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Published Date: 2018-08-31 10:26:33
Subject: PRO/AH/EDR> E. coli EHEC - USA (24): (FL) O26, grocery chain ground beef, alert, recall
Archive Number: 20180831.5998786
E. COLI EHEC - USA (24): (FLORIDA) O26, GROCERY CHAIN GROUND BEEF, ALERT, RECALL
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A ProMED-mail post
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ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org

In this posting:
[1] News report
[2] USDA-FSIS news release

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[1] News report
Date: Thu 30 Aug 2018 06:55 PM EDT
Source: Miami Herald [edited]
https://www.miamiherald.com/living/food-drink/article217612425.html


Publix [supermarket chain] is recalling ground beef products sold this summer [2018] after 18 cases of _E. coli_, mostly in Florida, can be traced to the beef, according to the USDA. The list of counties that received the tainted beef did not include Miami-Dade, Broward, Palm Beach or Monroe counties. But it did include Brevard; Charlotte; Citrus; Collier; DeSoto; Flagler; Hernando; Highlands; Hillsborough; Indian River; Lake; Lee; Manatee; Marion; Orange; Osceola; Pasco; Pinellas; Polk; Sarasota; Seminole; St. Lucie; Sumter; and Volusia.

The list of products, which were sold from 25 Jun 2018 through 31 Jul 2018, includes ground chuck; ground chuck burgers; gourmet burgers (Jalapeno & Cheddar, Pimento & Cheese, Bacon & Cheddar, Bacon & Fried Onion, Blue Cheese, and Swiss & Mushroom); seasoned ground chuck burgers (Badia, Mesquite, Montreal, and Steakhouse); meatballs (Bacon & Cheddar, Bacon & Fried Onion, Blue Cheese, Jalapeno & Cheddar, Swiss & Mushroom, and Spanish); Meatloaf (Seasoned and Grillers); sliders (Bacon & Cheddar, Bacon & Fried Onion, Ground Chuck, Blue Cheese, Jalapeno & Cheddar, and Swiss & Mushroom); and stuffed peppers.

This is a class 1 recall, defined by the USDA as "a health hazard situation where there is a reasonable probability that the use of the product will cause serious, adverse health consequences or death." Unless frozen, the products should have already been consumed or tossed. The USDA and Publix worry is about what's in home freezers across the counties above.

"Food safety is our top priority. We have been working closely with various federal agencies as we share the common goal of maintaining food safety and public health. We urge our customers to make sure they no longer have ground chuck products purchased in the affected Florida counties from 25 Jun through 31 Jul 2018 in their freezers," said Maria Brous, Publix media and community relations director in a company website statement. "Customers should dispose of the product or bring it in for a full refund."

People can become sick 2 to 8 days after eating the contaminated meat. Most _E. coli_ [the enterohemorrhagic cases related to Shiga toxin producing strains - Mod.LL] issues deal with _E. coli_ O157:H7. This is _E. coli_ O26, a similar strain. "Most people infected with O26 develop diarrhea (often bloody) and vomiting," the USDA said. "Some illnesses last longer and can be more severe. Infection is usually diagnosed by testing of a stool sample. Vigorous rehydration and other supportive care is the usual treatment; antibiotic treatment is generally not recommended. Most people recover within a week, but rarely, some develop a more severe infection.

"Hemolytic uremic syndrome (HUS), a type of kidney failure, is uncommon with the O26 infection."

[Byline: David J Neal]

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Communicated by:
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******
[2] USDA-FSIS news release
Date: Thu 30 Aug 2018
Source: US Department of Agriculture Food Safety and Inspection Service (USDA-FSIS) news release [edited]
https://www.fsis.usda.gov/wps/portal/fsis/topics/recalls-and-public-health-alerts/recall-case-archive/archive/2018/recall-072-2018-release


Publix Super Markets Inc. recalls ground chuck products due to possible _E. coli_ O26 contamination
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Publix Super Markets Inc., a Lakeland, Florida, retail grocery store chain is voluntarily recalling an undetermined amount of ground beef products made from chuck that may be contaminated with _Escherichia coli_ O26, the US Department of Agriculture's Food Safety and Inspection Service (FSIS) announced today, 30 Aug 2018.

