CDC: Investigating Multi-State Outbreak Of Shiga-Toxin Producing E. coli

 

E. coli – Photo Credit CDC

 

# 6380

 

Last year at this time you may recall that much of Europe’s public health system was embroiled in containing a massive outbreak of STEC (Shiga-toxin Producing Escherichia coli) that over a couple of months sickened more than 4,000 people and contributed to the deaths of more than 45 individuals (see Shiga toxin-producing E. coli (STEC): Update on outbreak in the EU (27 July 2011, 11:00)).

 

After more than a month of investigation the European Food Safety Authority (EFSA) zeroed in on a specific lot of imported fenugreek seeds (used for sprouting) imported from Egypt as the source of infection, although some person-to-person transmission was also suspected.

 

STEC (sometimes referred to as verocytotoxic E. coli (VTEC) or enterohemorrhagic E. coli (EHEC)) infections can produce serious illness, particularly among the very young and the elderly.

 

A particularly serious, but fairly rare complication is called HUS (hemolytic uremic syndrome) which is a type of kidney failure.  Not everyone who consumes Shiga-toxin producing strains of E. coli will develop symptoms, however, and far fewer still will go on to experience HUS.

 

 

E. Coli is believed responsible for more than 250,000 illnesses each year in the United States.  The CDC explains about STEC on their E. coli page.

 

 

What are Shiga toxin-producing E. coli?

Some kinds of E. coli cause disease by making a toxin called Shiga toxin. The bacteria that make these toxins are called “Shiga toxin-producing” E. coli, or STEC for short. You might hear them called verocytotoxic E. coli (VTEC) or enterohemorrhagic E. coli (EHEC); these all refer generally to the same group of bacteria. The most commonly identified STEC in North America is E. coli O157:H7 (often shortened to E. coli O157 or even just “O157”). When you hear news reports about outbreaks of “E. coli” infections, they are usually talking about E. coli O157.

 

In addition to E. coli O157, many other kinds (called serogroups) of STEC cause disease. These other kinds are sometimes called “non-O157 STEC.” E. coli serogroups O26, O111, and O103 are the non-O157 serogroups that most often cause illness in people in the United States.

 

Some recent outbreaks that have been investigated by the CDC over the past 18 months include:

 

2012

• Multistate Outbreak of Shiga toxin-producing Escherichia coli O26 Infections Linked to Raw Clover Sprouts at Jimmy John's Restaurants

2011

• Multistate Outbreak of E. coli O157:H7 Infections Linked to Romaine Lettuce
• Outbreak of Shiga toxin-producing E. coli O104 (STEC O104:H4) Infections Associated with Travel to Germany
• Multistate Outbreak of E. coli O157:H7 Infections Associated with Lebanon Bologna
• Multistate Outbreak of E. coli O157:H7 Infections Associated with In-shell Hazelnuts

 

The CDC is currently investigating a multi-state outbreak of STEC which has sickened 14 people across 6 states.  A common source for the infections has not yet been identified.

 

Multistate Outbreak of Shiga Toxin-producing Escherichia coli O145 Infections

Posted June 10, 2012 01:00 AM ET

Highlights

• Read the Advice to Consumers »
• A total of 14 persons infected with the outbreak strain of STEC O145 infection have been identified in 6 states.
  • The number of ill persons identified in each state is as follows: Alabama (2), California (1), Florida (1), Georgia (5), Louisiana (4), and Tennessee (1).
  • Three ill persons have been hospitalized; one death has been reported in Louisiana.
• Based on interviews conducted to date, a source for these infections has not been identified. If a specific source is identified, public health officials will advise the public and take steps to prevent additional illnesses.
• Dates for patients' onset of illness range from April 15 to May 12, 2012. It has been approximately 4 weeks since the last illness onset among reported cases. Although this indicates that this outbreak could be over, CDC continues to work with state public health officials to identify additional cases and the source of these STEC O145 infections.

 

 

Despite our modern technology, foodborne illnesses pose a heavy burden to Americans, with the CDC estimating that 1 in 6 of us (48 million) fall victim to food poisoning each year, and that 128,000 are hospitalized, and as many as 3,000 die.

 

While we await news of the source of this outbreak, the CDC’s advice to consumers is valid and should be heeded 365 days a year, regardless of whether an outbreak of E. coli is being investigated or not:

 

Multistate Outbreak of Shiga Toxin-producing Escherichia coli O145 Infections

Advice to Consumers

• No source has been identified for this outbreak, and therefore we do not have specific consumer advice at this time.  Recommendations for protecting against STEC infections are provided below.  If a specific source is identified for this outbreak, public health officials will advise the public and take steps to prevent additional illnesses.
• Practice proper hygiene, especially good hand washing
  • Wash your hands thoroughly after using the bathroom or changing diapers and before preparing or eating food. Wash your hands after contact with animals or their environments (at farms, petting zoos, fairs, even your own backyard).
  • Always wash your hands before preparing and feeding bottles or foods to  your infant, before touching your infant's mouth, and before touching pacifiers or other things that go into your infant's mouth.
  • If soap and water aren't available, use an alcohol-based hand sanitizer. These alcohol-based products can quickly reduce the number of germs on hands in some situations, but they are not a substitute for washing with soap and water.
• It is also important to keep all objects that enter infants' mouths (such as pacifiers and teethers) clean.
• Know your risk for food poisoning.  People at higher-risk for foodborne illness are pregnant women and newborns, children, older adults and those with weak immune systems.
• Cook meats thoroughly. Ground beef and meat that has been needle-tenderized should be cooked to a temperature of at least 160°F/70˚C. It’s best to use a thermometer, as color is not a very reliable indicator of how thoroughly meat has been cooked.
• Avoid consuming raw milk, unpasteurized dairy products, and unpasteurized juices (like fresh apple cider).
• Avoid swallowing water when swimming or playing in lakes, ponds, streams, swimming pools, and backyard “kiddie” pools.
• Prevent cross-contamination in food preparation areas by thoroughly washing hands, counters, cutting boards, and utensils after they touch raw meat. 
• Please see the FoodSafety.gov E.coli web site for information on what you can to  prevent from getting infected with STEC.
• Persons who think they might be ill with STEC should consult their healthcare providers.

The good news is that no new cases have been reported to local health departments since the middle of May, suggesting that this outbreak may all ready be winding down.

