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F.ood & H.ealth : B.iological A.gents Last Updated: Nov 12th, 2006 - 20:38:00


E. coli outbreak: What you need to know
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Sep 26, 2006, 10:02

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Update on Multi-State Outbreak of E. coli O157:H7 Infections From Fresh Spinach, September 25, 2006

As of 1 PM (ET) September 25, 2006, Monday, 175 persons infected with the outbreak strain of E. coli O157:H7 have been reported to CDC from 25 states.

Among the ill persons, 93 (53%) were hospitalized, 28 (16%) developed a type of kidney failure called hemolytic-uremic syndrome (HUS), and an adult in Wisconsin died. One hundred twenty-six (72%) were female and 16 (9%) were children under 5 years old. The proportion of persons who developed HUS was 29% in children (younger than 18 years old), 8% in persons 18 to 59 years old, and 16% in persons 60 years old or older. Among ill persons who provided the date when their illnesses began, 87% became ill between August 19 and September 5. The peak time when illnesses began was August 30 to September 1 -- 35% of persons with the outbreak strain became ill on one of those 3 days.

Two deaths among suspect cases have been reported. Suspect cases are not known to have been infected with the outbreak strain, so are not included in the confirmed case count. Idaho is investigating a suspect case in a 2-year-old child with HUS who died on September 20 and reportedly had recently consumed fresh spinach. E. coli O157 has not been detected in the child. Maryland is investigating a suspect case in an elderly woman who died on September 13 and had recently consumed fresh spinach. E. coli O157 was cultured from her stool, but "DNA fingerprinting" to determine whether it is the outbreak strain has not been possible.

CDC Advice for Consumers

The following is advice for consumers about this outbreak:

* Currently, we are advising consumers to not eat any fresh spinach or salad blends containing spinach grown in the three counties in California implicated in the current E. coli O157:H7 outbreak -- Monterey County, San Benito County, and Santa Clara County (see map of affected counties). Fresh spinach grown outside these counties can be safely eaten. Spinach grown in these counties is often packaged in other areas of the country. If consumers cannot tell where fresh spinach was grown, they are advised not to purchase or consume the fresh spinach. Frozen and canned spinach can be safely eaten.

* E. coli O157:H7 in spinach can be killed by cooking at 160° Fahrenheit for 15 seconds. (Water boils at 212° Fahrenheit.) If spinach is cooked in a frying pan, and all parts do not reach 160° Fahrenheit, all bacteria may not be killed. If consumers choose to cook the spinach, they should not allow the raw spinach to contaminate other foods and food contact surfaces, and they should wash hands, utensils, and surfaces with hot, soapy water before and after handling the spinach.

* Persons who develop diarrhea 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.

* Persons who ate fresh spinach or salad blends and feel well do not need to see a health-care provider.

More Information

For more information about the outbreak, about the investigation, and for prevention guidance, see E. coli O157:H7 Outbreak from Fresh Spinach.

Page last modified September 25, 2006
Content source: National Center for Infectious Diseases
Page Located on the Web at http://www.cdc.gov/foodborne/ecolispinach/current.htm


Questions and Answers about E. coli O157:H7 Outbreak from Fresh Spinach



September 24, 2006

Why is the number of cases increasing when the contaminated fresh spinach has been recalled and is being removed from the shelves?

The increasing number of E. coli O157:H7cases is partly due to the amount of time it takes to confirm that new cases are part of an outbreak. The time from the beginning of a patient’s illness to the confirmation that he or she was part of an outbreak is typically about 2-3 weeks. For a more detailed explanation of illness reporting, please see: http://www.cdc.gov/foodborne/ecolispinach/reportingtimeline.htm.

How long does it take for symptoms to show up after E. coli O157:H7 infection?

On average, symptoms from E. coli O157:H7 infection develop within 3 to 4 days of eating contaminated food, with a range of 1 to 10 days. Symptoms usually include severe bloody diarrhea and abdominal cramps; sometimes the infection causes non-bloody diarrhea or no symptoms. Usually little or no fever is present, and the illness resolves in 5 to 10 days. In some people, the infection can also cause a complication called hemolytic uremic syndrome (HUS), in which the red blood cells are destroyed and the kidneys fail.

How many and which states are affected?

Over 170 people in more than 20 states have been infected with E. coli O157:H7. For current information and daily updates, please visit the E. coli O157:H7 Outbreak website at http://www.cdc.gov/foodborne/ecolispinach/.

Which brands of spinach were contaminated?

