Reports of a potentially dangerous E: coli infection among children in a Bronx day care center, coupled with two Yankees players benched by parasitic infestations, seems to have turned the summer into an unplanned Food Borne Illness Awareness Month.
According to estimates by the federal Centers for Disease Control and Prevention (CDC), 76 million Americans get sick each year from food--borne illnesses, more than 300,000 are hospitalized, and 5,000 die.
The city's Department of Health and Mental Hygiene announced in the beginning of July that it is investigating a recent outbreak of E. coli 0157:H7 infection in children who attended the "For Kids Only" day care center in the Bronx. After three children who spent time in the same first-floor room of the center came down with confirmed cases of E. coli 0157:H7, health inspectors visited the site. They are also investigating suspected cases among 18 other children who attended "For Kids Only."
The day care center voluntarily closed during the investigation and has cooperated with the health department. An article in the New York Post reported that For Kids Only passed annual health inspections in March 2004 and April 2003, and quoted parents who praised the center for cleanliness and health consciousness. Toddlers in day care centers, however, are particularly vulnerable to outbreaks of E. coli 0157:H7 and other foodborne pathogens, because they eat the same meals, crowd together, often fail to wash hands after use of the toilet, and frequently wear diapers, which can lead to spread of the bacteria if caretakers fail even occasionally to handle them using precise sanitary procedures.
The health department is also investigating one confirmed case of E. coli 0157:H7 in a local child who does not attend the day care center. All children associated with the outbreak live in the Bronx and range in age from seven months to just over three years.
According to city Health Commissioner Thomas Frieden, all of the affected children "are doing well at this point." As E. coli 0157:H7 outbreaks go, then, this one was relatively benign. The pathogen can cause much more serious health consequences, especially among young children and the elderly. According to the CDC, in three to five percent of cases, a complication called hemolytic uremic syndrome (HUS) can occur several weeks after the initial symptoms (which are themselves debilitating -- severe, bloody diarrhea and painful stomach cramps.) HUS is the most common cause of acute kidney failure in children.
In 1999, there were 18 cases of E. coli 0157:H7 reported among New York City residents. In 2002, only 2 cases -- both in a private home -- were reported, according to the CDC, which collects statistics on foodborne disease outbreaks from state, local and territorial health departments each year.
Some types of E. coli bacteria are normally found in the intestines of humans and coexist harmlessly with their hosts, even performing useful functions. E. coli 0157:H7 is not such a one. Normally found in cattle and similar animals, it typically spreads to humans when they consume food or water contaminated with microscopic amounts of cow feces. Hamburgers have often been implicated in the spread of E. coli 0157:H7 outbreaks, since ground flesh from literally hundreds of different cows may be mixed together in a single hamburger. To paraphrase an old saying, scraps from one sick cow can spoil the whole barrel.
Thorough cooking of meat and pasteurization of beverages like milk will generally kill the bacteria, but are not always performed. In the notorious 1993 E. coli 0157:H7 outbreaks traced to Jack in the Box restaurants in Washington State, the fast-food outlets failed to cook hamburgers infected with the bacteria well enough to kill the pathogen before serving them. About 700 customers fell sick and four died.
Once humans are infected, they can spread the infection to each other through poor sanitary practices, such as inadequate hand-washing after use of the bathroom and/or the handling of diapers.
The health department is asking parents of any children who attend the For Kids Only center to be on the lookout for symptoms of E. coli 0157:H7 infection -- abdominal pain, watery diarrhea that becomes bloody, irritability, and sometimes fever. The department urges parents of children who develop symptoms to immediately contact a physician. It advises parents to consult their own physicians, but they can also call 311 or the New York City Poison Control Center at (212) 764-7667 if they need more information or help finding alternative day care arrangements.
The health department also asks that parents who have children with diarrhea not take their children to daycare. And it has issued an alert to medical care providers requesting that all suspected cases of E. coli 0157:H7 infection be immediately reported to the Department's Bureau of Communicable Diseases by calling the Provider Hotline at 1-866-NYC-DOH1. (E. coli 0157:H7 is one of the so-called "reportable diseases" that the health department tracks in order to identify outbreaks and register them with the national epidemiological surveillance system.
To prevent infection with the bacteria, the city health department makes the following recommendations:
- Do not eat undercooked hamburger or other ground beef products. Cook all ground beef and hamburger thoroughly. Make sure the cooked meat is brown throughout (not pink), and the juices run clear.
- Drink only pasteurized milk and milk products.
- Avoid unpasteurized apple cider.
- Make sure infected people, especially children, wash their hands carefully with soap after using the toilet to reduce the risk of spreading the disease.
Intestinal ParasitesMeanwhile, pitcher Kevin Brown became the second New York Yankee in short succession to be diagnosed with an intestinal parasite. He has the dubious honor of joining teammate Jason Giambi, who was diagnosed with a parasite a few days earlier, after being sidelined the day before for lackluster performance. Brown had complained of fatigue and the unintentional loss of 15 pounds since the start of the season, while Giambi has suffered from fatigue, vomiting, and flu-like symptoms that have significantly impaired his playing.
Intestinal parasites are contracted from contaminated food or water, and Brown and Giambi are still trying to puzzle out where they might have picked up the bugs. Their teammates were spooked by the second diagnosis of parasites in their midst, but none of the other Yankees are showing symptoms, according to a New York Times report. Parasites can be treated with medication, which typically takes 7 to 10 days, but until the intestinal freeloaders are banished and the players' strength has returned, Brown and Giambi will continue to ride the bench, probably in considerable discomfort.
There were 14 cases of parasitic foodborne illness reported among New York City residents in 2002, the last year for which the CDC has published data. All of those were caused by Cyclospora, a one-celled, microscopic parasite that until the mid-1990s was thought to exist only in developing countries, particularly in tropical climates. In 1996, however, cyclosporiasis broke out in the U.S. and Canada and was eventually traced to contaminated raspberries grown in Guatemala -- underscoring some of the hazards associated with the post-NAFTA mass importation of produce from developing countries, particularly Central America, where parasitic infections are endemic. Anything eaten raw, such as fresh fruits, vegetables, and oysters, can be particularly dodgy unless scrubbed with extreme thoroughness.
The range of foodborne pathogens is dizzying, and more are being identified all the time, from bacteria to parasites to fungus. Some of the most common bacterial sources of foodborne illness include Salmonella, which now infests chicken eggs, is rapidly developing antibiotic-resistant strains, strikes 1,400,000 Americans annually, and kills 580; the rare but deadly Listeria monocytogenes, which lurks in undercooked meat and sickens only 2,500 Americans per year but kills 500 of them, or 20 percent of its victims; and Campylobacter, which lives on most raw poultry meat and infects 2,500,000 Americans annually, killing 124. Among parasitic organisms, Toxoplasma gondii or toxoplasmosis, which most people associate with cat feces but which can also be contracted by eating raw or undercooked meat, infects 225,000 and kills 750, and is particularly dangerous to the unborn children of pregnant women who become infected. Among the viruses, Norwalk-like viruses (of cruise ship fame) reign as the U.S.'s Deans of Diarrhea, sickening 23,000,000 per year and killing 310. (A case-fatality rate of only 6.7 percent, however, means that Norwalk-like viral infections, while extremely common, are not particularly dangerous to most people.)
The CDC's web page on foodborne illnesses lists a number of simple ways consumers can help protect themselves from these and other pathogens that can turn what should be gustatory pleasures into gastrointestinal nightmares.
Sue Wilson is a journalist who writes frequently on health and science topics for such outlets as the New York Times, WNET, and UNICEF