 

E. Coli: In the Raw (cookie dough)

 

 

 

# 5998

 

Little noticed by the public, since it happened more or less at the same time as the emergence of 2009’s H1N1 virus, was a multistate outbreak of Shiga toxin-producing Escherichia coli (STEC) O157:H7.

 

Although more people were likely infected and experienced only minor symptoms, 77 patients with E. coli related illness were identified across 30 states.

 

Of these, 35 were hospitalized, and 10 developed HUS (Hemolytic Uremic Syndrome), a serious form of kidney failure. The victims were predominantly female (71%), and under the age of 19 (66%)

 

The CDC’s investigation (see archived details) determined:

 

Preliminary results of this investigation indicate a strong association with eating raw prepackaged cookie dough. Most patients reported eating refrigerated prepackaged Nestle Toll House cookie dough products raw.

 

This was the first time that the consumption of raw cookie dough had been associated with E. coli infection.

 

Nestle instituted a voluntary recall, while the FDA and CDC warned consumers not to eat any varieties of prepackaged Nestle Toll House refrigerated cookie dough. They warned that those with products on hand should discard them, rather than cooking them, as consumers might get the bacteria on their hands and on other cooking surfaces.

 

Fast forward 2 1/2 years and we have a study from the IDSA – embargoed until midnight last night – that warns of the dangers of eating raw cookie dough and recommends that manufacturers find ways to make it safer.

 

The 8 page PDF file is available at the link below.

 

A Novel Vehicle for Transmission of Escherichia coli O157:H7 to Humans: Multistate Outbreak of E. coli O157:H7 Infections Associated With Consumption of Ready-to-Bake Commercial Prepackaged Cookie Dough—United States, 2009

 

Published by Oxford University Press on behalf of the Infectious Diseases Society of America 2011.
DOI: 10.1093/cid/cir831

Karen P. Neil,Gwen Biggerstaff, J. Kathryn MacDonald, Eija Trees, Carlota Medus,  Kimberlee A. Musser, Steven G. Stroika, Don Zink, and Mark J. Sotir

 

 

Although the contaminated ingredient in this recalled batch of cookie dough was never conclusively identified, flour – which does not undergo a `kill step’ to rid it of pathogens – was strongly suspected.

 

We’ve a press release on all of this from the IDSA, excerpts of which you’ll find below.

 

Ready-to-bake cookie dough not ready-to-eat, study of E. coli outbreak finds

Consumer education and manufacturing changes may help prevent illness

[EMBARGOED FOR DEC. 9, 2011] The investigation of a 2009 multistate outbreak of Shiga toxin-producing Escherichia coli (STEC), an important cause of bacterial gastrointestinal illness, led to a new culprit: ready-to-bake commercial prepackaged cookie dough. Published in Clinical Infectious Diseases and available online, a new report describing the outbreak offers recommendations for prevention, including a stronger message for consumers: Don't eat prepackaged cookie dough before it's baked.

 

<SNIP>

 

The study authors conclude that "foods containing raw flour should be considered as possible vehicles of infection of future outbreaks of STEC." Manufacturers should consider using heat-treated or pasteurized flour, in ready-to-cook or ready-to-bake foods that may be consumed without cooking or baking, despite label statements about the danger of such risky eating practices, the authors conclude. In addition, manufacturers should consider formulating ready-to-bake prepackaged cookie dough to be as safe as a ready-to-eat food item.

(Continue . . . )

 

 

Eating raw cookie dough is apparently a popular culinary choice, based on the results of a Google search with the terms `eating raw cookie dough’.  

 

You’ll find abundant questionable `advice’ on the safety of this practice, including instructions on how to make `safe to eat’ raw cookie dough by eliminating `raw eggs’.

 

Much of this counsel needs to be taken with a pinch of salt (and a 350 degree oven for 15 minutes), since eggs aren’t the only potential source of contamination.

 

Since the 1980s more than 180 outbreaks of E coli have been reported across the United States from a variety of sources. This past summer, more than 4,000 people across Europe were sickened, and roughly 50 killed, by an E. coli outbreak traced to sprouts.

 

For more on how to avoid E. coli infection, and what to do if you are affected, visit foodsafety.gov’s  E. coli webpage.

 

 

http://www.foodsafety.gov/poisoning/causes/bacteriaviruses/ecoli/

ECDC: Lessons Learned On EHEC Outbreak

 

# 5677

 

 

At an informal health council meeting in Sopot, Poland over July 5th-6th, ECDC director Dr. Marc Sprenger delivered a speech on the lessons learned from the recent EHEC/STEC outbreak that began in Germany in mid-May.

 

The presentation was called "Outbreak of EHEC/STEC in Germany: Lessons Learned.", and the director cited the most obvious lesson as being `the EU is still vulnerable to epidemics’.

 

 

The entire presentation is available in the 2-page PDF file above, but a few excerpts include:

 

Lessons learned on how to further strengthen EU
cooperation against epidemics

Now for some lessons learned on how to further strengthen cooperation against epidemics

During this outbreak, it was very useful having an ECDC liaison officer embedded in the German outbreak investigation team – both for ECDC, and our German partners. It made information sharing much easier. ECDC is now developing some standard terms of reference for this liaison officer role, which we would like to agree with our national partners. If we can do this ahead of the next outbreak, then we can deploy a liaison officer even more quickly and efficiently. 

Let me leave you with my top four lessons learned on further strengthening our defences.

• Firstly, investment in microbiology is key. We need good labs in Europe to tackle outbreaks.

• Secondly, we should use temporary platforms to exchange clinical information during outbreaks.

• Thirdly, cross-sectoral cooperation is essential in all outbreaks, but particularly food borne outbreaks. Remember that “one voice” information to policy makers and citizens is key.

• Fourthly, remember that what looks like a local outbreak can quickly become an EU-wide event.

 

 

With remnants of the outbreak still underway, and many questions about the source and evolution of this virulent strain of E. Coli still unanswered, the final after-action report on this outbreak has yet to be written.

 

According to the latest ECDC figures (released July 6th), 50 people have died from this outbreak, and more than 4200 have been sickened.

 

 

Although the number of new cases continues to decline, there remain concerns that contaminated sprout seeds (believed to be behind this outbreak) may still be in the food pipeline.

 

The EFSA continues to advise to people: not to grow sprouts for their own consumption and not to eat sprouts or sprouted seeds unless they have been cooked thoroughly.

EFSA Task Force Report On E. Coli O104:H4

 

 

Photo Credit – ECDC 

 

# 5672

 

 

The European Food Safety Authority (EFSA) has released an updated task force report on the enterohaemorrhagic Escherichia coli (EHEC) outbreak that has affected more than 4000 people (including 47 fatal cases) across 13 nations in Europe since mid-May.