The ground chuck items were purchased by consumers from 25 Jun 2018, through 31 Jul 2018. The following products are subject to recall: https://tinyurl.com/y96wsd2h

These items were shipped to Publix Super Market retail locations in the following Florida counties: https://tinyurl.com/yck46ylb

On 16 Aug 2018, FSIS was notified of an investigation of _E. coli_ O26 illnesses. FSIS, the Centers for Disease Control and Prevention, and state public health and agriculture partners determined that raw ground chuck was the probable source of the reported illnesses. The epidemiological investigation identified 18 case-patients, predominantly from Florida, with illness onset dates ranging from 5 to 25 Jul 2018. Traceback information indicated that case-patients consumed ground chuck products purchased at various Publix Super Markets that was supplied by a yet-to-be determined source. As this investigation further develops, FSIS will continue to work with the supermarket, suppliers and public health partners, and will provide updated information should it become available.

_E. coli_ O26, like the more common _E. coli_ O157:H7, is a serovar of Shiga toxin-producing enterohemorrhagic _E. coli_ (EHEC). People can become ill from EHECs 2-8 days (average of 3-4 days) after exposure to the organism.

Most people infected with EHEC O26 develop diarrhea (often bloody) and vomiting. Some illnesses last longer and can be more severe. Infection is usually diagnosed by testing of a stool sample. Vigorous rehydration and other supportive care is the usual treatment; antibiotic treatment is generally not recommended. Most people recover within a week, but rarely, some develop a more severe infection. Hemolytic uremic syndrome (HUS), a type of kidney failure, is uncommon with EHEC O26 infection. HUS can occur in people of any age but is most common in children under 5 years old, older adults and persons with weakened immune systems. It is marked by easy bruising, pallor, and decreased urine output. Persons who experience these symptoms should seek emergency medical care immediately.

FSIS is concerned that some product may be frozen and in consumers' freezers. Consumers who have purchased these products are urged not to consume them. These products should be thrown away or returned to the place of purchase.

FSIS routinely conducts recall effectiveness checks to verify recalling firms notify their customers of the recall and that steps are taken to make certain that the product is no longer available to consumers. When available, the retail distribution list(s) will be posted on the FSIS website at http://www.fsis.usda.gov/recalls.

FSIS advises all consumers to safely prepare their raw meat products, including fresh and frozen, and only consume ground beef that has been cooked to a temperature of 160 F [71 C]. The only way to confirm that ground beef is cooked to a temperature high enough to kill harmful bacteria is to use a food thermometer that measures internal temperature (http://1.usa.gov/1cDxcDQ). Consumers should take proper precautions when handling raw meat products. Proper hand washing after handling raw meat, poultry and eggs can greatly reduce the risk of bacterial cross-contamination to other foods and kitchen surfaces. It is important to prevent cross-contamination by washing counter tops and sinks with hot, soapy water.

Media with questions can contact Maria Brous, Publix Super Market's Director of Media and Community Relations, at (863) 680-5339. Consumers with questions can contact Publix Super Market's customer care department at 1-800-242-1227 or visit their website at http://www.publix.com/contactus [the site is not fully available outside the USA].

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Communicated by:
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[HealthMap/ProMED-mail map of Florida, United States: http://healthmap.org/promed/p/212
Florida county map: https://www.mapofus.org/wp-content/uploads/2013/09/FL-county.jpg

The FSIS report states that not all cases were identified in Florida.

In analyzing the genetic and phenotypic profiles of non-O157 groups, it has been found that they belong to their own lineages and have unique profiles of virulence traits different from O157 (1). The serogroups appearing to be most prominent are O26, O111, O128, and O103 (2), the former serotype being the implicated strain in this outbreak.

If a laboratory is using sorbitol-MacConkey (sMAC) plates to identify EHEC by virtue of O157's inability to ferment sorbitol, the non-O157 strains will be missed. In a 3-year pediatric study from the University of Washington, USA (3), 1851 stool samples were processed for sorbitol fermentation as well as toxin production by EIA (enzyme immunoassay), and 28 strains of O157 were found along with O103 (4 strains), O118 (2 strains), O111 (2 strains), and 3 other strains.

