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Health officials attempting to sort out E. coli epidemiology
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Clusters of Escherichia coli in Tennessee and Virginia that have been mounting in recent weeks appear unrelated to a larger outbreak in Germany, according to health officials.
The puzzling epidemiology has CDC and local health departments scrambling to sort out where the cases are originating.
In Virginia, two people were confirmed to have the deadly strain of E. coli, 0157:H7. One of the Virginia patients, a minor, died. A spokesperson for the Department of Health in Virginia said health officials there were not ruling out that the cases were related to an outbreak in Tennessee.
Northeastern Tennessee, meanwhile, has reported 11 laboratory-confirmed cases of E. coli since June 1.
The outbreak in Germany is caused by a strain of non-O157 Shiga toxin-producing E. coli called O104:H4. Last week, CDC officials confirmed a few cases of this strain in returning tourists.
Health officials in both states are reportedly looking at numerous sources of infection, from contaminated food, to petting farm animals or water derived from various water sources.
This tragic outbreak brings to light many issues, and there are no simple solutions to the problems illuminated by this outbreak of E. coli O104:H4 infections.
First, the vehicle that is currently incriminated, sprouts, demonstrates that without a reliable microbial killing process, no ready to eat food can be guaranteed to be free of pathogens, regardless of its source. However, the benefit to children of consuming fresh fruits and vegetables is immense and the risk from their consumption in individual situations is extraordinarily low. Industry, regulatory agencies, professional societies, scientists and consumers will need to work together to reduce this risk even further.
Second, we cannot predict each and every pathogen threat, and must recognize that infectious diseases and pathogens will always be moving targets. The outbreak strain blends disparate virulence traits, and we had no indication prior to this outbreak that this particular serotype would have been so deadly, or the effects on human populations would have been so widespread. It is critical, therefore, that when such microbial threats surface, that our societies are protected by adequately resourced and well-trained disease investigation authorities. Outbreaks of this and other emerging infections demonstrate that public health surveillance and intervention capacities are critical to our safety. Unfortunately, public health services face budget pressures worldwide, and as in Europe, we (the US) have major vulnerabilities.
Third, diagnostic microbiology technology for enteric infections is cumbersome, expensive, and poorly adapted to emergencies, such as the one we are witnessing. We need more rapid and informative testing strategies, and more informed approaches to patients with alarm symptoms, such as bloody diarrhea.
Fourth, we must pay attention to the forces and principles that underlie the emergence of new infections.
Finally, this pathogen displays an unusual extended spectrum beta-lactamase pattern. It is critical that we understand, and then interdict, the pressures for the acquisition of antimicrobial resistance in bacteria acquired from the food supply.
Phillip I. Tarr, MD
Melvin E. Carnahan Professor
of Pediatrics and Professor of Molecular Microbiology
Director, Division of
Gastroenterology and Nutrition
Co-Leader, Pathobiology Research Unit
Department of Pediatrics, Washington University School of Medicine
James P. Nataro, MD, PhD
Benjamin Armistead Shepherd Professor
and Chair,
Department of Pediatrics
University of Virginia School of Medicine
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