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Marler Blog Providing Commentary on Food Poisoning Outbreaks & Litigation

Non-O157 E. coli – An Alphabet Soup of Illness

E. coli O157:H7, O26, O111, O103, O121, O45 and O145 – it can get a bit(e) confusing.

As of June 8, 2012, the CDC and various State health Departments report that there are 14 cases of Shiga toxin-producing Escherichia coli (STEC) O145 infection with indistinguishable DNA patterns that have been identified in lab samples from persons in 6 states: Alabama (2), California (1), Florida (1), Georgia (5), Louisiana (4), Tennessee (1). The dates when those people became ill range from April 15 to May 12, 2012.

Since the Jack-in-the-Box E. coli O157:H7 outbreak in 1992/1993, the food industry and public health has been focused on that most dangerous bug as an adulterant in ground beef.  However, under recently enacted rules adopted by the USDA’s FSIS, six additional strains of E. coli will be classified as adulterants on par with the better-known E. coli O157:H7, which was often linked to serious illnesses tied to hamburger. The new strains include E. coli O26, O111, O103, O121, O45 and O145.  Hopefully my Petition in 2009 helped prompt this movement a little.

According to the CIDRAP, these six STEC strains account for 80 percent of non-O157 E. coli illnesses infections. The Centers for Disease Control and Prevention estimates non-O157 E. coli strains cause 112,000 illnesses annually.

Although non-O157 E. colis tended not to be tracked as frequently as their nasty cousin E. coli O157:H7, there have been some reported outbreaks according to my friends at Outbreak Database:

Jimmy John’s Restaurants Raw Clover Sprouts 2011:  On February 15, 2012, the Centers for Disease Control first announced an ongoing investigation into illnesses linked to the consumption of raw clover sprouts consumed at Jimmy John’s Restaurants in several states. The illnesses were caused by E. coli O26. By April 3, 29 cases were known. Illness onsets ranged from December 25, 2011 to March 3, 2012. Ill persons ranged in age from 9 years to 57 years old, with a median age of 26 years old. Eighty nine percent of the cases were female. No cases developed hemolytic uremic syndrome (HUS), however 7 cases were hospitalized. No deaths were reported. The FDA and the states conducted a traceback that identified two separate sprouting facilities; both used the same lot of seed to grow clover sprouts served at Jimmy John’s restaurant locations. On February 10, 2012, the seed supplier initiated notification of sprouting facilities that received this lot of clover seed to stop using it. On February 17, Jimmy John’s Restaurants announced that it was pulling sprouts from its restaurant menus.

Cargill Meat Solutions/BJ’s Wholesale Club Ground Beef 2010:  A recall of ground beef was issued on August 28 when three people developed illnesses caused by rare strain of E. coli O26 after they had eaten the product. The ground beef produced by Cargill Meat Solutions, of Pennsylvania and was distributed to BJ’s Wholesale Clubs in New York, Maine, Connecticut, Virginia, New Jersey, New Hampshire, Massachusetts, and Maryland.

Freshway Foods Romaine Lettuce 2010, non-O157 STEC:  Cases of a genetically identical strain of E. coli O145 were identified in the states of Michigan, Ohio, Tennessee, Pennsylvania, and New York. Illness onsets occurred between April 10 and 26. Several of the cases were students at Ohio State University, the University of Michigan, and Daemen College (Buffalo, New York). Several of the ill in Ann Arbor, Michigan, had eaten at a common restaurant. At least four students in the Wappinger Central School District, in New York State, were also involved in the outbreak. Shredded lettuce served in the school district tested positive for E. coli bacteria. Romaine lettuce was named as the vehicle for this outbreak, on May 6, after the same strain of E. coli O145 was found in a Freshway Foods romaine lettuce sample in New York State. Freshway Foods issued a voluntary recall of various bagged lettuces. The traceback investigation suggested that the source of the lettuce was a farm in Yuma, Arizona. In Ohio, a second, independent strain, of pathogenic E. coli was isolated from Freshway Foods bagged, shredded, romaine lettuce, E. coli O143:H34. This strain was not linked to any known food-borne illness. The isolation of the second strain of E. coli led to an additional recall of lettuce. Andrew Smith Company, of California, launched a recall of lettuce sold to Vaughan Foods and to an unidentified third firm in Massachusetts. Vaughan Foods of Moore, Oklahoma, received romaine lettuce harvested from the same farm in Yuma, Arizona; the romaine lettuce had been distributed to restaurants and food service facilities.

Country Cottage Restaurant 2008, Non-O157 STEC:  Customers eating at the Country Cottage Restaurant in Locust Grove, Oklahoma, between August 15 and August 24, 2008, became ill with E. coli O111. The exact mode of spread within the restaurant was never established, however the epidemiological analysis suggested that there had been ongoing foodborne transmission until health officials closed the restaurant on August 25. E. coli O111 was not isolated from any food or environmental surface in the restaurant. It was uncertain how the contamination entered the restaurant. Five employees had reported consistent illness symptoms prior to, or concurrent with, the outbreak. Stool samples collected from ill employees failed to show the presence of E. coli O111. A private well on the premises had been accessed and used to supply water to the restaurant just prior to the initiation of the outbreak. Water sample testing showed the presence of total and fecal coliforms. Numerous E.coli were cultured from the well water samples, but none were found to be Shiga toxin producing or typed as O111. Twenty-six persons developed hemolytic uremic syndrome, a serious kidney and blood complication of toxigenic E. coli infections.

Jefferson County Jail Pasteurized American Cheese or Margarine 2007:  An outbreak attributed to three strains of E. coli bacteria, not E. coli O157:H7, occurred at the Jefferson County Jail, in Colorado. The strains of E. coli associated with this outbreak were: O121; O26; O84. A report from the Centers for Disease Control and Prevention named pasteurized, American style, cheese, or margarine, as the vehicles for this outbreak.

North Dakota Wedding Reception Held in Private Home 2007:  An outbreak of E. coli O111 occurred among attendees of a wedding reception that was held at a private home. Ground beef was the named vehicle of infection.

Strawberries or Blueberries 2006:  An outbreak of E. coli O26 occurred in Massachusetts. The vehicles were strawberries or blueberries.

Utah Wendy’s Restaurant Lettuce 2006:  Iceberg lettuce that had been prepared and served to patrons of the Wendy’s Restaurant, in Ogden, Utah, and to attendees of a catered teachers’ conference at a junior high school (CORE academy) was implicated in an outbreak of E.coli O121:H19. This is a rare strain of E. coli. Three people developed kidney failure. Lettuce was the only food that all of the sickened people had eaten. The lettuce was not available for testing after the outbreak was recognized.

DuPage County Restaurant 2005, non-O157 STEC:  Enterotoxigenic E. coli O169:H41 was implicated in 24 illnesses from a DuPage County, Illinois restaurant. The health department investigation implicated the restaurant as the likely source of the infections, however no particular food could be identified as the likely vehicle of infection.

Olive Garden Restaurant 2005, non-O157 STEC:  A Gresham, Oregon, Olive Garden was identified as the source of an E. coli O169:H41 outbreak in April. When members of two families and a case unrelated to the families were reported, the health department investigated. No one food served at the restaurant was strongly associated with an increased risk of illness. It was suspected that a food worker had contaminated the food.

New York State Apple Cider 2004, Non-O157 STEC:  Direct sales of fresh pressed apple cider from an orchard in New York State led to outbreaks of E. coli 0111 and Cryptosporidium parvum. The facility qualified as a retail establishment and was exempt from HACCP regulations.