Guest Blog: In Defense of Food Safety Leadership

The following Guest Blog first appeared on Food Safety News, and is reproduced here with the kind permission of its author, Nancy Donley.

In Defense of Food Safety Leadership

by Nancy Donley

My only child, Alex, died from hemolytic uremic syndrome (HUS) caused by eating E. coli O157:H7-contaminated ground beef back in 1993 when he was only 6 years old. It was the most horrendous experience possible.

His first symptoms were severe abdominal cramping and bowel movements that consisted strictly of blood and mucus. Alex suffered terribly as his organs shut down one by one. At one point one of his lungs collapsed, requiring bedside surgery. His brain swelled so horribly that shunts were drilled into his head in an effort to relieve the pressure, but to no avail.

My brave little boy’s last words to me before slipping into a coma were, “Don’t cry, Mommy” as I couldn’t stop the tears from silently flowing. His last gesture to his dad was to blow him a kiss. I was with him when he suffered a grand mal seizure and was put on a ventilator. My little boy, my only child, was dead.

Alex had wanted to be a paramedic when he grew up so that he “could help others” — his words. So when he died we hoped to be able to donate his organs so that he could fulfill that wish of helping others, but his organs were unsalvageable because of the damage caused by the E. coli toxins.

There was no cure for this awful disease then and there still isn’t today. Doctors can only hope to support bodily systems until the toxins pass through. It is for this reason that it is critically important for meat and poultry companies to put into place prevention strategies and technologies to ensure that contaminated meat doesn’t make its way into the marketplace. That’s why we need to support innovations and advances that enhance food safety.

After Alex’s death, I felt compelled — really more like obligated — to fulfill his wish of helping and protecting other consumers by being his voice and working with federal regulating agencies and with companies to see to it that we did a better job as a country in generating a safer food supply. In the process, I have visited numerous meat and poultry plants, have provided input on public policies and food safety laws, and have served on the National Advisory Board for Meat and Poultry Inspection.

One of the many plants I visited was Beef Products, Inc. I got to know the owners, Eldon and Regina Roth, and was impressed by their complete commitment to the safety and wholesomeness of the meat products they produced. I was also impressed by the food safety culture they instilled throughout their company. We shed tears together over what happened to Alex and realized how we share the common goal of preventing illness and death from foodborne pathogens. Ever since that moment, BPI has generously supported STOP and has never asked for anything in return.

That said, one point that needs to be perfectly clear is this: After what I personally experienced watching my son suffer and die, I am very skeptical and cynical about for-profit meat companies and their professed commitment to food safety. Not all companies “walk their talk.” BPI does.

There has been a lot of misinformation swirling around the Internet and on TV about lean beef trim produced by Beef Products, Inc. As I stated earlier, I have personally visited their plant and the categorization of calling their product “pink slime” is completely false and incendiary. Consumers need to understand that this product is meat, period, and that the use of ammonia hydroxide in minute amounts during processing improves the safety of the product and is routinely used throughout the food industry. There are many types of interventions including food-grade antimicrobial sprays which are used on all manner of foods. Some of these things may sound icky and gross, especially when inaccurately portrayed. These interventions are necessary in ridding meat of deadly pathogens and are required to prove they pose no threats to consumers. Companies would be prohibited by the USDA and FDA to use substances that could be harmful in human consumption.

I am very concerned that mis-categorization campaigns such as this “pink slime” campaign will cause well-intentioned companies such as BPI to cease innovations for developing better food safety technologies and strategies. Why try to do something better only to get set up as a target? If this does in fact happen, and promising technologies get thwarted, we, the American public, will be the losers. And tragedies like Alex will continue to go on and on and on.

About the author: Nancy Donley is recognized as a leading proponent of improvement in both government and private food safety efforts since the death of her six-year old son Alex in 1993 from consumption of E. coli O157:H7-contaminated ground beef. Alex was her and her husband Tom’s only child. Nancy works in a volunteer capacity for STOP Foodborne Illness and has served as its president for over 10 years. She has done extensive advocacy work on behalf of the organization and has been featured in numerous magazine articles, newspaper articles and television interviews in efforts to increase awareness about the risks of foodborne illness. Nancy serves on the United States Department of Agriculture’s National Advisory Committee on Meat and Poultry Inspection. She has received numerous awards for her advocacy efforts.

