Monday, 30 May 2011

Anxious about E coli? What you really need to know.......

In the last few days, those of us in the UK and Europe would have seen the headlines regarding the E Coli outbreak in Germany caused by infected cucumbers

(Update 6/6/11 a mix of sprouted seeds, which are used in salads and includes lentils, alfalfa seeds, fenugreek and adzuki beans, could be the cause of the E. coli outbreak, although there is currently no laboratory evidence to support this link.)

Unfortunately it has been reported that hundreds of people have fallen sick, of whom a much smaller number have died. Understandably this is quite worrying, although sensationalist media headlines have played an important role in fuelling excessive levels of panic. I included the cartoon above as many of you may be feeling like the little boy it features. I have also been providing bits of information about E Coli via twitter and facebook. However I decided it may be useful to do a summary blog post which includes links to websites that I know contain correct information. Why? Because although I am a princess, public health is in fact my day job!

What is E Coli?
E coli is a type of bacteria that is commonly found in the gut of humans and animals. There are many different types of E coli, some of which live harmlessly in the gut (actually most of us carry the harmless strains). Others unfortunately can cause a variety of diseases (see next section for VTEC E coli). The bacteria can be found in faeces and can survive for extended periods in the environment.

What is VTEC or E coli 0157?
The bad E coli tends to be the VTEC strains. VTEC is short for Vero cytotoxin producing E coli. The most common type in the UK is 0157. The one causing the outbreak in Germany is 0104 (which is rare in the UK). They cause infection from mild diarrhoea to serious inflammation of the gut (severe abdominal pain and bloody diarrhoea). A small percentage of people (2-7%), usually children or the elderly will develop a very serious condition called Hemolytic Uremic Syndrome (HUS) that can result in kidney failure. This condition is life threatening and can develop between 2 and 14 days after diarrhoea begins. 

Another important fact is that very small numbers of the bacteria can cause disease. This makes it very infectious and so the disease can spread easily within families, in schools, nursing homes, hospitals etc. 

What are the symptoms?
  • diarrhoea (about 50% of people will have bloody diarrhoea)
  • abdominal cramps
  • fever

How can I become infected?
  • eating contaminated food
  • drinking contaminated water or water that has not been properly treated
  • swimming or playing in contaminated water like streams or ponds
  • contact with infected animals directly or with animal poo (farms, campsites, petting farms)
  • contact with other people with the illness 

How can I avoid becoming infected?
This is definitely an example where prevention is better than cure! There is no specific treatment for VTEC infection and in most cases the infection will clear within a week. Drink plenty of fluids to avoid dehydration, avoid tea, coffee or fizzy drinks. Paracetamol is useful for pain relief. Antibiotics are NOT recommended as they can worsen complications. It is important to note that some people continue to shed the bacteria for a couple of weeks. 

It is very important to practise basic hygiene such as 
  • washing your hands regularly with soap after using the toilet
  • cleaning hard surfaces with disinfectant
  • cooking all minced meat products properly
  • avoid contact between raw and cooked meats
  • thoroughly washing ALL salad and vegetables that will be eaten RAW
  • not preparing salads using the same utensils used for raw meat
  • eating and drinking pasteurised dairy products
  • boiling drinking water if unsure of the source
  • not swimming in water that may be contaminated with sheep or cattle poo
Of course if you do become infected, it is important to contact your GP who will determine whether you will be treated at home or if you are ill enough to be taken to hospital. They will also inform public health agencies so that steps can be taken to control the outbreak or look for the source of the infection.

If you want to know more, I recommend the following sites

I hope you find the information useful. Let me know if you have any questions or if there is anything confusing in the comments. Enjoy your bank holiday and remember to eat your vegetables!

Vegetables are still good for you! But wash them first!


Steve said...

How is the virus carried on cucumbers on the inside or outside?

We wash everything we get from the supermarket here. But we find the Spanish cucumbers tend to be better quality, 'firmer' than the locally grown ones.

Jotje said...

(unsure if this will deserve the title "clever comment", but here ya go ....)
Question 1: how would you define Thorough cleaning of raw eaten vegetables like cucumbers or tomatoes? I rinse them with water, but doubt that this would get rid if the ecoli?
Question 2 (and likely unanswerable got you): how could the source be Spanish while there no sick pp reported in Spain? I assume Germany is not the only EU country consuming Spanish cucumbers? Wouldn't this rather suspect a glitch in the transporting system to Germany?
Tough question 3: why are mostly women affected in the current cases? Why not the usual vulnerable groups like the elderly, sick and young children?

Globetrotting Cacti said...

Thank for the informative post... still eating fruit & veg in this house (including cucumber!).

I do have a question though! We take the kiddums to petting farms & always carry alcohol gel/wipes in our bag. Are these sufficient or is soap & water the recommended cleaning agent? At 2 years of age, their hands are in their mouth frequently (& we often have an ice-cream treat) so I like the squirty gel best but do these products work?

Thanks for sharing your expertise....

Izzie said...