 

Although we’ve seen other E. Coli outbreaks in the past, this one is remarkable both for the total number of victims, and the virulence of this emerging 0104:H4 strain of E. Coli.

 

During the opening weeks of the outbreak suspicions regarding the source of the infection were cast in a variety of directions, causing serious economic harm to produce growers in Spain and elsewhere. 

 

Over the past two weeks, investigators have zeroed in on fenugreek seeds imported from Egypt as being the likely source of the E. Coli contamination.

 

Two links this morning, along with some excerpts from the EFSA’s press release and technical report.  Follow the links to read them in their entirety.

 

 

EFSA publishes report from its Task Force on the E. coli O104:H4 outbreaks in Germany and France in 2011 and makes further recommendations to protect consumers

Press Release
5 July 2011

The EFSA Task Force established to coordinate investigations to track down the possible source of the French and German outbreaks of E. coli O104:H4 has concluded that one lot of fenugreek seeds imported from Egypt and used to produce sprouts is the most likely common link between the two outbreaks.

 

However, it cannot be excluded that other lots of fenugreek imported from Egypt during the period 2009-2011 may be implicated. Based on these findings, EFSA recommends to the European Commission that all efforts be made to prevent any further consumer exposure to the suspect seeds and that forward tracing be carried out in all countries which may have received seeds from the concerned lots.

 

In this context, EFSA continues to advise consumers not to grow sprouts for their own consumption and not to eat sprouts or sprouted seeds unless they have been cooked thoroughly.

<SNIP>

 

The analysis of information from the French and German outbreaks leads to the conclusion that an imported lot of fenugreek seeds which was used to grow sprouts imported from Egypt by a German importer, is the most likely common link but other lots may be implicated. The report highlights that negative results from microbiological tests carried out on seeds cannot be interpreted as proof that a lot is not contaminated with STEC.

(Continue . . . )

 

Details on the trace back investigation that has led the EFSA to conclude that contaminated fenugreek seeds are behind this outbreak are contained in the technical document below.

 

The actual report is a 23-page PDF file.  The link below is to the summary.

 

 

 

Tracing seeds, in particular fenugreek (Trigonella foenum-graecum) seeds, in relation to the Shiga toxin-producing E. coli (STEC) O104:H4 2011 Outbreaks in Germany and France

Question number: EFSA-Q-2011-00817
Issued: 5 July 2011

Report (0.1 Mb)

Summary

On the 21^st of May 2011, Germany reported an ongoing outbreak of Shiga-toxin producing Escherichia coli- bacteria (STEC[1][2]), serotype O104:H4 (Frank et al., 2011). In Germany, between the 1^st of May and the 28^th of June 2011, 838 Haemolytic Uremic Syndrome (HUS) cases and 3 091 STEC cases with diarrhea have been reported, of which 47 persons have died (RKI, 2011).

 

On Friday the 24^th of June, France reported[3] a cluster of patients with bloody diarrhoea, after having participated in an event in the Commune of Bègles near Bordeaux on the 8th of June. As of 28 June, eight cases of bloody diarrhoea and a further eight cases with HUS have been identified. Eleven of these patients, seven women and four men, between 31 and 64 years of age, had attended the same event in Bègles. Infection with E. coli O104:H4 has been confirmed for four patients with HUS.

 

Six of the cases reported having eaten sprouts at the event on the 8^th of June, and leftovers are being analysed. Outbreak investigation revealed that the suspected sprouts of fenugreek, rocket and mustard had been privately produced in small quantities by the organiser of the event from seeds bought at an approved garden centre, and were not imported from the sprout producer implicated in the outbreak in Germany (INVS, 2011). An analytical epidemiological study is ongoing with the persons that attended the event on 8^th of June. Local trace back investigations in France suggested that the seeds for sprouting were distributed to the approved garden centre by a UK based company.

(Continue . . . )

 

After the row last week over the ECDC first printing, then removing the name of the (suspected) supplier of the contaminated seeds (see CIDRAP article), it is interesting to note that none of the links in the supply chain appear to be directly named in this report.

 

The bottom line is that while the number of new cases continues to decline, the potential exists for additional localized outbreaks as potentially contaminated seeds may still be in the pipeline.

 

From the report:

 

The number of Member States that have received parts of the suspected lots is much larger than previously known and it cannot be excluded that other Member States and third countries were supplied. The trace forward operation is becoming complex and widespread and may take weeks.

 

Hence the EFSA’s advise to people: not to grow sprouts for their own consumption and not to eat sprouts or sprouted seeds unless they have been cooked thoroughly.

Sweden: First Domestic EHEC Case

 

 

# 5659

 

 

Today, the Smittskyddsinstitutet (Swedish Institute for Communicable Disease Control) announced their first locally acquired case of EHEC due to the same enterohemorrhagic E. coli strain that has recently sickened thousands, and killed dozens, across Germany and parts of Europe.

 

Exactly how this patient – a middle-aged man from Skåne (southern Sweden) with no history of travel to Germany and no known contact with anyone returning from the region – came to acquire the infection is unknown.

 

Of particular concern would be if this virulent strain of E. Coli has managed to get into Sweden’s food supply.  There are other possibilities, of course, including acquiring the bacteria indirectly from contact with another person.

 

Tracking down the source of this infection is now a top priority for local health officials. 

 

This from The Local.se.

 

 

Sweden reports first domestic EHEC case

Published: 28 Jun 11 16:24 CET |

For the first time, a Swede with no connections to Germany has been infected with the virulent enterohaemorrhagic E. coli (EHEC) bacteria that has claimed dozens of lives across Europe, Swedish health authorities reported on Tuesday.

 

“This means that the source of the infection is in Sweden, which is a lot worse, because it might mean that there is some form of infected food product in circulation that we haven’t yet identified, “ said Sofie Ivarsson, epidemiologist at the institute to news agency TT.

(Continue . . . )

 

Meanwhile the latest ECDC update shows roughly 4,000 cases in Germany and 48 related deaths.

 

 

Separately, another much smaller outbreak featuring the same E. coli O104:H4 strain has been detected in Bordeaux, France, hospitalizing at least 9 people. 

