Anyone who has ever
cared for a child with enterohemorrhagic E. coli knows what a nightmare
it can be. The illness starts as a severe watery diarrhea and progresses
to a bloody diarrhea with severe abdominal cramping. Internal bleeding
in the skin, large intestines, and kidneys can develop. This can
lead to anemia, kidney failure, or even, death.
have to worry about dying from drinking apple cider, going camping,
or going to a petting zoo. But you do.
A recent report
in Morbidity and Mortality Weekly Reports describes fifty-six cases
of Escherichia coli O157 infection in Pennsylvania and Washington.
These are the first outbreaks of this disease to be associated with
the direct transmission of the bacteria from farm animals to humans.
During the fall of 2000, 51 people with an average age of 4 years
had diarrhea within ten 10 days of visiting a dairy farm in Pennsylvania.
16 were hospitalized and eight developed hemolytic-uremic syndrome.
Of the 216 cattle on the farm, 28 (13%) were infected with the same
type of E. coli that caused the disease in the children.
During the spring
of 2000, five children in Washington ranging in age from 2 to 14
years developed bloody diarrhea that was proven to be caused by
E. coli O157. Four of the children had visited a farm where they
were encouraged to handle poultry, rabbits, and goats. A calf was
kept in a pen and could be touched through a fence. One of the children
was a sibling of a child who had visited the farm. Three of the
children were hospitalized. Only five of the farm animals were tested
for E. coli O157 and none were positive.
In May of 2000, twenty
children were infected by E. coli O157 in New Aberdeenshire, Scotland, after
camping in a muddy field that had been used as a sheep pasture. None of
the children had direct contact with the animals, but the soil was found
to be heavily contaminated.
The largest outbreak
of E. coli O157 occurred in 1993, associated with contaminated hamburgers
at Jack in the Box restaurants. There were 500 culture-confirmed cases and
100 probable cases in Washington State. About 150 of the cases were hospitalized
and there were 45 cases of hemolytic-uremic syndrome, which causes internal
bleeding and kidney failure, of which 28 required kidney dialysis. Three
children died related to this outbreak.
E. coli O157 was first
identified as a cause of human illness in 1982, but subsequent research
has traced it back to Argentina in 1977. It quickly spread to cattle
all over the world. It is estimated that 3 to 10% of all cattle
carry the germ, and 20 to 50% of all herds have at least one infected
member. E. coli O157 does not cause disease in cattle, sheep, or
deer. Unlike other causes of food borne illness, it is just as common
among "free range" cattle as among those penned in feedlots.
There is currently no known farming practice that can prevent herds
from becoming contaminated. Therefore, the World Health Organization
and the Center for Disease Control recommend you assume that all
cows carry E. coli O157, and that you take precautions accordingly.
If you visit
a farm, make sure that you wash your hands well after any contact
with animals, manure or soil. Don't eat or smoke before washing
your hands well. Children, particularly children under five, are
at greatly increased risk. If they are allowed to have contact with
sheep, goats, or cattle at all, they must have one-to-one supervision
and should wash immediately afterwards.
The CDC recommendations
for farm visits can be found at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5015a5.htm.
The World Health
Organization fact sheet on E. coli O157, including the "Golden
Rules" for safe food preparation, can be found at http://www.who.int/inf-fs/en/fact125.html.
Several articles about E. coli O157 can regularly be found here
at VegSource in the "Mad Cow Corral."
My daughter's elementary
school is next door to a pasture. Flooding is common here in South
Texas, so the runoff could easily get onto her playground. The bottom
line, unfortunately, is that cow feces have contaminated our entire
world. Manure is spread on fruits, vegetables, and grains, even
those labeled "organic." Not eating meat will reduce your
chances of contracting E. coli O157, but as long as cattle and cow
manure can be found practically everywhere, even vegetarians must
Daniel Maloney is a pediatrician. He lives and works in The
Woodlands, Texas, north of Houston, with his wife, Liz, and his
two children, Ryan, 15, and Julie, 8. They will be coming to the
VegSource e-vent weekend
and hope to meet as many of you as possible.