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Rapid response, inspector experience critical in E. coli outbreaks in UK
A review of Escherichia coli O157 outbreaks in the United Kingdom from the 1980s to 2013 highlighted two key lessons: Rapid response to an outbreak is crucial, and inspector experience and intuition play an important role in identifying safety problems.
Unlike other countries, a significant number of E. coli O157 outbreaks in the United Kingdom were associated with butchers, although very few were caused by contaminated ground beef.
During a large butcher-associated outbreak in Scotland in 1996, a microbiologist who had been involved with a previous outbreak recognized that another outbreak was underway when E. coli O157 was identified in three patients from a low-risk area. Further examination linked the outbreak to a butcher who had provided contaminated beef to a church lunch, a birthday party, a nursing home and retail sales. This outbreak affected 503 people, 279 of whom were microbiologically confirmed, according to the review.
Another large outbreak occurred in Wales in 2005. In all, 118 people had microbiologically confirmed E. coli O157 and 39 had probable E. coli O157, which means they developed bloody diarrhea during the outbreak period. All cases were eventually linked to cooked, sliced meat from a butcher in Wales.
Farm visits were linked to 23 outbreaks in England and Wales between 1994 and 2008. An outbreak that affected 20 campers at an open farm in Scotland occurred in 2000. The largest U.K. farm outbreak occurred at Godstone Open Farm in 2009, with 93 people becoming infected with E. coli O157 after visiting the petting farm.
In 2009, an enhanced E. coli O157 surveillance system was established in England, which helped identify two outbreaks by noting an increase in a particular phage type in England and Wales, the reviewer wrote.
“A universal response to tragedy is to say ‘lessons must be learned,’ but the events in South Wales in 2005 repeated those in central Scotland in 1996, so it would be wise to restrict the number of lessons,” the reviewer wrote.
The first lesson: A rapid response to an outbreak is critical.
“Preventing primary cases by removing the source of infection is obvious, but preventing secondary cases by promulgating hygiene messages to the public is crucially important,” the reviewer wrote.
Second, food inspectors’ experience and intuition can be critical in identifying safety problems, according to the reviewer.
Disclosure: The researchers report no relevant financial disclosures.