By: Ryan Robinson, PhD
Ask any parent and you’ll find that the welfare and safety of their children is the absolute highest priority.  As parents, take we take our role as guardian and caretaker seriously. We work tirelessly to shield our little-ones from illness, injury, and harm. We also expect others to act with all due diligence, and help us to keep our children safe by ensuring that they are not exposed to dangerous pathogenic organisms in their food, water, or environment.

It is therefore understandable that we are shaken to our core by any incident involving an illness infecting young children. The recent E. coli outbreak in  Sharpe County, Arkansas that left one child dead and another hospitalized in critical condition is no exception. It reminds us of our charge to protect the most vulnerable among us from harm. Still, our collective memories are too short and in the wake of this recent event far too many parents will continue to underestimate the danger posed by pathogenic E. coli infections and other foodborne illnesses.

To better understand and combat these risks, to keep abreast of developing outbreaks, and to better protect our children, it is necessary that we arm ourselves with the facts by consulting the vast body of scientific literature that has been generated referencing E. coli infection in children and its immediate and prolonged effects:

What is STEC / Is STEC the same thing as O157?

(See our article “Twelve Fast Facts about E. coli and other foodborne illnesses” for more information)

STEC stands for Shiga toxin-producing Escherichia coli. The term STEC is used to describe a number of different strains of E. coli that produce a highly toxic compound known as Shiga-toxin. Exposure to Shiga-toxin can result in severe illness that may require hospitalization, and can even cause death.

The pathogenic bacterial Strain O157:H7 is the most common strain of Shiga toxin-producing E. coli. According to a report published by the CDC, O157:H7 is the most prevalent pathogenic STEC strain and accounts for approximately half of all diagnosed STEC-infections in the United States. While O157 is the best known and most prevalent STEC strain, there are many other strains that can cause severe illness as well.

Kids get sick all the time! What’s the big deal?

Children are certainly well known for their tendency to develop runny noses and upset tummies, but STEC infections are far more serious than most other foodborne illnesses. In fact, the CDC estimates that the O157 strain of E. coli alone will result in more than 2,000 hospitalizations this year.

The reason O157 and other STEC strains are so dangerous comes down to one tiny molecule: a bacterially produced toxic compound produced known as Shiga-toxin. Shiga toxin is particularly harmful, and significantly increases the likelihood that an E. coli infection will cause severe, life-threatening complications(Thorpe, 2004).

Shiga-toxin causes damage by targeting cells in the intestines and kidneys, preventing them from making new proteins, and eventually killing them (Obrig, 2010). The cellular damage accumulates throughout the course of infection, and eventually results in a serious medical condition known as Hemolytic-Uremic syndrome (HUS). According to the CDC, about 10% of STEC cases develop into HUS (CDC Factsheet).

What is Hemolytic-Uremic syndrome (HUS) and how dangerous is it?

Post-diarrheal HUS is a profoundly dangerous condition that results in destruction of platelets (the cells that help blood to clot) and damages the kidneys. HUS is most often triggered by an STEC infection, and it is one of the most common causes of acute kidney injury in children (Boyer & Niaudet, 2011).

Even with medical intervention, HUS has a relatively high morbidity and mortality rate. In an analysis of 770 childhood cases of HUS more than half of the patients treated required dialysis, nearly all required a blood transfusion, and almost 3% died (Mody et al, 2015).

Unfortunately, the damage from HUS doesn’t end once the E. coli infection is no longer present. After the initial incident, afflicted with HUS may have a long road to recovery. Acute kidney damage stemming from E. coli induced HUS may result in Chronic Kidney Disease, End-Stage Kidney Disease, and a host of other long term medical issues (Spinale et al, 2013). The incidence of long-term illness stemming from HUS is particularly heartbreaking in young children, who may have to struggle with a debilitating illness for the rest of their natural life.

STEC infections are under control, right?

Unfortunately, the evidence would suggest otherwise. Data from the most recent (2013) CDC report on STEC infections suggests that the incidence rate of all STEC infections nearly doubled between 1997 and 2013.  While the highly virulent O157 strain appears to have declined in prevalence, other dangerous strains have more than made-up the difference.  Some of this increase may be explained by improved methods of testing and reporting (a powerful new laboratory assay for detecting STEC infections became available in 2012), but the body of evidence appears to suggest that STEC infections are generally on the rise in the United States.

How can we protect our families?

Fortunately, HUS and its primary causative agent (Shiga toxin-producing E. coli) are both easy to defend against. The most common way to contract an E. coli infection is consumption of food that has been contaminated through improper handling. Uncooked meat (particularly ground beef), uncooked and unwashed vegetables, and unpasteurized dairy products are all significant sources of Shiga toxin-producing E. coli.

As we prepare to enter “grilling season,” it is worth noting that a CDC report on STEC infections shows a clear increase in reported infections throughout the summer months. Throughout the year, but particularly during this time, parents should ensure that hamburgers, hot-dogs, and other meat products are cooked to a proper internal temperature, that sources of cross-contamination are eliminated, and that produce is appropriately and thoroughly washed. Finally, we should pay close attention to the eateries we frequent, noting their health grades and holding them to the same or to a higher-standard than we hold our own kitchen.

As we continue to hold out hope for the children recovering from this recent outbreak, hopefully we can all move forward equipped with the facts, and an appropriate assessment of the risks involved, so that we may collectively prevent the next outbreak before it begins.