Clinically, the O157 infections had a higher frequency of bloody stools, fecal leukocytes, and abdominal pain with shorter symptom duration. Five (18 per cent) of O157 infections developed hemolytic uremic syndrome (HUS); none of the non-O157 strains did. Since toxin assay did not identify all O157 strains found on sMAC plates, the investigators did not advocate performing toxin assay alone. Non-O157 can produce HUS, as demonstrated by a cluster of O121 cases associated with a lake in Connecticut, USA (4).

Since toxin assays are not uniformly performed in many areas, and most cases do not produce HUS, it is likely that cases due to non-O157 strains are being missed. How frequent this phenomenon will become over time is unclear.

References
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1. Schmidt H, Geitz C, Tarr PI, et al. Non-O157:H7 pathogenic Shiga-toxin producing _Escherichia coli_: phenotypic and genetic profiling of virulence traits and evidence for clonality. J Infect Dis 1999; 179(1): 115-23; available at https://academic.oup.com/jid/article/179/1/115/877122.
2. Bettelheim KA. Role of non-O157 VTEC. Symp Ser Soc Appl Microbiol 2000; (29): 38S-50S; abstract available at http://www.ncbi.nlm.nih.gov/pubmed/10880178.
3. Klein EJ, Stapp JR, Calusen CR, et al. Shiga toxin-producing _Escherichia coli_ in children with diarrhea: a prospective point-of-care study. J Pediatr 2002; 141(2): 172-7; available at http://www.ncbi.nlm.nih.gov/pubmed/12183710.
4. McCarthy TA, Barrett NL, Hadler JL, et al: Hemolytic-uremic syndrome and _Escherichia coli_ O121 at a lake in Connecticut, 1999. Pediatrics 2001; 108(4): E59; available at http://pediatrics.aappublications.org/cgi/content/full/108/4/e59.
- Mod.LL]

