29 September 2006

 

Update: E. coli O157:H7 outbreak, United States

On 14 September 2006, the United States Food and Drug Administration (FDA) alerted US consumers to an outbreak of E. coli O157:H7 infection associated with fresh spinach [1]. As of 28 September, 187 persons have been infected in 26 US states [2]. Among ill persons, 97 (52%) have been hospitalised, 29 (16%) have developed the complication of haemolytic-uraemic syndrome, and one person has died. Eighty-two percent of the cases became ill between 19 August 2006 and 5 September, with the peak of illness from 30 August to 1 September.

Cases have been reported from the following states: Arizona (7 cases), California (2), Colorado (1), Connecticut (3), Idaho (4), Illinois (1), Indiana (9), Kentucky (8), Maryland (3), Maine (3), Michigan (4), Minnesota (2), Nebraska (9), New Mexico (5), Nevada (1), New York (11), Ohio (25), Oregon (6), Pennsylvania (9), Tennessee (1), Utah (17), Virginia (2), Washington (3), West Virginia (1), Wisconsin (49), and Wyoming (1) [2].

 

E. coli O157:H7, or Vero-cytotoxin producing E. coli, causes diarrhoea that is often bloody with abdominal cramping. No fever or only low-grade fever may be present. Infection is frequently associated with undercooked ground beef that has been contaminated with the bacteria, but leafy greens and unpasteurised milk may transmit infection. Infection may also be transmitted person to person in situations of poor faecal-oral hygiene. Although the illness often resolves on its own after about a week, a severe complication of infection, haemolytic-uraemic syndrome, occurs in some patients, particularly young children and the elderly.

 

Advice to travellers [2]:

• The US Food and Drug Adminstration advises that persons should not eat fresh spinach or salad blends containing fresh spinach grown in three counties in the US state of California that have been implicated in the outbreak: Monterey County, San Benito County, and Santa Clara County. If persons cannot tell where the fresh spinach was grown, they are advised not to purchase or consume it. Frozen and canned spinach can be eaten safely.
• E. coli in spinach can be killed by cooking at 70 degrees centrigrade for 15 seconds. (Water boils at 100 degrees.) If persons choose to cook the spinach, they should avoid cross-contamination of the fresh spinach with other foods and food contact surfaces. Wash hands, utensils, and surfaces with hot, soapy water before and after handling the spinach.
• Persons who develop diarrhoea after consuming fresh spinach or salad blends containing fresh spinach are urged to contact their health care provider and ask that their stool specimen be tested for E. coli O157.

Guidelines for diagnosis and managment of cases of E. coli O157 can be found on the Health Protection Agency website at: http://www.hpa.org.uk/infections/topics_az/ecoli/O157/menu.htm

References:

 

1. United States Food and Drug Administration. FDA warning on serious foodborne E. coli O157:H7 outbreak. One death and multiple hospitalizations in several states. [online resource, accessed 29 September 2006]. Available at: http://www.fda.gov/bbs/topics/NEWS/2006/NEW01450.html

 

2. Centers for Disease Control and Prevention. Update on Multi-State Outbreak of E. coli O157:H7 Infections From Fresh Spinach, September 28, 2006. [online resource]. Accessed 29 September 2006. Available at: http://www.cdc.gov/foodborne/ecolispinach/current.htm  

Links

 

Centers for Disease Control and Prevention. E. coli O157:H7 outbreask associated with fresh spinach. [on-line resource, accessed 29 September 2006]. Available at: http://www.cdc.gov/foodborne/ecolispinach/

 

Health Protection Agency. Vero cytotoxin-producing Escherichia coli (VTEC) O157. [on-line resource, accessed 29 September 2006]. Available at: http://www.hpa.org.uk/infections/topics_az/ecoli/O157/menu.htm