PEARSON & PEARSON, L.L.P.

About Salmonella & E Coli Outbreaks

·         What is an outbreak?

An outbreak is defined by the CDC as two or more cases of the same disease that share a common exposure.

·         How is the cause or source of an outbreak determined?

Once an outbreak is detected and the states and the CDC have determined that two or more cases of the same disease share a common food exposure, and the food is identified, the FDA conducts a "trace-back" investigation to determine the source of the contaminated food. The product is tracked from the point of purchase or service through each point in the distribution chain to find the source of the contamination.

At each point in the distribution chain, an environmental investigation is performed to determine whether the contamination may have occurred at that point and, if so, how it occurred. When outbreak illnesses occur across multiple states, the contamination often occurred at, or near, the original source of the product, such as the growing or packing area. In addition to helping to contain current outbreaks, information gained from trace-back and other investigations can help scientists develop measures to prevent future occurrences.

·         What does the FDA do to identify the source of an outbreak?

The FDA is conducts trace-back investigations. Epidemiological information about the disease serotype (such as Salmonella Saintpaul serotype in the recent tomato – pepper alerts) is examined, disease patterns are linked, and seasonal distribution patterns in the marketplace are analyzed to rule out sources.

The federal (principally CDC and the FDA) and state governments work together to analyze samples from ill persons and samples of produce. The strain of Salmonella or E Coli from ill persons is "fingerprinted" at public health laboratories around the country, as part of PulseNet (the network of public health laboratories that sub-type bacteria).

·         Why does it take the FDA so long to determine the source of an outbreak?

Investigators must track the pathways that the produce associated with illness followed, from multiple consumers who ate it to the multiple retailers or restaurants that sold it; from there to multiple points of supply and distribution; to where the produce was packed, and to where it was harvested and grown.

At the points where the produce was sold or prepared, investigators try to determine identifying information, such as packaging, labeling, and lot numbers; when the produce was purchased or prepared, and what the receiving, stock-rotation, inventory, handling, and shipping procedures were. They collect records about suppliers and shipments to retailers or restaurants for the period of the produce's shelf life. Investigators then chart and analyze distribution data, accomplished by tracing lot numbers - if they are available - or by using a shipment-delivery timeline to determine if the produce was useable and "sellable" during the period of infection.

Distributor interview, data collection, and analysis are repeated for multiple levels of distribution until the source of the produce is identified.

Among the complications that arise in this process is that lot numbers and other information identifying the food growers might not be included on receipts and shipping records. In some cases, investigators have to rely on reviewing records and interviewing the personnel who handle such matters, which increases the time and resources needed to trace implicated food products back to their sources. Another complication that delays the investigation is that often there is no package, no product code, no "sell by" date, and no marking on the food at the retail level.

Questions & Answers Re:  E. coli

What is E. coli?

E. coli is a common kind of bacteria that lives in the intestines of animals and people. There are many strains of E. coli. Most are harmless. However, one dangerous strain is called E. coli O157:H7. It produces a powerful poison. You can become very sick if it gets into your food or water.

In 1999 it was estimated that about 73,000 people in the U.S. got sick each year from E. coli. About 60 died. It’s believed that the number of illnesses and deaths has been dropping since then.

How is E. coli O157:H7 spread?

Outbreaks often are caused by food that has gotten the bacteria, E coli, in it. Bacteria can get accidentally mixed into ground beef before packaging. Eating undercooked meat can spread the bacteria, even though the meat looks and smells normal. E. coli can also live on cows’ udders. It may get into milk that is not pasteurized.

Raw vegetables, sprouts, and fruits that have been grown or washed in dirty water can carry E. coli O157:H7. It can get into drinking water, lakes, or swimming pools that have sewage in them. It is also spread by people who have not washed their hands after going to the toilet.

E. coli can be spread to playmates by toddlers who are not toilet trained or by adults who do not wash their hands carefully after changing diapers. Children can pass the bacteria in their stool to another person for 2 weeks after they have gotten well from an E. coli O157:H7 illness. Older children and adults rarely carry the bacteria without symptoms.

What are the signs of E. coli O157:H7 sickness?

Bloody diarrhea and stomach pain are the most common signs of E. coli O157:H7 sickness. People usually do not have a fever, or may have only a slight fever.

Some people, especially children under 5 and the elderly, can become very sick from E. coli O157:H7. The infection damages their red blood cells and their kidneys. This only happens to about 1 out of 50 people, but it is very serious. Without hospital care, they can die. See a doctor right away if you think you may have gotten sick from E. coli O157:H7.

How will my doctor know if E. coli O157:H7 made me sick?

Your doctor will test to see if your sickness was caused by E. coli by sending a stool sample to a lab. The lab will test for the bacteria.

How is it treated?

Your doctor will tell you what is best. Taking medicine on your own may not help you get better, and it could make things worse. Do not take antibiotics or diarrhea medicine like Imodium® unless your doctor tells you to.

Will E. coli O157:H7 infection cause problems for me later?

People who have only diarrhea and stomach ache usually get completely well in 5-10 days. They do not have problems later.

For those people who get very sick and have kidney failure, about 1 out of 3 may have kidney problems later. In rare cases, people have other problems like high blood pressure, blindness, or are paralyzed. Talk to your doctor if you have questions about this.

What is the U.S. government doing to keep food safe from E. coli O157:H7?

New laws have helped keep food from being contaminated with E. coli O157:H7. They keep meat safer during slaughter and grinding, and vegetables safer when they are grown, picked, and washed. But there is still a chance that E. coli O157:H7 could reach your food.

What can I do to stay safe from E. coli O157:H7?

During an outbreak: Carefully follow instructions provided by public health officials on what foods to avoid in order to protect yourself and your family from infection.

Cook all ground beef thoroughly. During an outbreak of E. coli O157:H7, vegetables should be boiled for at least 1 minute before serving.

Cook ground beef to 160° F Test the meat by putting a food thermometer in the thickest part of the meat. Do not eat ground beef that is still pink in the middle.