By: Heather Williams
The United States Centers for Disease Control and Prevention (CDC) issued a Media Release from the CDC Newsroom on Thursday, December 28, 2017 to provide notice of a multi-state outbreak involving Shiga toxin-producing E. coli O157:H7 also known as STEC O157:H7. This is a serious strain of E. coli known cause major health implications due to the additional harmful toxin the bacteria produce.
What We Know So Far
While the investigation is still underway and the nature of connecting cases to the outbreak can create a reporting lag, at this time the outbreak has spanned 13 states. So far 17 cases have been linked to this outbreak. The report indicates 3 patients from California, 2 patients in Connecticut, 1 patient in Illinois, 1 patient in Indiana, 1 patient in Michigan, 1 patient in Nebraska, 2 patients in New Hampshire, 1 patient in New York, 1 patient in Ohio, 1 patient in Pennsylvania, 1 patient in Virginia, 1 patient in Vermont, and 1 patient in Washington. These reported illnesses have symptom onset starting from November 15, 2017 through December 8, 2017.
Additionally, the Public Health Agency of Canada is investigating an outbreak of STEC O157: H7 throughout several provinces (the equivalent of a multi-state outbreak in the United States). Genomic sequencing is being performed of samples from those in the United States to gather more information for the investigation. This will help investigators link additional cases to the outbreak, potentially link the strain to a food source, and determine if the cases between the two countries are related. According to the CDC “preliminary results show that the type of E. coli making people sick in both countries is closely related genetically, meaning the ill people are more likely to share a common source of infection.”
The Public Health Agency of Canada has had a head start in identifying a source for their multi-province STEC outbreak, as illnesses began earlier for Canadians and reports have been updated since early December. This agency has identified the source of the Canadian outbreak as romaine lettuce. As for the United States, no specific food item has been indicated yet as the investigation is still early in the interview phase. The CDC is conducting interviews with those who are affected to determine what they ate and did in the weeks before the illness began to determine if there is a common food item among those who are ill. With the additional information from our neighbors to the North and the inferences made by them, questions will certainly be posed about leafy greens and romaine lettuce.
At this time the CDC has not identified a source, so the agency is “unable to recommend whether U.S. residents should avoid a particular food.” As more information becomes available, the CDC will release additional information and UnsafeFoods will provide updated information to help you and your family make food choice decisions accordingly to avoid illness in this outbreak.
What is E. coli?
E. coli, the common name for Escherichia coli, is a bacterium found in many places around us. From the environment we live in, to the foods we eat, and even in our own bodies (in our intestines and those of animals). Many forms of E. coli are harmless, though others can cause serious illness including diarrheal illness and even urinary tract infections, respiratory illness, bloodstream infections, and other illnesses associated with the bacteria making its way out of the intestines.
Some E. coli bacteria can produce a toxin known as Shiga toxin. These bacteria can cause serious illness and responsible for most illness causing E. coli infections.
Shiga toxin-producing E. coli
Shiga toxin-producing E. coli or STEC is the cause of most outbreaks involving E. coli in the United States. More specifically, E. coli O157:H7 often shortened to E. coli O157 and even simply O157. All other STEC are lumped into the category of “non-O157”.
The CDC estimates that STEC is responsible for about 265,000 illnesses each year in the United States. This estimate includes about 3,600 hospitalizations, and 30 deaths. While STEC can infect anyone and cause serious illness, the very young and the very old are more likely to develop additional serious illness. Children under the age of 5 years old are at risk for developing a kidney affecting condition called hemolytic uremic syndrome (HUS).
Symptoms of STEC
Symptoms of STEC range from mild to severe and life-threatening. They could include terrible stomach cramps, diarrhea (potentially bloody), and vomiting. Fevers are generally less that 101 ºF if present. Many affected people get better within 5 to 7 days.
When to Contact a Doctor
It’s hard to determine if what you are experiencing is just a bit of stomach upset or a viral bug or part of a multistate-outbreak. Your sample will not be taken and included in the investigation if you do not see a healthcare provider, though many are reluctant to make that appointment and just suffer through for a few days to see if they get better. For many, medical attention is not required, and the affected person will recover on their own.
But how do you know when to contact your healthcare provider without waiting too long? The CDC recommends contacting your healthcare provider if you experience diarrhea that lasts for more than 3 days or diarrhea that is accompanied by blood in the stool or high fever. If you are vomiting so much that you cannot keep down fluids and as a result you are not passing very much urine, you are extremely dehydrated and should seek medical attention.
Hemolytic Uremic Syndrome (HUS)
HUS affects somewhere between 5 and 10% of those diagnosed with E. coli O157. This is a bacterial toxin inducing kidney failure. Those with HUS may experience less urination, lose of the pink color inside the lower eyelids and cheeks, and feel very tired. While most people with HUS recover within just a few weeks, others can suffer permanent health problems or die. Those with HUS should be hospitalized to closely monitor kidneys as they may stop working and other serious health problems that could result from the illness.
UnsafeFoods will continue to monitor this outbreak and provide information as it becomes available.