 

ECDC update on outbreak in Germany and cluster in France

27 Jun 2011

ECDC

On Friday 24 June, France reported a cluster of eight patients with bloody diarrhoea, after having participated in an event in the commune of Bègles around Bordeaux on 8 June. Of these, seven have developed HUS, a severe complication of E. coli infection. In three of the patients, infection with E. coli O104:H4 has been confirmed.

 

The French authorities are investigating this new cluster of STEC - the suspected vehicle of infection for the cases and whether there is any link between that cluster and the large outbreak reported from Germany.

 

Since 25 June in the EU/EEA, 880 HUS cases, including 31 deaths, and 3 039 non-HUS cases, including 16 deaths have so far been reported. ECDC is continuously monitoring the enterohaemorrhagic E. coli (EHEC) and Shiga toxin-producing E. coli (STEC) oubreak in Germany and other EU Member States.

 

 

While the original outbreak in Germany is winding down, two fresh foci of infection – seemingly unrelated to the main outbreak – leave us with many unanswered questions.

 

And so the epidemiological investigation continues.

Referral: McKenna On Drug Resistant E. Coli And Chickens

 

 

# 5658

 

 

Maryn McKenna writing on her Superbug Blog today has the details of a new study out of the Netherlands which appears in the June edition of the CDC’s EID Journal  that takes close look at the genetic make up of drug resistant E. Coli carried by chickens and that carried by humans.

 

As Maryn tells us – assuming this study is correct – this research would appear to provide additional support to many scientist’s concerns over a link between the use of antibiotics in agriculture and the emergence of resistant pathogens in humans.

 

The study may be read at:

 

Volume 17, Number 7–July 2011

Research

Extended-Spectrum β-Lactamase Genes of Escherichia coli in Chicken Meat and Humans, the Netherlands

Ilse Overdevest, Ina Willemsen, Martine Rijnsburger, Andrew Eustace, Li Xu, Peter Hawkey, Max Heck, Paul Savelkoul, Christina Vandenbroucke-Grauls, Kim van der Zwaluw, Xander Huijsdens, and Jan Kluytmans

 

 

But for the short course, by a writer well-versed in the subject, I would refer you to Maryn’s article today.

 

 

Is Drug Resistance in Humans Coming From Chickens?

• By Maryn McKenna June 28, 2011 

WHO: EHEC Update

 

# 5654

 

 

From the World Health Organization this morning, an update on the EHEC (E. Coli) in Germany, and a few details on the similar outbreak now reported in Bordeaux, France.

 

The good news is that the number of new cases has declined significantly over the past couple of weeks in the German outbreak, and so far, the outbreak in France has been limited to just 8 cases.

 

 

 

EHEC outbreaks: Update 24, France reports 8 cases in new outbreak

27-06-2011

Since week 23/2011, the number of reported cases of haemolytic uraemic syndrome (HUS) enterohaemorrhagic Escherichia coli (EHEC) has declined significantly. In Germany, the daily numbers of reported cases have steadily decreased since they peaked on 22 May. Nevertheless, the cumulative numbers of cases from Germany continue to rise, primarily owing to delays in notification.

 

Investigations by the German authorities indicate that the vehicle of the bacterium responsible for the outbreak, enteroaggregative verocytotoxin-producing E. coli (EAggEC VTEC) O104:H4, is bean and seed sprouts, and the Robert Koch Institute has warned people in Germany not to eat raw sprouts of any origin.

 

On 24 June, France reported an outbreak of verocytotoxin-producing E. coli (VTEC)/HUS with 8 cases in adults (6 women and 2 men). E. coli O104:H4 has been confirmed in 3 cases. Investigations are ongoing, but the first findings suggest that locally grown sprouts might be involved. Intensive traceback is under way to identify a possible common source of the German and French sprout seeds. Other potential vehicles are also under investigation.

 

The table shows the reported cases of and deaths from HUS and EHEC infection as of 24 June at 15:00 CET. It does not include the 8 cases reported by France on 24 June, as these are considered a separate outbreak.

 

In Germany, the latest date of onset of diarrhoea is 22 June for HUS cases and 20 June for EHEC cases. All but 5 of the above HUS and EHEC cases were in people who had travelled to or lived in Germany during the incubation period for infection, typically 3–4 days after exposure (range: 2–10 days). The remaining 5 cases can also be linked to the outbreak in Germany.

Note

EHEC and HUS have exclusive notification categories, so case numbers should not overlap. The figures in any rapidly evolving outbreak, however, are provisional and subject to change for a variety of reasons.

 

In providing the above information, WHO wishes to recognize the contribution of its Member States, and technical partners such as the European Commission, the European Centre for Disease Prevention and Control and a number of WHO collaborating centres.

UK: Updated Sprout Safety Statement

 

 

# 5651

 

Even as the sprout-linked  EHEC outbreak in Germany drags on, a new (and similar) outbreak has been reported in Bordeaux, France - with seven people hospitalized.

 

This report from Deutsche Presse-Agentur.

 

French E coli outbreak likened to deadly German drama

Jun 26, 2011, 10:05 GMT

Paris - This week's outbreak of E Coli in the south-western French city of Bordeaux bears the hallmarks of the outbreak that claimed dozens of lives in Germany, French media reports said Sunday.

(Continue . . . )

 

 

As a possible link to a UK supplier of sprout seeds has been mentioned (but not confirmed), the UK’s Food Standards Agency has issued a revised safety statement on the preparing and handling of sprout seeds.

 

 

Updated sprouted beans statement

Saturday 25 June 2011

Following further cases of E. coli in France, the Food Standards Agency is revising its guidance on the consumption of sprouted seeds such as alfalfa, mung beans (usually known as beansprouts) and fenugreek.

 

As a precaution, the Agency is advising that sprouted seeds should only be eaten if they have been cooked thoroughly until steaming hot throughout; they should not be eaten raw.

 

The investigations into the outbreak of E. coli in France have suggested a possible link to sprouting seeds from a company based in the UK. To date, no cases of food poisoning have been reported in the UK linked to the outbreak in France. We are in close contact with the Health Protection Agency who is actively monitoring the situation.

 

The Agency also advises that equipment which has been used for sprouting seeds should be cleaned thoroughly after use. You should always wash your hands after handling seeds intended for planting or sprouting.

Referral: McKenna On E. Coli

 

 

 

# 5649

 

This week we’ve seen a number of new journal articles on Germany’s EHEC outbreak, appearing in The Lancet , Eurosurveillance Journal, and the NEJM.

