Posted: January 26th, 2012 - 7:26pm
by Doug Powell
When a strain of shiga toxin producing E. coli (VTEC O8:H19) was found in Spanish cucumbers in May 2011 during the Germany-based sprout outbreak that killed 53 – and subsequently proven to not be the outbreak strain – producers and politicians focused on how public health got it wrong, and demands for compensation.
Shouldn’t it have been worrisome that any shiga-toxin producing E. coli was found at retail, in a cucumber?
Researchers in Sweden are now reporting that microsporidia may be an underreported source of foodborne illness after cucumbers were linked to dozens of sick people visiting a hotel in Sweden. Abstract below.
Microsporidia are spore-forming intracellular parasites that infrequently cause disease in immunocompetent persons. This study describes the first report of a foodborne microsporidiosis outbreak which affected persons visiting a hotel in Sweden.
Enterocytozoon bieneusi was identified in stool samples from 7/11 case-patients, all six sequenced samples were genotype C. To confirm that this was not a chance finding, 19 stool samples submitted by healthy persons from a comparable group who did not visit the hotel on that day were tested; all were negative for microsporidia. A retrospective cohort study identified 135 case-patients (attack rate 30%). The median incubation period was 9 days.
Consumption of cheese sandwiches [relative risk (RR) 4·1, 95% confidence interval (CI) 1·4–12·2] and salad (RR 2·1, 95% CI 1·1–4) were associated with illness. Both items contained pre-washed, ready-to-eat cucumber slices.
Microsporidia may be an under-reported cause of gastrointestinal outbreaks; we recommend that microsporidia be explored as potential causative agents in food- and waterborne outbreaks, especially when no other organisms are identified.
Cucumbers came under fresh suspicion on Wednesday in Germany's desperate hunt for a pathogen that has killed 26 people, with investigators discovering the mutant bacteria on food scraps in a family's garbage.
It was the first time the type O 104 enterohaemorrhagic Escherichia coli (EHEC) had been confirmed on any food since the outbreak began in mid-May. All the other evidence has come from fecal tests.
The scraps turned up in garbage in the eastern city of Magdeburg, authorities of the state of Saxony-Anhalt said.
Three of the family have been sick: the father only had a stomach upset, the mother has been discharged after a hospital stay for diarrhea and the daughter is suffering from hemolytic-uraemic syndrome (HUS), a condition caused by EHEC where the kidneys fail.
Experts said they still did not know how the bacteria came to be on the cucumber, which had been in the bin for a week and a half.
Earlier in the day, investigators affirmed that bean sprouts from a market garden remained the likeliest cause of the E coli outbreak, despite the fact that the pathogen has not been found on any sprouts.
At a Berlin news conference, officials summed up the evidence against sprouts.
One woman working at the Bienenbuettel Gaertnerhof, an organic sprout grower, has been infected with EHEC, the germ behind the outbreak, and two other women there had unexplained diarrhea in May, Lower Saxony state officials said.
Two more clusters of EHEC victims were meanwhile confirmed as having eaten sprouts from the Gaertnerhof.
Consumer Affairs Minister Ilse Aigner said a total of eight clusters of EHEC victims who ate Gaertnerhof products had been spotted this way
Amy’s in Switzerland working on some memories, so while she had a salad with cucumbers and raw sprouts, me and Sorenne had pizza.
I have no trouble saying, ‘no sprouts’ and am known at a local Manhattan (Kansas) eatery as the no-sprouts person. So is Amy. But not in Europe.
There’s a lot of social protocol over there, in Europe, and I try to stay out of it when visiting, but when there’s an outbreak of foodborne illness linked to 18 dead, 520 with HUS and 1,733 sick, then I’d say something.
I say something if an employee doesn’t wash their hands.
Amy went to France the other day and I’ve got the 1973 classic, Come Monday by Jimmy Buffett running through my head (check the video below; now that’s a moustache).
But Amy’s worried about cucumbers.
This is a photo of her airplane meal.
For a continent that prides itself on traceability and farmers’ markets, the response to the E. coli O104 outbreak, which has killed 17, stricken 470 with severe kidney disease and sickened some 1,500, has been woefully inadequate.
