumptive positive for E. coli O157:H7.

The fresh ground beef products were produced on Aug. 22, 2023. 

FSIS is concerned that some product may be in restaurant refrigerators or freezers.

These items were shipped to restaurant locations in the greater San Antonio, TX area.

Recalled products:

• 1-lb., 5-lb., and 10-lb. vacuum-sealed plastic bags containing “Peeler Farms WAGYU BEEF GROUND BEEF” with lot code 17836 represented on the label.
• 5-lb. vacuum-sealed plastic bags containing “R-C RANCH TEXAS CRAFT MEATS WAGYU RC13610 STEAKHOUSE BLEND – GROUND BEEF 5 lb” with lot code 17816 represented on the label.
• 8-oz. vacuum-sealed plastic bags containing “R-C RANCH TEXAS CRAFT MEATS WAGYU RC13603 – GROUND BEEF PATTIES 8 oz” with lot code 17816 represented on the label.

The products subject to recall bear establishment number “EST. 51283” inside the USDA mark of inspection.

As of the posting of this recall, there have been no confirmed reports of adverse reactions due to consumption of these products.

Restaurants are urged not to serve these products. These products should be thrown away or returned to the place of purchase.

About E. coli infections
Anyone who has eaten any of the implicated products and developed symptoms of E. coli infection should seek medical attention and tell their doctor about their possible food poisoning. Specific tests are required to diagnose the infections, which can mimic other illnesses.

The symptoms of E. coli infections vary for each person but often include severe stomach cramps and diarrhea, which is often bloody. Some patients may also have a fever. Most patients recover within five to seven days. Others can develop severe or life-threatening symptoms and complications, according to the Centers for Disease Control and Prevention (CDC).

About 5 to 10 percent of those diagnosed with E. coli infections develop a potentially life-threatening kidney failure complication, known as a hemolytic uremic syndrome (HUS). Symptoms of HUS include fever, abdominal pain, feeling very tired, decreased frequency of urination, small unexplained bruises or bleeding, and pallor. 

Many people with HUS recover within a few weeks, but some suffer permanent injuries or death. This condition can occur among people of any age but is most common in children younger than five years old because of their immature immune systems, older adults because of deteriorating immune systems, and people with compromised immune systems such as cancer patients. 

People who experience HUS symptoms should immediately seek emergency medical care. People with HUS will likely be hospitalized because the condition can cause other serious and ongoing problems such as hypertension, chronic kidney disease, brain damage, and neurologic problems.

(To sign up for a free subscription to Food Safety News, click here.)

An article in the September issue of the publication Emerging Infectious Diseases describes a strain of E. coli O157:H7 that caused a large outbreak in late 2019. The outbreak included 167 patients and hospitalized 85 people from 27 states. The outbreak was associated with consuming romaine lettuce from Salinas Valley, CA.

“Researchers at CDC sought to characterize E. coli from this outbreak and other closely related strains. This strain is estimated to have emerged in late 2015, causing multiple outbreaks from 2016-2019,” according to the article. 

“An additional outbreak associated with this strain was detected in late 2020 after the conclusion of this study in which a reported 40 infections occurred in 19 states; 20 people were hospitalized, and four developed hemolytic uremic syndrome. CDC defined this strain as a reoccurring, emerging, or persistent strain causing illness over an extended time.” 

The authors said healthy cattle serve as the main source for E. coli O157:H7, but more recently, contaminated leafy greens have been recognized as a major source for E. coli O157:H7 outbreaks.

Detailed genomic characterization of additional reoccurring, emerging, or persistent strains will be needed to explain factors contributing to their emergence and persistence in specific environments, according to the study’s author Jessica C. Chen and the research team.

E. coli O157:H7 bacteria cause an estimated 63,000 foodborne illnesses and 20 deaths in the United States each year. Those infections typically involve abdominal cramps, bloody diarrhea, and vomiting. However, a rare but serious condition called hemolytic uremic syndrome can develop, resulting in anemia and acute kidney failure. 

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In 2020, 1,419 confirmed cases of Shiga toxin-producing E. coli (STEC) were reported in England and Wales. This included 402 culture-confirmed cases of E. coli O157 and 690, where a serogroup other than O157 was isolated. Five people died. For another 329 cases, samples tested positive by PCR for Shiga toxin genes, but STEC was not cultured. In 2019, 539 E. coli O157 and 768 non-O157 infections were noted.

Transmission can occur through direct or indirect contact with animals or their environments, consumption of contaminated food or water, and person-to-person spread.

Seven confirmed cases were infected with multiple types in 2020, including O145 and O157; O26 and O157; O26 and O168; O91 and O146 and O87 and O113. It is the lowest rate reported since 1996 when testing began in England for STEC O157 on all fecal specimens from patients with suspected gastrointestinal infection. However, it is probable that the pandemic played a role, so the trend should be interpreted with caution, said health officials.

E. coli O157 data
Of 365 confirmed STEC O157 cases in England, 195 were female. Children aged 5 to 9 had the highest incidence of infection. Those aged 1 to 4 had been the most affected in previous years.

Hemolytic Uremic Syndrome (HUS) occurred in 10 confirmed STEC O157 cases. Two HUS cases were under 5 years old, with a range of 1 to 93. Two deaths were reported among confirmed cases.

The decline in reported foreign travel by STEC O157 cases from 30 percent in previous years to eight percent in 2020 indicated limited travel abroad.

The highest incidence was in the South West, and the lowest was in London. Hospitalization occurred in 121, or a third, of cases with duration ranging from one to 14 days with a median of three days.

A drop in travel-related infections was observed, with only 30 people reporting being abroad during their incubation period, which was seven days prior to onset, compared to 28 percent and 31 percent in 2018 and 2019, respectively. Of those 30, five spent their entire incubation period abroad. The most frequent destinations included Turkey, Spain, and Malta.

In England, 557 culture-positive cases of 95 different serogroups were confirmed, and in Wales, the amount was 132 cases of 53 different types.

In total, 85 non-O157 STEC cases were hospitalized. HUS occurred in 28 confirmed cases. The most frequently isolated serogroups were O26 10 times and O145 on four occasions. HUS cases ranged from 10 months to 6 years old and 10 were between 1 and 4. Three people died.

Non-O157 figures
Detection of non-O157 STEC infections decreased compared to 2019. The most commonly isolated serogroup was STEC O26, followed by O146 and O91.

Ten percent of confirmed O26 cases developed HUS compared to 3 percent of confirmed O157 cases, and a higher proportion of O26 cases reported hospitalization compared to O157 patients.

In August 2020, UKHSA, Public Health Scotland (PHS), and Public Health Wales (PHW) investigated an outbreak with 20 confirmed cases, of which 15 were from England, four in Wales and one in Scotland. The median age was 42 years old. Five people were hospitalized.

Three recorded outbreaks
Three E. coli O157 outbreaks involving 63 cases were reported in 2020, but no related HUS cases or deaths were reported.

UKHSA and PHW investigated another outbreak and identified the vehicle of infection as imported cucumbers consumed as part of a fast-food product. There were 36 confirmed cases, of which 27 lived in England and nine in Wales. Thirteen people reported being hospitalized.

UKHSA investigated a third outbreak with 18 confirmed cases. Three people were hospitalized, but the source was not found.

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The Norwegian Institute of Public Health (FHI) said six people, living in different parts of the country, are sick. E. coli O157:H7 with the same genetic profile has been detected in all patients.

Two people fell ill in October and November 2022, while the remaining four became sick in February, March and May this year. No-one has developed serious illness. They are between the ages of 14 and 49, and five are men.

Two patients live in Rogaland, while Viken, Trøndelag, Vestland, and Oslo all have one case each.

Mild illnesses reported over time
The outbreak is being investigated by FHI, municipal chief medical officers, the Norwegian Food Safety Authority (Mattilsynet) and the Veterinary Institute.

“We have good procedures for following up cases with E. coli infection, and none of the people in this outbreak have developed the serious complication hemolytic uremic syndrome (HUS),” said Hilde Marie Lund, from FHI.

The source of infection has not been established but officials know people have been diagnosed in five counties at various times over a long period.

“We, therefore, assume that they are infected through a food product that is distributed throughout the country and has a relatively long shelf life. Interviews of the people are ongoing to determine whether they may have a common source of infection,” said Lund.

“We cannot say whether this is a limited outbreak or whether there may be new cases. Investigative work can be complicated and take time, and in many cases we are unable to find the source of infection or to clarify whether it is a common source.”

The Norwegian Veterinary Institute will analyze samples of foods that are suspected as possible sources of infection.

The Norwegian Food Safety Authority is helping obtain information from the sick people and their relatives.

“Interviews are conducted about what the people have eaten and what they have been in contact with. It may also be appropriate to take samples of food and food leftovers and food packaging, in order to, if possible, find the source of infection,” said Turid Berglund, from Mattilsynet.

Norway reported 518 E. coli cases in 2022 and one outbreak affecting seven people.

Austrian incident
Meanwhile, several children have fallen ill with E. coli infections in a state of Austria beginning in late May.

In recent weeks, 11 children and young people, mostly from three childcare facilities in the Frastanz area, have contracted infections caused by Shiga toxin-producing E. coli (STEC). The serotype was not mentioned by officials.

