Little-known E. coli strain O111 starts gaining notoriety
Braylee Beaver, 20 months old, is back to her playful self after a 12-day hospital stay in which she received dialysis treatment and was stuck with so many needles she thought she was being punished, says her father.
Beaver was allegedly sickened by an E. coli bacteria but not E. coli O157:H7, the type that most consumers are aware of. That bacteria drove the recall of almost 30 million pounds of meat last year and was blamed for an outbreak involving fresh spinach in 2006 in which five died.
Instead, the Centers for Disease Control and Prevention says Beaver and 313 others who ate food from an Oklahoma restaurant in August were sickened by E. coli O111, a rare type of E. coli that can also be deadly and is becoming increasingly familiar to public health officials.
From 1990 to 2007, O111 was linked to 10 reported illness outbreaks in the U.S., the CDC says. Four of the 10 were linked to food. Before the Oklahoma outbreak, in which one person died, the biggest O111 outbreak happened in New York in 2004. Unpasteurized apple cider was blamed for 212 illnesses.
E. coli O111 is a Shiga toxin-producing E. coli, or STEC. It is one of a handful of non-O157 STECs that have caused 22 reported illness outbreaks in the U.S. from 1990 to 2007, the CDC says. Food caused 10 of the outbreaks.
Illnesses caused by the non-O157 STECs tend to be milder than those caused by O157, the CDC says. But some can cause equally severe disease and kidney failure, a danger of O157. In Oklahoma, 17 needed dialysis, state officials say.
The number of reported non-O157 outbreaks is small. But others may have gone unreported because doctors may not have looked for non-O157 E. coli in sick patients. "There's a significant possibility that illnesses and outbreaks have been missed," says Elisabeth Hagen of the Office of Public Health for the U.S. Department of Agriculture.
The CDC estimates that more than 25,000 non-O157 STEC infections occur each year in the U.S. — about a third the number of O157:H7 infections.
Research has also shown that other E. coli types may be more prevalent than thought, Richard Raymond, the USDA's undersecretary for food safety, told officials meeting on the subject last October. He cited a recent study in Nebraska in which nearly 50% of E. coli infections there were non-O157:H7s. Other countries have seen the same, Hagen says.
Cattle are a primary source of E. coli. While there are many types of E. coli, only O157:H7 is routinely tested for by the meat industry and the USDA. It was identified in the 1980s and was declared an adulterant in ground beef in 1994.
Given increasing infection reports, the USDA plans to begin some testing of ground beef for six other E. coli types, including O111, that are causing most of the non-O157 infections, Hagen says. Testing may begin within months, she adds.
It's not clear whether more non-O157 STEC infections are occurring or whether they're being identified more often, Hagen says. The USDA wants to determine how prevalent they are and find ways to reduce any risks to consumers. None of the 22 non-O157 outbreaks has been linked to meat. That has occurred in other countries.
"We think it's a significant enough public health concern to see if it's a problem," Hagen says.
Food associations say they support study of other E. coli. But they say it's too soon to say whether they should be called adulterants, which would cause recalls in the future. Proper cooking destroys E. coli.
"We need a much better understanding of what the landscape looks like," says Robert Brackett of the Grocery Manufacturers Association. He also says that industry efforts to rid meat of E. coli O157:H7 — including washing cattle carcasses — work against other E. coli.
The Oklahoma outbreak, which state officials say ended last month, has been linked only to Country Cottage, an independent buffet-style restaurant in Locust Grove, Okla., but not to a cause. The restaurant has closed.
The CDC identified E. coli O111 as the culprit on Aug. 29, 10 days after Braylee had the biggest meal of her life, including chicken fried steak and potatoes.
When Braylee first got diarrhea, her parents thought it was a normal bug. Then her stools turned bloody and she was hospitalized, says her father, Jake Beaver. Her parents hope she'll avoid lifelong kidney problems, which can arise.
"I didn't know E. coli could do this," Beaver says. "I just thought people got a little sick."
Dana and Rick Boner of Monroe, Iowa, also thought their daughter, Kayla, had a regular bug last year when she fell ill on her 14th birthday. Kayla died 11 days later because of an E. coli O111 infection — the cause of which was never determined — her mother says.
"I didn't even know there were any other strains but O157," says Boner, an insurance agent.
She speculates that other non-O157 illnesses have gone undetected or incorrectly reported for years, given the lack of awareness about it.
"I want people to know there are other strains," she says. "How could my child be the only person who got this?"