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September 16, 1999 DES MOINES, Iowa-- The stomach plague of the millennium continues to gain notoriety as new outbreaks surface all over the world. In the United States an estimated 10,000 to 20,000 thousand cases are reported each year. Ninety-three people in Iowa were infected during 1998 and nine more succumbed in 1999. The cause of the debilitating malady wasn't discovered until 1982, following an outbreak on the West Coast caused by contaminated hamburger. Since that time, E. coli has continued to be one of the most prevalent health hazards in the modern world. It can result in kidney failure and, in a small percentage of cases, death. There have been 403 documented cases of E. coli in Iowa since 1995, when the Iowa Department of Public Health first began tracking rates of infection. Many more cases go undiagnosed, so the actual number of people afflicted is even higher. The most likely source of infection is contaminated, undercooked ground beef. Ingesting even a minuscule amount of the bacteria can produce severe symptoms. E. coli often mimics the symptoms of stomach flu. Bloody stools, diarrhea and abdominal cramping are the most common ailments. Most victims do not develop a fever during the course of the illness. The effects can last from five to 10 days. Rob Yancey, assistant bureau chief and program planner at the Iowa Agriculture and Land Stewardship Department's Meat Inspection Bureau, said the effects of E. coli--from the same source and in the same amount --can range from mild to severe. "There's no way to say how you're going to be affected," Yancey said. "The incubation period for E. coli is three to eight days so it probably didn't come from the last place you ate," said Judy Goddard, nurse epidemiologist at the Iowa Department of Public Health. The delayed onset makes it more difficult to trace the source of the contamination. So far, there hasn't been a large-scale outbreak of E. coli in Iowa. "We've looked at clusters of cases in areas and could not find any connections," Goddard said. "It's most likely to be contracted at home because of improper handling of food." The national Centers for Disease Control and Prevention estimate that approximately 2 to 7 percent of those infected with E. coli develop hemolytic uremic syndrome, a life-threatening condition causing a loss of red blood cells and kidney failure. An estimated 5 to 10 percent of small children, particularly those under age 5, will progress to this stage of the disease. Hemolytic uremic syndrome causes abnormal kidney function in about one-third of the cases. Lifelong effects, such as paralysis, high blood pressure, and blindness, occur in approximately 8 percent of the people stricken with HUS. Treatment may involve ongoing dialysis and/or having a portion of the bowel removed. An estimated 3 percent to 5 percent of HUS patients treated in intensive care units die from the syndrome. The death rate among the elderly is significantly higher, nearly 50 percent. Those with compromised immune systems are also prone to develop fatal complications. The strain of bacteria that creates this havoc in humans in called Escherichia coli 0157:H7, which contains a toxin that attacks the cells walls of the intestine. It can be found in the intestinal tracts of cattle, which show no outward signs of carrying the bacteria. "Not every animal carries the bacteria," said Yancey. E. coli is spread to humans when they ingest the bacteria. It can be contracted in a variety of ways, but the most common source is ground beef. "Normally the bacteria remains on the surface of most beef cuts and the exterior is cooked at a high enough temperature to kill the bacteria," Yancey said. However, cuts into the meat can allow E.coli to penetrate below the surface, where it is less likely to reach the temperature necessary to eradicate the bacteria. In packing plants, intestinal contents can be incorporated throughout ground beef. Meat containing E. coli looks and smells the same as other ground beef. Cooking meat until it reaches an internal temperature of 160 degrees, or until all the pink is gone will kill the E.coli bacteria. Using separate utensils and dishes for preparing raw meat keeps it from spreading to other food. "E. coli can be found on fruits and vegetables where manure is used for fertilizer," Yancey said. Drinking only pasteurized milk and juice, and thoroughly washing fruits and vegetables helps to alleviate the risk. Water containing raw sewage recently caused an outbreak in New York. Safety precautions include drinking only treated water. Any water that has not been through a treatment process should be boiled. Be careful not to swallow water when swimming in lakes, rivers, ponds or pools with low chlorine levels. Improper handling and disposal of diapers and soiled clothing carrying the bacteria can spread the disease from person to person. Good hygiene is one of the best preventatives. Wash hands thoroughly after changing diapers or using the bathroom. Anyone infected with E. coli should not handle food or provide child or patient care. "Day-care settings and places where large groups of people are served food are the most likely settings for an E. coli outbreak," Goddard said. She recommended storing and serving foods at the proper temperatures to avoid contamination. E. coli is widespread, but it is preventable. By following a few safety and hygienic precautions, Iowans can avoid the dangerous intestinal malady. |