Chase-Topping et al. report in the current issue of Emerging Infectious Disease that Escherichia coli O26 and O157 have similar overall prevalences in cattle in Scotland, but in humans, Shiga toxin–producing E. coli O26 infections are fewer and clinically less severe than E. coli O157 infections.

To investigate this discrepancy, we genotyped E. coli O26 isolates from cattle and humans in Scotland and continental Europe. The genetic background of some strains from Scotland was closely related to that of strains causing severe infections in Europe. Nonmetric multidimensional scaling found an association between hemolytic uremic syndrome (HUS) and multilocus sequence type 21 strains and confirmed the role of stx2 in severe human disease. Although the prevalences of E. coli O26 and O157 on cattle farms in Scotland are equivalent, prevalence of more virulent strains is low, reducing human infection risk.

However, new data on E. coli O26–associated HUS in humans highlight the need for surveillance of non-O157 enterohemorrhagic E. coli and for understanding stx2 phage acquisition.

The complete report is available at http://wwwnc.cdc.gov/eid/article/18/3/11-1236_article.htm.

Kirksville, Missouri, is home of Truman State University where Amy completed her undergraduate degree with bad 1980s hair and clothing (even though it was the 1990s), and where we trekked in March 2010 so French scholar Dr. Hubbell could give an invited seminar to her peers and reminisce.

Kirksville seems like a typical Midwest college town, which means the students probably like their Jimmy John’s sandwiches.

Jason Hunsicker of the Kirksville Daily Express reports that Jimmy John's is making a permanent menu change to put an end to the restaurant's connection to E. coli outbreaks from raw clover sprouts.

Will Aubuchon, owner and general manager of the Kirksville Jimmy John's, said an email was sent by "Jimmy himself" late Thursday night ordering all franchise locations to permanently remove raw clover sprouts from their menus.

It’s unclear whether the move applies to all raw sprouts or just clover (and the previously banned alfalfa) sprouts.

The move was made in the wake of an E. coli O26 outbreak that has sickened 12 people in five states, including Missouri. The Centers for Disease Control and Prevention issued a release stating an investigation into the outbreak determined the individuals were likely infected from raw clover sprouts they consumed at Jimmy John's restaurants.

The outbreak was not tied to the Kirksville restaurant and is not a direct result of conditions at any Jimmy John's restaurants, but instead problems with the company's supplier of the raw clover sprouts.

"Jimmy decided he was tired of the negative press from it and he thinks sprouts aren't necessary for Jimmy John's to rock," Aubuchon said.

Aubuchon said he's been working with Jimmy John's for 12 years and it is "kind of weird" to not have sprouts on the menu. He said regular Kirksville customers who ordered sprouts had read recent news reports and temporarily stopped adding the item to their sandwiches.

Now, however, the move will be permanent. Aubuchon expects some customers to be upset, but said he will encourage them to try alternative options like cucumbers. He also anticipates Jimmy John's will work to add a new vegetable offering to its menus.

Jimmy John's spokeswoman Mary Trader said on Thursday that the company is not releasing a statement at this time.

With five sprout-related outbreaks since 2008 at Jimmy John’s alone, they should be better at this public relations thing. A table of sprout-related outbreaks is available at http://bites.ksu.edu/sprouts-associated-outbreaks.

And if sprouts are gone from JJ’s menus, Jimmy may want to think about microbial food safety in general, those deli meats, lettuce and tomatoes. There have been lots of outbreaks and lots of sick people. Maybe this time it won’t have to happen in a Jimmy John’s outlet for the company to reassess what should be on the menu and what is required of suppliers to do business with Jimmy John’s.

Beginning in Nov. 2010, raw sprouts served on Jimmy John’s, sandwiches sickened 140 people, primarily in Indiana, with salmonella.

In January, 2011, Jimmy John’s owner Jimmy John Liautaud said his restaurants would replace alfalfa sprouts, effective immediately, with allegedly easier-to-clean clover sprouts.

This was one week after a separate outbreak of salmonella sickened eight people in Washington and Oregon in Jan. 2011 who had eaten at a Jimmy John’s that used clover sprouts. That’s a week after the salmonella-in-clover sprouts was publicly reported, yet the head of a large food franchise like Jimmy John’s was absolutely clueless about microbial risks associated with sprouts.

A year later, it’s happened again.

Raw clover sprouts served on Jimmy John’s sandwiches have sickened at least 12 people with E. coli O26; at least two people were sickened in my home state of Kansas, where I tell anyone who will listen why they might want to reconsider sprouts on sandwiches at Jimmy John’s, which are often catered in for meetings.

I won’t touch them.

A table of sprout-related outbreaks is available at http://bites.ksu.edu/sprouts-associated-outbreaks.

