HISTORY OF E.COLI

http://www.wales.nhs.uk/documents/e-coli-e.pdf

http://new.wales.gov.uk/ecolidocuments/FSA/FSA.07786.pdf

HISTORY OF E.COLI:-

E.coli is one of the commonly found bacteria found in the intestine of human beings and animals and is typically harmless . It is one of the important organism and plays an important role in the digestion which absorbs the useful vitamins from the food . Most of the E.coli bacteria are harmless which are useful and even prevents the growth of the harmful organisms . All the strains of the E.coli are useful but the only and the dangerous strain is the E.coli 0157:H7 which causes some of the diseases in the human beings . This harmful strain of the E.coli was first discovered in the year 1982 by some of the scientists in the disease control and prevention , which is a government agency who study about the control and prevention of the disease . It is one of the harmful bacteria which causes diarrhea and sometimes causes long term illness and death . This E.coli that has been named as E.coli0157:H7 is both pathogenic and antibiotic-resistant . E.coli is one of the highly virulent pathogen and is tolerant to dry conditions. It is fatal and in some of the cases it has caused brain and kidney damage . A very small number of this strain can cause an illness , all the young people below 5 years and elderly people above 75 age are affected by this pathogen .

The existence of this harmful E.coli 0157:H7 was first known in the year 1982 , at first the affected people with this disease had some symptoms like bloody diarrhoea in U.S . The largest outbreak of this strain of E.coli in England and Wales was in the year 1983. The people went to hospital to get free from that disease , so when the doctors observed the symptoms they have made some tests how the disease has been came and from were . So the doctors have made some tests related to some of the food poisoning bacteria and they found negative result , and they were unable to know what the disease is and when the doctors came to conclusion more people have became ill . The CDC ( disease control and prevention team) have stepped into the field to know from were the disease has come from and they have took some of the samples from the sick people and made some tests , they have found many of the new strains of the E.coli bacteria which they have been never seen and mentioned as E.coli0157:H7 .

http://books.google.com/books?id=rYnj-FXH01MC&printsec=frontcover&dq=what+is+e.coli#v=onepage&q=&f=false

STRUCTURE OF E.COLI:-

Escherichia coli is one of the bacteria which is a facultative anaerobe which mostly colonizes the lower gut of the animals . these bacteria are rod shaped and have got rod shaped fimbriae .(Blattner etal.1997).

E.coli0157 is an important food borne pathogen , whose major reservoir is the gastrointestinal tract of cattle, accordingly beef and dairy cattle are important point entry of this pathogen into the human food chain . Escherichia coli 0157 is one of the harmful and threatening human pathogen which has a large capacity of causing gastrointestinal illness in humans. After seeing the characteristics of E. coli0157 i.e; bio chemical and genetic characteristics in relationship with the other organisms the evolution of this bacteria was proposed. E.coli0157 is evolved from the enteropathogenic E.coli ancestor of serotype 055:H7

http://www.ingentaconnect.com/content/klu/wibi/2000/00000016/F0020008/00317190

The E.coli pathogens that are responsible for causing poisoning in the foods are those that produces the shiga toxin. The best known and the most effective pathogen that produces shiga toxin is the E.coli0157:H7. Not all the kinds of E.coli bacteria are harmful, but there are some useful bacteria as well. Some cause urinary tract infection in human beings.

MEAT CONTAMINATION:-

The meat gets contaminated in many ways, like the contamination of food by physical means by microorganisms. Meat contamination is one of the major hazard and it may occur due to some extraneous ,atter in the food . In order to prevent the contamination of food by the harmful or unsafe matter, the contamination should be reduced to the minimum. According to sprenger, 2004 there are three types of contamination of the meat .(Sprenger, 2004) .

1. Contamination by microorganisms

2. Physical contamination by extraneous material.

3. chemical contamination.

Conatamination by microorganisms:- The contamination of the food through microorganisms takes place through bacteria, mould or viruses . this type of contamination takes place when there is no proper handling of the food by the food handlers or no proper supervision and when the food handlers take shortcut ways to handle the food. This type of contamination is one of the dangerous and can cause food spoilage and food poisoning and sometimes it may lead to death.

According to sofos et al. (1999a) the animal products like carcasses and the meat that is fresh should be handled , processed and preserved properly to prevent from getting contaminated by microorganisms.

Food poisoning bacteria is mostly enter the food through food handlers or visitors, raw food, water, rodents, insects, birds, and even through soil and dust (Sprenger,2004).

Physical contamination by extraneous material:-

Extraneous materials like paper plastic and other metallic material may contaminate the food at the time of transportation, storage, service, etc (Sprenger, 2004).

Chemical contamination :-

According to Sprenger (2004) some of the unwanted chemicals enter the food stuff at the time of processing like cleaning the oils and sometimes at the time of transport there may be spillage and lekage of chemicals. Chemicals cause acute poisoning and they will cause longterm illness in human beings and causes some diseases like cancer.