State health officials, CDC, and FDA are currently working to determine the exact type(s) and brand(s) of fresh spinach that are contaminated. CDC is currently advising people to not eat any fresh spinach or salad blends containing spinach grown (not packaged) in the three counties in California implicated in the current E. coli O157:H7 outbreak — Monterey County, San Benito County, and Santa Clara County. Fresh spinach grown outside these counties can be safely eaten. Frozen and canned spinach can be safely eaten. If you cannot verify that the spinach was grown outside of these three counties, you should not buy or eat the fresh spinach.

Should I return purchased fresh spinach to the store where I bought it?

CDC recommends that you throw away any fresh spinach that you still have in your refrigerator or freezer in your regular trash.

How is E. coli O157:H7 illness treated?

Most people recover without specific treatment within 5 to 10 days. Antibiotics should not be used to treat this infection, and it is thought that treatment with some antibiotics could lead to kidney complications. Antidiarrheal agents, such as loperamide (Imodium®), should also be avoided.

In some people, E. coli O157:H7 infection can cause a complication called hemolytic uremic syndrome (HUS), a life-threatening condition that is 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%.

Can E. coli O157:H7 be passed to a baby?

Bacteria in diarrheal stools of infected persons can be passed from one person to another if the patient and family members do not properly wash their hands with soap and water before eating and using the bathroom and otherwise maintain good hygiene. This is particularly likely among toddlers who are not toilet trained. Family members and playmates of these children may be at high risk of becoming infected. Young children typically shed the organism in their feces for a week or two after their illness resolves. Older children rarely carry the organism without symptoms. To prevent transmission to a baby, infected individuals should avoid direct contact with infants and toddlers.

Have there been any other outbreaks of E. coli O157:H7 in the United States?

Outbreaks of E. coli O157:H7 infection occur regularly and have been both large and small, in localized areas and across several states. Transmission of E. coli was first associated with contaminated with ground beef, but have also been spread through unpasteurized fruit juices, lettuce, and contaminated drinking water, as well as contact with infected animals (such as petting zoos) and person-to-person, especially among children in day care centers. The way E. coli O157:H7 is transmitted changes over time which is why the CDC works closely with state health departments to monitor and investigate cases and outbreaks of E. coli O157:H7.

Are other leafy greens and vegetables safe to eat?

Other leafy greens, vegetables, and fruits are safe to eat.

Consumers should always practice safe food handling and preparation measures. At home, keep raw meat, poultry and seafood separate from produce and ready-to-eat foods. Wash hands, utensils, and surfaces with hot, soapy water before and after handling food. At the grocery store, separate raw meat, poultry, seafood and eggs from other foods in your shopping cart and grocery bags.

Do restaurants buy the same spinach that is available at the grocery store?

Restaurants and grocery stores often buy spinach from the same major food distributors in the U.S. Therefore, the spinach that you purchase from a grocery store may have been grown in the same fields and processed by the same company as the spinach that you eat in a restaurant.

CDC and FDA are working to ensure that the restaurant industry is fully aware of the E. coli O157:H7 outbreak related to spinach and are taking the appropriate measures to prevent exposure of their customers to E. coli O157:H7.

Restaurants should not purchase spinach grown in the three counties in California implicated in the current E. coli O157:H7 outbreak — Monterey County, San Benito County, and Santa Clara County. If you cannot verify that the spinach the restaurant is serving was grown outside of these three counties, you should not buy or eat the fresh spinach. For more information on restaurant guidelines, contact your local health department.

How should I clean my kitchen surfaces to kill E. coli O157:H7 bacteria?

Wash countertops with a solution of 5 milliliters (1 teaspoon) of chlorine bleach in about 1 liter (1 quart) of water or with a commercial kitchen cleaning agent diluted according to product directions.

If handling fresh spinach, avoid cross-contamination with other foods and/or food contact surfaces. Wash hands thoroughly with hot, soapy water; wash utensils and surfaces with bleach, cleaning agents and/or hot, soapy water before and after handling spinach.

Dish cloths and sponges can harbor bacteria and may promote their growth. Wash these items weekly in hot water in the washing machine.

Periodically sanitize kitchen sink drains by pouring a solution of 1 teaspoon of bleach to 1 quart of water or a commercial kitchen cleaning agent down the sink drain. Food particles often get trapped in drains and disposals and, along with moistness, can create an ideal environment for bacteria growth.

If I threw out spinach with my trash, do I need to clean/empty my refrigerator?

Keeping a refrigerator clean at all times helps keep food safe. Any spills – especially those involving fresh spinach – should be wiped up immediately and surfaces should be cleaned thoroughly with a solution of 1 teaspoon of chlorine bleach in 1 quart of water, with a commercial kitchen cleaning agent or with hot, soapy water, and then rinsed. Once a week, make it a habit to throw out perishable foods that are past their expiration date. Visit http://www.fsis.usda.gov/Fact_Sheets/Refrigeration_&_Food_Safety/index.asp for more information.