At least two children developed HUS and another four were hospitalized, said officials in the province of Vorarlberg.

At the three childcare facilities, hygiene visits were undertaken with recommendations for cleaning and disinfection made. Samples of food sent for analysis were all negative. Thirteen swab samples were taken from work surfaces in the kitchen area plus nine food samples from affected childcare facilities and the central kitchen.

Another 15 samples from the kitchen were sent to the Austrian Food Safety Agency (AGES) reference laboratory to be analyzed. These were also negative. Officials said an investigation into the cause of illnesses was ongoing with three children still in hospital. 

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The recall was initiated when the New Hampshire Department of Agriculture received a positive test result for E. coli 0157:H7 in a single package of lēf Farms “Spice” Packaged Salad Greens (4 oz) as part of routine testing.

lēf Farms “Spice” is the only product impacted to date and affected retailers include Hannaford and Market Basket in Maine, Massachusetts, New Hampshire, New York, Rhode Island, and Vermont.

Recalled product:

• The product comes in a 4-oz, clear, plastic clamshell container. 
• Information about the “best by” date, lot number, and UPC can be found at the bottom of the package. 
• “Best by” date 5/5/23
• Lot number SP10723- 1RGH1
• UPC 8 50439 00709 1

As of the posting of this recall, no illnesses have been reported.

In addition to today’s voluntary recall, the company is testing all products produced in its New Hampshire facility for E. coli 0157:H7 prior to distribution.

Retailers have been instructed to remove all recalled products from store shelves. Consumers who have purchased the affected lēf Farms “Spice” products should discard them or present a photo of the product or receipt to their place of purchase for a full refund and then discard.

About E. coli infections
Anyone who has eaten any of the implicated products and developed symptoms of E. coli infection should seek medical attention and tell their doctor about their possible food poisoning. Specific tests are required to diagnose the infections, which can mimic other illnesses.

The symptoms of E. coli infections vary for each person but often include severe stomach cramps and diarrhea, which is often bloody. Some patients may also have a fever. Most patients recover within five to seven days. Others can develop severe or life-threatening symptoms and complications, according to the Centers for Disease Control and Prevention (CDC).

About 5 to 10 percent of those diagnosed with E. coli infections develop a potentially life-threatening kidney failure complication, known as a hemolytic uremic syndrome (HUS). Symptoms of HUS include fever, abdominal pain, feeling very tired, decreased frequency of urination, small unexplained bruises or bleeding, and pallor. 

Many people with HUS recover within a few weeks, but some suffer permanent injuries or death. This condition can occur among people of any age but is most common in children younger than five years old because of their immature immune systems, older adults because of deteriorating immune systems, and people with compromised immune systems such as cancer patients. 

People who experience HUS symptoms should immediately seek emergency medical care. People with HUS will likely be hospitalized because the condition can cause other serious and ongoing problems such as hypertension, chronic kidney disease, brain damage, and neurologic problems.

(To sign up for a free subscription to Food Safety News, click here)

I am a trial lawyer who has for the last 30 years built a practice on food pathogens. Since the Jack in the Box E. coli outbreak in 1993, I have represented thousands of families who were devastated for doing what we all do every day – eat food.  In those 30 years a variety of members of the food industry have paid my clients over $900,000,000.

This may prompt some to consider me a blood-sucking ambulance chaser who exploits other people’s personal tragedies for personal gain. If that is the case, here is my plea:

Put me out of business, please!

For this trial lawyer, E. coli, Salmonella, Listeria, and other pathogens have made a far too successful practice – and a heart-breaking one. I am tired of visiting with horribly sick kids who did not have to be sick in the first place. I am outraged with a government and food industry that allow these poisons to reach consumers. 

So, stop making kids sick and I will happily retire.

The FDA is at a crossroads.  Over 10 years after the passage of the Food Safety Modernization Act (FSMA), the goals of the most significant food safety legislation in decades have remained unfulfilled.  As well-stated recently by Senator Durbin (D-Il) and Congressmember DeLauro (C-CT):

FDA is responsible for the oversight of nearly 80 percent of food in the United States.  Too often, however, FDA has failed to protect Americans from dangerous food pathogens and outbreaks.  Every year, more than 48 million Americans are sickened, 128,000 are hospitalized, and 3,000 lose their lives because of some bacteria or virus in their food.  In 2011, FMSA was signed into law to transform the United States’ approach to foodborne illnesses.  FSMA requested FDA to be more proactive, not reactive, to foodborne illnesses to prevent outbreaks in the first place.  FSMA empowered FDA with new authorities, resources, and funding to accomplish this goal.  But, as outlined in the Reagan-Udall report, FDA has not made this shift, despite FSMA’s passage more than a decade ago.  FSMA required FDA to promulgate several rules so that it would prevent rather than respond to foodborne outbreaks.  However, more than a handful of times, FDA missed congressionally mandated deadlines to implement them.  FSMA also required FDA to “increase the frequency of inspection of all [food] facilities,” to ensure companies’ compliance with safety and quality standards.  But FDA inspections have plummeted since FSMA was signed into law.

The FDA was, and for good reason, embarrassed by the likely illnesses of infants who became sick after consuming formula produced in a manufacturing plant that seemed to care little about the safety of its product.  The FDA failed to properly inspect the plant which then led to formula shortages that still threaten infants today.  For good reason FDA Commissioner Califf asked the Reagan-Udall Foundation expert panel to suggest fixes to the FDA.  

Mr. President, Mr. HHS Secretary and FDA Commissioner please listen to those experts.  Those experts were clear that the current structure at FDA needs change to make food safer.  In its final report the Reagan-Udall Foundation panel in part recommended: 

Given the economic impact that foodborne illness and diet-related chronic disease have on Americans and the federal budget, it is imperative that the Human Foods Program [which includes both food safety and nutrition] become more prominent. When compared to the medical products programs within FDA, the Human Foods Program continuously struggles for visibility and prominence. A component of this elevation of the Human Foods Program is strong advocacy to advance the Human Foods Program at all levels of the government, especially at the Department of Health and Human Services (HHS) and the White House, including the Office of Management and Budget. 

• The Human Foods Program should have clear lines of authority. 
• Within the Human Foods Program, the importance of nutrition should be elevated. 
• The foods portfolio of ORA [inspections] should be integrated directly with the other elements of FDA’s Human Foods Program.
• The food-relevant work of CVM [animal food] should be integrated with the overall FDA Human Foods Program. 
• A new Foods Advisory Committee, at the Commissioner-level, should be established to strengthen external input to Human Foods Program activities.

My vision, perhaps a bit more aggressive, is of a more empowered food-side of the FDA that would create two Senate appointed Commissioners – one with a portfolio of all aspects of food (food safety and nutrition) as mentioned above, and one with a portfolio of drugs and medical devices.

The time for half measures is past.  It is time to be bold.  It is time to move the FDA from reactive to proactive.  It is time to do what needs to be done to bend the curve in the numbers of those negatively impacted by the food they consume.

Progress in the safety of our food supply can be made and history can be a guide.

When the Jack in the Box E. coli outbreak happened in 1993 several hundred were sickened, many severely, with at least four dead, from eating a hamburger.  It was the first crisis of the Clinton Administration and the USDA/FSIS. The meat and restaurant industries were facing the ire of an angry public. Many thought the problem insoluble. Yet, the industry, government and consumers came together to find a way to lower E. coli in hamburger and to drive the numbers of ill down.  

It worked. For years E. coli in hamburger was my firm’s “bread and butter.”  In time the numbers of people sickened by E. coli in hamburger continued to fall to a point that, with government help, the meat industry met my challenge to: Put me out of business, please!

It is now time for the FDA to be reformed enough that the successes of the USDA/FSIS in the 1990’s can be replicated today. The time is long past for the FDA to: Put me out of business, please!

Mr. President, Mr. HHS Secretary and FDA Commissioner please listen.  

The problem was discovered during routine FSIS product testing when a sample confirmed positive for E. coli O157:H7. There have been no confirmed reports of adverse reactions due to the consumption of these products. Anyone concerned about an illness should contact a healthcare provider.

A recall was not requested because no product is currently available for sale to consumers; however, the ground beef product may remain in consumers’ homes and could cause illness if eaten. FSIS is concerned that some products may be in consumers’ refrigerators or freezers.

The raw ground beef was ground in store on Nov. 28, 2022. The product was packaged for consumers behind the meat counter in varying weights. 

Recalled product:

• Varying weights of ground beef packed in butcher paper, containing “CARNE MOLIDA REGULAR/GROUND BEEF” with “Packed On” dates ranging from Nov. 28 to Dec. 1, 2022, and “Sell By Dec. 1, 2022” on the label.

These items were only sold in La Michoacana Meat Market retail store, located at 5106 Wesley St., Greenville, Texas, 75402. The last date that the product was available for sale was Dec. 1, 2022.

Consumers who have purchased these products are urged not to consume them. These products should be thrown away or returned to the place of purchase.

About E. coli infections

Anyone who has eaten any of the implicated products and developed symptoms of E. coli infection should seek medical attention and tell their doctor about their possible food poisoning. Specific tests are required to diagnose the infections, which can mimic other illnesses.

