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Turning Up the Heat on E. coli 0157:H7
In December 1992, an outbreak of food-related illness began for more than 500 people after eating E. coli O157:H7-contaminated hamburger from a fast-food restaurant in Washington. Just three months later, customers at another Northwest restaurant became ill after eating foods which contained mayonnaise cross-contaminated with E. coli O157:H7. And this past June, some 40 New Jersey residents fell victim to the same emerging pathogen from eating undercooked food.
These serious incidents, as well as many smaller outbreaks in homes, day care centers, schools and nursing homes, have heightened national attention to foodborne illness.
In July, the American Gastroenterological Association Foundation (AGAF), an education and research organization devoted to digestive health, joined with other public and private groups to examine the emerging crisis of E. coli O157:H7.
"E. coli O157:H7 infections pose a clear and present danger to our public health," said panel chairman Martin Brotman, M.D., and head of the Department of Medicine at California's Pacific Medical Center. "Bringing government, industry, the medical community and consumers to the table to hammer out a consensus strategy on this problem is a critical first step toward a safe food supply."
Although there are many strains of E. coli commonly found in the environment and some with beneficial uses, the strain O157:H7 is extremely virulent.
E. coli O157:H7 is found in the intestinal tract and feces of both animals and man, and can be transmitted by numerous routes: from animal to animal, animal to person, animal to person on food, and person to person through close contact. Although it can survive both refrigeration and freezing, the pathogen is destroyed by thorough cooking.
According to the Centers for Disease Control and Prevention, as many as 20,000 cases of 0157:H7 infection may occur annually.
Symptoms of E. coli food poisoning include severe abdominal cramps, followed by watery diarrhea that often becomes bloody. Individuals also may experience vomiting and nausea, accompanied by low-grade fever. In children, the elderly and immune-compromised individuals, the infection can lead to kidney failure and possible death.
Undercooked ground beef represents one of the greatest risks of E. coli due to its handling and preparation. But outbreaks also have been traced to undercooked roast beef, raw milk, improperly processed cider, contaminated water and mayonnaise, and vegetables grown in cow manure.
Among the major recommendations of the AGAF panel was to upgrade the present meat inspection system to a prevention-focused program known as Hazard Analysis Critical Control Point (HACCP).
The HACCP approach would focus on preventing public health hazards in the production, slaughter, processing, storage, distribution and final preparation stages of meat products.
USDA is expected to announce plans for a HACCP-based meat inspection system in the near future. In late July, the Food and Drug Administration (FDA) issued an advance notice of proposed rule-making to require HACCP for all food production under its jurisdiction.
Although the panel emphasized that a better inspection system would help reduce the possibility of infection, it also acknowledged there are no guarantees for completely eliminating the bacterium. Thus, the panel endorsed irradiation of ground beef as another pathogen control strategy. A petition has since been filed with the FDA to approve the use of irradiation on beef.
The panel's endorsement of irradiation joins that of the American Medical Association's Council on Scientific Affairs, the World Health Organization, the Food and Agriculture Organization of the United Nations and the Inter-national Atomic Energy Agency, who have reviewed the scientific evidence on irradiation and have determined it is safe.
Gaining consumer acceptance of irradiation must begin with education and dispelling myths, noted panel member Christine Bruhn, Ph.D., consumer food marketing specialist at the University of California at Davis. "When the public receives science-based information...at least half or more will respond positively," Bruhn said.
Still, irradiation is not a magic bullet, and extensive education and training programs from farmer to consumer must be implemented. Targeted audiences would include farmers and growers, employees at slaughter and food-processing facilities, day care and nursing home providers, food regulatory officials, teachers and physicians.
"Observations in the U.S. and other countries have demonstrated that the incidence of foodborne illness can dramatically decline as a result of active public education and effective media coverage," said Brotman.
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