E. coli 0157:H7

1. E. coli 0157:H7

2. Presented by • Kendra McQueen • Jennifer Rasmussen • Edward Guevara

3. E. coli 0157:H7 In February 2004, the Okinawa Prefectural Chabu Health Center and the Okinawa Prefectural Institute of Health and Environment reported multiple cases of E. coli 0157:H7 in a single family possibly after eating contaminated meat bought at a U.S. military commissary in Okinawa. Positive ID of E. coli 0157:H7 was made on 02/17/2004, after OCHC gathered samples of the frozen meat and analyzed it by means of pulse field gel electrophoresis (PFGE), a process in which gel medium can differentiate between DNA fragments, simply by changing the electrical potential within the gel. The samples were sent to PulseNet USA for comparison to U.S. isolates, and matched E. coli 0757:H7. To exclude the possibility of contamination after opening of the meat packages, the U.S. Naval Hospital, Okinawa, Jp. Obtained unopened packages, leftovers, and the samples of human isolates, and compared all the samples. Per the report by the CDC, the isolates had indistinguishable PFGE patterns. Over 90000 Lbs of frozen meat from the U.S. and Far East bases were pulled by Richwood Meat Co., Inc., of Merced, California.

4. I thought E. Coli was Good?

5. E. coli 0157:H7 • E. coli is a normal inhabitant of the intestines of all animals, including humans. Normally E. coli serves a useful function in the body, by suppressing the growth of harmful bacterial species, and by synthesizing appreciable amounts of Vitamins. E. coli 0157:H7 on the other hand produces toxins that cause severe damage to the lining of the intestine, and produce illness in humans. Some of the S/S are diarrhea, fever, cramps, Abd. pain, vomiting and in severe cases hemorrhagic diarrhea that can cause death in the very young and the very old. • An estimated 73,000 cases occur annually in the United States. That number is probably many times multiplied due to poor reporting in less industrialized countries.

6. Where does it come from?

7. Come and get it, mmm

8. E. coli 0157:H7 • Undercooked or raw hamburger (ground beef) has been implicated in many of the documented outbreaks, however E. coli O157:H7 outbreaks have implicated alfalfa sprouts, unpasteurized fruit juices, dry-cured salami, lettuce, game meat, and cheese curds. Raw milk was the vehicle in a school outbreak in Canada.

9. Treatment

10. E. coli 0157:H7 • Most persons recover without antibiotics or other specific treatment in 5-10 days.Treatment of E. coli infection generally consists of managing dehydration caused by diarrhea. Usually, the infection goes away on its own. If you develop a severe blood problem, such as anemia, you will receive fluids and, if necessary, have a blood transfusion. If you develop kidney problems, you may have wastes removed from your blood (dialysis).Hemolytic uremic syndrome is a life-threatening condition usually treated in an intensive care unit. Blood transfusions and kidney dialysis are often required. With intensive care, the death rate for hemolytic uremic syndrome is 3%-5%.

11. How do we control this type of epidemic outbreak ?

12. E. coli 0157:H7 • There are many ways to control this type of epidemic outbreak. Most important is to cook all ground beef and hamburger thoroughly. That means not only cooking until completely browned but also keeping a digital meat thermometer to check internal temperature. Also equally important is to avoid spreading the bacteria in the kitchen this is done a few different ways, always keep raw meat separate from ready-to-eat foods, always wash hands, counters and utensils with hot soapy water after they touch raw meat, never place cooked hamburgers or ground beef on the same plate that held the raw meat, and wash meat thermometers and utensils between tests of patties that require further cooking. Never hesitate to send a hamburger or ground beef back that looks undercooked. Another way to stop the spread of contamination is to assist toddlers to the bathroom and help them wash their hands thoroughly. Definitely be sure to wash hands after changing soiled diapers. Always have wipes and disinfectant spray handy in the bathroom, kitchen, and other places of need. Anyone with diarrhea should avoid swimming in public pools or lakes, sharing baths with others, and preparing food for others.

13. How was this allowed to spread?

14. E. coli 0157:H7 • There were many conditions present that allowed bacterial growth and spread. First, since the organism is found in the intestines of healthy cattle, it is noted that meat can become contaminated during slaughter, and organisms can be thoroughly mixed into beef when it is ground. Also, meat is not being cooked sufficiently enough to kill the bacteria E. coli 0157:H7. The bacteria in stool of infected persons can be passed from one person to another if hygiene and hand washing habits are inadequate. Toddlers and children contribute to the “infecting others” category greatly. This leads to children and toddlers spreading the bacteria to family members and playmates. Finally the 6 month lag between the production in the U.S. and the actual sale in Japan, demonstrates the long life of products such as frozen ground meat and the prolonged survival of food borne pathogens in frozen food.

15. Can this be prevented?

16. E. coli 0157:H7 • The CDC explains that this organism lives in the intestines of healthy cattle, so preventative measures need to be taken at the very beginning. They go on to explain that research is being done to find measures that will prevent meat from being contaminated during the slaughter process. The consumer would take the next step of prevention, the CDC says that safe food handling in preparation of foods can correct the problem of contamination. Meat has to be cooked to the proper temperature. The CDC explains that a digital instant read thermometer should be used and the temperature should read 160 degrees F to be safe. The USDA explains that it is not enough to go by the color of the meat, depending on whether the meat is fresh or frozen can make a difference in the color of the meat at the safe temperature. They go on to explain how research shows that one quarter of the burgers tested were brown before the safe temperature was met. The CDC agrees and adds that beef can turn brown before the pathogenic bacteria are killed. CDC states that proper hand washing, as well as cleaning and disinfecting areas used in cooking can prevent and correct an outbreak.

17. How do we educate the public?

18. E. coli 0157:H7 Being educated about foods that hold a certain risk to consumers is very important in preventing outbreaks of E.coli as well as other food borne pathogens. The CDC says to cook beef thoroughly, avoid raw milk or fruit juice and wash hands. • Get off to a CLEAN start: One of the best ways to prevent the spreading of and illness is handwashing. This needs to be done before and after food handling as well as when switching between different foods. • CHILL food and stop bacteria cold: The danger zone for bacterial growth is between 40-140 degrees F. Chilling foods does not kill the bacteria it only stops growth. Cooking kills. • SEPARATE don’t cross contaminate: Raw meat should be placed on the bottom shelf in the fridge so it cannot drip onto other foods. When shopping, storing or preparing food, raw meat should be placed away from ready to eat foods. • COOK safely: Cooking meat to the safe temperature, 160 degrees F, kills E.coli. Hamburger can turn brown before it is at this safe temperature. The look, color, or feel of the meat is not a test for doneness, only trust the thermometer.

19. Sources • CDC website http://www.cdc.gov • Food Safety and Inspection Service http://www.fsis.usda.gov • U.S. Food & Drug Administration http://www.fda.gov http://www.cfsan.fda.gov • Yahoo Health http://health.yahoo.com/ency/healthwise/hw133795 • USDA www.fsis.usda.gov/oa/news/1998/colorpr.htm • Canadian Food Inspection Agency www.inspection.gc.ca/english/corpaffr/foodfacts/ecolie.shtml