United States 1993 food contamination of E. coli

E. coli O157:H7 has become well known for its association with food borne illness outbreaks related to produce. Unpasteurized apple juice, apple cider, cantaloupe, sprouts lettuce and spinach are some of the suspected or implicated vehicles on outbreaks of E. coli.

Food contamination by E. coli bacteria in Western Washington gained wide attention was a multistate outbreak between 15 November 1992 and 28 February 1993. This outbreak resulted in more than 700 illnesses, 195 hospitalizations and four deaths.

In January and February 1993, food contamination by E. coli bacteria kills three children in Western Washington. More than 450 persons fall ill or being exposed to infected persons epidemiologically linked to the consumption of undercooked hamburger patties or a single chain restaurants.

The source of the contamination will be traced to Jack in the Box Restaurants and to its meat supplier, Von's in California. Definitively it pointed to ground beef as the source of the infections.

On January 11, 1993, young Michael Nole and his family ate dinner at a Jack-in-the-Box restaurant in Tacoma, Washington, where Michael enjoyed his $2.69 ‘Kid’s Meal’. The next day, Michael was admitted to Children’s Hospital and Medical Center in Seattle with severe stomach cramps and bloody diarrhea. Several days later Michael died of kidney and heart failure.

Between January 3 and January 17, 1993, 50 people, most of them children and most of them in Western Washington, reported to hospitals complaining of severe stomach cramps and bloody diarrhea. Some children had to be placed on dialysis after their kidneys failed.

On January 19 alone, 38 people reported the symptoms. Ultimately, three children died, a two-year-old girl from Snohomish County, a two-year-old boy from Tacoma, and a 16-month-old boy from Bellingham. Children who survive E. coli illness often develop kidney problems in 10 to 15 years.

Some survivors lost organs such as colons and gall bladders which were damaged.

Origin of the Outbreak
The bacterium, officially known as Escherichia coli O157:H7 was traced to undercooked hamburger served at Jack in the Box Restaurants in Washington, California, Nevada and Utah.

Investigation by health officials found that Jack in the Box had received the large tubes of ground beef from a November 19, 1992, production run at Von's in California. One child in San Diego died in December after eating hamburger from a fast food restaurant there. Jack in the Box offered to pay the medical costs of all the victims.

A meat trace back identified five slaughter plants in the United States and one in Canada as the likely sources of carcasses used in the contaminated lots of meat.

By the end of March 1993, reports of the illness had stopped. About 700 people had developed diarrheal disease symptoms, and 56 of them had developed a very severe disease called ‘hemolytic uremic syndrome’ after the diarrhea subsided.

Food inspection official later confirmed that the source of the E. coli 0157:H7 was the Monster Burger, which was part of a promotion and was sold at a reduced price. Demand for the burgers was unusually high, and the restaurant had difficulty keeping up with it. As a result, the burgers were not cooked long enough to kill the E. coli bacterium.

After the Jack-in-the-Box poisonings, the federal government recommended that all states increase their cooking temperature requirements to 155 degrees. Burger King cooks to 160 degree; Hardee’s, Wendy’s and Taco Bell cook to 165 degree. The US Agriculture Department also changed its meat inspection standards.
United States 1993 food contamination of E. coli

Infection of E. coli O157:H7

During 2004-2005, three outbreaks of Escherichia coli O157:H7 infections occurred among agricultural fair, festival and petting zoo visitors in Arizona, Florida and North Carolina. No death occurred, and illnesses primarily affected children who visited petting zoo.

E. coli O157:H7 is one of hundreds of strains of the bacterium E. coli. Although most strains are harmless and live in the intestines of healthy humans and animals, this strain produces a powerful toxin and can cause severe illness.

E. coli O157:H7 is a toxin producing bacteria that causes intestinal disease in people which lasts about one week. Infection often causes severe bloody diarrhea and abdominal cramps; sometimes the infection causes non-bloody diarrhea. Frequently, no fever is present.

E. coli

In some people, particularly children under 5 years of age and the elderly, the infection can also cause a complication called hemolytic uremic syndrome, in which the red blood cells are destroyed and the kidneys fail. About 2%-7% of infections lead to this complication.

In the United States, hemolytic uremic syndrome is the principal cause of acute kidney failure in children, and most cases of hemolytic uremic syndrome are caused by E. coli O157:H7.

Hemolytic uremic syndrome is a life-threatening condition usually treated in an intensive care unit. Blood transfusions and kidney dialysis are often required. With intensive care, the death rate for hemolytic uremic syndrome is 3%-5%.

Most epidemiologic investigations of E. coli O157:H7 infections have involved restaurant associate outbreaks. However, in California in 1993, three cases of culture-confirmed E. coli O157:H7 infections were traced to consumption of hamburger purchased at a local grocery store and cooked at home.
Infection of E. coli O157:H7

The effects of E. coli O157:H7 on human health

Escherichia coli O157:H7 was first identified as a human pathogen in 1982 and it was first isolated in cattle.

E. coli O157:H7 is one of hundreds of strains of the bacterium E. coli. Although most strains are harmless and live in the intestines of healthy humans and animals, this strain produces a powerful toxin and can cause severe illness.

A rare but dangerous type of E. coli, the strain O157:H7 is now a major public health problem worldwide.

Infection often causes severe bloody diarrhea and abdominal cramps; sometimes the infection causes non-bloody diarrhea. Frequently, no fever is present. It should be noted that these symptoms are common to a variety of diseases, and may be caused by sources other than contaminated drinking water.

In an estimated 4 percent of cases, E. coli O157:H7 produces shiga toxin that attacks the lining of the intestine and enters the blood stream, causing hemolytic uremic syndrome or HUS, which can lead to kidney failure, anemia, internal bleeding and other complication, including death.

In some people, particularly children under 5 years of age and the elderly, the infection can also cause a complication called hemolytic uremic syndrome, in which the red blood cells are destroyed and the kidneys fail.

The capacity of E. coli O157:H7 to cause disease is a direct result of its possession of a number of genetic elements for virulence factors. Due to the severity of O157:H7 infection, research into the virulence factors has been intense.

In the United States, hemolytic uremic syndrome is the principal cause of acute kidney failure in children, and most cases of hemolytic uremic syndrome are caused by E. coli O157:H7. Hemolytic uremic syndrome is a life-threatening condition usually treated in an intensive care unit. Blood transfusions and kidney dialysis are often required. With intensive care, the death rate for hemolytic uremic syndrome is 3%-5%.
The effects of E. coli O157:H7 on human health