See Also

E. coli EHEC - USA (23): (OK) possible recreational water exposure 20180801.5941698
E. coli EHEC - USA (22): (WA) restaurants 20180708.5893948
E. coli EHEC - USA (21): (TN) O157, 2 clusters, 2 sources 20180706.5891482
E. coli EHEC - USA (20): O157, romaine lettuce, water source 20180702.5882323
E. coli EHEC - USA (19): (UT, AZ) O157, 2017 20180616.5858104
E. coli EHEC - USA (18): (TN) raw milk, more cases 20180614.5856110
E. coli EHEC - USA (17): (OR) O111, daycare center 20180613.5854733
E. coli EHEC - USA (16): (TN) raw milk 20180607.5844304
E. coli EHEC - USA (15): O157, romaine lettuce, more cases, fatal 20180604.5837662
E. coli EHEC - USA (14): (WA) sandwich shops 20180527.5820803
E. coli EHEC - USA (13): O157, romaine lettuce, increasing cases, fatality 20180517.5799620
E. coli EHEC - USA (12): O157, romaine lettuce, increasing cases, fatality 20180510.5791677
E. coli EHEC - USA (11): (OK) day care center 20180502.5780250
E. coli EHEC - USA (10): O157, romaine lettuce, fatality 20180502.5780249
E. coli EHEC - USA (09): O157, romaine lettuce 20180427.5771229
E. coli EHEC - USA (08): (CA) military outbreak, undercooked beef, 2017 20180425.5769489
E. coli EHEC - USA (07): O157, romaine lettuce 20180425.5769488
E. coli EHEC - USA (06): O157, romaine lettuce 20180421.5761217
E. coli EHEC - USA (05): O157, romaine lettuce 20180418.5756056
E. coli EHEC - USA (04): O157, romaine lettuce 20180413.5745944
E. coli EHEC - USA (03): O157, expansion of NJ outbreak 20180411.5738813
E. coli EHEC - USA (02): (NJ) poss. restaurant chain link, RFI 20180405.5728398
E. coli EHEC - USA: O157, leafy greens 20180110.5550773
2017
----
E. coli EHEC - USA (39): relatedness to Canada isolates 20171229.5527271
E. coli EHEC - Canada (14): O157, lettuce, fatal 20171222.5518867
E. coli EHEC - Canada (13): O157, lettuce, fatal 20171215.5506384
E. coli EHEC - Canada (12) : O157, lettuce 20171212.5497097
E. coli EHEC - USA (38): (CA) 20171212.5498214
E. coli EHEC - USA (37): raw dough, FDA alert 20171202.5479176
E. coli EHEC - USA (36): (CA) military outbreak, O157 20171111.5436982
E. coli EHEC - USA (35): (CA) military outbreak, O157 20171104.5424631
E. coli EHEC - USA (34): (CA) military outbreak, O157 20171103.5422415
E. coli EHEC - USA (33): (CA) military outbreak, O157 20171102.5421203
E. coli EHEC - USA (32): (CA) military outbreak, revised case numbers 20171102.5420166
E. coli EHEC - USA (31): (CA) military outbreak 20171101.5417972
E. coli EHEC - USA (30): (CA) military outbreak, RFI 20171031.5416569
E. coli EHEC - USA (29): (MI) farm animal exposures, RFI 20171030.5410350
E. coli EHEC - USA (28): (VT) O157, ground beef, alert, recall 20171014.5381117
E. coli EHEC - USA (27): (WI) O157, RFI 20170921.5330484
E. coli EHEC - USA (26): (MI) O157, antimicrobial resistance 20170824.5272308
E. coli EHEC - USA (25): (CA) O157, recreational water 20170818.5258783
E. coli EHEC - USA (24): (CO) county fair, RFI 20170811.5243577
E. coli EHEC - USA (23): (CA) recreational water 20170810.5240983
E. coli EHEC - USA (22): (CA) recreational water 20170804.5227891
E. coli EHEC - USA (21): (CA) recreational water 20170802.5220799
E. coli EHEC - USA (20): (CA) recreational water, RFI 20170731.5217061
E. coli EHEC - USA (19): (UT, AZ) O157, fatalities, susp. livestock exposure 20170730.5215421
E. coli EHEC - USA (18): (UT, AZ) O157, fatalities 20170727.5206988
E. coli EHEC - USA (17): (OH) summer camp, RFI 20170724.5198725
E. coli EHEC - USA (16) : (MN) fatality 20170721.5195217
E. coli EHEC - USA (15): (UT) O157, fatalities 20170711.5167176
E. coli EHEC - USA (14): (UT) O157, fatalities 20170705.5152059
E. coli, EHEC - USA (13): (UT) fatalities, susp EHEC, RFI 20170703.5147181
E. coli EHEC - USA (12): (TX) 20170621.5121066
E. coli EHEC - USA (11): O157, deer droppings, water exposure, 2016 20170511.5028649
E. coli EHEC - USA (10): O157, soynut butter 20170505.5014128
E. coli EHEC - USA (09): (AR) fatality, unrelated cases 20170422.4988037
E. coli EHEC - USA (08): (AR) fatality, RFI 20170421.4984124
E. coli EHEC - USA (07): (MA) O157, restaurant chain, RFI 20170414.4970974
E. coli EHEC - USA (06): O157, soynut butter 20170405.4949992
E. coli EHEC - USA (05): O157, soynut butter, CDC update 20170401.4941247
E. coli EHEC - USA (04): (OR) O157, soynut butter, preschool 20170315.4902827
E. coli EHEC - USA (03): O157, soynut butter, more cases, recall 20170308.4887992
E. coli EHEC - USA (02): O157, soynut butter 20170307.4883675
E. coli EHEC - USA 20170302.4875298
2016
----
E. coli EHEC - USA (25): O121, O26, flour, alert, expanded recall 20160726.4371012
E. coli EHEC - USA: O26, restaurant chain, 2nd genotype, RFI 20160110.3924096
2015
----
E. coli EHEC - USA (27): O26, restaurant chain 20151205.3842020
E. coli EHEC - USA (21): O26, restaurant chain 20151122.3809128
E. coli EHEC - USA (20): (WA, OR) O26, restaurant chain 20151117.3799040
E. coli EHEC - USA (18): (WA,OR) O26, restaurant chain 20151107.3774942
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