 

Maryn McKenna gives us an excellent walk-thru of their findings this morning in her SUPERBUG BLOG post:

 

E. coli: Some Answers, Many Questions Still

• By Maryn McKenna
• June 24, 2011  | 

 

Highly Recommended.

 

And for a terrific (ongoing) multi-part series on HUS (Hemolytic Uremic Syndrome) – a devastating complication in some toxic E. Coli infections - I would refer you to Tara C. Smith’s Aetiology Blog.

Study: Sub-Therapeutic Antibiotic Exposure Drives Resistance

 

 

# 5630

 

 

For years battle lines have been drawn between agricultural interests and concerned scientists over the extensive and routine use of sub-therapeutic doses of antibiotics in farm animals.

 

Low levels of antibiotics – delivered to healthy herds via their water or feed – have been found to promote growth, lower production costs, and reduce animal mortality and morbidity on crowded factory farms. 

 

Which makes them very popular among farmers.

 

But worried scientists point out that most of the antibiotics being used on the farm are functionally identical to those used in humans, and that their overuse (or misuse) can lead to the development of resistant organisms.

 

Late last year it was disclosed that roughly 80% of all antibiotics sold in the United States are used in agriculture  (see Maryn McKenna’s Update: Farm Animals Get 80 Percent of Antibiotics Sold in U.S.). 

 

The economic and public health stakes here are enormous, and so over the past few years we’ve seen a steady stream of conflicting statements and studies on the matter designed to influence the public, and regulators.

 

Despite a rising tide of resistant organisms being detected on the farm, the agricultural lobby maintains that scientific proof that the use of sub-therapeutic doses of antibiotics drives bacterial resistance is lacking.

 

Countering that position, today we’ve a new study appearing in the peer reviewed journal Microbial Drug Resistance that finds that low level exposures to three common antibiotics: amoxicillin, tetracycline, and enrofloxacin drives the acquisition of resistance in Escherichia coli.

 

First some excerpts from the press release, then a link to the study.

 

Mary Ann Liebert, Inc./Genetic Engineering News

E. coli bacteria more likely to develop resistance after exposure to low levels of antibiotics, reports a study in Microbial Drug Resistance

New Rochelle, NY, June 14, 2011—E. coli bacteria exposed to three common antibiotics were more likely to develop antibiotic resistance following low-level antibiotic exposure than after exposure to high concentrations that would kill the bacteria or inhibit their growth, according to a timely article in Microbial Drug Resistance, a peer-reviewed journal published by Mary Ann Liebert, Inc.

<SNIP>

Bacterial resistance to commonly prescribed antibiotics is an enormous and growing problem, largely due to misuse of antibiotics to treat non-bacterial infections and environmental exposure of the bacteria to low levels of antibiotics used, for example, in agriculture. In the article "De Novo Acquisition of Resistance to Three Antibiotics by Escherichia coli," the authors studied the mechanisms by which E. coli acquire resistance to three common antibiotics: amoxicillin, tetracycline, and enrofloxacin.

 

Depending on the antibiotic and the level of exposure, different mechanisms may come into play. The authors report that exposure to antibiotics at relatively low levels--below those needed to inhibit growth of the bacteria--are more likely to result in the development of antibiotic resistance. "Exposure to low levels of antibiotics therefore clearly poses most risk," a finding that "contradicts one of the main assumptions made questioning the threat of usage of antibiotics in food animals," conclude the authors.

 

 

The study (available as a PDF) is called:

 

De Novo Acquisition of Resistance to Three Antibiotics by Escherichia coli

Michael A. van der Horst,Jasper M. Schuurmans,
Marja C. Smid, Belinda B. Koenders, and Benno H. ter Kuile

 

 

For more on the legal wrangling surrounding the use of growth-promoting antibiotics in agriculture, I would direct you to Maryn McKenna’s Superbug Blog and her recent article:

 

Growth Promoters: If You Can’t Convince Them, Sue Them

• By Maryn McKenna
• May 25, 2011  | 

 

 

Meanwhile - as scientists study, lobbyists lobby, and regulators contemplate their next move – nearly 80,000 pounds of antibiotics are used in this country every day on farm animals (28.8 million pounds/year).

 

Making regulation of the sane and sensible use of antibiotics on the farm desperately needed sooner rather than later.

ECDC: EHEC/STEC Update June 13th

 

 

# 5625

 

Although German authorities are hopeful that the peak of the EHEC or Shiga-Toxin Producing E. Coli outbreak has now passed, the latest ECDC update reports one new fatality since yesterday, and nearly 70 new cases.

 

 

Outbreak of Shiga toxin-producing E. coli in Germany (13 June, 11:00)

13 Jun 2011

 

With an incubation period of up to 2-weeks, it is considered likely that more cases (and perhaps more deaths) will be reported before this outbreak completely burns itself out.

 

Meanwhile, Spiegel Online is reporting that as many as 100 people who developed the life-threatening complication called HUS (Hemolytic Uremic Syndrome) experienced severe enough kidney damage to either need life-long dialysis or a kidney transplant.

 

06/13/2011

Long-Term Impact of E. Coli Outbreak

Expert Warns 100 Patients Will Need New Kidneys or Dialysis

 

 

While the source of the infection has been traced to a specific sprout farm in lower Saxony, exactly how their sprouts came to be contaminated has not been established.    

 

Health authorities warn that sprout seeds may harbor the bacteria, which reproduce rapidly during the sprouting process, and warn that home growers should not consume their produce raw.

 

E.coli warnings over bean sprout seeds

RKI: Sprouts Behind Europe’s EHEC Outbreak

 

 

# 5617

 

 

Although none of the test samples taken from the sprout farm under suspicion in Lower Saxony have come back positive, the epidemiological investigation of cases has convinced investigators at the Robert Koch Institute that locally grown sprouts are behind the ongoing outbreak of E. Coli  (EHEC/STEC) in Europe.

 

The announcement was made by RKI’s president, Reinhard Burger at a press conference this morning, where the warning against eating cucumbers, tomatoes and lettuce was lifted, but the warning regarding sprouts was left in place.

 

The following appears on Monsters & Critics and comes from Deutsche Presse-Agentur. 

 

German all clear for cucumbers, tomatoes, lettuce

Jun 10, 2011, 8:59 GMT

Berlin - Cucumbers, tomatoes and lettuce were given an official all-clear Friday by German authorities, who said the evidence was strong that sprouts grown from beans or peas caused an E coli outbreak that has killed 30 people.

 

'It's the sprouts,' said Reinhard Burger, head of the Robert Koch Institute, the federal infectious-disease laboratory.

