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On March 18, France notified a health alert about frozen pizzas contaminated with the Shiga toxin-producing Escherichia coli bacteria (known as STEC). The pizzas involved in the alert have been distributed in other countries (Luxembourg, Belgium, among others) but not in Spain.
During the month of March, the French authorities made several press releases in relation to ongoing investigations into serious cases of hemolytic uremic syndrome in children.
As of March 30, the French authorities reported that they are monitoring 75 cases in children, 41 of them with hemolytic uremic syndrome aged between 1 and 18 years, with a mean age of 7 years. To date there have been two deaths in children.
Epidemiological, microbiological and traceability investigations carried out by the French authorities have confirmed a possible link between the appearance of clustered cases of hemolytic uremic syndrome and the consumption of frozen pizzas from the Fraîch’Up range of the Buitoni brand contaminated by E. coli producing Shiga toxins (STEC 026).
On March 18, the withdrawal from the market of pizzas from the aforementioned range began, marketed since June 2021. In addition, the authorities have asked people who have said pizzas not to consume them and destroy them.
What is the danger of E.coli bacteria?
Escherichia coli is a bacterium that is naturally present in the intestines of people and warm-blooded animals. Most strains of E. coli are not pathogenic. However, on some occasions this bacterium has been involved in intestinal infections and extraintestinal infections.
They recognize six categories of E. coli that produce diarrhea: enterotoxigenic (ETEC), enteropathogenic (EPEC), enteroinvasive (EIEC), enteroaggregative (EAEC), diffusely adherent (DAEC) and Shiga toxin producers (STEC). The latter is also known as verotoxigenic E. coli (VTEC), since they produce cytotoxins (Vtx) that affect cells of the Vero line.
Specifically, STEC can cause serious illness in people. In the European Union in 2020, infection by this bacterium was the fourth most frequent foodborne disease in people, with 4,446 people affected (cases), 652 hospitalizations and 13 deaths.
It should be noted that one of the largest outbreaks associated with this bacterium occurred in Germany in 2011 with 3,128 cases, 817 with hemolytic uremic syndrome and 46 deaths. In said outbreak, the foods involved were sprouted seed sprouts.
Food is the main cause of transmission
The transmission of STEC is mainly produced by the consumption of contaminated food and water. Although transmission can also occur from person to person by fecal-oral transmission due to poor hygiene measures. Sometimes it can be caused by direct contact with infected animals or their feces.
Most outbreaks of Shiga toxin-producing E. coli have been associated with the consumption of
undercooked meat, especially hamburgers and minced meat; raw milk; dairy products made from raw milk; uncooked vegetables (lettuce, spinach, germinated seed sprouts, among others) and fruit.
Therefore, it is important to avoid food contamination with STEC by maximizing hygiene measures during the production, handling and consumption of food. Food business operators are responsible for placing safe food on the market. To do this, they must comply with hygiene standards and implement self-control systems. It should be noted that this bacterium is destroyed by heat, so proper cooking is an effective tool.
Should this type of infection alert us?
Shiga toxin-producing E. coli infection initially manifests as severe abdominal pain, watery diarrhea, and sometimes vomiting, followed by bloody diarrhea and hemorrhagic colitis (a type of gastroenteritis). The incubation period ranges from 2 to 10 days.
In general, affected people usually recover within ten days, but in some cases, especially in children and elderly peoplethe infection can evolve and trigger a serious illness: the hemolytic uremic syndrome (SUH).
Children affected by this syndrome present paleness, fatigue, decreased urine volume and in some cases seizures. This syndrome can lead to kidney failure and trigger death. It is estimated that between 5 and 10% of infected children develop hemolytic uremic syndrome.
In 2020 in the European Union, hemolytic uremic syndrome occurred in 320 of the 4,446 reported cases, being more frequent in children aged 0 to 4 years (234 cases), followed by children aged 5 to 14 years (57 cases).
How to prevent transmission
To prevent the transmission of Shiga toxin-producing E. coli, it is important to adopt the following measures in the preparation and consumption of food, especially in children under 15 years of age and the elderly:
– Hygiene measures must be followed during the handling and cooking of food. It is essential the hand washing after going to the bathroombefore preparing food and before consumption.
-Raw foods should be kept separate from cooked foods.
-Cross-contamination between raw and cooked foods should be avoided. For this, it is essential to wash hands before and after handling raw food and to wash surfaces and utensils in contact with raw food (boards, knives, etc.).
-You have to cook the meat properly, especially if it is minced meat or hamburgers. A temperature of 70ºC in the center for at least 2 minutes.
– Raw milk should not be consumed.
-In children under five years of age, the consumption of cheeses and other dairy products made with raw milk should be avoided.
-The vegetables and fruitsespecially if they are to be eaten raw, should wash carefully and, if possible, peel them before preparation and consumption. Washing can reduce microbial contamination, but its effect is limited.
-The flour-based preparations (pizza, cookie dough, cakes, etc.) should not be eaten raw or undercooked.
-In the preparation of packaged food The indications reflected on the packaging must be followed, especially in relation to the temperature and cooking time indicated by the manufacturer.
-Cooked foods that are not going to be consumed immediately should be keep refrigerated. Before consumption, they must be reheated in a convenient way.
-If cooking or reheating is done in the microwave, special attention should be paid to the times, since longer processes may be necessary.
Elena Gonzalez Fandos. Professor of Food Technology, University of La Rioja.
This article was originally published on The Conversation.
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