The Missouri Department of Health and Senior Services (DHSS) is investigating an increase in cases of Shiga toxin-producing Escherichia coli (STEC) in Central Missouri during late March and early April, 2012. Five cases of E. coli O157:H7 have been identified during this time period. Two of the cases, a two-year old child and a 17-month old child, reportedly have developed hemolytic uremic syndrome (HUS).

The investigation is ongoing and the source of the infections has not been identified.

Is you is, or is you ain't, my constituency?

The U.S. beef industry said last week beef is safer than it was 10 years ago, and cited survey data to show consumers agreed.

Surveys still suck.

“When asked whether someone is more likely to get sick from foodborne bacteria eating at home or at a restaurant, 65 percent of consumers answered “at a restaurant.” However, 72 percent of the experts attending the summit answered “at home.”

“In fact, statistics back up the experts’ opinion showing between 60 percent and 70 percent of foodborne illnesses occur at home.”

Got a reference for that? Or were the press release authors too busy inserting “dick fingers” and statements of nonsense like, “In fact.”

“In fact, it isn’t beef safety consumers are concerned about. When asked which fresh food they might buy in the supermarket was their biggest safety concern, 48 percent of consumers answered “Fish and Seafood.” Only 10 percent said beef was their biggest safety concern.”

Beef safety may have improved, but industry types can’t help but continue to cast stones. Beef types have lots to concern themselves with – non-O157 shiga-toxin producing E. coli, pink slime, cross-contamination, welfare and workplace issues -- instead of wasting rhetorical energy about who’s to blame for foodborne illness.

It’s called playing to your constituency

Jacob, C.J. and Powell, D.A. 2009. Where does foodborne illness happen—in the home, at foodservice, or elsewhere—and does it matter? Foodborne Pathogens and Disease, 6(9): 1121-1123.
http://www.liebertonline.com/doi/abs/10.1089/fpd.2008.0256
Foodservice professionals, politicians, and the media are often cited making claims as to which locations most often expose consumers to foodborne pathogens. Many times, it is implied that most foodborne illnesses originate from food consumed where dishes are prepared to order, such as restaurants or in private homes. The manner in which the question is posed and answered frequently reveals a speculative bias that either favors homemade or foodservice meals as the most common source of foodborne pathogens. Many answers have little or no scientific grounding, while others use data compiled by passive surveillance systems. Current surveillance systems focus on the place where food is consumed rather than the point where food is contaminated. Rather than focusing on the location of consumption—and blaming consumers and others—analysis of the steps leading to foodborne illness should center on the causes of contamination in a complex farm-to-fork food safety system.

Stigi et al. report in the March, 2012, issue of Emerging Infectious Disease that in a survey of laboratories in Washington State, increased use of Shiga toxin assays correlated with increased reported incidence of non-O157 Shiga toxin–producing Escherichia coli (STEC) infections during 2005–2010.

Despite increased assay use, only half of processed stool specimens underwent Shiga toxin testing during 2010, suggesting substantial underdetection of non-O157 STEC infections.

Strains of Shiga toxin (Stx)–producing Escherichia coli (STEC) are differentiated by the O antigen on their outer membrane and are broadly classified as O157 or non-O157 STEC. The ability to produce Stx is a key virulence trait of STEC. STEC infections in humans often cause a self-limited diarrheal illness but can be complicated by hemorrhagic colitis or hemolytic uremic syndrome.

Unlike other E. coli strains, serogroup O157 isolates do not ferment sorbitol and are readily identified by culture, appearing colorless on sorbitol MacConkey agar. Both O157 and non-O157 STEC can be identified by detecting Stx with nonculture assays that became commercially available in the United States in 1995. The Centers for Disease Control and Prevention (CDC) published formal STEC testing recommendations for clinical laboratories in 2009, advocating that all stool specimens submitted for routine bacterial pathogen testing be simultaneously cultured for O157 STEC and tested with a nonculture assay to detect Stx. Use of this testing protocol ensures timely identification of all STEC infections. Exclusive testing for Stx delays specific identification of O157 STEC and may impede prompt detection of common-source outbreaks.

Non-O157 STEC infection has been a nationally notifiable condition since 2000. Although studies have documented the increased incidence of reported non-O157 STEC infections over the past decade, few have determined the proportion of laboratories that routinely test all submitted stool specimens for Stx and, to our knowledge, no study has quantified STEC testing practices by wwwnc.cdc.gov/eid/article/18/3/11-1358_article.htmproportion of stool specimens processed for bacterial culture. Our objectives, therefore, were to quantify statewide STEC testing practice by proportion of stool specimens processed for bacterial culture and to determine the contribution of enhanced STEC testing practice to increased reported incidence of non-O157 STEC infections.