(Continue . . .)

 

 

Last night Lisa Schnirring of CIDRAP News wrote about the investigation, and how the trace-back investigation into the outbreak continued to lead to locally grown sprouts.

 

Sprouts data complicate outbreak investigation

Lisa Schnirring Staff Writer

Jun 9, 2011 (CIDRAP News) – An epidemiologic report from German investigators yesterday said the initial case-control study found that just 28% of patients reported they had eaten sprouts, the lead suspect in Europe's Escherichia coli outbreak, pointing up a factor can be difficult to interpret in foodborne illness situations.

 

Though German public officials seem to be zeroing in on sprouts, interviews comparing the food consumption patterns of sick patients and healthy people still suggest that several types of vegetables could be the source, and a third study is under way to focus more on salad ingredients. The full report, posted on the Robert Koch Institute's Web site, appears in German. (CIDRAP News obtained a professionally translated version of the findings.)

(Continue . . . )

 

 

While epidemiological trace-backs often end up being the only method of determining the source of a food borne outbreak, after so many false accusations over the past two weeks, the lack of a `smoking sprout’ will no doubt leave some unconvinced.

 

Criticism of the German response to this outbreak abounds, with legislators, doctors, and public health officials all weighing in.

 

Two days ago, in an AP article appearing in the Detroit Free Press,  CIDRAP’s Director Michael Osterholm is quoted as calling the German response `erratic’ and `a disaster’.

 

 

Experts: E. coli crisis flubbed

June 8th, 2011

 

 

Meanwhile, the outbreak goes on, although German health officials are hopeful that the worst is over. 

 

The most recent ECDC report (June 9th) lists nearly 3,000 victims and 27 deaths.  Other reports have the death toll at at least 30.

 

A Double Referral: McKenna And Smith On EHEC

 

 

# 5615

 

With a constant barrage of confusing and conflicting media reports regarding the E. Coli  (EHEC/STEC) outbreak in Europe, it is fortunate that we have two very expert bloggers to help guide us through this maze.

 

Maryn McKenna and Tara C. Smith.

 

This morning, referrals to their latest blogs, listed in order of appearance.

 

 

E. coli: What we know and need to

• By Maryn McKenna  June 8, 2011  | 

 

 

Next up, Tara Smith’s Aetiology Blog, which also references Maryn’s last post.

 

 

The case of the missing smoking sprouts

Posted on: June 9, 2011 8:00 AM, by Tara C. Smith

 

If you want to get a good handle on the EHEC outbreak in Germany, both blogs are highly recommended.

EHEC: Preliminary Sprout Tests Negative

 

 

# 5610

 

 

You could almost see this coming.

 

After a 24-hour news cycle with the media all-but indicting an organic sprout farm in Germany for the deaths of 22 individuals – we’ve news this morning indicating that the initial tests from that farm have been negative for E. Coli.

 

Reuters and  Deutsche Presse-Agentur are both reporting that of 40 samples taken from the farm, 23 have reportedly come back clean, while the results of the others are still awaited.

 

 

Sky News is reporting these findings this way:

 

German Tests Reveal Sprouts Not E.coli Source

Monday, 6th June 2011 04:00

Initial test results reveal that bean sprouts from an organic farm in Germany are not the source of an E.coli outbreak which has so far killed 22 people.

 

Preliminary examinations had found that bean sprouts from a farm in the Uelzen area, between the northern cities of Hamburg and Hannover, could be traced to infections in five German states.

 

A wider test will now be carried out on a sample of older sprouts and packaging.

(Continue . . . )

 

 

Which isn’t quite the same thing as full exoneration, but it is hardly the smoking sprout that the news media had been expecting.

 

Of course, we’ll have to await further testing before we can know if this organic farm can be completely eliminated as the source of the E. Coli outbreak across Europe.

 

But as I wrote yesterday in ECDC EHEC Update & Collateral Damage:

 

. . . a new `prime suspect’ in this outbreak seems to emerge on practically a daily basis. While these theories make for good newspaper fodder, they can also unfairly malign and trample the innocent.

 

 

If this organic farm is eventually eliminated from the suspect column - the list of collateral damage from this outbreak will have incremented once more - and the investigators will find themselves tasked with looking for another source.

Stay tuned.

Germany: Waiting For Test Results

 

 

 

# 5606

 

Although many in the news media have latched firmly onto `organic sprouts’ as the `likely source’ of the E. Coli infection spreading across Europe, test results on the suspect produce have not been released yet.

 

The Associated Press is reporting that these test results are expected later today.

 

Tests to Determine if Sprouts Are to Blame for Killer E. Coli Outbreak

Published June 06, 2011

 

If test results do come back positive, the next step will be to determine exactly how they came to become contaminated. 

 

Fertilizers are not used in the growing of sprouts (essentially all you need is water or steam, the right temperature, darkness, and the seeds).

 

So the `obvious suspects’ would include the water supply, the seed stock, shipping containers, or perhaps accidental introduction of the bacteria by an infected employee.

 

As a home sprouter of mung beans (I have a jar going right now), I’ll be very interested to learn how this contamination – if it is confirmed – came to be.

 

Meanwhile, the ECDC has released their latest figures (June 6th) on cases of HUS and non-HUS STEC cases and associated deaths.

 

WHO Europe: EHEC Update & FAQ

 

 

# 5600

 

 

The expanding outbreak of EHEC (or STEC  Shiga-Toxin Producing E. Coli) in Europe has produced an avalanche of news articles and analysis. Most days we are seeing literally scores of updates.

 

Both Crof at Crofsblog and the newshounds at FluTrackers  (see news forum Escherichia coli (E. Coli), Enterohemorrhagic Escherichia Coli (EHEC), Hemolytic-Uremic Syndrome) have been providing outstanding hour-to-hour coverage of this story.

 

Of course, I haven’t been ignoring the crisis.  My coverage, however, has been focused less on the breaking news aspects, and more on research updates (CDC, ECDC, WHO) and background information.

 

Today, an update and a well-done FAQ from WHO Europe.

 

 

EHEC outbreak: Update 6 (04-06-11)

04-06-2011

These are the current figures for the outbreak. Enterohaemorrhagic Escherichia coli (EHEC) and haemolytic uraemic syndrome (HUS) have exclusive notification categories, so case numbers should not overlap. The figures in any rapidly evolving outbreak are provisional, however, and subject to change for a variety of reasons.