Profiling E. coli O157:H7 and Other STECs

Escherichia coli O157:H7 and other shiga toxin producing E. coli (STEC) can be found in meat and in a number of different fruits and vegetables, and may cause potentially deadly infections, especially in children and in the elderly. STEC also are referred to as verocytotoxic E. coli (VTEC) or enterohemorrhagic E. coli (EHEC)

Some history

Many decades ago, a run-of-the-mill strain of E. coli acquired the ability to produce a toxin known as stx2 – probably courtesy of a bacteriophage that transported it from a random Shigella microbe. After undergoing mutations that changed its antigenic structure and its ability to ferment certain carbohydrates, our E. coli acquired the capacity to produce a second toxin – stx1 – and shiga toxin-producing E. coli O157:H7 was born.

E. coli O157:H7 was isolated for the first time in 1970, from an Irish piglet that had developed enteritis. Five years later, the microbe was found in the stool of a California woman who was suffering from bloody diarrhea. The first confirmed foodborne disease outbreaks caused by E. coli O157:H7 took place in 1982, among patrons of McDonalds – the first on in Oregon, the second in Michigan.

E. coli O157:H7 is just one of several shiga toxin-producing E. coli strains, known collectively as STEC. Other strains include O104:H4 (the cause of a massive sprout-related outbreak in Germany in 2011), as well as O26, O45, O103, O111, O121, and O145.

What are shiga toxin-producing E. coli (STECs) and what is their natural habitat?

E. coli O157:H7 and other STECs are members of the family Enterobacteriaceae. They are motile, rod-shaped bacteria that are capable of growing either with or without oxygen. STECs are found in the large intestines of many animals, especially in ruminants such as cattle. They are introduced into the soil and surface water through contaminated feces or the use of raw manure as fertilizer.

How is STEC transmitted? What is the incubation period of the infection?

STEC food poisoning results when an individual eats food that is contaminated with the microbe. The infection also can be transmitted secondarily by contact with stool from an infected individual. It takes only 100-200 STEC microbes to cause an infection.The incubation period varies from one to eight days, depending on the dose, and on the susceptibility of the victim.

What are the symptoms of an infection with STEC? How long do they last?

Symptoms of STEC infections include severe – often bloody – diarrhea, abdominal pain, and vomiting. Unless complications arise, symptoms typically last for 5 to 10 days.

What is the prognosis?

STEC infections are self-limiting in most cases involving healthy adults. Young children and some elderly victims are at risk of developing hemolytic uremic syndrome (HUS), a severe and sometimes fatal complication. HUS strikes approximately 5-10% of STEC-infected children under the age of 10 years, affecting the function of the kidneys, digestive system and other organs. HUS is fatal in 3 to 5% of cases; 12-30% of HUS victims continue to suffer long-term consequences of their illness, including hypertension or impaired kidney function.

What foods carry STEC?

E. coli O157:H7 and other STEC bacteria can be found most commonly in raw beef, unpasteurized dairy products, and raw produce.

How can people protect themselves from STEC?

People acquire STEC infections by person-to-person transmission; by ingesting contaminated food, milk or water; by coming into contact with infected animals (for example at petting zoos); or by swimming or playing in contaminated water.

The US Centers for Disease Control and Prevention offer these suggestions for avoiding STEC infections:

WASH YOUR HANDS thoroughly after using the bathroom or changing diapers and before preparing or eating food.
WASH YOUR HANDS after contact with animals or their environments (at farms, petting zoos, fairs, even your own backyard).
COOK meats thoroughly. Ground beef and meat that has been needle-tenderized should be cooked to a temperature of at least 160°F/70˚C. It’s best to use a thermometer, as color is not a very reliable indicator of “doneness.”
AVOID raw milk, unpasteurized dairy products, and unpasteurized juices (like fresh apple cider).
AVOID swallowing water when swimming or playing in lakes, ponds, streams, swimming pools, and backyard “kiddie” pools.
PREVENT cross contamination in food preparation areas by thoroughly washing hands, counters, cutting boards, and utensils after they touch raw meat.

