HUS is Leading Cause of Kidney Failure in Children
World Kidney Day is March 11 and part of raising awareness about the importance of our kidneys to our overall health is understanding that food poisoning is a major contributor to kidney failure in children.
The worldwide leading cause of kidney failure in children is hemolytic uremic syndrome, or HUS. Many of these cases are preventable because they stem from infections of E. coli O157:H7 or other bacteria transmitted by contaminated food. The bacteria grows harmlessly in the guts of cattle and other animals but persistently enter the human food supply via contamination from an animal’s E. coli-laden feces.
About 5 percent of the children who develop hemolytic uremic syndrome are killed by it. Those who survive are often left with permanent disabilities.
The main job of our kidneys is to remove toxins and excess water from our blood. Kidneys also help to control our blood pressure, to produce red blood cells and hormones, and to keep our bones healthy. E. coli HUS can quickly put previously healthy children and adults into end stage renal failure.
That happens because E. coli O157:H7 and some other types of E. coli emit a powerful toxin that attacks red blood cells. The damaged and misshaped cells clog up the kidneys and shut them down.
Because World Kidney Day — which is always held on the second Tuesday of March — is a visible opportunity to inform and educate health policy-makers, an appropriate part of the discussion is how to keep E. coli O157:H7 out of our food supply.
In the U.S., an important step forward in the fight against E. coli and other pathogens would be passage of a major piece of food safety legislation already passed by the House and now waiting action in the Senate.
Elsewhere in the U.S., government researchers and private labs are developing vaccines for cattle to suppress the microbe at its origin. Nothing, so far, has made much difference because outbreaks of E. coliO157:H7 have continued with disturbing frequency and scale.
In children and adults, HUS does more than just shut down renal function. HUS coma is a problem not uncommon in child HUS patients because many patients experience central nervous system disorders.
In addition, HUS seizures can be caused by vascular damage or cerebral hemorrhage. HUS seizures can also be caused by uremia (urea and other waste products staying in the blood due to kidney failure), hyponatremia (sodium levels are low and water levels are high) or other metabolic derangement.
Estimates are imprecise, but microbiologists guess that more than 70,000 Americans fall ill every year from E. coli bacterial infections, the largest source of which is contaminated ground beef. Of those infected, more than 5 percent develop life-threatening HUS E. coli. Those most at risk are children, older adults and others who have weakened immune systems.
Better Tracing of E coli in Hamburger
As the United States heads into warmer months when outbreaks of E. coli O157:H7 become more prevalent, USDA’s Food Safety and Inspection Service (FSIS) is holding public meetings for input on strengthening the E. coli tracing system.
Of particular concern is improving record keeping at the retail grocery level concerning the origin of ground beef, the commodity most often at the center of E. coli outbreaks. The next meeting starts at 8:30 a.m. Wednesday at the USDA South Building in Washington, D.C.
Knowing quickly and exactly the origin of every pound of beef sold at checkout could help save lives whenE. colioutbreaks happen because detailed records speed vital traceback investigations conducted by public health officials.
It’s hard to believe in 2010 that many retailers don’t keep records or that the records they keep are inadequate for tracing. Tracebacks help us identify the products that are making people sick in order to bring outbreaks under control as quickly as possible.
The current safety gap caused by improper ground beef record keeping at the retail level is acknowledged by top FSIS officials. The agency has been frustrated by the lack of records kept by retailers who grind their own ground beef. It’s essential for them to document where the bulk trimmings and cuts come from in the event a package of ground beef purchased by a consumer is later found to be contaminated with E. coli O157:H7.
If investigators can quickly identify by traceback what products are making people sick, they can also trace contaminated products forward through the distribution system and issue appropriate recalls and warnings.
Orderly documentation of what beef is used in a retail chain’s grindings also will put more pressure on suppliers to eliminate contamination. A major benefit of tracing is to allow the FSIS to assess the establishment that produced the contaminated product to detect if there’s a systemic problem at the plant.
The CDC estimates that as many as 300,000 people in the U.S. are hospitalized each year from foodborne illnesses and millions become ill and don’t even realize that it is connected to tainted food. Estimates of E. coli infection are imprecise, but microbiologists guess that more than 70,000 Americans fall ill every year from Shiga toxin-producing E. coli, the largest source of which is contaminated ground beef.
Of those infected, more than 5 percent develop life-threatening HUS E. coli, or hemolytic uremic syndrome, the leading cause of kidney failure in children and the leading cause of E. coli deaths.