The symptoms of E. coli infections vary for each person but often include severe stomach cramps and diarrhea, which is often bloody. Some patients may also have a fever. Most patients recover within five to seven days. Others can develop severe or life-threatening symptoms and complications, according to the Centers for Disease Control and Prevention (CDC).

About 5 to 10 percent of those diagnosed with E. coli infections develop a potentially life-threatening kidney failure complication, known as a hemolytic uremic syndrome (HUS). Symptoms of HUS include fever, abdominal pain, feeling very tired, decreased frequency of urination, small unexplained bruises or bleeding, and pallor. 

Many people with HUS recover within a few weeks, but some suffer permanent injuries or death. This condition can occur among people of any age but is most common in children younger than five years old because of their immature immune systems, older adults because of deteriorating immune systems, and people with compromised immune systems such as cancer patients. 

People who experience HUS symptoms should immediately seek emergency medical care. People with HUS will likely be hospitalized because the condition can cause other severe and ongoing problems such as hypertension, chronic kidney disease, brain damage, and neurologic problems.

(To sign up for a free subscription to Food Safety News, click here.)

The 2011 book, “Poisoned: The True Story of the Deadly E. coli Outbreak that Changed the Way Americans Eat,” chronicles a deadly 1993 Jack in the Box E. coli outbreak and the rise of Bill Marler as a food safety attorney. The new edition can be pre-ordered now.

“Turning this story into a film has been a writer’s dream.  Grateful to Bill and Julie Marler for trusting me with their odyssey (I didn’t expect to find a love story when I set out to write about a food borne illness outbreak),” Benedict wrote about the documentary and new edition. “Fortunate that Simon & Schuster and AvidReader Press keep me around. Lucky to have worked with Ross Dinerstein and his great filmmaking team at Campfire Studios.”

The documentary is being executive produced by award-winning author and journalist Jeff Benedict. Benedict is joining forces with Ross Dinerstein’s Campfire — know for Jiro Dreams of Sushi and HBO Max’s Heaven’s Gate — as well as filmmaker Stephanie Soechtig and her banner Atlas Films — Fed Up; The Devil We Know — for the documentary, which carries the same name as the book. 

The documentary will chronicle the evolution and history of America’s food supply system, as well as the untold stories from the victims of notorious outbreaks and spotlighting high-profile criminal prosecutions for those responsible.

“Poisoned” will go directly to the source, following the distribution trail from start to finish, examining where the process breaks down, as well as the bureaucratic red tape and collusion among lobbyists and lawmakers that work against addressing this life-or-death problem.

The documentary makers are promoting the project as an all-encompassing, infuriating, and at times even humorous roller-coaster ride that seeks to ask the question: “How did we get to a place with 15 government agencies in charge of the country’s food, yet none of them can keep its citizens safe?”

The film will be directed by Soechtig. Dinerstein serves as producer alongside Soechtig and Atlas Films’ Kristin Lazure. Benedict and Campfire’s Ross Girard and Rebecca Evans are executive producers.

About Campfire
Founded in 2014 and headed by producer and CEO Ross Dinerstein, Campfire is a production company known for its broad bench of content. scripted and unscripted, for feature film and TV/streaming platforms. Part of Wheelhouse Entertainment, Campfire’s projects include docuseries Heaven’s Gate: The Cult of Cults for HBO Max; Hulu’s upcoming WeWork feature documentary; FX’s first true crime docuseries The Most Dangerous Animal of All; Netflix’s true-crime documentary series John Grisham’s The Innocent Man; and Netflix’s Emmy-nominated, scripted series Special.

Editor’s note: Bill Marler is publisher of Food Safety News.

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In 2021, 1,437 specimens were processed at the National Reference Centre for E. coli. Overall, 1,286 human samples, 79 food, and 35 pet food samples were analyzed.

A total of 476 human stool samples tested positive for Shiga toxin-producing E. coli (STEC). Of these, 310 isolates were confirmed as Shiga toxin-producing compared to 242 in 2020.

In 2021, only 34 were E. coli O157 with the rest non-O157. Among the latter, there were 25 O26, 26 O103, three O111, and 12 O145 isolates. In the Austrian Epidemiological Notification System (EMS), 384 cases were reported, up from 304 in 2020.

In Upper Austria, 53 cases were reported to the EMS in 2020 compared to 104 in 2021. This same state sent 123 human samples to the National Reference Centre in 2020 versus 566 in 2021.

HUS and patient details
Eighteen cases of the hemolytic uremic syndrome (HUS), 12 female and six male, were diagnosed with 11 in children under the age of 15. Five of the 18 cases were caused by STEC O26:H11. This is up from 11 cases in 2020.

One was a 10-year-old girl from Upper Austria that was triggered by a STEC/enteroaggregative E. coli hybrid strain of O104:H4, which was very similar to a German outbreak strain of 2011.

There were 12 family outbreaks with two to five cases and one STEC O157:H7 outbreak with five cases because of contaminated drinking water reported in EMS.

Forty-six of the 1,286 human samples tested positive for the presence of enteropathogenic E. coli (EPEC). Three were positive for enteroinvasive E. coli (EIEC) and Enterotoxin E. coli (ETEC) were detected in four samples.

As in previous years, the most STEC cases reported in EMS occurred in the age group 0 to 4 years old with 107. Next are 5 to 14-year-olds and people over the age of 65. Most STEC-positive samples were registered in the summer months of July and August, but also in September.

One fatality was reported in the EMS. The patient was a 79-year-old woman from Upper Austria who had heart and kidney failure from diarrhea caused by STEC O91:H14.

Outbreaks summary

In 2021, 20 foodborne outbreaks with 92 patients were notified. A total of 27 people needed hospital treatment and two deaths were reported. In 2020, there were 21 outbreaks, 67 patients, and 17 hospitalizations.

Salmonella caused nine outbreaks with 61 cases this past year, followed by Campylobacter with six, four were due to STEC, and one by Listeria monocytogenes with five patients. Fifteen were considered household outbreaks and three were associated with foreign travel.

Salmonella Enteritidis was behind five outbreaks, while monophasic Salmonella Typhimurium, Salmonella Braenderup, Coeln, and Muenchen all caused one each.

The Salmonella Braenderup outbreak was part of a multi-country incident linked to melons from Honduras. Austria had 11 cases in five federal states.

A monophasic Salmonella Typhimurium outbreak sickened 31 people from seven states. A connection to a restaurant in Eastern Styria was established for 24 people. The outbreak strain was detected in various dishes served by the restaurant or in the petting zoo belonging to it. After the temporary closure of the restaurant and hygiene measures at the outlet and petting zoo, no further cases occurred.

Fatal Listeria incident
Campylobacter jejuni was the cause of five outbreaks, two were caused by Campylobacter coli, and both types were found in one household outbreak with two patients.

Serotypes STEC O26:H11, O146:H21, O157:H7 and O91:H14 were identified in E. coli outbreaks which sickened 14 people.

A Listeria outbreak affected five people between January 2020 and September 2021 with four cases in 2021. Two people died. Meat products from two processing companies in Lower Austria were identified as the source. Damaged areas on the floor were suspected as possible sources of contamination.

Travel-associated outbreaks included two Salmonella Enteritidis incidents with one after a stay in Romania. A STEC O91:H14 outbreak was reported after going to Turkiye for a family celebration.

Meat products except poultry were linked to a STEC O91:H14 and Listeria outbreak. Poultry meat other than chicken was suspected in Salmonella Enteritidis and Campylobacter coli epidemics and bakery products in two Salmonella Enteritidis outbreaks. Sweets and chocolate were suspected in an E. coli O146:H21 outbreak.

It had been previously reported that the number of human isolates sent to the National Reference Centre for Salmonella increased from 906 in 2020 to 1,048 in 2021.

A total of 6,019 cases of campylobacteriosis were reported in Austria and 36 cases of invasive listeriosis were recorded with seven people dying within 28 days of diagnosis.

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The Centers for Disease Control and Prevention reports that the outbreak investigation is closed with seven patients having been confirmed across six states. Six of the patients were so sick they required hospitalization. No deaths were reported.

State and local public health officials interviewed the patients about the foods they ate in the week before they got sick. Of the six people interviewed, all six reported eating ground beef from HelloFresh meal kits. Sick people ranged in age from 17 to 69 years old.

“The true number of sick people in this outbreak is likely much higher than the number reported, and this outbreak may not have been limited to the states with known illnesses. This is because many people recover without medical care and are not tested for E. coli,” according to the CDC outbreak update.

There is concern that some consumers may have frozen the ground beef and still have it in their homes. Consumers can determine whether they have the implicated beef by looking for the following information:

10-oz. plastic vacuum-packed packages containing “GROUND BEEF 85% LEAN/15% FAT” with codes “EST#46841 L1 22 155” or “EST#46841 L5 22 155” on the side of the packaging. 

Ground beef was sold online throughout the United States.

“The meal kits containing ground beef for this public health alert were shipped to consumers from July 2-21, 2022,” according to a public health alert posted on Sept. 10 by the USDA’s Food Safety and Inspection Service. 

The FSIS did not enact a recall because it was believed the implicated ground beef was no longer in the stream of commerce.

