What else could explain the large discrepancy in state by state reporting results? It’s not that certain borders are immune from bacteria.

Now there’s a study by the Center for Science in the Public Interest (CSPI) that attempts to quantify the problem, saying that at least 23 states need to improve outbreak reporting. Nationally, public health protection against outbreaks of E. coli O157:H7 and other foodborne illness provided by the Centers for Disease Control and Prevention is only as good as the reporting network of states.

CSPI’s study looked at 2007 outbreak data and used health deparments in Oregon and Minnesota as a baseline because they have excellent laboratory facilities and strict regiments for quickly interviewing subjects of food poisoning. Each state reported 10 outbreaks per million people in 2007.

According to the study, seven states had even better reporting records in 2007, including Maine, Kansas, Wyoming, Vermont, Alaska, Hawaii and North Dakota. Those states generated more reports and provided CDC with better information to prevent future outbreaks.

On the other end of the spectrum, twelve states reported just one outbreak of foodborne illness per million people, and 11 states had reporting rates almost as low. 

 The 23 states with the lowest reporting rates in 2007 were Delaware, Georgia, Pennsylvania, New York, and Massachusetts, each with three outbreaks per million; Missouri, New Jersey, Virginia, Alabama, West Virginia, and Kentucky, each with two outbreaks per million; and Texas, North Carolina, Indiana, Louisiana, Nebraska, Utah, Arkansas, Montana, New Mexico, Nevada, Mississippi, and Oklahoma, each reporting just one outbreak per million.

Frequently Asked Questions about Hemolytic Uremic Syndrome (HUS)

What is hemolytic uremic syndrome (HUS)?

HUS is a disease that destroys red blood cells. Healthy red blood cells (left) are smooth and round. In hemolytic uremic syndrome, toxins destroy red blood cells (right). These misshapen cells may clog the tiny blood vessels in the kidneys. A healthy kidney is a filtration device that removes waste products from the blood. It contains hundreds of thousands of tiny filters (glomeruli), tiny tubes through which blood passes.

When kidneys are healthy, the artery brings blood and wastes from the bloodstream into the kidneys. The glomeruli clean the blood. Then wastes and extra fluid go out into the urine through the ureter. Clean blood leaves the kidneys and goes back into the bloodstream through the vein.
The red blood cells damaged and misshaped by HUS cannot pass through the glomeruli and cause blockage. This blockage results in destruction of the glomeruli. If enough glomeruli are damaged, function of the kidney is compromised. In severe cases, the person suffers end-stage renal disease or even death.

What causes HUS?

HUS develops when Escherichia coli (E. coli) bacteria lodged in the digestive tract make toxins that enter the bloodstream and start to destroy red blood cells. Most cases of HUS occur after an infection of the digestive tract by the E. coli bacterium, which is found in foods like meat, dairy products, leafy greens and juice when they are contaminated. Some people have contracted HUS after swimming in pools or lakes contaminated with feces. Most people who suffer E. coli O157:H7 poisoning do not suffer HUS.

What are the signs and symptoms of HUS and kidney failure?

With HUS, the child remains pale, tired, and irritable. Other signs include small, unexplained bruises or bleeding from the nose or mouth that may occur because the toxins also destroy the platelets, cells that normally help the blood to clot. Signs and symptoms of HUS may not become apparent until a week after the digestive problems have occurred.

More than half of children with HUS develop acute kidney failure. With kidney failure, the child’s urine output decreases. The urine may also appear red. Urine formation slows because the damaged red blood cells clog the tiny blood vessels in the kidneys, making them work harder to remove wastes and extra fluid from the blood. The body’s inability to rid itself of excess fluid and wastes may in turn cause high blood pressure or swelling of the face, hands, feet, or entire body.

Parents or guardians should call the child’s doctor immediately if the child has unexplained bruises, unusual bleeding, swollen limbs or generalized swelling, extreme fatigue, or decreased urine output. A child who goes 12 hours without urinating should be taken to a doctor or an emergency room.