And now, 10 days after the outbreak emerged, the Germans say it wasn’t Spanish cucumbers in some sort of European revisionist history (they’re good at that).
Here are the top-5 dumb things about the E. coli O104 outbreak; at some point politics may take a back seat to public health; but this is Europe.
Spain's agriculture minister Rosa Aguilar defended her country's fresh produce and said it is still unclear exactly when and where the vegetables were contaminated.
She even tucked in to some cucumbers grown in Spain on Monday to show they cannot be blamed for one of the largest E. coli outbreaks in the world.
What no one has mentioned is the on-farm food safety steps that Spanish and other growers, distributors and retailers take to ensure microbial food safety. An outbreak this huge is an opportunity to brag – if procedures are in place. But maybe that’s why no one is bragging.
4. Terrible journalism
Why has no one tried to track down the source and looked at food safety procedures? The New York Times, 10 days into the crisis went with, Outbreak of Infections, probably the worst headline ever. E. coli O104 is not herpes. Time magazine went with, don’t panic, but be concerned.
3. It’s a trade/money thing
Contrary to humanistic goodwill, most food safety trade issues have nothing to do with public health and everything to do with market access. That’s why Gerd Sonnleitner, the head of the German Farmers' Association (DVB), called for stronger regulation of imported vegetables and said there has been unwarranted fearmongering about German vegetable products.
“We have very strict rules over the entire chain on controlling and accepting what we think is right,” Sonnleitner said. “Unfortunately imports are tested much more laxly.
So why isn’t Sonnleitner explaining all the things German farmers do to enhance on-farm food safety?
No need. They’ve decided to sue German health authority the Robert Koch Institute and the Federal Consumer Ministry for damages over warnings about eating vegetables made to the public in the wake of the E. coli bacteria outbreak.
2. It’s a small risk thing
More people die every day in car accidents than are likely to perish from the current E. coli outbreak. Yet we know every time we get behind the wheel of a car that we are taking a small risk. We don't, on the other hand, expect to die from eating a cucumber.
The left-wing Berliner Zeitung was the strongest proponent of the latter case, arguing that 21st-century consumers were so geographically and psychologically disconnected from their food production that they had only themselves to blame.
The right-wing Berliner Morgenpost pointed out that swine flu resulted in a much higher death toll than that caused so far by E. coli. And swine flu, ultimately, was seen as media hype.
Even the small risk posed by the bacteria could be avoided by taking sensible hygiene precautions. And if a person does get sick, they can see their doctor right away.
“Women prepare food more often, and it is there they could have come into contact with it, possibly while cleaning vegetables or other foodstuffs.”
In a German version of blame-the-consumer, the Robert Koch Institute has recommended people improve kitchen hygiene, making sure in particular that cutting boards and knives are clean.
It’s doubtful that 1,500 women practiced lousy kitchen cleanliness at the same time across Germany.
Medical authorities appeared no closer to discovering either the source of the infection or the mystery at the heart of the outbreak: why the unusual strain of the E. coli bacteria appears to be causing so many cases of hemolytic uremic syndrome, which attacks the kidneys and can cause seizures, strokes and comas.
The outbreak has hit at least nine European countries but virtually all of the sick people either live in Germany or recently traveled there.
German authorities initially pointed to cucumbers from Spain after people in Hamburg fell ill after eating fresh produce. After tests of some 250 samples of vegetables from around the city, only the three cucumbers from Spain and one other of unknown origin tested positive E. coli.
But further tests showed that those vegetables, while contaminated, did not cause the outbreak. Officials are still warning all Germans to avoid eating raw cucumbers, tomatoes or lettuce.
German Health Minister Daniel Bahr said Monday that authorities still haven't pinned down definitively the source of the E. coli infection — and "we unfortunately still have to expect a rising number of cases."
An EU official who spoke on condition of anonymity due to standing regulations, said the transport chain was long, and the cucumbers from Spain could have been contaminated at any point along the route.
Spain, meanwhile, went on the defensive, saying there was no proof that the E. coli outbreak has been caused by Spanish vegetables.
