Germany’s E. coli Nightmare

Lessons for the U.S. from Europe

By David Acheson, MD

The summer of 2011 will be memorable for many in Europe as the time of one of the most aggressive and extensive foodborne illness outbreaks in history. With thousands of people becoming sick, hundreds developing the life-threatening hemolytic uremic syndrome (HUS), and dozens dying, one has to look at this from the United States with the view that we dodged a bullet on this one—at least so far.

While we in the U.S. were clearly watching with rapt attention and lots of questions and criticism as the outbreak unfolded, the one thing we were not doing here with any great vigor was asking the most important question: What can we learn to make sure that we minimize the likelihood of such a devastating outbreak of foodborne illness in the U.S.?

Looking from the outside at the outbreak in the European Union (EU), it is natural to wonder if this could happen in the United States. There is little doubt that it could, and so we should not lose the opportunity to learn our own lessons from this outbreak.

While there are many lessons to be learned, some major points must be considered:

• The importance of preventive controls;
• Rapid and effective response systems;
• The importance of using new intervention tools; and
• The risks of reduced funding.

Prevention should be the goal of anyone handling food, from the farm to the fork. Yet prevention is always hard to do well and very difficult to measure. This is clearly not a new lesson, but looking at the situation in the EU and drawing parallels in the U.S. shows that we have become obsessed with a single serotype of E. coli, namely 0157:H7.

In recent months, there has been a large push to declare six other serotypes of E. coli adulterants in meat. The situation in the EU, with a previously unrecognized pathogen—in this case, E. coli 0104:H4—causing a major outbreak, demonstrates the lack of logic of this approach.

When it comes to E. coli, what constitutes an adulterant is any E. coli that is going to make someone sick—irrespective of its serotype. To this end, any preventive control strategy should focus on keeping all pathogens out of our food supply—and not be directed at just a handful of serotypes. This is fundamental both in the use of risk-based preventive controls in the meat industry and in the use of hazard analysis and critical control points (HACCP) systems.

This approach is not restricted to the meat industry but extends to all areas where pathogens like the European outbreak strains of E. coli 0104 can enter our food supply. Such entry points are on farms where the pathogens may get on fresh produce—as appears to have happened in the EU—or may be a constituent of the intestinal flora of animals that are destined to become part of our food supply.

However, no amount of on-farm control or careful use of HACCP systems will offer a guarantee, and what is needed is a multifaceted approach that includes controls throughout the supply chain, from farms during processing (of meat, fresh produce, or other higher risk items like raw milk) to food handling at home. The lesson from the EU is that you never know what is going to appear next as a food safety hazard, so keep the preventive strategies broad to deal with both known and, to the greatest possible extent, unknown pathogens.