• As of 02 June at 15:00 CET, Germany had reported 520 cases of HUS, including 11 fatalalities: 50 more than the previous day. 70% of the cases were in females and 89% in adults aged 20 years or older. 
• As of 02 June 15:00 CET, 1213 cases of EHEC infections (without HUS) had been reported in Germany, 6 of them fatal: 149 more than the previous day. Of those cases, 61% were in females, and 88% in adults aged 20 years or older. Case onset dates for EHEC ranged from 1 to 30 May.
• As of 03 June 18:00 CET, 11 other European countries (see table) had reported a total of 31 HUS (1 fatal) and 70 EHEC cases (0 fatal). 

• In addition, the Centers for Disease Control and Prevention (CDC) in Atlanta, United States of America had previously  published information on two cases of HUS in the United States that were linked to this outbreak.  
• All but 1 of the above HUS and EHEC patients had travelled to or from Germany during the incubation period for infection, typically 3–4 days after exposure (range 2–10 days). An increasing number of cases is laboratory confirmed as EHEC serotype O104:H4.

Since various agencies and news organizations around the world have elected to use different terminology to describe this outbreak, following this story can sometimes be a bit confusing.

 

The World Health Organization has put together a good FAQ (Frequently Asked Questions) file on the outbreak, which may serve to clear up some of the confusion.

 

 

 

Frequently asked questions on the EHEC infection outbreak in Germany

Background

1. What are EHEC and HUS?

Enterohaemorrhagic Escherichia coli (EHEC) is a human pathogenic E. coli bacterium that is able to cause haemorrhagic colitis (bloody diarrhoea), which sometimes develops into haemolytic uraemic syndrome (HUS). HUS is a life-threatening disease that causes kidney damage and is a severe complication of EHEC infection. EHEC is so-called Shigatoxin-producing E. coli (STEC), also known as verocytotoxin-producing E. coli (VTEC). Animals can carry other types of STEC/VTEC in their intestines that are not necessarily pathogenic for humans.

2. Surely E. coli is very common, so why the concern?

Yes, E. coli is a common bacterium that is found in the intestines of humans and warm-blooded animals. Nevertheless, this particular strain, a rare serotype of EHEC (namely E. coli O104:H4), is severe, and has caused much illness and some deaths in Germany. Cases have also occurred in 11 other countries, all of whom had travel links to, or residence in, Germany, except for one case still under investigation. This is a significant outbreak of HUS. It is affecting mostly women and mostly people over 20 years of age, which is unusual. As the source of the outbreak has not been found, it is difficult to say how long it will last.

3. Is this unique?

The serotype of EHEC, O104:H4, isolated from cases in the EHEC infection outbreak in Germany, is a rare one, seen in humans before but never in an EHEC outbreak. This has been confirmed by the WHO Collaborating Centre for Reference and Research on Escherichia and Klebsiella, the Statens Serum Institut in Denmark. The molecular/genetic features of this pathogen are important in helping authorities to identify cases in other countries that could be associated with the outbreak in Germany and to identify the source of the outbreak. While epidemiological and laboratory investigations continue, the source of the outbreak still remains unknown.

4. How would you describe the EHEC outbreak currently happening in Germany?

Germany is experiencing a significant outbreak of EHEC, a highly pathogenic bacterium subgroup of STEC. A minority of cases are presenting complications with HUS, a life-threatening disease characterized by acute kidney failure (uraemia), haemolytic anaemia, and a low platelet count (thrombocytopenia).

5. When was the last EHEC outbreak?

Every year there are EHEC outbreaks in different parts of the world including Europe, sometimes involving HUS and even deaths, but the number of affected people is very much lower than what Germany is now experiencing. In 1996, the world’s biggest recorded outbreak was registered in Japan and included over 10 000 infected cases.

6. How many countries are involved in the current outbreak?

Cases have now been notified from 11 countries in addition to Germany: Austria, the Czech Republic, Denmark, France, the Netherlands, Norway, Spain, Sweden, Switzerland, the United Kingdom and the United States of America. These are typically people who have recently visited northern Germany or, in one case, had contact with a visitor from northern Germany who was an EHEC case.

7. Do people outside Germany need to worry?

Most of the cases are linked to the northern part of Germany, and investigations are taking place to define the exact geographical areas where transmission is occurring. There is no indication so far of confirmed domestic or secondary infection in other countries.

CDC Health Advisory (HAN) On Shiga-Toxin Producing E. Coli 0104

 

 

# 5599

 

 

The CDC’s Health Alert Network (HAN) is designed to ensure that communities, agencies, health care professionals, and the general public are able to receive timely information on important public health issues.

 

You can sign up for HAN messages, and scores of other CDC and HHS email notifications, by going to the CDC - Quick Subscribe GovDelivery page.

 

There are 4 types of HAN releases.

Health Alert

Conveys the highest level of importance; warrants immediate action or attention.

Health Advisory

Provides important information for a specific incident or situation; may not require immediate action.

Health Update

Provides updated information regarding an incident or situation; unlikely to require immediate action.

Info Service
Provides general information that is not necessarily considered to be of an emergent nature.

 

Today we have a HAN ADVISORY on the outbreak of EHEC or Shiga-Toxin producing E. Coli in Europe, with instructions for Health Care providers to be on the lookout of possible symptoms in travelers returning from Europe.

 

As of May 31st, the CDC has been made aware of 3  cases of HUS among travelers who recently entered the United States after leaving Germany.

 

While most of the information below is of greatest interest to clinicians, this illustrates that in today’s highly mobile society, even an outbreak of a food borne illness can impact countries oceans apart.

 

 

 

This is an official

CDC HEALTH ADVISORY

Distributed via Health Alert Network
June 3, 2011, 9:30 a.m. EST
CDCHAN-00322-ADV-N

Notice to Health Care Providers — Shiga Toxin-producing E. coli O104 (STEC O104:H4) Infections in U.S. Travelers Returning from Germany

 

CDC is monitoring a large outbreak of Shiga toxin-producing Escherichia coli O104:H4 (STEC O104:H4) infections ongoing in Germany. The responsible strain shares virulence characteristics with enteroaggregative E. coli (EAEC). As of May 31, 2011, the Robert Koch Institute (RKI) reported 470 patients with hemolytic uremic syndrome, or HUS (a severe condition associated with STEC infection that can lead to kidney failure), and nine deaths. The strain of STEC that is causing this illness, STEC O104:H4 is very rare. The illness that it causes is similar to that caused by E. coli O157:H7 or STEC O157:H7, which is also a Shiga toxin-producing E. coli.