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As of Oct. 26 the outbreak has 10 confirmed patients, according to a statement from the Food and Drug Administration. The agency is reporting that the source of the E. coli is unknown.

The agency did not report where the patients live or their ages. The FDA also did not indicate whether any of the patients have been hospitalized.

The FDA statement says traceback efforts have begun, but the agency has not revealed what food or foods are being traced.

As of this afternoon, the Centers for Disease Control and Prevention had not posted any information about the outbreak. That is the CDC’s usual practice until a specific source of a pathogen is identified or found to be suspect.

About E. coli infections
Anyone who has developed symptoms of E. coli infection should seek medical attention and tell their doctor about their possible exposure to the bacteria. Specific tests are required to diagnose the infections, which can mimic other illnesses.

The symptoms of E. coli infections vary for each person but often include severe stomach cramps and diarrhea, which is often bloody. Some patients may also have a fever. Most patients recover within five to seven days. Others can develop severe or life-threatening symptoms and complications, according to the Centers for Disease Control and Prevention.

About 5 to 10 percent of those diagnosed with E. coli infections develop a potentially life-threatening kidney failure complication, known as a hemolytic uremic syndrome (HUS). Symptoms of HUS include fever, abdominal pain, feeling very tired, decreased frequency of urination, small unexplained bruises or bleeding, and pallor. 

Many people with HUS recover within a few weeks, but some suffer permanent injuries or death. This condition can occur among people of any age but is most common in children younger than five years old because of their immature immune systems, older adults because of deteriorating immune systems, and people with compromised immune systems such as cancer patients. 

People who experience HUS symptoms should immediately seek emergency medical care. People with HUS will likely be hospitalized because the condition can cause other serious and ongoing problems such as hypertension, chronic kidney disease, brain damage, and neurologic problems.

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A judge certified the case in recent days. It seeks compensation for people who were sickened after consuming pork products from The Meat Shop at Pine Haven, which is a meat packing and retail store at the Pine Haven Hutterite colony near Wetaskiwin. 

One person died and 42 others were sickened in the outbreak during the spring of 2018. The cases were linked to pork products contaminated with E. coli  O157:H7. Fourteen of the patients had to be hospitalized and five developed a kind of kidney infection known as hemolytic uremic syndrome (HUS), which frequently causes lifelong injuries and sometimes death.

About half of the cases involved people who had eaten at Mama Nita’s, a Filipino restaurant in southeast Edmonton that has since closed. The Canadian Food Inspection Agency traced the pork products to The Meat Shop at Pine Haven, according to court documents.

“The defendants owed a duty of care to the plaintiff and other class members to ensure that its products were safe for consumption and that ingestion of those products would not cause illness or injury,” the plaintiffs say in their complaint.

In total, the plaintiffs seek $15 million in damages and another $1 million in special damages.

Edmonton lawyer Rick Mallett represents the plaintiffs. He expects the case could take up to two years to reach trial.

About E. coli infections
Anyone who has developed symptoms of E. coli infection should seek medical attention and tell their doctor about their possible exposure to the bacteria. Specific tests are required to diagnose the infections, which can mimic other illnesses.

The symptoms of E. coli infections vary for each person but often include severe stomach cramps and diarrhea, which is often bloody. Some patients may also have a fever. Most patients recover within five to seven days. Others can develop severe or life-threatening symptoms and complications, according to the U.S. Centers for Disease Control and Prevention (CDC).

About 5 to 10 percent of those diagnosed with E. coli infections develop a potentially life-threatening kidney failure complication, known as a hemolytic uremic syndrome (HUS). Symptoms of HUS include fever, abdominal pain, feeling very tired, decreased frequency of urination, small unexplained bruises or bleeding, and pallor. 

Many people with HUS recover within a few weeks, but some suffer permanent injuries or death. This condition can occur among people of any age but is most common in children younger than five years old because of their immature immune systems, older adults because of deteriorating immune systems, and people with compromised immune systems such as cancer patients. 

People who experience HUS symptoms should immediately seek emergency medical care. People with HUS will likely be hospitalized because the condition can cause other serious and ongoing problems such as hypertension, chronic kidney disease, brain damage, and neurologic problems.

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E. coli O157:H7 is one of thousands of serotypes of Escherichia coli.

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.

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. 

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. 

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. 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.  

Cattle as Reservoirs

Beef and dairy cattle are known reservoirs of E. coli O157:H7 and non-O157 STEC strains. In reviews of STEC occurrence in cattle worldwide, the prevalence of non-O157 STECs ranged from 4.6 to 55.9% in feedlot cattle, 4.7 to 44.8% in grazing cattle, and 0.4 to 74% in dairy cattle feces.  The prevalence in beef cattle going to slaughter ranged from 2.1 to 70.1%.  While most dairy cattle-associated foodborne disease outbreaks are linked to milk products, dairy cattle still represent a potential source of contamination of beef products when they are sent to slaughter at the end of their useful production life (termed “cull” or “spent” dairy cows); this “dairy beef” is often ground and sold as hamburger. 

The high prevalence of E. coli O157 and non-O157 STEC in some cattle populations, combined with the lack of effective on-farm control strategies to reduce carriage, represents a significant risk of contamination of the food supply and the environment.  Non-O157 STEC are also harbored in other ruminants, including swine.

Beef Products

Numerous Shiga toxin-producing E. coli serotypes known to cause human illness are of bovine origin, thus putting the beef supply at-risk.  Both E. coli O157:H7 and non-O157 STEC may colonize the gastrointestinal tract of cattle, and potentially contaminate beef carcasses during processing.  Although not as well studied, the risk factors for contamination of beef products from cattle colonized with non-O157 STECs are probably the same or very similar to E. coli O157:H7.  For example, cattle hides contaminated with E. coli O157:H7 during slaughter and processing are a known risk factor for subsequent E. coli O157:H7 contamination of beef products.  One study showed that the prevalence of non-O157 STEC (56.6%) on hides is nearly as high as that found for E. coli O157:H7 (60.6%).

A review of published reports from over three decades found that non-O157 STEC were more prevalent in beef products compared with E. coli O157. In this study, the prevalence of non-O157 STEC ranged from 1.7 to 58% in packing plants, from 3 to 62.5% in supermarkets, and an average of 3% in fast food restaurants.  In a recent survey of retail ground beef products in the United States, 23 (1.9%) of 1,216 samples were contaminated with non-O157 STEC. In another study, researchers found a 10 to 30% prevalence of non-O157 STEC in imported and domestic boneless beef trim used for ground beef.

Environmental Sources of E. coli

E. coli O157:H7 bacteria and other pathogenic E. coli are believed to mostly live in the intestines of cattle, but these 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. coliO157: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. Over seven percent 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.

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 most 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.

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 available and remains controversial.

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 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. 

What to do to protect yourself and your family from E. coli 

Since there is no fail-safe food safety program, consumers need to “drive defensively” as they navigate from the market to the table.  It is no longer enough to take precautions only with ground beef and hamburgers; anything ingested by family members can be a vehicle for infection.  Shiga toxin-producing E. coli are so widely disseminated that a wide variety of foods can be contaminated.  Direct animal-to-person and person-to-person transmission is not uncommon.  Following are steps you can take to protect your family.  

1. Practice meticulous personal hygiene.  This is true not only for family members (and guests), but for anyone interfacing with the food supply chain.  Remember that E. coli bacteria are very hardy (e.g., can survive on surfaces for weeks) and that only a few are sufficient to induce serious illness.  Since there is no practical way of policing the hygiene of food service workers, it is important to check with local departments of health to identify any restaurants that have been given citations or warnings.  The emerging practice of providing sanitation “report cards” for public display is a step in the right direction.
2. Be sure to clean and sanitize all imported and domestic fruits or vegetables.  All can be carriers of disease.  If possible, fruits should be skinned, or at least vigorously scrubbed and/or washed. Vegetables (and of course meat) should be cooked to a core temperature of at least 160 degrees Fahrenheit for at least 15 seconds. If not cooked, fruits and vegetables should be washed to remove any dirt or other material, and then soaked in chlorinated water (1 teaspoon of household bleach in one quart of water, soaked for at least 15 minutes).  They can then be rinsed in clean water to remove the chlorine taste.  This will remove most, but not all, bacteria.  In the case of leafy vegetables, bacteria may not be limited to the leaf’s surface, but can reside within the minute circulatory system of the individual vegetable leaves.
3. Be careful to avoid cross contamination when preparing and cooking food, especially if beef is being served.  This requires being very mindful of the surfaces (especially cutting boards) and the utensils used during meal preparation that have met uncooked beef and other meats.  This even means that utensils used to transport raw meat to the cooking surfaces should not be the same that are later used to remove the cooked meat (or other foodstuffs) from the cooking surfaces.
4. Do not allow children to share bath water with anyone who has any signs of diarrhea or “stomach flu”.  And keep any toddlers still in diapers out of all bodies of water (especially wading and swimming pools).
5. Do not let any family members touch or pet farm animals.  Merely cleaning the hands with germ “killing” wipes may not be adequate!
6. Wear disposable gloves when changing the diapers of any child with any type of diarrhea.  Remember that E. coliO157:H7 diarrhea initially is non-bloody, but still very infectious.  If gloves are not available, then thorough hand washing is a must.
7. Remember that achieving a brown color when cooking hamburgers does not guarantee that E. coli bacteria have been killed.  This is especially true for patties that have been frozen.  Verifying a core temperature of at least 160 degrees Fahrenheit for at least 15 seconds is trustworthy.  Small, disposable meat thermometers are available, a small investment compared to the medical expense (and grief) of one infected family member.
8. Avoid drinking (and even playing in) any non-chlorinated water.  There is an added risk if the water (well, irrigation water or creek/river) is close to, or downstream from any livestock.