Should I be concerned about the meals served at my child’s school?

Schools should not purchase spinach grown in the three counties in California implicated in the current E. coli O157:H7 outbreak — Monterey County, San Benito County, and Santa Clara County. If you cannot verify that the spinach the restaurant is serving was grown outside of these three counties, you should advise your child to not buy or eat the fresh spinach. For more information on school cafeteria guidelines, contact your local health department.

If you or your child have developed diarrhea after consuming fresh spinach or salad blends containing fresh spinach, contact your health care provider.

For information about E. coli O157:H7 symptoms, treatment, and prevention, see http://www.cdc.gov/ncidod/dbmd/diseaseinfo/escherichiacoli_g.htm.

Page last modified September 24, 2006
Content source: National Center for Infectious Diseases
Page Located on the Web at http://www.cdc.gov/foodborne/ecolispinach/qa_ecoli_freshspinach.htm


E. coli: Frequently Asked Questions




Escherichia coli O157:H7 is a leading cause of foodborne illness. Based on a 1999 estimate, 73,000 cases of infection and 61 deaths occur in the United States each year. In the ten CDC Foodborne Diseases Active Surveillance Network (FoodNet) sites (which represent 15% of the US population), there was a 29% decline in E. coli O157:H7 infection since 1996-98 (see FoodNet Reports).

Infection with E. coli often leads to bloody diarrhea, and occasionally to kidney failure. People can become infected with E.coli O157:H7 in a variety of ways. Though most illness has been associated with eating undercooked, contaminated ground beef, people have also become ill from eating contaminated bean sprouts or fresh leafy vegetables such as lettuce and spinach. Person-to-person contact in families and child care centers is also a known mode of transmission. In addition, infection can occur after drinking raw milk and after swimming in or drinking sewage-contaminated water.

Consumers can prevent E. coli O157:H7 infection by thoroughly cooking ground beef, avoiding unpasteurized milk, and by washing hands carefully before preparing or eating food. Fruits and vegetables should be washed well, but washing may not remove all contamination. Public service announcements on television, radio, or in the newspapers will advise you which foods to avoid in the event of an outbreak.

Because the organism lives in the intestines of healthy cattle, preventive measures on cattle farms, during meat processing, and during the growth, harvest and processing of produce are being investigated.

What is Escherichia coli O157:H7?

E. coli O157:H7 is one of hundreds of strains of the bacterium Escherichia coli. Although most strains are harmless, this strain produces a powerful toxin that can cause severe illness. E. coli O157:H7 has been found in the intestines of healthy cattle, deer, goats, and sheep.

E. coli O157:H7 was first recognized as a cause of illness in 1982 during an outbreak of severe bloody diarrhea; the outbreak was traced to contaminated hamburgers. Since then, more infections in the United States have been caused by eating undercooked ground beef than by any other food.

The combination of letters and numbers in the name of the bacterium refers to the specific markers found on its surface and distinguishes it from other types of E. coli.

How is E. coli O157:H7 spread?

The organism can be found on most cattle farms, and it is commonly found in petting zoos and can live in the intestines of healthy cattle, deer, goats, and sheep. Meat can become contaminated during slaughter, and organisms can be accidentally mixed into meat when it is ground. Bacteria present on the cow's udders or on equipment may get into raw milk. In a petting zoo, E.coli O157:H7 can contaminate the ground, railings, feed bins, and fur of the animals.

Eating meat, especially ground beef, that has not been cooked sufficiently to kill E. coli O157:H7 can cause infection. Contaminated meat looks and smells normal. The number of organisms required to cause disease is very small.

Among other known sources of infection are consumption of sprouts, lettuce, spinach, salami, unpasteurized milk and juice, and by swimming in or drinking sewage-contaminated water.

Bacteria in loose stool of infected persons can be passed from one person to another if hygiene or hand washing habits are inadequate. This is particularly likely among toddlers who are not toilet trained. Family members and playmates of these children are at high risk of becoming infected.

Young children typically shed the organism in their feces for a week or two after their illness resolves. Older children and adults rarely carry the organism without symptoms.

What illness does E. coli O157:H7 cause?

People generally become ill from E. coli O157:H7 two to eight days (average of 3-4) after being exposed to the bacteria. Escherichia coli O157:H7 infection often causes severe bloody diarrhea and abdominal cramps. Sometimes the infection causes non-bloody diarrhea or no symptoms. Usually little or no fever is present, and the illness resolves in 5 to 10 days.