Thanks for this post, it's very interesting! I live in Hamburg, where it all kind of started with cucumbers coming from Spain to the market in Hamburg where they have been distributed to Germany. It's horrible to hear every 30 minutes on the radio: "more than 400 people in Hamburg have been infected now".
I hope everything will be better soon and I definitely avoid eating cucumbers etc since there are still supermarkets selling spanish cucumbers.

Leia said...

I'm really glad you wrote this post! I really appreciate it. I was just reading about the e coli outbreak this morning and wondering how to prevent it / what to do if it happens to me. Your tips are fantastic! Thank you!


caribbean princess said...

E coli is a bacterium not a virus. Viruses may cause GI illness as well for example rotavirus, norovirus (winter vomiting bug)etc.

E coli is unlikely to be internalised in plants. A 2009 paper in the Journal of Food Protection by Sharma et al. found that although E coli cells could migrate into the roots of spinach plants they were unlikely to become internalised in the leaves or shoots of baby spinach plants.

Usually the vegetable is contaminated externally by manure that has not composted properly, exposure to contaminated water, contamination via improper handling by someone who is infectious in transit, at the retailer or in the home.

Washing vegetables in tap water that is fit for drinking is sufficient. :-)

caribbean princess said...

Jotje you have asked tough questions!
1. Thorough cleaning means washing properly in water that is fit for drinking. Don't do it half heartedly, wash thoroughly. For example with lettuce wash the individual leaves to ensure they are properly washed. Washing wont get rid of every single E coli but it should reduce to acceptable levels.

2. That is a good point. It is possible that the vegetables could have been contaminated in transit or at the retailer by someone who was infected or by washing the vegetables in contaminated water. They may not have been contaminated at the source. The investigators will try to find out what happened although sometimes it is impossible to get the truth.

3. Some reports suggest that this strain is behaving differently in terms of who it is affecting but that hasnt been confirmed.If we assumed that women do more of the cooking then they are more likely to come into contact with raw vegetables? Maybe men dont eat their veggies? DH certainy doesnt like toeat his so lots of possibilities! My guess is that a fair amount of the outbreak is likely to be caused by person to person transmission in homes, schools etc and not just from the original source of infected cucumbers.

caribbean princess said...

Globetrotting, soap and water is recommended instead of alcohol gels/wipes which will not remove E coli in dirt.

Here is a useful guide for parents on farm visits from the Health protection Agency

caribbean princess said...

Izzie it must be quite a stressful time in Germany. Have they determined what is the source of the infection in the cucumbers? It is possible that they were not contaminated in Spain but in transit, or even at the retailers? They should be carrying out further investigations to try to find out although it is sometimes difficult to find the truth as people change their practices.

caribbean princess said...

No problem Leia, I am glad you found it helpful. I was supposed to do a what's in my bag post today or post pictures from my short trip but decided this was more important ;-)

Globetrotting Cacti said...

Thanks for the feedback (and learnt a lot from all of your feedback). Will check out the link...

Jotje said...

Thanks for your answers, K.! Much appreciated. DH believes that more women are infected because they eat more (raw) veggies as they tend to be more aware of their weight (he did put it that cautiously, haha).

As for the alcoholic gels: In the prenatal were E (my youngest) once was, the nurses and docs always used the desinfectant gel (from a dispenser), they never washed their hands with water. I had to do it too (each and every time I entered the room), and it gave me an aweful exemic rash on my hands (brrrr).

I don't use it at home, because it just doesn't "feel" clean.

caribbean princess said...

No problem Globetrotting and Jotje. I was happy to answer the questions as I really enjoy public health, especially health protection. It is fascinating :-)

angela said...

I too, have been following the stories on BBC news very intently regarding this outbreak. Not least because last term's module was on 'Immunology' so anything vaguely related to that is interesting to me!

I do agree that the press do play a part in making people panic more than they would if the stories were less melodramatic. My parents were certainly a bit worried by the story! However, we all do tend to eat all vegetables cooked as we rarely eat salads so it doesn't worry me too much.

Either way, I like how informative this post is. If more people read this post, maybe they'd realise just how much the press can exaggerate sometimes in relation to disease outbreaks and the like.

caribbean princess said...

Angela, you are right although I won't deny that it is a huge outbreak in Germany, as more than a thousand affected with 16 deaths. However the reporting of deadly cucumbers in media headlines here is sensationalist and has caused a lot of panic outside the worst affected places. Now they are saying that a different strain of E Coli was found on the Spanish cucumbers to the one causing the outbreak. So blaming the cucumbers may have been very premature.

As I said they cannot rule out contamination at some point along the distribution chain of the vegetables and a lot of the new cases will be person to person spread so they need to implement public health measures beyond telling people not to eat cucumbers.

Steve said...

Thank you for your detailed answers.

Seeing the news this evening there seems some confusion about the origins of this outbreak. But where ever it is coming from. I'm sure we will hopefully take more precautions from now on.

Thanks again

caribbean princess said...

No problem Steve. The plot thickens. It seems they have totally backtracked on the Spanish cucumbers as the outbreak source. But the Spanish farmers won't be too impressed by the initial blame, not to mention the hit on Spain's economy.

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