ESCHERICHIA COLI O157:H7
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1 Fact Sheet N 125 July 1996 ESCHERICHIA COLI O157:H7 1. What is Escherichia cli O157:H7? Escherichia cli is a bacterium that is a cmmn inhabitant f the gut f warm blded animals, including man. Mst strains f E.cli are harmless, hwever, sme strains, such as E. cli O157:H7, can cause severe fdbrne disease and are referred t as enterhaemrrhagic E.cli (EHEC). This pathgen prduces txins, knwn as vertxins r Shiga-like txins because f their similarity t the txins prduced by Shigella dysenteriae. The rganism can grw frm arund 7-10C t 50C, with an ptimum temperature f 37C. Sme EHEC can grw in acidic fds, dwn t a ph f 4.4, and in fds with a minimum water activity (Aw) f It is destryed by thrugh cking f fds until all parts reach a temperature f 70C r higher. The designatin "O157:H7" in the name f this bacterium refers t specific chemical cmpunds that are fund n its surface that distinguishes it frm ther strains f E. cli. 2. What illnesses des E. cli O157:H7 cause? Symptms f the illness caused by E.cli O157:H7 include abdminal cramps and watery diarrhea that can develp int bldy diarrhea (haemrrhagic clitis ). Fever and vmiting may als ccur and mst patients recver within 10 days. Hwever, in a small prprtin f patients, particularly yung children and the elderly, the infectin can result in lifethreatening cmplicatins, such as haemlytic uraemic syndrme (HUS), fr example. HUS is characterized by acute renal failure, haemlytic anaemia and thrmbcytpenia. It is estimated that up t 10% f patients with EHEC infectin may develp HUS, with a case-fatality rate ranging frm 3% t 5%. The incubatin perid fr the illness can range frm 3 t 8 days, with a median f 3-4 days. 3. Surces f infectin The reservir f this pathgen appears t be mainly cattle. It is transmitted t man principally thrugh cnsumptin f cntaminated fds, such as raw r undercked grund meat prducts and raw milk. Faecal cntaminatin f water and ther fds, as well as crss-cntaminatin during fd preparatin will als lead t infectin. Examples f fds implicated in utbreaks f E. cli O157:H7 include hamburgers, fresh-pressed apple cider,
2 ygurt, cheese, dried cured salami, and cked maize. EHEC can survive and grw n salad vegetables. Waterbrne transmissin has been reprted, bth frm cntaminated drinking water and frm recreatinal waters. Persn-t-persn cntact is an imprtant mde f transmissin thrugh the ral-faecal rute. An asymptmatic carrier state has been reprted, where individuals shw n clinical signs f disease but are capable f infecting thers. The duratin f excretin f EHEC is abut ne week r less in adults, but can be lnger in children 4. Cntrl and Preventin Methds The preventin f infectin requires cntrl measures at all stages f the fd chain, frm agricultural prductin n the farm, t prcessing, manufacturing and preparatin f fds in bth cmmercial establishments and the dmestic envirnment. There are insufficient data t recmmend specific interventin methds n the farm in rder t reduce the incidence f EHEC in cattle. Gd hygienic slaughtering practices will reduce cntaminatin f carcasses by faeces but will nt guarantee the absence f EHEC frm prducts. Educatin in hygienic handling f fds fr abattir wrkers and thse invlved in the prductin f raw meat is essential t keep micrbilgical cntaminatin t a minimum. Similarly, preventin f cntaminatin f raw milk n the farm is virtually nt feasible but educatin f farm wrkers in principles f gd hygienic practice is necessary in rder t keep cntaminatin t a minimum. The nly effective methd f eliminating EHEC frm fds is t intrduce a bactericidal treatment, such as heating (e.g. cking r pasteurizatin) r irradiatin. Preventive measures fr f E.cli O157:H7 infectin are similar t ther fdbrne diseases. Hwever, sme f the measures may need t be reinfrced fr this infectin, particularly because f the imprtance f EHEC infectin in vulnerable grups such as children and elderly. Recmmendatins t the public and travellers Make sure yur fd, particularly fds made with grund beef (e.g. hamburger) are prperly cked and are still ht when served; Avid raw milk and prducts made frm raw milk. Drink nly pasteurized r biled milk; Wash hands thrughly and frequently using sap, in particular after having been t the tilet, r after cntact with farm animals; Wash fruits and vegetables carefully, particularly if they are eaten raw. If pssible, vegetables and fruits shuld be peeled; When the safety f drinking water is dubtful, bil it r if this is nt pssible, disinfect it with a reliable, slw release disinfectant