The harmful microbes live in the intestines of cattle and are expelled in feces. The volume of germs surges in warmer weather and the bacteria can contaminate meat during the slaughter process when intestines are nicked or when feces flake off hides. It takes very few bacteria to make a person sick and testing doesn’t catch all lots of beef that are contaminated.
Grocery retailers can help reduce the spread of E. coli O157:H7 by pinpointing the origin of the ground beef they sell with well-kept records.
Vet’s Testimony on Oversight Sheds New Light on Beef E. coli
Years of ground beef E. coli outbreaks will be put in new light today by a slaughterhouse veterinarian’s testimony that supervisors shelved citations written by front-line government safety personnel for dangerous and cruel practices.
The vet says writers of citations were threatened with transfers. It is easy to imagine in the culture he describes that inspectors might have looked the other way at ground beef E. coli risks to stay out of trouble with supervisors in order to keep their jobs.
The whistleblower is Dean Wyatt, a supervisory veterinarian at the USDA’s Food Safety and Inspection Service (FSIS), the agency responsible for keeping E. coli O157:H7 and other potentially deadly pathogens out of our meat supply. According to USA Today reporter Peter Eisler, who obtained an advance copy of the testimony, Wyatt is to appear before the House Oversight and Government Reform Committee in Washington.
Wyatt witnessed practices as an FSIS vet that would increase the risk of E. coli O157:H7 contamination. For instance, he found downed calves being dragged through pens to slaughter — a violation because contact with feces can contaminate animals.
The abuse occurred at Bushway Packing Inc. in Grand Isle, Vermont. Wyatt says he ordered suspensions in operations three times at Bushway in 2008 and early 2009 but managers overruled him and allowed the plant to keep running.
Bushway subsequently made headlines last fall when the Humane Society of the United States filmed undercover video of workers hitting and using electric prods to move calves. The plant was shut down. USDA Secretary Tom Vilsack ordered a criminal investigation.
Wyatt also says superiors dismissed violations he reported in 2007 and 2008 at a Seaboard Foods pork plant in Guymon, Oklahoma. He cited the plant for slaughtering conscious pigs, beating pigs and trampling of pigs, USA Today is reporting.
Wyatt’s experiences “illustrate a pattern that FSIS is broken and must be fixed,” Amanda Hitt of the Government Accountability Project, told USA Today. USDA spokesman Caleb Weaver told the newspaper that inaction on Wyatt’s reports occurred before the tenure of Vilsack, who is “fully committed” to enforcing safe and humane slaughtering rules.
Fresh Produce E. coli and Salmonella Targeted by New FDA Rulemaking
Fresh produce E. coli and Salmonella outbreaks have prompted a review by the Food and Drug Administration that will lead to a proposed new safety regulation for the produce industry.
The rule-making process has been launched with four public meetings to elicit feedback and comments from growers and other produce safety stakeholders. About 100 people attended the first session in Rochester, New York, in February and three more meetings are scheduled for March and April in Columbus, Ohio; Tifton, Georgia and Hyattsville, Maryland.
Currently there are no mandatory national produce safety standards in place, but the FDA did issue voluntary guidelines in 1998. Jim O’Hara, director of the Produce Safety Project at Georgetown University, has said that many retailers and supermarkets have their own safety guidelines, but there is no set standard across the board.
There is also a voluntary leafy green growers safety pact started by the industry, but problems have continued.
Attention to food safety in fresh produce has followed such high-profile foodborne illness outbreaks as the 2006 spinach E. coli outbreak that killed three people and sickened more than 200. One of the victims was a 2-year-old child who contracted HUS E. coli, or hemolytic uremic syndrome, the leading cause of kidney failure in children
Lettuce and leafy greens are on the top of the list of the 10 riskiest foods regulated by the FDA.
Center for Science in the Public Interest, a nutrition watchdog group for consumers, said the food group has been linked to the most food poisoning outbreaks — 363 outbreaks from 1990 to 2006 — of any of the foods that it surveyed.
The outbreaks of lettuce E. coli O157:H7, Salmonella, Campylobacter, Norovirus and other pathogens have caused more than 13,500 illnesses, the report said. Manure, contaminated irrigation water, or poor handling practices are all possible culprits in those outbreaks.
The next three FDA “stakeholders’ meetings” for produce safety rule making will be March 11 at the Blackwell Inn in Columbus, Ohio; March 25 at the University of Georgia’s College of Agriculture and Environmental Sciences in Tifton and April 7 at the Marriott Inn and Conference Center in Hyattsville, Md.