 

CDC is not aware of any cases of STEC O104:H4 infection ever being previously reported in the United States. However, as of May 31, 2011, three cases of HUS in the United States have been reported in persons who recently traveled to Hamburg, Germany. CDC is working with state health departments to learn more about these suspected cases and obtain bacterial isolates for further characterization.

 

CDC has recommended that any person who has recently traveled to Germany and has signs or symptoms of STEC infection, or HUS, should seek medical care and let the medical provider know about the outbreak of STEC infections in Germany and the importance of being tested for STEC infection.

 

Symptoms of STEC infection include severe stomach cramps, diarrhea (which is often bloody) and vomiting. If there is fever, it usually is not very high. Most people get better within 5–7 days, but some patients go on to develop HUS, usually about a week after the diarrhea starts. 

 

(Continue . . . )

Report: EHEC Outbreak From New E. Coli Strain

 

 

 

# 5594

 

 

It is being widely reported this morning by the International press that Chinese scientists at the Beijing Genomics Institute, after completing the sequencing the genome of the E. Coli bacterium responsible for the massive outbreak of food poisoning in Germany, have pronounced it to be a `new strain’.

 

E.coli outbreak in Europe caused by new toxic strain - Reuters

WHO says E.coli strain never seen before – SwissInfo.Ch

E coli outbreak: WHO says bacterium is a new strain – The Guardian

 

Excerpts from the press release from the Beijing Genomics Institute follows:

 

 

BGI Sequences Genome of the Deadly E. Coli in Germany and Reveals New Super-Toxic Strain

2011-06-02 15:28:36

Sequence analysis indicated this bacterium is an EHEC serotype O104 E. coli strain; however, this is a new serotype — not previously involved in any E. coli outbreaks.

 

Comparative analysis showed that this bacterium has 93% sequence similarity with the EAEC 55989 E. coli strain, which was isolated in the Central African Republic and known to cause serious diarrhea. This new strain of E. coli, however, has also acquired specific sequences that appear to be similar to those involved in the pathogenicity of hemorrhagic colitis and hemolytic-uremic syndrome.

 

The acquisition of these genes may have occurred through horizontal gene transfer. The analysis further showed that this deadly bacterium carries several antibiotic resistance genes, including resistance to aminoglycoside, macrolides and Beta-lactam antibiotics: all of which makes antibiotic treatment extremely difficult.

 

According to a number of press reports this morning, Hilde Kruse, a food safety expert at the World Health Organization  has confirmed with The Associated Press that "this is a unique strain that has never been isolated from patients before", and that - the new strain has "various characteristics that make it more virulent and toxin-producing.”

 

The source of this contamination, and how (and where) this new strain may have evolved, remains a mystery.

CDC Statement On Europe’s EHEC (STEC) Outbreak

 

 

 

# 5592

 

 

 

While the Robert Koch Institute (RKI) in Germany has the lead on the investigation of the large outbreak of Shiga toxin-producing E. coli  STEC O104, the CDC is naturally following the events there closely. 

 

Earlier today the CDC released a statement outlining what is currently known about the outbreak, along with a brief Q&A section that addresses some common questions the public may have.

 

I’ll not reprint the entire statement, but you are encouraged to follow the link to read it in its entirety. 

 

 

For Immediate Release: June 1, 2011
Contact: CDC Media Relations
(404) 639-3286

CDC Statement on Outbreak of STEC O104:H4 infections in Germany

CDC is following a large outbreak of Shiga toxin-producing E. coli O104, or STEC O104, infections currently going on in Germany. As of May 31, 2011, the Robert Koch Institute (RKI), Germany's disease control and prevention agency, has confirmed six deaths and 373 patients with hemolytic uremic syndrome, or (HUS) (kidney failure), a life-threatening complication of E. coli infections.

 

To date, no confirmed cases of STEC O104 infections have been reported in U.S. travelers to Europe. Two cases of HUS in the United States have been reported in persons with recent travel to Hamburg, Germany. CDC is working with state health departments to learn more about these two cases and to identify others. CDC has been in contact with the German public health authorities at RKI. We have alerted state health departments in the United States of the ongoing outbreak. We have also requested that they report to CDC any cases in which people have either HUS or Shiga toxin-positive diarrheal illness, with illness onset during or after travel to Germany since April 1, 2011.

 

The strain of STEC causing illness, STEC O104:H4, is very rare. CDC is not aware of any cases of STEC O104:H4 infection ever being reported in United States. Any person with recent travel to Germany with signs or symptoms of STEC infection or HUS, should seek medical care and let the medical provider know about the outbreak of STEC infections in Germany and the importance of being tested. Symptoms of STEC infection include severe stomach cramps, diarrhea, which is often bloody, and vomiting. If there is fever, it usually is not very high. Most people get better within 5–7 days, but some patients go on to develop HUS—usually about a week after the diarrhea starts. Symptoms of HUS include decreased frequency of urination, feeling very tired, and losing pink color to skin and membranes due to anemia.

(Continue . . . )

 

 

For some of the best day-to-day coverage of this story, I would direct my readers to Crof at Crofsblog, who has been spending a lot of time finding and translating news items from the German Press.

 

For now, the source of this rare form of E. coli remains a mystery, and the number of cases continues to grow.

Cucumbers Linked To German E. Coli Outbreak

 

 

# 5577

 

The severe outbreak of E. coli in Germany – which as reportedly killed 4 people and sickened hundreds (see E. Coli & Hemolytic Uremic Syndrome In Germany) - has apparently been traced to cucumbers.

 

Three of four contaminated cucumbers analyzed by the Hamburg Institute for Hygiene and the Environment came from Spain, while the fourth was described as `organic’ but without a specified place of origin.

 

 

This report from Reuters.

 

Germans pin E. coli outbreak on Spanish cucumbers

HAMBURG | Thu May 26, 2011 8:57am EDT

HAMBURG May 26 (Reuters) - German health officials identified imported cucumbers from Spain on Thursday as the source of a two-week E. coli outbreak that has killed at least four people and made more than 100 others ill.

(Continue . . . )

 

 

While this may help solve the mystery as to how this virulent form of E. coli ended up in the food chain, with more than 100 people hospitalized and seriously ill with HUS (Hemolytic Uremic Syndrome), this story is far from over.

 

Genetic analysis of this rare VTEC (Verotoxin Producing Escherichia coli) continue.