The complete report is available at: wwwnc.cdc.gov/eid/article/18/3/11-1358_article.htm.

In January 1993 I was in 10th grade. I had just discovered the Violent Femmes and punk rock; was worried about figuring out calculus (I eventually did); and spent most of my time being uncool and longing to be cool. Probably pretty similar to every other awkward teenager. I didn't have a clue that a tragic foodborne illness outbreak was unfolding in the Pacific Northwest and that the event would eventually define a bunch of what I focus on every day.

I had never even heard of Jack-in-the-Box.

The outbreak was linked to four deaths, over to 700 illnesses and almost 200 hospitalizations. E. coli O157:H7 contaminated hamburger was then undercooked and served to thousands from 73 Jack-in-the-Box restaurants. Jack-in-the-Box will forever be linked to this event - and over the past 18 years has become a prominent force in food safety risk reduction.

News of this outbreak hit on President Clinton's inauguration day and as Doug has written,

Those two events, more than any other, dramatically changed the public discussion of food safety in the U.S. The Jack-in-the-Box outbreak had all the elements of a dramatic story: children were involved; the risk was relatively unknown and unfamiliar; and a sense of outrage developed in response to the inadequacy of the government inspection system. The newly inaugurated President Clinton made microbial food safety a Presidential issue.

And the first focus went to E. coli O157:H7 - the serogroup linked to the Jack-in-the-Box illnesses. Food microbiologists and epidemiologists have seen lots of other equally dangerous shigatoxin-producing serogroups (shigatoxin is what makes E. coli O157:H7, along with its ability to stick to cells so devastating). Here's a list of the non-O157 STEC outbreaks we've been able to find going back to the mid-1990s.

Later this afternoon I will be on my way to Lincoln, NE to meet with a group of academics, researchers, extension folks and regulators to talk about a large 5-year integrated project focused on reducing STECs from farm-to-fork that USDA NIFA has funded. Through the wonders of the Internet, Doug will be Skyping in.

LINCOLN, Neb. -- The U.S. Department of Agriculture (USDA) announced today that it has awarded a research grant to the University of Nebraska-Lincoln (UNL) to help reduce the occurrence and public health risks from Shiga toxin-producing E. coli (STEC) along the entire beef production pathway. Dr. Chavonda Jacobs-Young, acting director of USDA's National Institute of Food and Agriculture (NIFA), is scheduled to award the $25 million grant to the UNL-lead research team today at the university in Lincoln.

"Shiga toxin-producing E. coli are a serious threat to our food supply and public health, causing more than 265,000 infections each year," said Chavonda Jacobs-Young, acting NIFA director. "As non-O157 STEC bacteria have emerged and evolved, so too must our regulatory policies to protect the public health and ensure the safety of our food supply. This research will help us to understand how these pathogens travel throughout the beef production process and how outbreaks occur, enabling us to find ways to prevent illness and improve the safety of our nation's food supply."

Dr. James Keen at UNL, along with a multi-institutional and multi-disciplinary team of researchers, educators and extension specialists, will use the $25 million grant to improve risk management and assessment of eight strains of STEC in beef. This work will include the O104 strain that caused the recent outbreak in Germany. The project will focus on identifying hazards and assessing exposures that lead to STEC infections in cattle and on developing strategies to detect, characterize and control these pathogens along the beef chain. This knowledge will then be used to find practical and effective STEC risk mitigation strategies. The five main objectives of the project include:

Detection: develop and implement rapid detection technologies for pre-harvest, post-harvest and consumer environments.

Biology: characterize the biological and epidemiological factors that drive outbreaks of STEC in pre-harvest, post-harvest, retail and consumer settings.

Interventions: develop effective and economical interventions to lessen STEC risk from cattle, hides, carcasses, and ground and non-intact beef and compare the feasibility of implementing these interventions for large, small and very small beef producers.

Risk analysis and assessment: develop a risk assessment model for STEC from live cattle to consumption to evaluate mitigation strategies and their expected public health impacts.

Risk management and communication: translate research findings into user-friendly food-safety deliverables for stakeholders, food safety professionals, regulators, educators and consumers.

For more check out the full PR here.