October 2011 Issue

Lessons From Europe’s E. Coli Outbreak — What Dietetic Professionals Need to Know
By Lori Zanteson
Today’s Dietitian
Vol. 13 No. 10 P. 10

What’s being called the deadliest E. coli outbreak in modern history has claimed more than 50 lives and infected more than 4,400 people in 16 countries in Europe and North America. Though much is known about the unusual E. coli strain, the tragedy has renewed focus on global food safety. The outbreak offers nutrition professionals an opportunity to examine this tragedy and the implications for food safety in the United States.

E. coli usually isn’t something we fear. Most strains common in the digestive systems of cattle and humans are harmless. Bacteria mutate as a “part of the natural evolution of life,” says Christine Bruhn, PhD, a consumer food marketing specialist and director of the Center for Consumer Research at the University of California, Davis. Some, however, such as the strain behind the outbreak in Europe, exchange genes that release what are known as Shiga toxins that make people sick, causing infection that results in symptoms such as abdominal cramping, diarrhea, vomiting, and fever. More serious complications also can occur, such as hemolytic uremic syndrome, which attacks the kidneys and can cause stroke, seizure, coma, and even death.

Early in the outbreak, German scientists identified that the gene that produced the Shiga toxin also worsened patient symptoms in response to certain antibiotics used to treat E. coli. The strain to which the toxin attached itself was identified weeks later in a July 27 New England Journal of Medicine article as an unusual subgroup of a known enteroaggregative E. coli, which has been linked to sporadic disease, but nothing on a large scale. The evolutionary pathway of this strain and the reason for the outbreak remain unclear.

One thing that is clear is the speed at which the infecting E. coli strain was identified. Modern DNA-sequencing technologies enabled researchers worldwide to sequence and analyze the German enteroaggregative E. coli outbreak strain. Sequencing happened in mere hours, allowing analyses to proceed more quickly than ever before, “providing a glimpse into a new era in which communities of researchers rapidly share large-scale data sets and analyses that are vital for public health,” The New England Journal of Medicine reported.

Uncovering the Source
The source’s identity, however, wasn’t revealed so quickly, and the testing of produce, such as tomatoes, lettuce, and cucumbers, came up negative for the bacteria but, nonetheless, resulted in bans on imported fresh fruits and vegetables from the European Union. The likeliest source of the E. coli strain has been traced to contaminated fenugreek seeds exported to Germany from Egypt. The seeds were used to grow fresh salad sprouts that most of the victims had eaten.

“Sprouts are risky. I know no food safety specialist who eats sprouts,” Bruhn says, who explains that the warm, moist environment in which sprouts grow is ideal for bacterial growth. “Once bacteria grow, it’s hard to remove,” she says. E. coli, which is naturally in the environment, gets deposited on plants and even may reside beneath the hard outer seed coat that’s released with moisture. Washing produce under running water is recommended, but “not all bacteria runs off with water,” Bruhn cautions. “Running your fingers along the produce will help, but it won’t get everything. The bacteria can be inside the nooks and crannies.”

“Cooking kills the bacteria, not the rinsing,” explains John Krakowski, RD, food safety coach and trainer in Flanders, N.Y. Rinsing cleans the visible soil and dirt from them, not the microorganisms. “Seeds and sprouts and food safety isn’t new,” Krakowski says, who recommends that those who are vulnerable to foodborne illness should either not eat them or cook them first.

With any outbreak, Krakowski says, there’s a reason not everyone who came into contact with the bacteria became ill. It often comes down to the normal things we do with food like rinsing, cleaning, and cooking. Generally, if a person is sufficiently healthy, “you’ll fight it off.”

Those at highest risk are young children, older adults, and people with diabetes, those who are pregnant, or who have chronic health conditions. However, the outbreak in Europe infected mostly young adult women who ate the sprouts. “We all think we’re fine,” Bruhn explains, “but your susceptibility isn’t the same as it used to be.” Children under the age of 5 are very susceptible, but [teenagers] are still a concern. The same is true for older adults. The elderly are at risk, but people in their 50s may be more at risk than they were in younger years. It takes only a small amount of E. coli bacteria to put a susceptible person in the hospital, Bruhn says. It’s important to eat produce to maintain health, but those at high risk should not consider eating raw vegetables. “It’s high risk,” she says.