Additionally, always pay attention to recall notices, and return any recalled item to the store, or discard it in a sealed bag.

For more information on STECs and other food-borne pathogens, visit the CDC website or read Food Safety: Old Habits, New Perspectives.

Investigators Need A Break In St. Louis E. coli O157:H7 Outbreak

Local, state and federal investigators are scratching their heads and hoping for a break as they try to identify the source of an outbreak of E. coli O157:H7 that has sickened at least 26 people in and around St. Louis, Missouri since October 25th. At least 19 outbreak victims have been hospitalized.

According to the Washington Post, the outbreak victims range in age from 1 to 94, and live in St. Louis city and four surrounding counties – St. Louis, Jefferson and St. Charles counties in Missouri, and St. Clair county in Illinois. The Illinois Department of Public Health acknowledged on October 28th that it was investigating a single illness in St. Clair County that might be linked to the Missouri outbreak.

The Missouri Department of Health and Senior Services is testing samples from an additional 25 suspect cases as part of the investigation into the outbreak, which appears to be linked to food sold from supermarket salad bars. At least some of the suspect salad bar components were supplied by distributors or processors outside of the state of Missouri, and FDA has been called in to assist in the inspection of the individual links in the distribution chain.

Initial patient interviews appeared to point to Schnucks Markets, Inc. salad bars as a common link. Schnucks is a regional supermarket chain headquartered in St. Louis, with Schnucks stores located in Missouri, Illinois, Indiana, and Iowa, and Logli/Hilander stores located in Rockford, Illinois and Janesville, Wisconsin.

Based on the initial information obtained from patients, Schnucks removed certain items from all of its salad bars, and replaced the items with products obtained from other suppliers. None of the items sampled so far from Schnucks salad bars or from the homes of patients have yielded E. coli.

After an additional round of patient interviews, a further 38 food samples have been collected from five Schnucks stores and submitted to the State lab for testing. These new samples include Bistro Salad Dressing, broccoli florets, deviled eggs, diced hard-boiled eggs, honey Dijon dressing, Italian dressing, pineapple chunks, red wine vinaigrette, shredded carrots, shredded radishes, shredded zucchini, and sliced red onions. In addition, six packaged salads that contain salad bar ingredients were submitted for analysis: Bistro Chopped Salad, Fresco House Salad, Fried Chicken Salad, Garden Salad, Italian Salad, and Turkey Cobb Salad.

The U.S. Centers for Disease Control and Prevention (CDC) has been called upon to assist in the epidemiological investigation, and is carrying out a case control study. The study will compare foods eaten by confirmed outbreak patients with foods consumed by a control group of healthy individuals living in the same area. With judicious questioning – and with some luck – the case control study might be successful in identifying one or more probable food sources for the outbreak.

Salad bar-related outbreaks can be especially difficult to trace to a source, due to the sheer number of different items present, and the potential for cross-contamination from serving utensils or the dropping of one salad bar item into another. Small salad ingredients, such as sliced vegetables, cherry tomatoes, and sprouts are especially susceptible to landing in the wrong bin. And people often don’t remember every vegetable or garnish that they selected.

Another complication in this outbreak investigation is the short shelf life of salad ingredients. The contaminated component may no longer be in the distribution chain. The longer it takes for a possible food to be identified via patient interviews and the case control study, the less likely it becomes that the contaminated food will be identified.

The State has not provided any time-related breakdown of the reported cases, so it’s difficult to tell whether or not the outbreak has reached its peak. Consumers in the St. Louis metropolitan area and surrounding counties should be especially careful in purchasing and handling salad items while this outbreak continues.

Public health officials in Missouri are urging anyone experiencing gastrointestinal symptoms, such as severe stomach cramps, diarrhea or nausea to seek medical attention.