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E. coli has been confirmed in three nurseries, while another two are shut as investigations and testing are carried out.

A total of 47 cases have been confirmed. Officials previously said E. coli O157 had sickened a number of young people in the East Lothian area. Some patients were hospitalized but most people had mild symptoms and did not require hospital treatment.

Cases are linked to Pear Tree Nursery on Church Street and Meadowpark Pear Tree Nursery, both in Haddington and Musselburgh Private Nursery, Bridge Street.

Church Street nursery was reopened on Aug. 29. Pear Tree Nursery on West Road is shut but no cases of E. coli have been confirmed.

Musselburgh Private Nursery was closed as a precaution after sicknesses, but now E. coli has been confirmed. Musselburgh Nursery in Stoneybank has also been closed after reports of symptoms and a connection with its sister nursery were identified.

NHS Lothian, local and national agencies, including Public Health Scotland, formed an Incident Management Team (IMT) at the beginning of August to investigate a cluster of cases at Pear Tree Nursery.

Officials said families must remain at home and should not mix with others until they go through the clearance process, which includes producing two negative samples.

The majority of samples are being processed at the E. coli reference lab in Edinburgh with results taking two weeks. Labs are processing more than 500 tests so there may be delays in getting results to staff and parents.

E. coli infections can develop in different ways such as by eating contaminated food, touching infected animals or coming into contact with their feces, contact with people who have the illness, or drinking contaminated water.

Breaking the infection chain
Graham Mackenzie, the consultant in public health medicine and chair of the Incident Management Team investigating the outbreak, said it was vital that parents and carers self-isolate.

“It is crucially important that families understand that this is a rapidly evolving situation and it is affecting the lives of hundreds of people. We need everyone to work with us to bring an end to this outbreak as swiftly as possible,” he said.

“If you have been given an exclusion order, it means that you must self-isolate at home, just as we have all done with COVID-19. You must not go to work or school, the shops, the playpark, or to parties and sleepovers.”

Mackenzie said after two negative samples families can return to normal.

“There is light at the end of the tunnel and as soon as enough exclusions are lifted and investigations are complete, nurseries will be able to reopen. However, if families choose to mix with others when they have been instructed to self-isolate, they are putting themselves and others at risk,” he said.

“As well as staying home, it is vital for siblings or those children leaving the nursery, taking up a new nursery place, and starting school for the first time to remain at home until their exclusion period is complete if they have been in contact with someone with E. coli or any other vomiting bug. This outbreak reinforces the importance of washing hands regularly, particularly before eating or preparing food, and after going to the toilet.”

The outbreak in Scotland comes at the same time as a warning from Public Health Wales about an increase in cases of diarrhea and vomiting, specifically those caused by E. coli, in the Wrexham and Flintshire areas.

The agency said it was important to remember that handwashing is one of the best ways to fight infections. By doing this regularly, but particularly before and after handling food, people can protect themselves and others from getting sick.

Data from UK laboratories shows there were 55 E. coli O157 cases in the first three weeks of August. The Public Health Agency in Northern Ireland has recently published an information leaflet for E. coli O157 patients.

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The Wood County Health Department reports three years of E. coli cases have occurred just during the past week.

Health Commissioner Ben Robison told the Wood County Board of Health on Thursday that 16 known cases of E. coli have been identified in the last week. In the last five and a half years the county has logged 27 E. coli cases.

The health commissioner said: “We are in the very front stages of an investigation.”

The Ohio Department of Health is testing to see if there is a link between the cases, which affected Wood County residents between the ages of 13 and 60. Test results are due back Tuesday.

The 15 known cases are likely just the beginning, according to Robison. “This number we expect will grow,” he said.

The health department is asking that anyone in the county who believes they are or have recently experienced possible E coli symptoms go to https://woodcountyhealth.org/health-promotion-and-preparedness/infectious-disease/ and click on the “take this survey” link in blue.

Of the 16 cases reported so far, at least five people were hospitalized, ranging in age from 21 to 60. 

Wood County Health is partnering with other agencies to try and solve the puzzle of the origin of E. coli. Those partners include the Ohio Department of Health and other county health departments. It could be expanded to the Ohio Department of Agriculture if a link is identified to food products in the early stages of growing or processing.

Robison explained that people sometimes believe the last place or food item they ate is the culprit when it comes to gastrointestinal issues. But the first symptoms of E. coli may not show up until 10 days after they ate the contaminated food, he said.

One health board member reported Thursday that a relative of his became very ill and had to be taken to the hospital after eating at the Wood County Fair. But Robison noted that the fair food establishment may not have been the problem.

Robison is hopeful that the lab results from ODH will provide vital information – such as if the E. coli is all the same strain.

“We’re moving quickly but intentionally,” he said.

Board member Bob Midden asked if there have been any alerts about national or regional contaminated produce or other foods. Robison said the health department will be looking “in every direction” for the culprit.

“We’re not closing any doors,” Robison said.

E. coli are bacteria found in the environment, foods, and intestines of people and animals. E. coli are a large and diverse group of bacteria, according to the CDC.

About E. coli infections

Anyone who has eaten any of the implicated products and developed symptoms of E. coli infection should seek medical attention and tell their doctor about their possible food poisoning. Specific tests are required to diagnose the infections, which can mimic other illnesses.

The symptoms of E. coli infections vary for each person but often include severe stomach cramps and diarrhea, which is often bloody. Some patients may also have a fever. Most patients recover within five to seven days. Others can develop severe or life-threatening symptoms and complications, according to the Centers for Disease Control and Prevention (CDC).

About 5 to 10 percent of those diagnosed with E. coli infections develop a potentially life-threatening kidney failure complication, known as hemolytic uremic syndrome (HUS). Symptoms of HUS include fever, abdominal pain, feeling very tired, decreased frequency of urination, small unexplained bruises or bleeding, and pallor. 

Many people with HUS recover within a few weeks, but some suffer permanent injuries or death. This condition can occur among people of any age but is most common in children younger than five years old because of their immature immune systems, older adults because of deteriorating immune systems, and people with compromised immune systems such as cancer patients. 

People who experience HUS symptoms should immediately seek emergency medical care. People with HUS will likely be hospitalized because the condition can cause other serious and ongoing problems such as hypertension, chronic kidney disease, brain damage, and neurologic problems.

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 I was an active advocate for the Food Safety Modernization Act, landmark legislation which was signed into law Jan. 4, 2011, and is now being implemented throughout the nation. I don’t have a background in nutrition, microbiology, epidemiology or agriculture. My sole qualification as a food safety advocate, is that I’m a consumer and the mother of a survivor of the 2006 E. coli outbreak linked to fresh, packaged spinach. 

My daughter Rylee was 8 years old; it was two days before her ninth birthday. She had gone to the grocery store that day with her stepfather, she picked out the cake mix and frosting for her birthday cake, and she chose the package of “triple washed, ready to eat” spinach we used to make our dinner. We didn’t know it at the time, but that spinach was contaminated with E. coli O157:H7. One week later, my daughter was fighting for her life. She spent 35 days in the hospital, 24 of those days in the ICU and 11 days on a ventilator.

Rylee and I continue to advocate for safe food by working with STOP Foodborne Illness, a non-profit group that strives to prevent foodborne illness and supports people directly impacted by it. As part of our work, we’ve come to know another organization dedicated to preventing foodborne illness – the California Leafy Greens Marketing Agreement (LGMA).

My first experience with LGMA was in June 2013, when the organization invited a small group of food safety advocates from Stop Foodborne Illness to tour farms and processing facilities located in the Central Coast of California. Rylee was still dealing with the long-term affects of her illness, and it was my belief that she was just a faceless statistic to the industry that sold the spinach that made her ill. We were apprehensive at best.

However, what we saw during that trip was not what we expected.  We were given an overview of LGMA’s food safety program and procedures and saw it in action on farms and in processing facilities; from the workers harvesting the crops, to the packaged product ready to ship. It was clear that the safety of the product was taken into account at every step.

But it wasn’t the processes, or the extensive government audits, or even the science behind it all that stood out to me. It was the people. I met farmers, harvesters, packers, and shippers who feed their children and grandchildren from the same fields they work on. The leafy greens we buy at the store do not come from an impersonal corporate entity. They come from real people; many working on family farms, doing their jobs to provide us with a safe product.

So, when the LGMA approached me last year to join their Board of Directors as a public member, I said yes without hesitation, not only because I have a great amount of respect for the work of this organization, but because I wanted to ensure the interests of consumers are represented in the policies and decisions.   

