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A ProMED-mail post <> ProMED-mail is a program of the International Society for Infectious Diseases <>

Date: Tue 3 Jul 2018
Source: Irish Mirror [edited] <>

The HSE has urged the public to take care with food after _E. coli_ infection cases skyrocketed in the last few days. The health service said that 96 cases had been reported in the last 10 days -- 3 times higher than this time in 2017 -- and that the recent hot weather provides the perfect conditions for the numbers to grow. The HSE Health Protection Surveillance Centre warned people to "take extra care when handling and preparing food." The infections involve a particular group of _E. coli_ bacteria, EHEC (enterohemorrhagic _E. coli_).

The Food Safety Authority of Ireland's website outlines that "although most strains of _E. coli_ are harmless and live in the intestines of healthy humans and animals, EHEC strains produce a powerful toxin and can cause severe illness." The symptoms of EHEC infection vary but often include bloody diarrhea and abdominal cramps. Symptoms usually pass within 5 to 10 days. However, EHEC infection can also cause a more serious complication called hemolytic uremic syndrome (HUS) in up to 10 percent of cases, which can lead to kidney failure and occasionally even death. HUS is more common in children under 5 and the elderly. It is important to visit your doctor if you develop bloody diarrhea, the HSE said.

The health service added that people should "always wash your hands before and after handling food; wash your fruit and vegetables thoroughly before eating them, and always ensure minced meats are cooked all the way through." It added in a statement: "A study carried out in Ireland in 2013 showed that raw minced beef burgers and minced beef samples from retail and catering premises were contaminated with VTEC, which was detected in 2.5 percent of samples.

Eating meat (especially minced beef) that has not been thoroughly cooked all the way through to kill these bugs can cause food poisoning. Therefore, to ensure that minced meat burgers are safe to eat, they should be cooked to a core temperature of 75 C [167 F]. EHEC can also be found in the stool of an infected person and can be passed from person to person if hygiene or hand-washing habits are inadequate. This is particularly common among toddlers, who are not toilet trained. Family members and playmates of these children are at high risk of becoming infected.

Commenting on the figures, Dr Kevin Kelleher, Assistant National Director, Public Health, said: "While investigations haven't identified a specific reason for the increase in cases, we would like to remind people to be careful about food safety during this heatwave to protect themselves against food poisoning.

"This hot weather provides the right conditions for bacteria such as EHEC to grow and multiply on foods, which can lead to high numbers of cases of food poisoning in adults and children. Not washing hands after handling raw meat, not washing fruits and vegetables, and undercooking minced meats such as beef burgers are common ways of getting food poisoning at this time of year."

There are 4 simple steps from SafeFood that you can take to prevent food poisoning:

Clean - always wash your hands before and after preparing, handling and eating food, after visiting the toilet or after playing with pets or animals.

Cook - make sure that food is cooked all the way through in order to destroy any harmful bacteria that might be present.

Chill - keep food cool in order to prevent bad bacteria from growing; make sure that your fridge is at the correct temperature to keep cold foods chilled; aim to keep your fridge at 5 C [41 F] or below.

Separate to prevent cross-contamination - separate raw and cooked foods during storage and cooking and never let raw food, for example raw meat, come into contact with ready-to-eat foods such as salads.

[Byline: Brynmor Pattison]

Communicated by: ProMED-mail from HealthMap Alerts <>

[It is unclear whether this warm, global-warming-associated summer season is behind the dramatic increase in cases or whether a particular food is linked to genetically-linked EHEC strains, or both.

Regarding HUS, the following was extracted from Lutwick LI. Enterohemorrhagic _E. coli_ infections. In: Confronting emerging zoonoses: the One Health paradigm. Yamada A, Kahn LH, Kaplan B, Monath TP, Woodall J, Conti LA (editors). Tokyo, Japan: Springer, 2014, 77-112:

Risk factors for the subsequent development of HUS after EHEC include children less than 10 years of age, elevated white blood cell counts, persistent low platelet counts without reversal and the use of either antimicrobial agents or antimotility agents during the diarrhea stage before or after bloody diarrhea develops. Since fever is generally not part of the presentation but significant abdominal pain is, patients with diarrhea, significant abdominal pain and no fever should be considered to have EHEC infection, and antimicrobial or antimotility agents should be avoided. Additionally, certain strains -- for example, the so-called clade 8 and the chimeric organism _E. coli_ O104:H4 -- can be associated with a higher risk of HUS.

HUS itself is a thrombotic illness primarily caused by the effects of the EHEC produced Shiga toxin acting on the vascular endometrium of organs where the toxin's receptors are expressed, particularly the kidney and brain. The syndrome consists of the combination of prominent low platelet counts (thrombocytopenia), intravascular red blood cell destruction (hemolysis), and diminished kidney function that can require hemodialysis. Neurological involvement occurs mostly in those who develop renal failure and the central nervous system involvement portends much higher mortality. Indeed, most of the acute mortality relates to neurological disease. Most patients will recover, but some, perhaps 10 per cent, remain with renal failure and require chronic hemodialysis.

1. Schmidt H, Geitz C, Tarr PI, et al. Non-O157:H7 pathogenic Shiga-toxin producing _Escherichia coli_: phenotypic and genetic profiling of virulence traits and evidence for clonality. J Infect Dis 1999; 179(1): 115-23; available at: <>
2. Bettelheim KA. Role of non-O157 VTEC. Symp Ser Soc Appl Microbiol 2000; (29): 38S-50S; abstract available at: <>. - Mod.LL

HealthMap/ProMED map available at: Ireland: <>]

[See Also:
E. coli EHEC - France (02): O26, unpasteurized cheese, more cases
E. coli EHEC - Ireland: (Ulster) childcare center
E. coli EHEC - France: O26, unpasteurized cheese, alert, recall
E. coli EHEC - Canada: cheese, 2013, 60 day rule

E. coli EHEC - UK (09): (Scotland) O157, unpast cheese, children, fatal
E. coli EHEC - UK (08): (Scotland, England) O157, unpast cheese, recall, fatal
E. coli EHEC - France: O80:H2, hybrid invasive pathogen, 2005-2014
E. coli EHEC - UK (07): (Scotland, England) O157, unpast. cheese, fatality
E. coli EHEC - UK (06): (Scotland, England) O157, unpast. cheese, alert, recall
E. coli EHEC - USA (26): (MI) cheese, alert, recall
E. coli EHEC - UK (05): (Scotland, England) O157, unpast. cheese, alert, recall
E. coli EHEC - Romania (03): O26, soft cheese susp, recall
E. coli EHEC - Romania (02): O26, soft cheese susp
E. coli EHEC - Romania: (AG) O26, cottage cheese

E. coli EHEC - France (02): (SW) O157, ground beef, recall
E. coli EHEC - France: (southwest), O157, ground beef, recall
E. coli EHEC - Europe: (France, Germany, Denmark) O104]

Published 27-09-2017 in Focus on , last update 05-07-2018


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