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.

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.

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.

A press release from the university in Pullman, Washington, said Tom Besser, professor of veterinary microbiology has three years to delve into the subject.  He says there has been promising work over the past 15 to 20 years by scientists interested in reducing the rate at which cattle get infected with E. coli O157:H7.

Besser says vaccines, beneficial bacteria or “probiotics,” and certain feeds have had some good results, but not all of the research took different E. coli  strains into account. He wants to identify the seasonal variations and processes that kill clinical genotypes of E. coli  O157:H7 — the types most dangerous to humans. Bovine-biased genotypes cause only a small percentage of illnesses.

A vaccine, for example, could cut incidence ofE. coli O157:H7  in half. “That could be really good if the half that it’s cutting it by is mostly clinical genotypes,” said Besser.

In humans, E. coli O157:H7 releases a powerful toxin that attacks the lining of the intestine, causing severe abdominal cramps followed by watery, then bloody diarrhea that subsides within a week or so. Sometimes the diarrhea is accompanied by vomiting and a low-grade fever.

In more than 5 percent of cases, the Shiga toxins enter the bloodstream, causing HUS E. coli, or hemolytic uremic syndrome, which can lead to kidney failure, anemia, internal bleeding, and the destruction of vital organs. About 5 percent of children who develop E. coli  HUS  are killed by it. Those who survive are often left with permanent disabilities, including brain damage or paralysis.

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.

The information was compiled by The Food Industry Center at the University of Minnesota in an in-depth case study of the 2008 recall of 143 million pounds of beef from Westland/Hallmark Meat Packing Co. in Chino, California.

In that case, the massive recall was spurred by Humane Society of the United States video of inhumane treatment of cows at the plant and USDA’s admission that meat produced at the plant was unfit for human consumption because it was processed without lawful inspection.

The Westland/Hallmark recall on February 17, 2008, was by far the largest ever. The two next largest were caused by Listeria contamination — one in Michigan in 1999 for 35 million pounds and a poultry recall in Pennsylvania in 2002 for 27 million pounds.

Numbers four, five and six were beef E. coli recalls related to E. coli O157:H7 outbreaks that included cases of life-threatening hemolytic uremic syndrome (HUS), the leading cause of kidney failure in children.

Fourth Largest:  1977 Hudson Foods Co. of Nebraska/ 25 million pounds of ground beef sold to quick-service retailers. Tied to an E. coli O157:H7 outbreak of about 20 illnesses.

Fifth Largest: 2007 Topps Meats Co. of New Jersey/ 21.7 million pounds of frozen ground beef patties. Tied to more than 30 E. coli O157:H7 illnesses in eight states.

Sixth Largest: 2002 ConAgra Foods of Colorado/ 18.6 million pounds of beef. Tied to an E. coli O157:H7 outbreak in 10 states that sickened at least 34 people.

The new theory was published in the journal Molecular Cell and summarized in a story by USA Today.

It is based on a finding that that exposure to low levels of antibiotics increases mutations in E. coli and Staphylococcus bacteria hundreds of times more than normal, making the creation of drug-resistance strains more likely.

“This finding adds to concerns about antibiotic resistance brought on by poor prescriptions practices among doctors, patients who don’t take all their medicine and even low doses of antibiotics given to help animals grow faster,”  the newspaper story said.

James Collins is a biomedical engineer at Boston University and one of the paper’s authors. He told USA Today that while low levels of antibiotics may not be enough to kill off the bacteria, they still stress them. That stress causes them to produce free radicals. The free radicals damage the bacteria’s DNA, causing some of the affected bugs to mutate.

Basically, if the antibiotic dose isn’t high enough to kill every bacteria in sight, “you could be creating a zoo with a wide range of mutations,” Collins said.

E. coli O157:H7 is a human pathogen capable of causing kidney failure, heart damage, strokes, paralysis and other neurological damage. In more than 5 percent of cases, infection leads to life-threatening hemolytic uremic syndrome (HUS) or thrombotic thrombocytopenic purpura (TTP).

The enteric bacteria originates in the guts of cattle and other animals and can contaminate beef, other meat, fresh produce and other food products. The Centers for Disease Control and Prevention estimates that some 70,000 Americans are infected each year from shiga-toxin product E. coli, leading to approximate 2,000 hospitalizations and some 60 deaths.

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.

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.

Already since December 24, more than 1 million pounds of beef products have been recalled because they had potential to be contaminated with E. coli O157:H7.

Separate stories this week by USA Today  reporter Elizabeth Weise and by Scott Canon of  the Kansas City Star highlight an important trend in the battle: Intervention at the farm and feedlot level to reduce levels of the bacteria in animals’ guts and hides before they reach slaughter.

“The theory is that animals are carrying higher levels of E. coli during the summer months, and sometimes they may overwhelm the systems in place to control pathogen contamination in (processing) plants,”  said James Marsden, a professor of food safety and security at Kansas State University.

As the USA Today story noted, new interventions are intended to flatten out the curve between winter months when less bacteria is entering the system and the April-September period when cattle shed higher concentrations of E. coli O157:H7 and external temperatures are more suitable for the  pathogens to cluster.

Each new method, it is hoped, might take down the incidence of E. coli O157:H7 by a factor of 100. Together they could substantially lower the toll inflicted by the disease, which can cause cramps, bloody diarrhea, kidney failure and death. More than 5 percent of infections lead to life-threatening hemolytic uremic syndrome (HUS) or thrombotic thrombocytopenic purpura (TTP).

What follows is a quick run-down on some of the methods being employed to reduce the overall universe of E. coli O157:H7 in cattle: 

• Phages:  Cattle walk through a car-wash-like spray of bacteria-eating viruses called phages.  These viruses are harmless to humans and have been successfully used to kill a spotting bacteria on tomatoes and peppers in agricultures.
• Probiotics: Basically these are bacterial cultures much like those in yogurt, given to cattle in their feed. They’re called “competitive exclusion” cultures because they out-compete the bad bacteria and exclude them in the animals’ guts. The challenge to these is that they are hard to consistenting administer in large feedlot conditions.
• Diet:  Research in Texas, Kansas and Idaho has shown that switching cattle from grain to a more expensive diet of high quality hay before slaughter may lower E. coli O157:H7 rates, though the findings have not always been consistent.
• Vaccine: Cargill Meat Solutions is in the midst of  an active vaccination program in 100,000 cattle that will reach slaughter this spring. At an estimated cost of $3 to $10 per animal, vaccination against E. coli appears to have the potential to dramatically hinder the population of E. coli in the guts of cattle. A Minnesota-made vaccine called Epitopix already is in trial in the U.S. and Canada has its own E. coli vaccine that could possibly gain approval in the U.S.

From an epidemiologic standpoint, it’s clear that these pre-slaughter interventions lower the E. coli  O157:H7 burden in the cattle, says Guy Loneragan, a professor of animal science and expert in O157:H7 in cattle at West Texas A&M University in Canyon, Texas.