"You can't attribute the origin of this sickness to Spain," Spain's Secretary of State for European Affairs, Diego Lopez Garrido told reporters in Brussels. "There is no proof and that's why we are going to demand accountability from those who have blamed Spain for this matter."
The European Centre for Disease Prevention and Control said in a risk assessment today that the HUS/STEC E. coli O104 outbreak is the largest in the world of its kind, with 14 dead, 352 with hemolytic uremic syndrome and over 1,200 sick.
German Health Minister Daniel Bahr said Monday that authorities still haven't pinned down definitively the source of the E. coli infection — and "we unfortunately still have to expect a rising number of cases."
An EU official who spoke on condition of anonymity due to standing regulations, said the transport chain was long, and the cucumbers from Spain could have been contaminated at any point along the route.
Spain, meanwhile, went on the defensive, saying there was no proof that the E. coli outbreak has been caused by Spanish vegetables.
"You can't attribute the origin of this sickness to Spain," Spain's Secretary of State for European Affairs, Diego Lopez Garrido told reporters in Brussels. "There is no proof and that's why we are going to demand accountability from those who have blamed Spain for this matter."
EU spokesman Frederic Vincent said Sunday that two greenhouses in Spain that were identified as the source of the contaminated cucumbers had ceased activities. The water and soil there are being analyzed to see whether they were the problem, and the results are expected Tuesday or Wednesday, Vincent said.
More women have died in Germany from an E. coli O104 outbreak linked to cucumbers grown in Spain, bringing the death toll to 10. Of the 1,000 or so sick, 276 have hemolytic uremic syndrome (HUS).
Hospitals in the city of Hamburg, where more than 400 people are believed to have been infected, were said to be overwhelmed and sending patients to clinics elsewhere in the country.
Austria's food safety agency ordered a recall of organically grown cucumbers, tomatoes and aubergines supplied by a Spanish producer which is thought to be the source of the outbreak. It said 33 Austrian stores were affected.
According to Denmark's National Serum Institute, there are nine confirmed cases, with at least another eight people suspected of having the intestinal infection, also known as VTEC, in Denmark.
Sweden has reported 25 E. coli cases, of whom 10 developed HUS, according to the European Commission, while Britain counted three cases (two HUS).
Officials in the Czech Republic said the cucumbers may have been exported there, as well as to Austria, Hungary and Luxembourg.
"As long as the experts in Germany and Spain have not been able to name the source of the agent without any doubt, the general warning for vegetables still holds," German Agriculture and Consumer Protection Minister Ilse Aigner said on Sunday in a report in the Bild am Sonntag newspaper.
The European Commission says experts are now probing two agricultural sites in southern Spain, in Almeria and Malaga, suspected of exporting products, most likely cucumbers, tainted with E. coli.
More women have died in Germany from an E. coli O104 outbreak linked to cucumbers grown in Spain, bringing the death toll to seven (or nine, depending on the media source). Of the 800 or so sick, 276 have hemolytic uremic syndrome (HUS).
The European Commission says experts are now probing two agricultural sites in southern Spain, in Almeria and Malaga, suspected of exporting products, most likely cucumbers, tainted with E.coli.
Fear of infection has lead many in Germany to change their eating habits. A survey carried out by Emnid for Bild am Sonntag has found that 58 percent of Germans are following the advice of the Robert Koch Institute and not eating raw cucumbers, lettuce or tomatoes.
"The Andalusian authorities are investigating to find out where the contamination comes from and when it took place," said a spokesman for the Spanish food safety agency AESA on Friday.
Spanish senior official Josep Puxeu said Germany informed the press about the disease before informing the EU, as it should have done, and that Spain has stopped cucumber deliveries while stressing there is no proof that the EHEC entered Germany through Spanish cucumbers.
There has been no report of contamination within Spain, AESA said.
Meanwhile, the outbreak is spreading across northern Europe. Health officials in Denmark and Sweden reported Friday a total of 32 confirmed cases of people afflicted by the EHEC bacterium, all of whom had previously been travelling in Germany.
Denmark's veterinary and food products agency said Friday it had found contaminated cucumbers from Spain in the stocks of two wholesalers in the west of the country and ordered them withdrawn.