FOOD: What is making us sick?

1. Jackie Dawson, PhDPublic Health EpidemiologistChelan, Douglas, Grant, Kittitas and Okanogan Counties886-6428jacqueline.dawson@cdhd.wa.gov FOOD: What is making us sick?

4. Outbreak of Shiga toxin-producing Escherichia coliO121 Infections Linked to Raw Clover Sprouts • Last update: June 10, 2014 • Case Count: 17 • Age range 11 to 45 years (median=27 yrs) • States: 5 • Deaths: 0 • Hospitalizations: 47% • Recall: No

5. What are Shiga toxin-producing E. coli? • Some kinds of E. coli cause disease by making a toxin called Shiga toxin. • “Shiga toxin-producing” E. coli, or STEC for short • STEC live in the guts of ruminant animals: • Cattle (major source for human illnesses) • Goats • Sheep • Deer • Elk • STEC generally do not make animals sick. • Pigs and birds sometimes pick up STEC from the environment and spread it.

6. E.coli Clinical Features • People usually get sick 2-8 days (average of 3-4 days) after swallowing the bacteria • Severe stomach cramps, diarrhea (often bloody) & vomiting • If there is fever, it usually is not very high (less than 101˚F) • Most people get better within 5–7 days. • 5–10% develop kidney failure called hemolytic uremic syndrome (HUS) • HUS can occur in people of any age, but is most common in young children under 5 years, older adults, and people with weakened immune systems. • Symptoms of HUS can include fever, abdominal pain, pale skin tone, fatigue and irritability, small, unexplained bruises or bleeding from the nose and mouth, and decreased urination. • Most recover within a few weeks, but some suffer permanent damage or die.

7. What is the best treatment for STEC infection? • Non-specific supportive therapy (including hydration) • Antibiotics should not be used to treat this infection. • Taking antibiotics may increase the risk of HUS. • Anti-diarrheal agents like Imodium® may also increase that risk. • Work and Child Care Restrictions: • Food handlers, child care attendants, child care attendees and healthcare workers require 2 negative stool specimens before returning to work or child care. • Stool specimens should be collected 24 hours apart and not sooner than 48 hours after the last dose of antibiotics

8. How long can an infected person carry STEC? • Typically disappear from the feces by the time the illness is resolved • May shed for several weeks-months, even after symptoms go away. • Young children tend to carry STEC longer than adults. • Good hand-washing!

9. ~265,000 STEC infections occur each year • O157 =36% (95,400 cases) • non-O157 =64%(169,600 cases)

10. Source of E. coli O121 Infection? Advice to Consumers: • Raw clover sprouts have not been recalled from Evergreen Fresh Sprouts (Moyie Springs, Idaho) • Evergreen Sprouts supplied sprouts to 7 restaurants • CDC recommends that consumers do not eat any raw clover sprouts produced by Evergreen Fresh Sprouts. • Contact your health care provider if you think you may have become ill from eating raw clover sprouts. • Sprouts are a known source of foodborne illness. • 1996, ~10 000 cases of E. coli O157:H7 occurred primarily in schoolchildren in Osaka, Japan • 2011, ~4,000 cases (>50 deaths) of E. coli O104:H4 occurred in northern Germany • Children, older adults, pregnant women, and persons with weakened immune systems should avoid eating raw sprouts of any kind (alfalfa, clover, radish, and mung bean sprouts). • Cook sprouts thoroughly to reduce the risk of illness. • When in doubt, throw it out!

11. FDA Inspection • FDA also conducted an inspection of Evergreen Fresh Sprouts' facility on 22-23 May 2014; 27-30 May 2014; and 6 Jun 2014. • Investigators observed a number of unsanitary conditions, • condensate and irrigation water dripping from rusty valves • rusty and corroded mung bean room watering system • tennis rackets that had scratches, chips, and frayed plastic used to scoop mung bean sprouts • pitchfork with corroded metal being used to transfer sprouts • squeegee with visible corroded metal and non-treated wood being used to agitate mung bean sprouts inside a soak vat • Recall: No

12. Past Problems at Evergreen Sprouts • April- July, 2011, a total of 25 persons infected with the outbreak strain of Salmonella Enteritidis have been reported from 5 states. • On July 1, 2011, Evergreen Fresh Sprouts LLC of Moyie Springs, Idaho, announced a recall of specific lots of alfalfa sprouts and spicy sprouts.

13. How can STEC infections be prevented? • WASH YOUR HANDS thoroughly after: • using the bathroom • changing diapers • before preparing or eating food • contact with animals or their environments (farms, petting zoos, fairs, home) • 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 • AVOID raw milk,unpasteurized dairy products,unpasteurized juices • 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: • washing hands, counters, cutting boards, & utensils after they touch raw meat

14. http://www.cdc.gov/foodnet/PDFs/incidence-bacterial-infections-2013-508c.pdfhttp://www.cdc.gov/foodnet/PDFs/incidence-bacterial-infections-2013-508c.pdf

15. Bacteria (Vibriovulnificus) • Isolated from oysters and other shellfish in warm coastal waters during the summer • 85% cases occur between May and October • Transmission: Eating raw or undercooked shellfish, particularly oysters harvested from warmer waters. • Bacteria does not alter the appearance, taste, or odor of oysters • Signs/symptoms: • Wound or soft tissue infections (direct contact with seawater) • Healthy people: causes watery diarrhea, vomiting & abdominal pain • Underlying medical conditions: especially liver disease, can cause bloodstream infections characterized by fever, chills, decreased blood pressure, blistering skin lesions, and often, death.

16. Questions?