How is HUS diagnosed?

A doctor may suspect that a child has HUS after examining the child and learning the history of symptoms. The diagnosis is confirmed by microscopic examination of a blood sample to see if the red blood cells are misshapen.

How is HUS treated?

Treatments, which consist of maintaining normal salt and water levels in the body, are aimed at easing the immediate symptoms and preventing further problems. A child may need a transfusion of red blood cells delivered through an intravenous, or IV, tube. In severe cases, several sessions of dialysis, a blood-cleansing treatment, may be required to temporarily take over the kidneys’ job of filtering wastes and extra fluid from the blood.

Some children may sustain significant kidney damage that slowly develops into permanent kidney failure and will then require long-term dialysis or a kidney transplant. Some studies suggest that limiting protein in the child’s diet and treating high blood pressure with a medicine from a class of drugs called angiotensin-converting enzyme (ACE) inhibitors helps delay or prevent the onset of permanent kidney failure.

How can HUS be prevented?

Washing and cooking foods adequately, especially meats, and avoiding unclean swimming areas are the best ways to protect a child from this disease.

What are the most serious outcomes resulting from HUS?

Death and end-stage renal disease (ESRD).

End-stage kidney disease is the complete, or almost complete failure of the kidneys to function. The kidneys can no longer remove wastes, concentrate urine, and regulate many other important body functions.

End-stage kidney disease occurs when the kidneys are no longer able to function at a level needed for day-to-day life. It usually occurs when chronic kidney disease has worsened to the point at which kidney function is less than 10% of normal.

Patients who have reached this stage need dialysis or a kidney transplant. Most people who die or develop ESRD do so during the acute phase of HUS. According to a leading medical journal article, the incidence of death or permanent ESRD from HUS is 12%.

If my child survives HUS, does that mean there will be no future problems?

Unfortunately not.

A 2003 study appearing in the prestigious Journal of the American Medical Association (JAMA) entitled “Long-term Renal Prognosis of Diarrhea-Associated Hemolytic Uremic Syndrome” analyzed almost 50 other journal articles on the subject and found that 25% of people who developed HUS had long-term kidney problems resulting from the disease.

Some of the same authors published a follow-up article in 2009 analyzing data from a Canadian water-borne E. coli O157:H7 outbreak. The data from that study were more encouraging: although some abnormalities persisted, no child with HUS had serious kidney problems five years after the outbreak. The authors cautioned, however, that this more favorable data may be a function of factors unique to that particular outbreak and not prognostic for outcomes from other outbreaks.

What are those kidney complications?
There are three primary kidney complications: decreased glomerular filtration rate (GFR), hypertension and/or proteinuria.

Regarding decreased GFR, GFR is a test used to check how well the kidneys are working. Specifically, it estimates how much blood passes through the tiny filters in the kidneys, called glomeruli, each minute.
The GFR test measures how well your kidneys are filtering a waste called creatinine, which is produced by the muscles. When the kidneys aren’t working as well as they should, creatinine builds up in the blood.

According to the National Kidney Foundation, normal GFR results range from 90 – 120 mL/min. Older people will have lower normal GFR levels, because GFR decreases with age. Levels below 60 mL/min for 3 or more months are a sign of chronic kidney disease. Those with GFR results below 15 mL/min are a sign of kidney failure.

Regarding hypertension, or high blood pressure, in this context, it is usually defined as requiring antihypertensive medication or blood pressure measurement higher than the 90th percentile. Uncontrolled high blood pressure can lead to a number of problems including artery damage, aneurysm, heart failure, stroke and other serious problems. At a minimum, it requires medical monitoring and medication. Hypertension also increases the risk of further kidney disease.

Regarding Proteinuria, it is the presence of excessive amounts of protein in the urine. It occurs in the context of HUS as a result of decreased kidney function. It is a sign of chronic kidney disease.

If my child suffered a milder form of HUS, does that mean there will be no future problems?