Much has changed since my daughter’s illness in 2006, with efforts on many fronts to prevent foodborne illness. The work is clearly not done and, as I’ve come to understand, growers of leafy greens are more frustrated than anyone that outbreaks continue to occur. I’m very pleased to be working with the LGMA and I believe they will find solutions to prevent someone from experiencing a foodborne illness. Someone like Rylee.

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The recalled products are Dole™ Organic Romaine Hearts 3pk (UPC 0-71430-90061-1), combined English/French packaging, with Harvested-On dates of 10-23-20 and 10-26-20, and Wild Harvest Organic Romaine Hearts (UPC 7-11535-50201-2), with Harvested-On dates of 10-23-20 and 10-26-20.

The recall is being conducted due to possible health risk from E. coli in the two products.  Dole Fresh Vegetables is coordinating closely with regulatory officials. No illnesses have been reported to date in association with the recall.

Pathogenic E. coli can cause diarrhea, severe stomach cramps, and vomiting.  Most people recover within a week, but some illnesses can last longer and can be more severe.

The Harvested-On sticker is located on the upper right corner of each bag and the UPC code is located on the bottom right corner of the back of each bag. The Dole package contains three organic romaine hearts and the Wild Harvest product is packaged in a 12oz bag.

The impacted products were distributed in AZ, HI, IA, IL, IN, KS, MD, MI, MN, MO, MS, MT, NC, ND, and VA. These products were harvested and packed nearly 4 weeks ago and should no longer be in commerce.  Consumers are advised to check products they have in their homes and discard any product matching the production description, UPC codes, and Harvested-On dates listed above.

This precautionary recall notification was issued due to an isolated instance in which a package of Dole™ Organic Romaine Hearts – 3pk yielded a positive result for pathogenic non-O157 E.coli STEC in a routine sample collected at a retail store by the Michigan Department of Agriculture and Rural Development.

The Dole recall notice says “there is no indication at this time that this positive result is related to any illnesses nor consumer complaints and it is not associated with the strains connected to the ongoing outbreaks currently under regulatory investigation.”

No bagged or clamshell salad romaine products are included in the recall.   Only the specific Organic Romaine Hearts listed, with the exact UPC codes and Harvested-On dates identified above, are included in the recall.

Consumers who have any remaining product with these UPC codes and Harvested-On dates should not consume it, but rather discard it.

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The notice from the Food and Drug Administration, dated Nov. 6, reports that the California company is recalling certain whole heads of romaine. Tanimura & Antle officials said the implicated romaine was packed on Oct. 15 and 16 and therefore no longer available to consumers.

“The recall is being conducted in consultation with FDA, and is based on the test result of a random sample collected and analyzed by the Michigan Department of Agriculture and Rural Development as part of their routine sampling program,” the company officials said in the recall notice.

No confirmed illnesses have been associated with the recalled romaine, according to the company’s notice.

The company distributed 3,396 cartons of potentially affected product under the Tanimura & Antle brand. Potentially affected product was distributed in the following states: AK, OR, CA, TX, AR, OK, IN, NE, MO, TN, WI, NM, SC, WA, NC, OH, VA, MA, PR, and IL.

Additional information that retailers and consumers can use to determine whether they have any of the recalled romaine include the UCP number 0-27918-20314-9, and one of the two following Produce Traceability Initiative (PTI) numbers: 571280289SRS1 or 571280290SRS1.  

“We are asking that if any of the packaged single head romaine described above is in the possession of consumers, retailers or distributors, the product be disposed of and not consumed,” the company urged.

Consumers with questions or concerns may call the Tanimura & Antle consumer hotline at 877-827-7388.

About E. coli infections
Anyone who has eaten any of the recalled romaine lettuce and developed symptoms of E. coli infection should seek medical attention and tell their doctor about their possible exposure to the bacteria. Specific tests are required to diagnose the infections, which can mimic other illnesses.

The symptoms of E. coli infections vary for each person but often include severe stomach cramps and diarrhea, which is often bloody. Some patients may also have a fever. Most patients recover within five to seven days. Others can develop severe or life-threatening symptoms and complications, according to the Centers for Disease Control and Prevention (CDC).

About 5 to 10 percent of those diagnosed with E. coli infections develop a potentially life-threatening kidney failure complication, known as a hemolytic uremic syndrome (HUS). Symptoms of HUS include fever, abdominal pain, feeling very tired, decreased frequency of urination, small unexplained bruises or bleeding, and pallor.

Many people with HUS recover within a few weeks, but some suffer permanent injuries or death. This condition can occur among people of any age but is most common in children younger than five years old because of their immature immune systems, older adults because of deteriorating immune systems, and people with compromised immune systems such as cancer patients.

People who experience HUS symptoms should immediately seek emergency medical care. People with HUS will likely be hospitalized because the condition can cause other serious and ongoing problems such as hypertension, chronic kidney disease, brain damage, and neurologic problems.

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Lena-Mari Tamminen’s doctoral dissertation at the Swedish University of Agricultural Sciences (SLU) identified possible target areas for on farm measures to reduce prevalence of the deadly pathogen.

In Sweden, domestic transmission of a highly virulent subtype of Shiga toxin-producing E. coli (STEC) O157:H7, originating in regional clusters of infected cattle farms, is increasing. A total of 40 reports of hemolytic uremic syndrome (HUS) — the highest ever number of annual cases — were recorded in 2018 and half of these occurred in children younger than 10 years old.

By reducing incidence in cattle, the spread of infection to humans could be prevented, but since the animals show no symptoms, it is not easy to know when and how to act. However, E. coli is not part of the animal’s normal intestinal flora so they can be free from it given the right conditions.

Risk factors
The risk of introduction of STEC O157:H7 on cattle farms was studied by collecting environmental samples in spring and fall from 80 sites on the island of Öland. One risk factor for introduction of the infection was purchase of animals.

By comparing farms in an area where the bacteria circulated, Tamminen and colleagues could get a picture of how the bacteria spread and what types of farms are most at risk of getting it.

On four farms, environmental sampling with analysis of strains was carried out during summer, between the spring and fall sampling. Animals picked up the neighbor’s bacteria on pasture, perhaps through contact with other animals or the environment, and took it back to the farm.

Sharing of agricultural machines was a risk factor for being positive in the fall sampling so moving vehicles between farms could be an issue. Being positive in both spring and fall, sampling was associated with farm size, with larger ones more likely to be positive, and combining milk and meat production.

Individual samples from calves on 12 dairy farms with STEC O157:H7, established by environmental sampling, were collected. Indicators of animal welfare and behavior to study individual differences were used to explore differences between colonized and non-colonized calves.

Only one farm had positive environmental samples from young and weaned calves, young stock and dairy cows. On all farms, the pathogen was found among calves between 2 and 6 months old. On six farms, groups including animals up to 12 months old were also positive in environmental sampling.

Mitigation measures
Results suggest social and active animals are more likely to be colonized by the pathogen while it was less likely for animals showing signs of poor health and welfare. Variables associated with carrying the bacteria were rubbing as well as self-licking and licking other calves. These findings were published in the journal Scientific Reports.

Colonized animals shedding high levels of the bacteria were important for transmission but environmental exposure also increased risk of transmission within pens.

Frequent transmission of virulent strains between nearby farms occur in cattle dense areas with regular contacts. Many neighboring farms increase the risk of infection on a farm and routes of transmission are related to human and animal contacts between farms.

On infected farms, STEC O157:H7 is most often found among calves and young stock and only occasionally in dairy cows. Transmission dynamics within farms is influenced by direct contacts between animals, presence of super-shedders as well as pen hygiene.

Farmers can prevent sporadic human cases caused by direct contact with animals by informing visitors, especially children, to wash their hands after this activity. Other actions are avoiding mixing of groups and preventing the pathogen from moving between pens by dirty boots, flies and other potential vectors.

Measures to help the farm clear infection faster include making sure that bedding is dry and trying to reduce stocking density in animal groups. Biosecurity measures reducing human and animal contacts between other farms will decrease risk. These could include providing protective clothing for visitors, especially those travelling between farms, and avoiding pastures where animals can have contact with those from other farms.

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E. coli O157:H7 is widely recognized due to the severity of illnesses it causes. There are another six serogroups identified by the United States Food and Drug Administration as emerging pathogens commonly found in foodborne disease outbreaks. E. coli O26, O45, O103, O111, O121, and O145 are known as the “big six.”

A research team led by Professor Hongshun Yang from the Department of Food Science and Technology at the National University of Singapore (NUS) used metabolomics technologies to study the adaptive response of pathogens under different inactivation stresses such as electrolyzed water, ultrasound and a natural antibacterial agent.

They investigated the metabolic profiles of eight serotypes including E. coli O157:H7, O26:H11, O45:H2, O103:H11, O111, O121:H19, O145 and non-pathogenic E. coli ATCC 25922 using nuclear magnetic resonance (NMR).

Scientists said it was important to be able to characterize these pathogens and understand their behavior so more effective control measures can be developed.

Results, published in the journal Food Microbiology, showed metabolic diversity existed among the eight and different strains exhibited different tolerance towards acidic conditions.

Large differences between non-pathogenic and pathogenic strains were recorded and the most varied pair being ATCC 25922 and O26:H11 were further analyzed.

