By: Candess Zona-Mendola

News broke today that at least 8 people have fallen ill with Shiga toxin-producing E. coli (STEC E. coli) after attending the Mesa County Fair between July 25, 2017 and July 29, 2017. Mesa County Public Health officials announced today that they are working closely with fair organizers and victims of the E. coli infections to pinpoint a potential food or animal source that is the cause of the illnesses.

The fair, which was held in Grand Junction, Colorado, had a large amount of food vendors, as well as several different kinds of livestock – which are known carriers of this particular type of E. coli. Close proximately and direct contact with livestock, particularly cattle, pigs, and goats, have been linked to E. coli outbreaks in the past. This is likely due to cross contamination and the environment in which the animals interact with people. In fact, petting zoos, who regularly keep animals of this kind, are especially of concern for E. coli infections.

Despite the outbreak, fair officials contend they have done everything to prevent such an issue:

“Outbreaks are always a possibility at fairs. We worked closely with Mesa County fair officials to put preventive measures in place prior to the start of the event. Otherwise, this could have been much worse,” said Mesa County Fair’s Executive Director Jeff Kuhr.

More Details to Come?

The public health officials have also announced that they are working with local health providers and daycares to determine if there are potentially more cases and the extent of the illnesses. As of today’s announcement, it is unknown if any of the victims of this outbreak have required hospitalization or developed hemolytic uremic syndrome – a rare, but potentially fatal complication of STEC E. coli infections.

At this time, it appears that an investigation is ongoing by the Mesa County Health Department.

What is E. coli?

STEC E. coli are bacteria. They usually live in soils and even in the digestive systems of animals. But STEC E. coli do not make these animals sick like us. As these types of infections can be dangerous, and even fatal, it is a good idea to know the symptoms of infections of these kind.

The early symptoms of E. coli are watery diarrhea and severe stomach cramps.  These usually begin to show anywhere from 2 to 10 days after exposure. Sometimes, the victim will experience nausea and maybe vomiting as well. A minor fever may also accompany other symptoms, but not in all cases. If the illness progresses, as it often does, the diarrhea will become increasingly watery and bloody. In cases without severe complications, the course of the illness is usually between 2 and 9 days.

But in approximately 3-7% of STEC E. coli cases, the infection will progress to a more severe complication, hemolytic uremic syndrome (HUS). HUS is a form of kidney failure. Of victims who develop HUS, anywhere from 3-5% will die. Those who survive the illness may have future complications and may require a kidney transplant.

Because of how serious these types of E. coli infections can be, it is critical that people who suspect they may have it seek medical attention immediately.  The earlier a victim is tested to identify the E. coli pathogen and begins receiving treatment, the better the odds are of avoiding HUS and the more severe complications that result from it.

What Made Them Sick?

The source has not been identified yet in this outbreak. But that does not mean that there aren’t potential leads to what may be the cause. There are several likely sources of the outbreak, based on what we know about past outbreaks. There are many sources that E. coli can be contracted.  These are some of the ways that E. coli can be contracted and some of the possible areas that investigators may look in to.

Meat

Meats often in the past have been identified sources of E. coli infection.  At fairs, where vendors sell various kinds of meat from hot dogs to sausage on a stick to turkey legs, it is a high probability that undercooked meats may be implicated. Often times, the E. coli is transmitted through ingesting meat, especially hamburger meat.  This is because E. coli is primarily carried in the intestines of mammals like: cows, goats, pigs, and humans.  If there is contamination of the meat from its mishandling during butchering or processing and that meat is subsequently not cooked properly, the conditions are suitable for an infection. Transmission can be avoided or minimized by proper sanitation and washing hands after handling meat, decontaminating any cooking tools and surfaces raw meats come in contact with, and ensuring proper temperature when cooking meats.  Most meats must reach a minimum internal temperature of 165 ⁰F.

Fresh Fruits and Vegetables

Fresh fruits and vegetables are another likely source of E. coli infections.  In fact, in the past E. coli outbreaks have been traced back to many fresh fruits and vegetables such as: sprouts, lettuce, spinach, parsley, and other fresh produce.  Apples picked from the ground and made into unpasteurized cider and fruit juices have contributed to several E. coli outbreaks.  E. coli is also often found in vegetables and legumes that have been fertilized with unsterilized manure or feces contaminated irrigation them not processed properly to guard against E. coli. Major outbreaks of E. coli have been linked to peanuts used in peanut butter, soynut butter, lettuce, sprouts, spinach and radishes.

Animal to Person Contact

Another common source of E. coli infection is animal to person contact.  As there are often many animals that are known carriers of E. coli at county fairs, this is a very likely cause of the outbreak. In outbreaks related to live animals, it is usually cross-contamination to blame. E. coli bacteria live inside of the digestive tract of many animals, making them hosts to these harmful bacteria. It is important to note that these bacteria do not make the livestock or animals sick, and often, infections that are transferred to humans are usually from healthy animals. Cross-contamination occurs because animals often lay in areas they defecate, transferring E. coli from their feces onto their bodies.  Infections can be a result of handling animals, coming in contact with feces, and even inhaling dust from the pens that may contain E. coli.  Always wash hands after handling animals or even being in their enclosures to prevent accidental ingestion of the harmful bacteria.

Person to Person Contact

Person to person transmission of E. coli results in a fecal-oral transfer.  These types of infection transmissions are especially concerning in daycare settings. E. coli can be transferred after using the bathroom or changing the diaper of an infected person. A person can also become ill from contamination on clothing or shoes. Therefore, it is always a good idea to wash your hands after using the restroom, changing a diaper, and other activities that you might come in contact with feces.

UnsafeFoods will continue to provide coverage on this outbreak as the details unfold.