The U.S. Centers for Disease Control reported today that preliminary results of the epidemiologic and traceback investigations indicate eating raw clover sprouts at Jimmy John's restaurants is the likely cause of this outbreak.

The number of ill persons identified in each state is as follows: Iowa (5), Missouri (3), Kansas (2), Arkansas (1), and Wisconsin (1).

Two ill persons have been hospitalized, and no deaths have been reported.

FDA's traceback investigation is ongoing. Traceback information on sprouts has identified a common lot of clover seeds used to grow clover sprouts served at Jimmy John's restaurant locations where ill persons ate.

The type of bacteria responsible for this outbreak are referred to as shiga-toxin producing E. coli (STEC). STEC bacteria are grouped by serogroups (e.g., O157 or O26). The STEC serogroup found most commonly in U.S. patients is E. coli O157. Other E. coli serogroups in the STEC group, including O26, are sometimes called "non-O157 STECs." Some types of STEC frequently cause severe disease, including bloody diarrhea and hemolytic uremic syndrome (HUS). Others, such as common strains of STEC O26, typically cause milder illness. Currently, there are limited public health surveillance data on the occurrence of non-O157 STECs, including STEC O26; therefore, STEC O26 infections may go undiagnosed or unreported. Because non-O157 STEC infections are more difficult to identify than STEC O157, many clinical laboratories do not test for them. The STEC O26 PFGE pattern in this outbreak has rarely been seen before in PulseNet.
Initial Case Count

Among persons for whom information is available, illness onset dates range from December 25, 2011 to January 15, 2012. Ill persons range in age from 9 years to 49 years old, with a median age of 25 years old. One hundred percent of ill persons are female. Among the 12 ill persons, 2 (17%) were hospitalized. None have developed HUS, and no deaths have been reported.

Epidemiologic and traceback investigations conducted by officials in local, state, and federal public health, agriculture, and regulatory agencies have linked this outbreak to eating raw clover sprouts. Among the 11 ill persons with information available, 10 (91%) reported eating at a Jimmy John's sandwich restaurant in the 7 days preceding illness. Ill persons reported eating at 9 different locations of Jimmy John's restaurants in 4 states in the week before becoming ill. One location was identified where more than one ill person reported eating in the week before becoming ill. Among the 10 ill persons who reported eating at a Jimmy John's restaurant location, 8 (80%) reported eating a sandwich containing sprouts, and 9 (90%) reported eating a sandwich containing lettuce. Currently, no other common grocery stores or restaurants are associated with illnesses.

Preliminary traceback information has identified a common lot of clover seeds used to grow clover sprouts served at Jimmy John's restaurant locations where ill persons ate. FDA and states conducted a traceback that identified two separate sprouting facilities; both used the same lot of seed to grow clover sprouts served at these Jimmy John's restaurant locations. Preliminary distribution information indicates that sprouts grown from this seed lot were sold at a number of restaurant and grocery store locations in Iowa, Kansas, Missouri, and Wisconsin, and were likely distributed beyond these states. On February 10, 2012, the seed supplier initiated notification of sprouting facilities that received this lot of clover seed to stop using it. Investigations are ongoing to identify other locations that may have sold clover sprouts grown from this seed lot.

Based on previous outbreaks associated with sprouts, investigation findings have demonstrated that sprout seeds might become contaminated in several ways. They could be grown with contaminated water or improperly composted manure fertilizer. They could be contaminated with feces from domestic or wild animals, or with runoff from animal production facilities, or by improperly cleaned growing or processing equipment. Seeds also might become contaminated during harvesting, distribution, or storage. Many clover seeds are produced for agricultural use, so they might not be processed, handled, and stored as human food would. Conditions suitable for sprouting the seed also permit bacteria that might be present on seeds to grow and multiply rapidly.

In 1999, FDA released guidance to help seed producers and sprout growers enhance the safety of their products. Specific measures recommended in the guidelines include a seed disinfection step and microbiologic tests of water that has been used to grow each lot of sprouts. The microbiologic tests currently recommended under this guidance would not identify the presence of STEC O26.

My other youngest daughter is getting ready to go to camp for a month. I told her to watch the 1979 flick, Meatballs, again, for some tips as a councilor-in-training.

But not for food safety.

The Spokesman-Review reports that five kitchen workers at Camp Lutherhaven have been sickened by E. coli O26 Idaho Panhandle Health officials confirmed this morning.

Three more staffers are ill, but lab tests haven’t linked it to the bacterial infection.

No one has been hospitalized and the ill workers have been excluded from the kitchen. None of the 300-plus campers has reported getting sick during the first two weeks of summer camp along the shores of Lake Coeur d’Alene.

A review of the camp by health and safety investigators determined that the camp’s food handling procedures were more than adequate. They suspect that the employees may have contracted the infection in their living quarters.