Understanding acid tolerance
Researchers found the pathogenic serotypes require higher energy production to fuel their physiological activities when compared to the non-pathogenic strain. Metabolic differences under acid stress indicate that energy and amino acid metabolisms contributed to the different acidic adaptive capacities of the E. coli serotypes.

Findings suggest the control of related metabolic pathways during sanitizing treatments could potentially improve bacteria inactivation.

Thirty-eight metabolites were identified in the eight E. coli strains. Metabolites including lysine, arginine, alpha-ketoglutaric acid, adenosine, and fumaric acid were responsible for the separation of E. coli ATCC 25922.

Pathogenic O26:H11 had higher acid tolerance than the non-pathogenic surrogate. Glutamic acid dependent system was the major acid resistance mechanism of this strain.

Traditional bacteria characterizations involve using cultured bacteria on different media. These tests are time consuming, complex, and labor-intensive. NMR provides a non-destructive and mostly automated method of obtaining a metabolic profile of the microorganisms.

Lin Chen, a student working on the project, said: “By monitoring the changes of microbial metabolomics, a precise snapshot of cells with different physicochemical states can be obtained. The research outcomes from the metabolomics analysis of the big six pathogens provided a better understanding of food safety related bacterial properties.”

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No illnesses are yet confirmed related to the recalled product.

The CFIA is verifying the removal of the recalled veal from the marketplace and the agency is conducting a food safety investigation, which may lead to the recall of other products. If other high-risk products are recalled, the CFIA will notify the public through updated Food Recall Warnings. The Italian Store distributes products in the Canadian province of Alberta.

The Italian Store in Calgary is recalling the Scarpone’s Italian Store brand frozen Ground Veal from the marketplace due to the possible E. coli O157:H7 contamination. Consumers should not consume the recalled product described below.

Products from Wilke Waldecker Fleisch- und Wurstwaren are suspected to be behind a Listeria outbreak in Germany involving 37 people and three deaths. One infection was recorded in 2014, three in 2016, four in 2017, 21 in 2018 and at least eight in 2019.

Between May 24 and Aug. 8, 2019, six people in Austria contracted an identical Listeria strain identified as Listeria monocytogenes IIa.

Following illnesses in the federal states of Carinthia, Styria, and Vienna the Federal Ministry of Labor, Social Affairs, Health and Consumer Protection (BMASGK) asked the Austrian Agency for Health and Food Safety (AGES) to investigate the outbreak.

Authorities in the Waldeck-Frankenberg district of Germany stopped production at a Wilke facility in Twistetal, Berndorf in October.

The suspected source of infection
The company recalled meat and sausage products from Austria in early October due to the connection with a foodborne outbreak in Germany. At the time, authorities said there had been no related illnesses in Austria.

AGES officials said while it was not possible to prove the source of infection beyond any doubt, epidemiological evidence pointed to the German meat producer as the source of infection.

“The fact that after the closure of the German production plant there were no further illnesses in Austria underlines the hypothesis of AGES.”

The United States is one of more than 20 countries that may have received meat from the German company linked to the outbreak.

A previous Listeria outbreak in Austria with the same sequence type (ST) of 155 and complex type (CT) 1234 affected seven people from November 2015 to September 2017.

The outbreak strain was found among isolates from food samples, collected in September and October 2015. Matching isolates were traced back to a meat processing company in eastern Austria. The outbreak strain was detectable at this unnamed company until May 2018.

Salmonella and E. coli outbreaks
Meanwhile, the number of people ill as part of a Salmonella outbreak solved earlier this year has gone up from 235 to 304.

Investigations by AGES found the source was caged eggs from a Polish producer. Ill people live in the federal states of Styria, Lower Austria, Vienna, Burgenland, Tyrol, Carinthia, Upper Austria, and Salzburg.

Since mid-June, people in Austria contracted the Salmonella Enteritidis strain with Multi Locus Variable-Number Tandem Repeat (MLVA) pattern 3-10-5-4-1.

Austrian authorities have also closed an investigation into a Salmonella Mikawasima outbreak without finding the source of infection.

In 2019, 13 cases in several federal states were confirmed by the National Reference Center for Salmonella at AGES. The increase pointed to a foodborne outbreak as Salmonella Mikawasima is rare in the country.

Officials in the country have also ended an investigation into an E. coli O157 outbreak.

Since April, 10 people contracted Shiga toxin-producing E. coli (STEC) and two had to be treated in hospital. The type of E. coli O157 had not previously been found in humans, animals or food.

Authorities said since no new illnesses have been recorded since late September the outbreak appears to have spontaneously disappeared. While the investigation has been closed if further infections occur in the future it will be reopened.

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Although the implicated ground beef was sold between Oct. 19 and 23, there is concern that some people may have it in their home freezers. The Oregon Health Authority issued a public notice urging customers who purchased the ground beef to throw it away immediately.

The recalled ground beef comes in 5 percent, 10 percent and 20 percent fat content varieties and is ground at individual New Seasons Market stores’ meat counters. The retailer has stores in Oregon, Washington and California.

All three of the confirmed patients are in the Portland, OR, area and are recovering from their infections, according to the notice posted by the state health officials. The infected people ate ground beef purchased at three different New Seasons Market locations.

“OHA identified the outbreak after laboratory tests conducted at the Oregon State Public Health Laboratory determined that an identical strain of E. coli O157:H7 was present in all three patients,” according to the public health notice.

“New Seasons Market has reported to OHA that it suspended the sale of the product while Oregon Department of Agriculture continues its investigation into the cause of the outbreak.”

About E. coli infections
Anyone who has eaten any of the implicated products and developed symptoms of E. coli infection should seek medical attention and tell their doctor about their possible exposure to the bacteria. Specific tests are required to diagnose the infections, which can mimic other illnesses.

The symptoms of E. coli infections vary for each person but often include severe stomach cramps and diarrhea, which is often bloody. Some patients may also have a fever. Most patients recover within five to seven days. Others can develop severe or life-threatening symptoms and complications, according to the Centers for Disease Control and Prevention (CDC).

About 5 to 10 percent of those diagnosed with E. coli infections develop a potentially life-threatening kidney failure complication, known as a hemolytic uremic syndrome (HUS). Symptoms of HUS include fever, abdominal pain, feeling very tired, decreased frequency of urination, small unexplained bruises or bleeding, and pallor.

Many people with HUS recover within a few weeks, but some suffer permanent injuries or death. This condition can occur among people of any age but is most common in children younger than five years old because of their immature immune systems, older adults because of deteriorating immune systems, and people with compromised immune systems such as cancer patients.

People who experience HUS symptoms should immediately seek emergency medical care. People with HUS will likely be hospitalized because the condition can cause other serious and ongoing problems such as hypertension, chronic kidney disease, brain damage, and neurologic problems.

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The Canadian Food Inspection Agency also continues to report that it has not received any information about confirmed illnesses in relation to the recalled beef and veal products. All of the products in the 23 recalls have the potential to be contaminated with E. coli O157:H7, which is a particularly virulent strain of the pathogen.

In all of the recalls posted since Oct. 3, the agency (CFIA) says the action was “triggered by the CFIA’s inspection activities.” The agency has not released any details on what kinds of inspection activities or whether they included laboratory testing.

As with many of the other 22 recalls the CFIA does not identify what company has initiated the 23rd recall. The agency reports that “industry” is recalling the products. 

Similarly the CFIA has not made public how many tons of meat is involved overall or the entities involved in the supply chain, from ranchers forward through slaughterhouses, packers, distributors, etc. Some retail brands have been named in the list of 875 recalled products.

About E. coli infections
Anyone who has eaten any of the implicated products and developed symptoms of E. coli infection should seek medical attention and tell their doctor about their possible exposure to the bacteria. Specific tests are required to diagnose the infections, which can mimic other illnesses.

The symptoms of E. coli infections vary for each person but often include severe stomach cramps and diarrhea, which is often bloody. Some patients may also have a fever. Most patients recover within five to seven days. Others can develop severe or life-threatening symptoms and complications, according to the Centers for Disease Control and Prevention (CDC).

About 5 to 10 percent of those diagnosed with E. coli infections develop a potentially life-threatening kidney failure complication, known as a hemolytic uremic syndrome (HUS). Symptoms of HUS include fever, abdominal pain, feeling very tired, decreased frequency of urination, small unexplained bruises or bleeding, and pallor.

Many people with HUS recover within a few weeks, but some suffer permanent injuries or death. This condition can occur among people of any age but is most common in children younger than five years old because of their immature immune systems, older adults because of deteriorating immune systems, and people with compromised immune systems such as cancer patients.

People who experience HUS symptoms should immediately seek emergency medical care. People with HUS will likely be hospitalized because the condition can cause other serious and ongoing problems such as hypertension, chronic kidney disease, brain damage, and neurologic problems.

(To sign up for a free subscription to Food Safety News, click here.)