Some HUS cases are milder than others. For example, cases in which urine output is preserved and no dialysis is required are considered less severe than cases in which there is no urine output and/or longer term dialysis.

However, some studies have shown that even some mild cases of HUS develop renal problems at longer-term follow-up. Those problems include chronic renal failure. There does not appear to be any reliable data about the frequency of long-term kidney problems following mild HUS cases.

If my child survives HUS, does that mean there will never be future kidney problems?

The usual measure of full recovery following HUS is a normal GFR.

According to some studies, the presence of a normal GFR following acute HUS does not guarantee long-term kidney health, although the data is far from conclusive. For example, in four studies of patients who apparently completely recovered after acute illness, anywhere from 8% to 61% went on to develop a lower-than-normal GFR, hypertension or proteinuria during long-term follow-up. Other studies, however, seem to indicate that full recovery following acute HUS means there will be no future complications. These studies are limited by follow-up times of five years or less which means that the full extent of future problems requires further study.

Are there problems other than kidney damage that my child may experience?

Sadly, kidney damage is not the only problem that can result from HUS. Other complications include neurological deficits (acute and chronic), diabetes and gastrointestinal problems.

Studies about the long-term problems associated with these complications are inconsistent. For example, in one study of patients with HUS who had major neurological symptoms during their acute illness, on long-term follow-up they continued to show subtle neurological deficits including posturing, clumsiness, poor fine-motor coordination, hyperactivity and distractibility.

A recent study involving adults with complications similar to HUS (thrombotic thrombocytopenic purpura (TTP)) noted that “After recovery, patients have significantly abnormal health-related quality of life; neurocognitive studies have documented deficits of attention, processing speed and memory, and also fatigue.”

A recent report about the long-term outcomes of selected foodborne pathogens, including E. coli O157:H7, may be found at the Center for Foodborne Illness.

If my child develops HUS, should I make a legal claim?

The decision to undertake legal action should not be taken lightly.

Few people who suffer serious injury are “sue happy.” Any sane person would gladly give up the right to collect money damages in return for his/her health. But when that is not possible, especially in catastrophic loss cases such as HUS, it is important to think about issues like “Who will pay for the medical bills (or even the co-pays if insurance is involved) now and in the future?” “Who will care for my child while I’m away at work or, worse, after I’m gone?” “What if my child has permanent injuries and life-long complications?”

It’s also important to understand that in order to successfully make a claim, one has to identify the source of the E. coli O157:H7 that resulted in HUS, determine how and when the food product became contaminated and prove by the greater weight of the evidence that the resulting harms and losses were the direct result of the illness. This is often a very complicated process. In fact, in the majority of HUS cases, the source of the contamination is never identified (and therefore a claim is not possible).

Whether you ultimately decide to make a claim or not, you should speak with an attorney to better understand your rights and the issues involved and then decide whether it’s right for you and your family to make a claim (or whether it’s even possible to do so).

What kind of lawyer should I consult with?

Very, very few lawyers in the United States have experience with foodborne illness cases in general and E. coli HUS in particular.

These cases are extremely complicated and require extensive knowledge and experience in fields such as epidemiology, microbiology, medicine, food safety, sanitation and, of course, trial law. Only a tiny percentage of lawyers have this training and experience and fewer still have ever successfully handled an HUS case to conclusion.

The attorneys at Pritzker Olsen have handled E. coli O157:H7/HUS cases resulting from virtually every major foodborne illness outbreak in the United States. The firm has collected millions of dollars for HUS survivors and their families and its lawyers have been interviewed by and quoted in the New York Times, Wall Street Journal, USA Today and a host of national and local television news programs. Firm attorneys meet with HUS survivors and their families at the hospital or in their homes and are available virtually any time. We believe in the importance of frequent, direct and personal contact with our clients.

If I decide to hire your firm, how much will it cost and how will I pay you?

