Ability to trace source of infection rapidly the key to control

It is hard to reconcile the fact that E-coli 0157 can be controlled so readily with its potential to cause death and seriously…

It is hard to reconcile the fact that E-coli 0157 can be controlled so readily with its potential to cause death and seriously debilitate people, even when a mere handful of organisms are present.

Its sinister side is the often fatal toll it takes on vulnerable people: the very young, the very old, pregnant women and those whose immune system is compromised by illness. This strain seemed to surface from nowhere in 1982 and adds a ruthless dimension to the mostly harmless E-coli present in the guts of humans and animals.

The outbreak in Lanarkshire, central Scotland, during 1996 was traced to a butcher's shop, and was believed to have been caused by cross-contamination of cooked meats by raw meats. Most who died were elderly.

The longer the source of the Co Cork outbreak goes undetected the graver the risk for those vulnerable groups. Public health specialists might not be as lucky as they have been so far, with three children and an adult now recovering. An English boy who recently holidayed in Ireland is on dialysis in a UK hospital due to E-coli 0157, though its source has not been found.

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About 10 per cent of cases go on to develop a condition called haemolytic uraemic syndrome after the onset of the symptoms of diarrhoea, stomach cramps and sometimes vomiting or fever. This can cause kidney failure. Against that background, public health specialists have to work in a microbiological race against time, employing meticulous detective work to pinpoint a source and contamination route.

Research into this outbreak is focusing on minced meat, with particular attention on the greater Fermoy area. The ability to trace food and identify strains quickly is vital, yet samples have still to be sent to the UK for final confirmation. Few, if any, Irish laboratories are suitably equipped.

Infected cattle are the main reservoir of E-coli 0157. Meat can be contaminated during slaughter and processing, particularly if minced. Unpasteurised milk, contaminated raw vegetables and contaminated water are also potential sources. Cooking at high temperature for a few minutes eliminates the E-coli; with minced meat, cook until the juices run clear and there are no pink areas inside. Its spread is prevented by good hygiene, especially by food handlers.

Supermarkets need to be especially careful given the huge range of raw and cooked meats they sell.

"The onus is on food outlets to ensure their meat is in order," says Dr Patrick Wall of the Food Safety Authority.

Ireland is set to follow Britain, where outbreaks are rising sharply and some 30 E-coli deaths have occurred. There have been three small outbreaks here and one fatality (a child in Co Kildare). In view of that trend, the Food Safety Authority has set up a special task force to ensure the Irish response is adequate.

It is pertinent to ask if it will take a number of deaths before we have the ability to trace meat properly? And do we have the necessary ability to detect rapidly E-coli 0157? Many would contend that we are not yet getting the right answers to those questions.