The raw ground beef items were produced on various dates from Sept. 23, 2019 to Oct. 10, 2019. The following products are subject to recall:

• 24-lb. Case containing 1-lb chubs of “CIRCLE A BRAND 85-15 LEAN GROUND BEEF” with pack date Oct. 8, 2019; package code of Oct. 8. 2020 and case code of 1-86407-30002-5.
• 24-lb. Case containing 1-lb chubs of “CIRCLE A BRAND 80/20 GROUND BEEF” with pack dates 9-26-19, 9-27-19, 9-30-19; package codes of Sept. 26, 2020, Sept. 27, 2020, Sept. 30, 2020; and case code of FG-8020-24-1.
• 12-lb. Case containing 1-lb chubs of “CIRCLE A BRAND 80/20 GROUND BEEF” with a pack date of 9-26-19; package code of Sept. 26, 2020; and a case code of FG-8020-12-1.
• 15-lb. Case containing 20-oz packages of “CLARKS 5 CHOPPED BEEF STEAKS” with a pack date of 9-23-19; a package code of Sept. 23, 2020; and a case code of 0-73673-00211-4.
• 13-lb. Case containing 17.5-oz packages of “CLARKS 5 CHOPPED PEPPER STEAKS” with a pack date of 9-23-19; a product code of Sept. 23, 2020; and a case code of 0-73673-00222-0.
• 20-lb. Case containing 5.3-oz packages of “SOUTHEAST PROTEIN PURVEYOR GROUND BEEF PATTIES” with a pack date of 10-18-19; a package code of Oct. 10, 2020; and a case code of FG-8020-20-5.3.
• 40-lb. Case containing 10-lb packages of “SOUTHEAST PROTEIN PURVEYOR 81/19 GROUND BEEF” with pack dates of 9-30-19, 10-2-19, 10-8-19, package codes of Sept. 30, 2020, Oct. 2, 2020, and Oct. 8, 2020; and case codes of FG-81/19-10C-40# and FG-81/19-10C-40.
• 60-lb. Case containing 10-lb packages of “SOUTHEAST PROTEIN PURVEYORS 80-20 GROUND BEEF” with a pack date of 9-26-19; a package code of Sept. 26, 2020; and a case code of FG80/20-60-6/10

The recalled products bear establishment number “EST. 18506” inside the USDA mark of inspection. The beef was shipped to commercial distributors and a cold storage warehouse in Florida.

The possible E.coli  was discovered when the firm’s third-party laboratory found that a sample was positive for E. coliO157: H7. But the products associated with the sample had already been shipped into commerce.  No illness or adverse reaction reports are associated with the recall, so far.

Anyone concerned about an injury or illness should contact a healthcare provider. E. coli O157: H7 is a potentially deadly bacterium that can cause dehydration, bloody diarrhea and abdominal cramps 2–8 days (3–4 days, on average) after exposure to the organism.

While people often recover within a week, some develop a type of dangerous kidney failure called hemolytic uremic syndrome (HUS). This condition can occur among persons of any age but is most common in children under 5-years old and older adults. It is marked by easy bruising, pallor, and decreased urine output. Persons who experience these symptoms should seek emergency medical care immediately.

FSIS is concerned that some product may be frozen and held in commercial freezers. Distributors who have obtained these products are warned not to distribute them. These products should be thrown away or returned to the place of origin.

FSIS routinely conducts recall effectiveness checks to verify recalling firms notify their customers of the recall and that steps are taken to make certain that the product is no longer available to consumers. When available, the distribution list(s) will be posted on the FSIS website.

Hotels, Restaurants, and Institutions

Initially Metro Ontario Inc. recalled a variety of products including ground beef, steaks and veal. But, the updates name “industry” as the recalling entity.

“Industry is recalling various raw beef and raw veal products from the marketplace due to possible E. coli O157:H7 contamination,” according to the recall notice posted by the Canadian Food Inspection Agency. “Distributors, retailers and food service establishments such as hotels, restaurants, cafeterias, hospitals and nursing homes should not sell or use the recalled products described below.

“This recall was triggered by the CFIA’s inspection activities. The CFIA is conducting a food safety investigation, which may lead to the recall of other products. If other high-risk products are recalled, the CFIA will notify the public through updated food recall warnings.”

None of the recall notices specify what the inspection activities were that prompted the recalls. The CFIA also did not post any product photos or labels with the recalls. The agency did not report the volume of meat implicated in the recalls.

There have been no reported illnesses associated with the consumption of these products.

Product information from the second expansion are as follows:

About E. coli infections
The symptoms of E. coli infections vary for each person but often include severe stomach cramps and bloody diarrhea. Many patients recover within five to seven days. Others can develop severe or even life-threatening symptoms and complications.

About 5 percent to 10 percent of those who are diagnosed with E. coli infections develop a potentially life-threatening kidney failure complication, known as hemolytic uremic syndrome (HUS). Symptoms of HUS include fever, abdominal pain, feeling very tired, decreased frequency of urination, small unexplained bruises or bleeding, and pallor. 

Many people with HUS recover within a few weeks, but some suffer permanent injuries or die. This condition can occur in people of any age but is most common in children younger than 5 years old because of their immature immune systems, older adults because of their deteriorating immune systems, and people with compromised immune systems such as cancer patients. 

People who experience HUS symptoms should seek emergency medical care immediately. People with HUS should be hospitalized because it can cause other serious and ongoing problems such as hypertension, chronic kidney disease, brain damage and neurologic problems.

Related recalls
For information and product lists for the previous two recalls, please see:

2019-10-04 – Various raw beef and raw veal products recalled due to E. coli O157:H7

2019-10-03 – Various raw beef and raw veal products recalled due to E. coli O157:H7

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The Food and Agriculture Organization of the United Nations (FAO) and World Health Organization (WHO) figures based on 2010 estimates show STEC infections cause more than 1 million illnesses and 128 deaths annually.

The report analysed data from global STEC foodborne outbreak investigations, as well as a systematic review and meta-analysis of case-control studies of sporadic infections for all dates and locations.

It concluded that prioritizing interventions for control on beef supply chains may provide the largest return on investment when implementing strategies for STEC control.

Food sources of STEC
A total of 957 STEC outbreaks from 27 countries covering 1998 to 2017 were included. Data identified that 16 percent of outbreaks were attributed to beef, 15 percent to produce including fruits and vegetables, and 6 percent to dairy products.

However, food sources involved in 57 percent of outbreaks could not be identified and data were only available from three of six WHO regions. Researchers considered the number of outbreaks caused by each food and not the amount of ill people in each one.

A total of 236 E. Coli outbreaks that involved haemolytic uremic syndrome (HUS) cases were reported and nearly all in the Americas. Almost 30 percent of all reported outbreaks were associated with either HUS or deaths. Most of the 45 outbreaks with fatalities were also recorded in the Americas region. HUS is a type of kidney failure that can result in lifelong, serious health problems and death.

Significantly more information was available for STEC O157 than for other STEC serogroups.

Regional variation
In the European and American sub-regions of the WHO, the primary sources of outbreaks were beef and produce. However, produce and dairy were the top causes in the WHO Western Pacific sub-region.

“Possible explanations for regional variability include differences in the proportion of specific foods in the diet and how they are prepared for consumption, the level of STEC contamination of foods and live animals from which foods are derived, the virulence characteristics of regionally predominant STEC strains, or differences in how outbreaks are detected, investigated and reported,” according to the report.

Beef and produce were responsible for the highest proportion of cases in the American sub-regions, with source attribution estimates of 40 percent for beef, 35 percent for produce and 12 percent for dairy.

In the European region, ranking of the sources of cases was similar, with an overall attribution proportion of 31 percent for beef; 30 percent for produce and 16.4 percent for dairy.

In Western Pacific sub-region, the most common source was produce at 43 percent, followed by dairy with 27 percent and with game and beef third and fourth at 9 and 8 percent respectively.

Analysis of the data from case-control studies of sporadic infection showed the most important source of STEC globally was beef. In the Western Pacific region chicken was the most significant risk factor.

The report, part of the microbiological risk assessment series, follows another document published last year covering the burden, source attribution, hazard characterization and monitoring of STEC.

It proposed criteria for categorizing potential risk of severity of illness associated with STEC in food, presented initial results on source attribution of foodborne STEC and provided a review of monitoring programs and methodology for the pathogen.

The Codex Alimentarius Commission decided this year at its annual meeting to start developing guidelines to control STEC in beef, leafy greens, raw milk and cheese produced from it, and sprouts.

Irish E. coli report
Earlier this year, the Food Safety Authority of Ireland (FSAI) published advice on STEC detection in food.

Since 2008 – and except for 2011, when Germany had the highest rate due to a large E. coli O104:H4 outbreak – Ireland has had the highest reported STEC notification rate in Europe.

From 2012 to 2016, there were 3,531 STEC notifications in Ireland. Of these, 2,910 were symptomatic and 582 were asymptomatic. Among symptomatic cases, 1 in 20 developed HUS. Of symptomatic cases, 40.3 percent were hospitalized. From 2004 to 2016, five deaths were attributed to STEC and two were fatal HUS cases.

Garvey et al. (2016) reviewed Irish STEC outbreak data from 2004 to 2012 including 219 outbreaks. Food was reported as a suspected transmission route for 21 of them. No microbiological or analytical epidemiological evidence was reported implicating specific foods in any of the outbreaks. Suspect foods were reported in four household outbreaks, minced beef for two and goat and lamb meat for one each.

The report helped to establish the risk in Ireland associated with the consumption of foods in which STEC has been detected.

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