1. Jackie Dawson, PhD Public Health Epidemiologist Chelan, Douglas, Grant, Kittitas and Okanogan Counties 886-6428 jacqueline.dawson@cdhd.wa.gov jacqueline.dawson@cdhd.wa.gov

4.  Last update: June 10, 2014  Case Count: 1717  Age range 11 to 45 years (median=27 yrs)  States: 55  Deaths: 0  Hospitalizations: 47%  Recall: No

5.  Some kinds of E. coli cause disease by making a toxin called Shiga toxin.  “Shiga toxin-producing” E. coli, or STEC for short  STEC live in the guts of ruminant animals:  Cattle (major source for human illnesses)  Goats  Sheep  Deer  Elk  STEC generally do not make animals sick.  Pigs and birds sometimes pick up STEC from the environment and spread it.

6.  People usually get sick 2-8 days (average of 3-4 days) after swallowing the bacteria  Severe stomach cramps, diarrhea (often bloody) & vomiting  If there is fever, it usually is not very high (less than 101˚F)  Most people get better within 5–7 days.  5–10% develop kidney failure called hemolytic uremic syndrome (HUS)  HUS can occur in people of any age, but is most common in young children under 5 years, older adults, and people with weakened immune systems.  Symptoms of HUS can include fever, abdominal pain, pale skin tone, fatigue and irritability, small, unexplained bruises or bleeding from the nose and mouth, and decreased urination.  Most recover within a few weeks, but some suffer permanent damage or die.

7.  Non-specific supportive therapy (including hydration)  Antibiotics should not be used to treat this infection.  Taking antibiotics may increase the risk of HUS.  Anti-diarrheal agents like Imodium® may also increase that risk.  Work and Child Care Restrictions:  Food handlers, child care attendants, child care attendees and healthcare workers require 2 negative stool specimens before returning to work or child care.  Stool specimens should be collected 24 hours apart and not sooner than 48 hours after the last dose of antibiotics

8.  Typically disappear from the feces by the time the illness is resolved  May shed for several weeks-months, even after symptoms go away.  Young children tend to carry STEC longer than adults.  Good hand-washing!

9. ~265,000 STEC infections occur each year O157 =36% (95,400 cases) non-O157 =64% (169,600 cases)

10. Advice to Consumers:  Raw clover sprouts have not been recalled from Evergreen Fresh Sprouts (Moyie Springs, Idaho)  Evergreen Sprouts supplied sprouts to 7 restaurants  CDC recommends that consumers do not eat any raw clover sprouts produced by Evergreen Fresh Sprouts.  Contact your health care provider if you think you may have become ill from eating raw clover sprouts.  Sprouts are a known source of foodborne illness.foodborne illness  1996, ~10 000 cases of E. coli O157:H7 occurred primarily in schoolchildren in Osaka, Japan  2011, ~4,000 cases (>50 deaths) of E. coli O104:H4 occurred in northern Germany  Children, older adults, pregnant women, and persons with weakened immune systems should avoid eating raw sprouts of any kind (alfalfa, clover, radish, and mung bean sprouts).  Cook sprouts thoroughly to reduce the risk of illness.  When in doubt, throw it out!

11.  FDA also conducted an inspection of Evergreen Fresh Sprouts' facility on 22-23 May 2014; 27-30 May 2014; and 6 Jun 2014.  Investigators observed a number of unsanitary conditions,  condensate and irrigation water dripping from rusty valves  rusty and corroded mung bean room watering system  tennis rackets that had scratches, chips, and frayed plastic used to scoop mung bean sprouts  pitchfork with corroded metal being used to transfer sprouts  squeegee with visible corroded metal and non-treated wood being used to agitate mung bean sprouts inside a soak vat  Recall: No

12.  April- July, 2011, a total of 25 persons infected with the outbreak strain of Salmonella Enteritidis have been reported from 5 states.  On July 1, 2011, Evergreen Fresh Sprouts LLC of Moyie Springs, Idaho, announced a recall of specific lots of alfalfa sprouts and spicy sprouts.Evergreen Fresh Sprouts LLC of Moyie Springs, Idaho, announced a recall of specific lots of alfalfa sprouts and spicy sprouts

13.  WASH YOUR HANDS thoroughly after:  using the bathroom  changing diapers  before preparing or eating food  contact with animals or their environments (farms, petting zoos, fairs, home)  COOK meats thoroughly  Ground beef and meat that has been needle-tenderized should be cooked to a temperature of at least 160°F/70˚C  It’s best to use a thermometer  AVOID raw milk, unpasteurized dairy products, unpasteurized juices  AVOID swallowing water when swimming or playing in lakes, ponds, streams, swimming pools, and backyard “kiddie” pools.  PREVENT cross contamination in food preparation areas by:  washing hands, counters, cutting boards, & utensils after they touch raw meat

14. http://www.cdc.gov/foodnet/PDFs/incidence-bacterial-infections-2013-508c.pdf

15.  Bacteria (Vibrio vulnificus)  Isolated from oysters and other shellfish in warm coastal waters during the summer  85% cases occur between May and October  Transmission: Eating raw or undercooked shellfish, particularly oysters harvested from warmer waters.  Bacteria does not alter the appearance, taste, or odor of oysters  Signs/symptoms:  Wound or soft tissue infections (direct contact with seawater)  Healthy people: causes watery diarrhea, vomiting & abdominal pain  Underlying medical conditions: especially liver disease, can cause bloodstream infections characterized by fever, chills, decreased blood pressure, blistering skin lesions, and often, death.