3 agent. These are usually available at pharmacies. A WHO Guide n Safe Fd fr Travellers is available frm the Sales and Distributin Office, Geneva, Switzerland, that gives practical advice fr safeguarding health when travelling. Recmmendatins t prfessinal and dmestic fd handlers: As fd handlers, yu shuld be vigilant during the preparatin f fd and bserve hygienic rules f fd preparatin (see the attached WHO Glden Rules fr Safe Fd Preparatin). Prfessinal fd handlers wh suffer frm a fdbrne illness, including E.cli O157 infectin, shuld reprt t their emplyer immediately. Mre infrmatin fr fd handlers is given in the WHO Guide n Hygiene in Fd Service and Mass Cartering Establishments. Further infrmatin f Fd Safety can be btained at the WHO WWW Site (hppt:/ r at fdsafety@wh.ch. Fr further infrmatin please cntact Valery Abramv, Health Cmmunicatins and Public Relatins, WHO, Geneva. Tel. (41 22) , r Fax (41 22) All WHO press releases, fact sheets and features are available n the Internet n the WHO Hme Page THE WHO GOLDEN RULES FOR SAFE FOOD PREPARATION 1. Chse fds prcessed fr safety While many fds, such as fruits and vegetables, are best in their natural state, thers simply are nt safe unless they have been prcessed. Fr example, always buy pasteurized as ppsed t raw milk and, if yu have the chice, select fresh r frzen pultry treated with inizing radiatin. When shpping, keep in mind that fd prcessing was invented t imprve safety as well as t prlng shelf-life. Certain fds eaten raw, such as lettuce, need thrugh washing. 2. Ck fd thrughly Many raw fds, mst ntably pultry, meats, and unpasteurized milk, are very ften cntaminated with disease-causing pathgens. Thrugh cking will kill the pathgens, but remember that the temperature f all parts f the fd must reach at least 70C. If cked chicken is still raw near the bne, put it back in the ven until il's dne -- all the way thrugh. Frzen meat, fish,
4 and pultry must be thrughly thawed befre cking. 3. Eat cked fds immediately When cked fds cl t rm temperature, micrbes begin t prliferate. The lnger the wait, the greater the risk. T be n the safe side, eat cked fds just as sn as they cme ff the heat. 4. Stre cked fds carefully If yu must prepare fds in advance r want t keep leftvers, be sure t stre them under either ht (near r abve 60C) cnditins. This rule is f vital imprtance if yu plan t stre fds fr mre than fur r five hurs. Fds fr infants shuld preferably nt be stred at all. A cmmn errr, respnsible fr cuntless cases f fdbrne disease, is putting t large a quantity f warm fd in the refrigeratr. In an verburdened refrigeratr, cked fds cannt cl t the cre as quickly as they must. When the centre f fd remains warm (abve 10C) t lng, micrbes thrive, quickly prliferating t disease-prducing levels. 5. Reheat cked fds thrughly This is yur best prtectin against micrbes that may have develped during strage (prper strage slws dwn micrbial grwth but des nt kill the rganisms). Once again, thrugh reheating means that all parts f the fd must reach at least 70C. 6. Avid cntact between raw fds and cked fds Safely cked fd can becme cntaminated thrugh even the slightest cntact with raw fd. This crss-examinatin can be direct, as when raw pultry meat cmes int cntact with cked fds. It can als be mre subtle. Fr example, dn't prepare a raw chicken and then use the same unwashed cutting bard and knife t carve the cked bird. Ding s can reintrduce all the ptential risks fr micrbial grwth and subsequent illness present prir t cking. 7. Wash hands repeatedly Wash hands thrughly befre yu start preparing fd and after every interruptin -- especially if yu have t change the baby r have been t the tilet. After preparing raw fds such as fish, meat r pultry, wash again befre yu start handling ther fds. And if yu have an infectin n yur hand, be sure t bandage r cver it befre preparing fd. Remember t, that husehld pets -- dgs, birds, and especially turtles -- ften harbur dangerus pathgens that can pass frm yur hands int fd. 8. Keep all kitchen surfaces meticulusly clean Since fds are s easily cntaminated, any surface used fr fd preparatin
5 must be kept abslutely clean. Think f every fd scrap, crumb r spt as a ptential reservir f germs. Clths that cme int cntact with dishes and utensils shuld be changed every day and biled befre reuse. Separate clths fr cleaning the flr als require, frequent washing. 9. Prtect fds frm insects, rdents, and ther animals Animals frequently carry pathgenic micrrganisms which cause fdbrne disease. String fds in tightly sealed cntainers is yur best prtectin. 10. Use pure water Pure water is just as imprtant fr fd preparatin as fr drinking. If yu have any dubts abut the water supply, bil water befre adding it t fd r making ice fr drinks. Be especially careful with any water used t prepare an infant's meal. The Wrld health Organizatin regards illness due t cntaminated fd as ne f the mst widespread health prblems in the cntemprary wrld. In infants and the elderly, the cnsequences can be fatal. Prtect yur family by fllwing these simple rules. They will reduce the risk f fdbrne disease significantly. Fr further infrmatin please cntact the Fd Safety Unit, Wrld Health Organizatin, 1211 Geneva 27, Switzerland. WHO/OMS, 1998 Cncept
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