USDA Should Ban More Types of Shiga-Toxin E. coli From Meat
Dana Boner lost her 14-year-old daughter to E. coli O111 in 2007.
Now she is a member of Chicago-based S.T.O.P.-Safe Tables Our Priority, which is renewing its plea to the USDA to declare disease-causing E. coli types other than E. coli O157:H7 as adulterants in beef and begin testing for them. National food safety law firm Pritzker Olsen and many other supporters of S.T.O.P. have made the same request.
The USDA declared E. coli O157:H7 an adulterant in ground beef in 1994 in the aftermath of a west coast outbreak that sickened over 700 people and killed at least 4. Adulterant status makes it illegal to sell contaminated product — knowingly or unknowingly. With it comes an obligation to test for the pathogen.
The Centers for Disease Control and Prevention (CDC) has identified 6 additional strains of shiga-toxin producing E. coli (STEC) — O26, O111, O103, O121, O45 and O145 — that are associated with severe illness and death. Shiga-toxin — whether it comes from the O157:H7 bug or any other bug attacks red blood cells with the same life-threatening result.
Just like E. coli O157:H7, these other STEC strains are found in cattle and get into our beef supply when feces contaminate the meat during slaughter and processing. The powerful toxin, which has no antidote, can lead to renal failure, cause strokes, damage neuro systems and create heart problems. It leads to hemolytic uremic syndrome (HUS) and thrombotic thrombocytopenic purpura (TTP), two life-threatening complications of STEC infection.
“You can’t find what you’re not looking for and USDA needs to start actively looking for these pathogens,” Dana said in a press release issued by S.T.O.P. ”It’s too late for Kayla, but not too late for others.”
Nancy Donley, S.T.O.P.’s President, whose 6-year-old son died from E. coli O157:H7-contaminated ground beef, said that in 2007 and 2008 USDA had public meetings on this issue, but failed to enact any prevention-based strategy. Instead, USDA declared that it would first conduct testing of ground beef and components to determine the extent of non-O157 STEC and implement a regulatory program if needed.
“While S.T.O.P. has no objection to conducting a baseline study, we object to holding up declaring these additional E. coli strains as adulterants in beef,” Donley said.
Food Safety Experts Want USDA to Dig Deeper When Tests Find E coli 0157:H7 in Meat
Food safety advocates have asked Secretary of Agriculture Tom Vilsack for a policy change when routine inspections turn up positive tests in meat for E. coli O157:H7.
They are calling for a shift to deeper investigations — a reform supported by national food safety law firm Pritzker Olsen. Such a move would better safeguard consumers, especially amid a spate of beef recalls. Already since December 24, 2009, more than 1 million pounds of beef have been recalled after USDA testing in plants found beef E. coli poisoning.
When positive test results are found in connection with a beef E. coli outbreak or other foodborne disease, USDA launches a comprehensive investigation to find the root cause. Those probes are carried out with layers of assistance form Centers for Disease Control and Prevention, state health departments and sometimes the Food and Drug Administration (FDA).
But an in-depth story by Chicago Tribune reporter Steve Mills questions why investigators don’t also kick out the jams when inspectors for USDA’s Food Safety and Inspection Service (FSIS) detect E. coli O157:H7 in finished meat samples at packing and processing plants. It does not appear unreasonable given the small number of positive test results.
In 2009, for instance, there were 41 positive results from more than 11,600 tests, the Tribune reported. Six of those positive tests occurred at five facilities in Illinois. Since 2001, the highest number of positive E. coli O157:H7 test results was 59.
Deeper investigations are especially needed when E. coli O157:H7 inspections are positive in ground beef. Ground beef is made from various lots of meat that are combined at a grinding facility. The lots are frequently divided and sold to a number of different grinding locations. Safety advocates told the Tribune those facts highlight the need to work backward to identify the source of contamination, so tainted meat from other facilities does not reach consumers.
“There’s ironclad evidence that contaminated product is out there, but they don’t do a full investigation,” said Felicia Nestor, a senior policy analyst at the food safety group Food & Water Watch, which also signed the letter to Vilsack. “It’s unconscionable.”
“Why are they doing these investigations if they’re not doing them to put their arms around all the product and find out what went wrong?” asked Donna Rosenbaum, executive director of Safe Tables Our Priority.
A spokesman for FSIS told the Tribune that the agency will “continue working on refining traceability methods and approaches to meat inspections.” Officials are planning a public meeting, tentatively scheduled for March, to discuss approaches to meat inspections.
