By: James Peacock

Year in and year out, E. coli infections remain one of the most common forms of foodborne illness in the United States. While there are several different types of E. coli that cause illness in humans, some of these bacteria are able to produce a toxin known as Shiga toxin. E. coli that produce this toxin are commonly referred to as STEC. The CDC estimates that there are around 265,000 cases of E. coli poisoning each year in the United States. Cases of E. coli poisoning can occur even if only a small amount of bacteria is consumed. E. coli outbreaks have been caused by a number of sources, including beef products, raw milk, yogurt, mayonnaise, cheeses, unpasteurized fruit juices, bagged lettuce, alfalfa sprouts, spinach, various water sources, and more. E. coli infections and outbreaks have been steadily on the rise since 2009, reaching an incidence rate of 2.85 cases per 100,000 persons, the highest it has been since 1996. E. coli is also particularly dangerous for 2 reasons. First, it seems to target children, especially those less than 5 years of age, at a much higher rate than other age groups. In fact, according to the CDC, the incidence rate of E. coli poisoning in children under 5 is more than double the next closest age group, which is children age 5 to 9. Young children under 5 have an incidence rate of 7.86 cases per 100,000; almost triple the overall incidence rate. This has led health officials to declare that children, along with the elderly and those with suppressed immune systems, are at an increased risk of catching an E. coli infection. The other major issue is that STEC bacteria are able to cause a very serious side effect known as hemolytic uremic syndrome, or HUS for short.

Hemolytic uremic syndrome occurs in about 3 to 7 percent of E. coli cases. HUS damages red blood cells and platelets in the blood, which are then sent to the kidneys in order to be filtered out. Removing these damaged blood cells can damage the kidneys. The damage from the filtration process, coupled with the increased rate of damage inflicted on the kidneys by shiga toxins, can lead to serious kidney damage and even kidney failure. Health officials have reported that the majority of HUS cases come in children, with the elderly making up the other major affected group. The CDC has tracked HUS incidence for many years, but in recent years the amount of HUS cases has held rather steadily between 55 and 65, with most years reporting about 61 cases. In 2015, the most recent year for which we have data, 62 cases of HUS were reported in children under the age of 18. More than half of these cases were attributed to the less than 5 age group. With no noticeable reduction in HUS cases over the last few years, children will remain at a high risk for young children especially.

There have been many outbreaks of E. coli over the years, and the CDC has tracked them for decades. Based on CDC estimates for the number of illnesses caused by E. coli each year and how many are estimated to be related to outbreaks, about 31,000 cases of E. coli poisoning take place due to outbreaks each year. In 2015 alone there were 40 outbreaks caused by E. coli bacteria. Earlier this year, an outbreak of E. coli poisoning was connected to soy nut butter manufactured and distributed by The SoyNut Butter Company. The product in question, I.M. Healthy Original Creamy SoyNut Butter, was linked to a growing E. coli outbreak that would eventually sicken 32 people. More than 80 percent of those sickened, making up 26 out of the 32 illnesses, were in children under the age of 18. Twelve people would need to be hospitalized over the course of the outbreak, and 9 cases of HUS were developed. Thankfully, both those with HUS and those with E coli poisoning would make a full recovery. The SoyNut butter, which is popular with kids who have peanut allergies, would end up being recalled, although that recall would eventually be expanded. An inspection done by the FDA at the facility that produced the SoyNut butter under recall would reveal a wide variety of issues. These issues would include, but are not limited to, improper sanitation of production equipment, improper storage and sanitation of equipment used to move waste products, and improper use of thermometers to verify the adequacy of bacteria killing processes.

Though outbreak after outbreak has been caused by E. coli bacteria and disproportionately affected children, the CDC estimates that only about 12% of E. coli infections are connected to an established outbreak. The vast majority of cases are individually based, but that does not mean that they are any less likely to develop life-threatening hemolytic uremic syndrome.

Again, E. coli infections represent one of the most common forms of foodborne illness in the United States. Symptoms of an E. coli infection will usually occur between 3 and 4 days after exposure, but they can begin to cause symptoms anywhere between 1 and 9 days after exposure. Symptoms of an E. coli infection will typically include severe cramping, vomiting, nausea, and watery or bloody diarrhea. There is sometimes a low-grade fever associated with the infection as well. These symptoms will, much of the time, go away on their own after about a week, but can last longer. There are a couple of complications associated with an E. coli infection. Diarrhea can cause dehydration, which can be very serious if left untreated. E. coli infections can also cause a rare but potentially fatal complication called hemolytic uremic syndrome (HUS). If a case of E. coli poisoning has progressed to HUS, symptoms such as decreased frequency in urination, fatigue, and loss of color in the eyes and cheeks will be present. HUS is a very serious complication that needs to be treated as quickly as possible. If you or a loved one begins to show the symptoms of E. coli poisoning, contact a medical professional. Immediate medical attention can potentially reduce the risk of long-term complications.

Sources:

https://www.cdc.gov/foodnet/reports/prelim-data-2016.html

https://wwwn.cdc.gov/foodnetfast/

https://www.cdc.gov/ecoli/general/index.html

https://www.cdc.gov/mmwr/volumes/66/wr/mm6615a1.htm

http://www.swvatoday.com/news/floyd/article_7ab1fb9c-4706-11e7-9663-171eb4d89233.html

http://emedicine.medscape.com/article/201181-overview#a5

https://wwwn.cdc.gov/foodborneoutbreaks/

https://www.cdc.gov/ecoli/2017/o157h7-03-17/index.html

https://www.fda.gov/Safety/Recalls/ucm545368.htm