CDC says outbreak a long-shot to jump to US.
A virulent strain of the E. coli bacterium responsible for a huge outbreak in Europe is not expected to reach the United States any time soon, according to the Centers for Disease Control and Prevention. But that does not mean a similar outbreak could not occur in the U.S.
State epidemiologist Dr. Alfred DeMaria said contamination of food products such as the deadly toxin-producing E. coli strain - and its many variants - can happen at any time.
"The risk in the U.S. is no more or no less to the food supply ordinarily," he said. "The current epidemic seems to be limited to Northern Germany, since all primary cases are arising there."
The O104:H4 strain, which has killed 22 and sickened more than 2,000 in Europe, produces a toxin called "Shiga" in the intestines of those who have eaten contaminated food, or who contracted it through hand-to-mouth contact with an infected person.
The toxin, which causes diarrhea at first, is absorbed into the blood, where it attacks the kidneys, resulting in a life-threatening condition called hemolytic uremic syndrome which destroys blood cells, clogs arteries, and causes intestinal bleeding and kidney failure.
Typically, fewer then 5 percent of patients with toxic-producing E. coli develop the syndrome, but the percentage in the European outbreak is much higher, approximately 25 percent, indicating that the bacteria produce more Shiga toxin, or that it is better absorbed in the gut.
According to the CDC, as of Monday there were 642 patients with hemolytic uremic syndrome in Germany.
In the U.S., there are one confirmed and three suspected cases of Shiga toxin E. coli O104:H4. Those infections have been identified in people who recently traveled to Hamburg, Germany, where they were likely exposed. The strain has also been reported in at least a dozen other countries.
The U.S. has about approximately 100,000 cases a year of infections from toxin-producing E. coli strains, and about 80 deaths a year.
Non-toxic strains of E. coli are found normally in the intestinal tracts of humans and animals and do not cause disease.
Dr. DeMaria said the main concern is that treating diarrhea caused by the Shiga toxin strain with antibiotics could be a factor in precipitating the kidney disease, so antibiotics should be avoided, if possible.
"Of course, if the patient is critically ill with infection, they should be treated," he said.
Some health officials have speculated that antibiotic treatment of the more serious cases in Europe may have made matters worse, because more toxin is released when the E.coli bacteria themselves are killed.
The source of the outbreak in Germany has not been identified, although residents, tourists and military personnel stationed there are warned to avoid vegetables such as cucumbers, tomatoes, leafy salads, and raw vegetable sprouts.
A CDC bulletin says a small number of U.S. military service members stationed in Germany are under investigation because they have come down with diarrhea.
Symptoms of Shiga toxin E. coli infection include severe stomach cramps, diarrhea, often bloody; and vomiting, sometimes accompanied by a slight fever. Anyone with those symptoms who has recently traveled to Germany should seek medical attention.
Vegetable sprouts from an organic farm in Northern Germany were suspect at first, but have been ruled out. Such sprouts have previously caused food-borne illnesses elsewhere, Dr. DeMaria said.
"Rinsing the bean sprouts, if they are contaminated, could help some, but the only safe course is not to eat them," he said.
A different strain of toxin-producing E. coli caused a U.S. outbreak in ground beef in 1982, and in raw spinach five years ago.
Although rare, an outbreak of Shiga toxin-producing virulent E. coli strain was reported in the Republic of Georgia two year ago.
Dr. DeMaria said food handlers and household contacts can be a source of transmission, and secondary cases.
"So it is critical that the highest standard of hand hygiene is maintained because the hands are the most likely source of further contamination and spread," he said.
E. coli in meat is destroyed by cooking. Irradiation of raw meat also kills the bacterium, and could be used on vegetables as well. The U.S. Food and Drug Administration approved the use of radiation for spinach and lettuce three years ago, but consumer mistrust has kept such products off most shelves.
CUTLINE: A worker at the Werder Frucht vegetables company throws away tomatoes yesterday in Werder, Germany.
PHOTOG: THE ASSOCIATED PRESS
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|Publication:||Telegram & Gazette (Worcester, MA)|
|Date:||Jun 8, 2011|
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