Looking to the Sprout Industry
One of the steps the sprout industry can take to curtail the growth of bacteria is to irradiate the seeds, which penetrates the seed coat. Bruhn concedes that a smaller percentage of seeds sprout, but it’s still economically viable. The FDA has approved irradiation of sprout seeds, she says, but the industry prefers not to irradiate due to the preferences of organic customers. Another solution the FDA has tried is rinsing sprouting seeds and then watching the water for microbial material. Such methods have been used for years, but outbreaks associated with sprouts continue. “Many of us feel it’s too darn risky,” she says. “Look at the data. Bacteria are a part of our environment and are very challenging. Make it safe by cooking, irradiating, or eating something else.”

Dietetic professionals know well the ins and outs of food safety, but it’s all too easy to let the basics of food safety slide when consulting with clients. It’s not uncommon that Krakowski encounters people he describes as “brazen” because they knowingly don’t follow the rules. In fact, he says, they seem to enjoy telling him that they rinsed a chicken or stuffed a turkey, well aware those practices go against food safety recommendations. People need to know that times have definitely changed. It’s not like when we were kids sampling a cherry at the market, Krakowski explains. Today, “I find it disgusting. It’s so unwise. We shouldn’t be afraid of food,” he urges, but people need to understand the very real dangers of not knowing and not practicing food safety. “People are so intent on kids washing their hands after using the restroom, yet we let them eat cake batter.”

Making Food Safety Top Priority
Bruhn, a member of the American Dietetic Association (ADA), feels confident that dietitians are speaking to people at high risk, but believes food safety is less a part of the program than it should be. Krakowski is adamant that “every single dietitian should include food safety guidance. It doesn’t have to be someone with cancer or HIV,” he says. “It should be given to every client. People need to know U.S. standards of food safety.”

Keeping pace with the most current food safety standards is imperative for all dietetic professionals. With so many resources available, including those on the ADA website in association with ConAgra Foods, Krakowski recommends dietitians include food safety as part of their continuing education. In light of the recent outbreak in Europe, food safety has never been more important and will continue to be a valuable and lifesaving resource.

— Lori Zanteson is a southern California-based food and health writer whose work has appeared in various publications.


Top 6 Food Safety Tips
Here are some tips to share with clients when giving them the lowdown about food safety:

1. Shop strategically. Keep fruits and vegetables separate from meat, poultry, and fish in the grocery cart. Ask the cashier to bag these items separately, and store them in different bins or on separate shelves in the refrigerator to avoid cross contamination.

2. Clean fruits and veggies. Wash all fruits and vegetables, even those organically grown in your own garden or that come from a farmers’ market. Use a clean brush or your hands to wash produce with inedible rinds (eg, oranges, lemons, melons) under running water before slicing. Instead of using soap, choose a commercial cleaning solution specifically designed for produce. Another tip: You can eat prewashed, bagged produce without further washing if it’s consumed before the use-by date.

3. Prep the kitchen. Clean all surfaces and utensils with hot, soapy water before and after washing and preparing fruits, vegetables, meats, and fish.

4. Keep it separate. Use different cutting boards and utensils when prepping beef, poultry, and fish.

5. Sanitize. After cutting meats, poultry, fish, or any produce, wash the cutting boards and prep areas with hot soapy water. To sanitize the boards, pour boiling water over them for 20 seconds. Plastic cutting boards can go in the dishwasher on a normal cleaning cycle. Another way to sanitize prep areas and cutting boards is to wash them with a solution of 1 tsp chlorine bleach and 1 quart water.

6. Refrigerate leftovers to keep food fresh.

— Source: “Safe Handling of Fruits And Vegetables,” University of California Division of Agriculture and Natural Resources