Our firm is paid a percentage of the recovery, usually one-third. If there is no recovery, you owe us nothing. There are no up-front fees or retainers. We are not paid until we obtain a recovery for you.

Costs involved in prosecuting the case are advanced by our firm. If a recovery is obtained, we are reimbursed for our costs. This is in addition to our fee.

If you would like to discuss your case or learn more about our firm, visit us on the web , call for a free consultation at 1-888-377-8900 or email us at fhp@pritzkerlaw.com

“This public meeting provides an opportunity for FDA to collaborate more closely with FSIS as well as with members of the food industry, many of whom have been making important innovations in food safety practices and technology, and all of whom bear primary responsibility for producing and marketing safe food,” said Michael R. Taylor, senior advisor to FDA’s Commissioner Margaret Hamburg, M.D.

The announcement comes in the wake of a multistate outbreak of E. coli 0157:H7 that struck 26 people in late October and early November, killing two and hospitalizing others. The illnesses are associated with more than half a million pounds of ground beef that was recalled Oct. 31 by Ashville, N.Y.-based Fairbank Farms. Just days earlier, another recall of about 1,000 pounds of beef from a Massachusetts firm was associated with several cases of E. coli 0157:H7 in a group of Rhode Island school children.

Food safety attorney Fred Pritzker supports the FSIS and FDA in their recognition that it is vital to improve America’s faltering food safety system by addressing gaps in food product tracing and mandating testing and inspection at all points along the food supply chain. “Families should not have to worry about whether the food on their dinner table, be it hamburgers or salad, is contaminated with E. coli,” Pritzker said. “There are clear measures government officials can take to mitigate that risk.”

There are many strains of E. coli bacteria that are categorized into more than 170 serogroups, which in turn are broken down into one or more serotypes. The E. coli strain primarily responsible for E. coli-related injury and death is classified as Escherichia coli O157:H7 (E. coli 0157:H7). The harmful pathogen can do severe damage to the intestinal lining and can also result in hemolytic uremic syndrome (HUS), which is the leading cause of kidney failure in children in the United States.

Those interested in attending the public meeting can pre-register online and consumer inquiries may be directed to: 888-INFO-FDA.

The story of 1-year-old Isaiah Romero is getting known around the country as this once-happy toddler is battling a violent complication of E. coli O157:H7 infection known as HUS, or hemolytic uremic syndrome.

Isaiah’s case could possibly be linked to the JBS Swift outbreak of E. coli that has sickened at least 23 people in nine states. One of his recent well-wishers was Susan Vaughn Grooters, public health coordinator for the national non-profit food safety group Safe Tables Our Priority, or STOP. She wrote to the Romero family on a public website kept by the television station in Sioux Falls, South Dakota, that provided the initial coverage of Isaiah’s story. Grooters said STOP has been helping families whose children develop HUS for the past 16 years. “Our hearts go out to the Romero family,” she wrote.

Collectively, she was speaking for a lot of people who have been close to HUS, a disease that attacks the red blood cells and can wreak havoc around the body, especially the kidneys.

Isaiah is from Sioux Center, Iowa, and he has been treated this week at Sanford Childrens’ Hospital in Sioux Falls, South Dakota. The TV report by station KSFY said he showed symptoms of food poisoning a few weeks ago with diarrhea, vomiting and stomach pain, but an initial test for E. coli returned negative. But his illness last weekend developed into HUS, which occurs in a number of children who have E. coli  infections. It’s very plausible that Isaiah’s illness is related to the JBS Swift outbreak.

The Greeley, Colorado, beef packer has recalled 421,000 pounds of meat cuts that were possibly contaminated with E. coli O157:H7. It was sold to grocery outlets around the country and many stores ground the cuts into store-packaged hamburger sold on foam trays covered by clear wrap. People from California to Maine have come down with the same type of  E. coli that was found in the JBS Swift beef.

National food safety law firm Pritzker Olsen Attorneys, based in Minneapolis, is currently representing families who have loved ones who developed HUS from a foodborne case of E. coli infection.