In some persons, particularly children under 5 years of age and the elderly, the infection can also cause a complication called hemolytic uremic syndrome (HUS), in which the red blood cells are destroyed and the kidneys fail. About 8% of persons whose diarrheal illness is severe enough that they seek medical care develop this complication. In the United States, HUS is the principal cause of acute kidney failure in children, and most cases of HUS are caused by E. coli O157:H7.

How is E. coli O157:H7 infection diagnosed?

Infection with E. coli O157:H7 is diagnosed by detecting the bacterium in the stool. About one-third of laboratories that culture stool still do not test for E. coli O157:H7, so it is important to request that the stool specimen be tested on sorbitol-MacConkey (SMAC) agar for this organism. All persons who suddenly have diarrhea with blood should get their stool tested for E. coli O157:H7.

How is the illness treated?

Most people recover without antibiotics or other specific treatment within 5 to 10 days. Antibiotics should not be used to treat this infection. There is no evidence that antibiotics improve the course of disease, and it is thought that treatment with some antibiotics could lead to kidney complications. Antidiarrheal agents, such as loperamide (Imodium®), should also be avoided.

In some people, E. coli O157:H7 infection can cause a complication called hemolytic uremic syndrome (HUS), a life-threatening condition that is 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%.

What are the long-term consequences of infection?

Persons who only have diarrhea usually recover completely.

A small proportion of persons with hemolytic uremic syndrome (HUS) have immediate complications with lifelong implications, such as blindness, paralysis, persistent kidney failure, and the effects of having part of their bowel removed. Many persons with hemolytic uremic syndrome have mild abnormalities in kidney function many years later.

What can be done to prevent the infection?

Cattle are the principal source of E. coli O157 infection; they carry E. coli O157 in their intestines. Changes in the preparation of animals for slaughter and in slaughter and processing methods could decrease the contamination of carcasses with E. coli O157 and the subsequent contamination of meat. Testing ground beef for E. coli O157 and withholding it from the market until the test is negative, as many meat producers began doing in 2002, is probably partly responsible for the subsequent decrease in illnesses.

Cattle manure is an important source of E. coli O157. Manure can contaminate the environment, including streams that flow through produce fields and are used for irrigation, pesticide application, or washing. Collaborative efforts are needed to decrease environmental contamination and improve the safety of produce.

What can you do to prevent E. coli O157:H7 infection?

* Cook all ground beef and hamburger thoroughly. Because ground beef can turn brown before disease-causing bacteria are killed, use a digital instant-read meat thermometer to ensure thorough cooking. Ground beef should be cooked until a thermometer inserted into several parts of the patty, including the thickest part, reads at least 160º F. Persons who cook ground beef without using a thermometer can decrease their risk of illness by not eating ground beef patties that are still pink in the middle.

* If you are served an undercooked hamburger or other ground beef product in a restaurant, send it back for further cooking. You may want to ask for a new bun and a clean plate, too.

* Avoid spreading harmful bacteria in your kitchen. Keep raw meat separate from ready-to-eat foods. Wash hands, counters, and utensils with hot soapy water after they touch raw meat. Never place cooked hamburgers or ground beef on the unwashed plate that held raw patties. Wash meat thermometers in between tests of patties that require further cooking.

* Drink only pasteurized milk, juice, or cider. Commercial juice with an extended shelf-life that is sold at room temperature (e.g. juice in cardboard boxes, vacuum sealed juice in glass containers) has been pasteurized, although this is generally not indicated on the label. Juice concentrates are also heated sufficiently to kill pathogens.

* Wash fruits and vegetables under running water, especially those that will not be cooked. Be aware that bacteria are sticky, so even thorough washing may not remove all contamination. Remove the outer leaves of leafy vegetables. Children under 5 years of age, immunocompromised persons, and the elderly should avoid eating alfalfa sprouts until their safety can be assured. Persons at high risk of complications from foodborne illness may choose to consume cooked vegetables and peeled fruits.

* Drink municipal water that has been treated with chlorine or another effective disinfectant.

* Avoid swallowing lake or pool water while swimming. (For more information, see the CDC Healthy Swimming website.)

* Make sure that persons with diarrhea, especially children, wash their hands carefully with soap after bowel movements to reduce the risk of spreading infection, and that persons wash hands after changing soiled diapers. Anyone with a diarrheal illness should avoid swimming in public pools or lakes, sharing baths with others, and preparing food for others.

updated Sept. 24, 2006


All content cited from http://www.cdc.gov/foodborne/ecolispinach/whatsnew.htm




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