Germany is currently suffering from the deadliest E.coli outbreak in modern history. So far, over 2500 people have been infected, and 25 have died. More than 700 have developed Hemolytic Uremic Syndrome (HUS), a rare, severe complication characterized by acute kidney failure. The outbreak has been occurring since early May, an extremely long time considering most E.coli outbreaks only last for two weeks.
The cause of the outbreak has been identified as a strain of E.coli never before isolated in humans, Shiga toxin-producing Escherichia coli O104:H4 (STEC O104:H4). The source of the outbreak has still yet to be confirmed, with officials initially suspecting cucumbers, lettuce, and tomatoes from Spain then later organic sprouts from Germany. At this point, however, it may be impossible to isolate the bacteria from a farm – the source may only be deduced via epidemiological information.
Because of next-generation sequencing techniques, the genome of the strain has already been sequenced. Early reports show close relationship with EAEC 55989 E.coli, a strain isolated in the Central African Republic and known to cause serious diarrhea. Sequencing also suggests increased pathogenicity resulting from acquisition of several virulence genes.
The strain has also shown increased resistance to antibiotics. While this may seem like yet another complicating factor, it is actually irrelevant to treatment of cases. Generally, E.coli infections are not treated with antibiotics because it is believed that the bacteria respond by producing more Shiga toxin, causing a toxin cascade and increasing damage to the body. Increased drug resistance, however, may have contributed to the survival of the bacteria on food or in the environment.
The outbreak has struck Germany hard, creating chaos in trade throughout the European Union. Luckily, it appears that the situation is stabilizing and cases of the disease are beginning to slow, though more cases are likely to appear over the next few weeks as the outbreak comes to an end.
The current STEC O104:H4 outbreak does not pose a threat to the United States, but that does not mean that the U.S. should ignore the situation in Germany. The events unfolding across the Atlantic can be viewed as a cautionary tale. A robust and comprehensive food safety program cannot be understated, for both protection against naturally occurring disease events and intentional contamination by terrorists.
Initial reports suggest that the novel strain of STEC may have emerged directly from the environment, affecting raw vegetables that were never properly washed or cooked upon arrival at their final destination. But contamination during shipping, storing, or packaging has not been ruled out. The possibility of this occurring in the United States is not out of the question, and it is important that authorities are prepared to deal with any type of food contamination.
Despite stringent food safety programs, measures, and procedures, some contamination still occurs here in America. The United States has seen several outbreaks of E.coli and Salmonella over the past decade, but even the largest (2006) pales in comparison to the outbreak in Germany. Regardless, it is important that the U.S. maintain a strong food safety program in order to safeguard Americans against deadly foodborne illnesses.
Moreover, there is the threat of deliberate contamination of the food supply. In the wake of the outbreak in Germany, the UK has discussed its vulnerabilities to such an attack. Though several experts say the U.S. is better prepared for an attack than the UK, terrorists could nonetheless attempt to taint food in America. Along the “farm to fork continuum”, there are multiple steps that terrorists could exploit, using either a biological agent (live organism or toxin) or a chemical agent to cause harm to the end consumer.
Such an attack would not only create a medical crisis, but it would also induce panic and, perhaps most importantly, have a far-reaching economic effect as well. An attack on the food supply would shatter both domestic and international confidence in food from the United States, and the financial consequences could be in the billions of dollars.
Granted, attacking American food would not be a simple task. Terrorists would need to consider where along the process they are targeting, then determine how much agent would be needed to counteract the effects of dilution. Additionally, whatever agent they select would need to survive through processing of the food, and it would need to survive cooking/heating at the end consumer’s location. Depending on the terrorists’ motives, however, simply claiming to have contaminated the food supply could result in the same dire consequences as the actual act.
Moving forward, it will be important for the United States to continue funding food safety and security program, not only to defend against terrorists, but also to ensure preparedness for naturally occurring events. The outbreak in Germany has demonstrated that novel, especially virulent pathogens have the ability to emerge without much warning from the natural environment. The same could happen here in America, and it is vital that the country is prepared.
For more information on E.coli and the current outbreak in Germany, please refer to CDC, WHO, and ProMed-Mail.
Tags: e.coli, food safety, germany, infectious diseases