MODE OF CONTAMINATION OF THE FOOD BY E.COLI 0157 :-

The source of the E.coli 0157 bacteria is mainly through the animals like sheep, cattle , etc. which are present in the intestine of the animal . The animals excrete more amount of bacteria in their faeces. The affected animal do not show any symptoms of the disease in the affected animal . This type of bacteria have a capacity of contaminating the environment.

Most of the meat in the food industries get contaminated in the slaughter houses when the meat comes in direct contact with the hides , skins , and fleeces but sometimes it may get contaminated with the gut contents of the animal in the slaughter place . The surface of the raw meat that has got contaminated is mainly when the meat comes in contact with the working surfaces . Mainly large amount of contamination to the animals in the slaughter house by the bacteria takes place during the handling of the animals at sale yards or at the work places . People get contaminated by E.coli 0157 mainly through the contact by eating contaminated drinks and foods , which when swallowed through the mouth . The contamination also occurs through the no proper cooking of the meat i.e; when the meat is not cooked to the required temperature the growth of the bacteria takes place . The bacteria may also enter and contaminate the food when the raw and cooked meat are not handled properly with care and even by the insects and animals when they enter the food premises, contamination of food by various bacteria occurs . http://www.eastriding.gov.uk/corp-docs/foodservices/Food_Advice_Notes/food_services_advice_01.pdf

E.coli 0157 bacteria is present mostly on the surfaces of the raw meat and when the meat is minced it enters inside the meat and the food is also contaminated by the knives used for mincing the meat which contains the E.coli 0157 bacteria . This bacteria gets enter into the human body when the people come in direct contact with the animals and even while preparing food if correct hygiene practices are not followed then there will be a risk of entry of this bacteria . Contamination of the food may also takes place by physical means i.e; foreign objects may fall like jewellery and some times pieces of machinery may also cause contamination of the food .

http://www.leighday.co.uk/news/news-archive/recent-e.-coli-and-salmonella-food-poisoning

TYPE OF DISEASES CAUSED BY E.COLI 0157 :-

When the bacteria enters the stomach it attaches to the wall of the intestine and releases some of the toxins which causes the inflammation and the blood vessels that are present get damaged due to the toxins that are released by the bacteria and so the damage of the kidneys and the brain takes place . The period of infection by this bacteria takes place for 2 to 12 days . Some of the symptoms that are seen in the infected person are headache , nausea , vomiting . Some of the infections seen are: -

(i)" Mild diarrhoea.

(ii) Haemorrhagic colitis, which is caused by inflammation of the large bowel, with bloody diarrhoea.

(iii) Haemolytic uraemic syndrome ("HUS") : - mostly occurs in childrens and causes kidney failure.

(iv) Thrombotic thrombocytopaenic purpura ("TTP").":- This causes the destruction of the cell i.e; platelets .

The research made by some of the scientists have said that about 2-7 % of the people have been affected by the HUS ( childrens about 15%) , in which the damage to the red blood cells takes place . Thrombocytopaenia causes damage to the kidney .

Some people donot show the symptoms of the infection and are called asymptomatic but they excrete some amount of E.coli . Most of the asymptomatic people develop HUS . There is no cure or antidote for getting prevented from this bacteria infection, so only way is treatment and taking care .

http://wales.gov.uk/ecolidocs/3008707/reporten.pdf?skip=1&lang=en

FUNCTIONS OF THE WELSH OFFICE AFTER THE OUTBREAK OF E.COLI IN FOOD (SCOTLAND) AND THE FOOD SAFETY PRECAUTIONS/ RECOMMENDATIONS :-

The main function of welsh office is to implement the recommendations that have been made by professor Hugh pennington , after the recommendations were taken action by the central government . Some of the recommendtions that have been followed after the outbreak of E.coli 0157 in Scotland :-

(i). "Additional funding for the HACCP approach.

(ii) Food hygiene training provided in the primary and secondary school curriculum.

(iii) Guidance and education about food handling and hygiene.

(iv) Non-registered premises should be encouraged to adopt HACCP principles.

(v) Good hygiene practice encouraged amongst those working with vulnerable groups.

(vi) Accelerated HACCP implementation and funding for local authorities.

(vii) Written reports of large or otherwise significant outbreaks and adequate numbers of personnel with appropriate skills to deal with outbreaks . "

HACCP IMPLEMENTATION:-

The secretary for the state of welsh has advised all the local authorities to follow the HACCP food safety principles to get safe from the food contamination , a circular was also issued for revision and enforcement was made to follow hazard analysis requirements. In the year 1995 the separation of raw meat and the unwrapped cooked meat were separated to prevent from cross contamination were they thought it was necessary . During the year 1997 of December the local authority people were given the rights to follow the HACCP principles and each officer in the local authority were trained in the HACCP implementation in the butchers shops .

TYPE OF INSPECTIONS AND THE TECHNIQUES :-

The manager who introduce the systems and insists on the standards will result in the good inspection and he should maintain a record to make the up to date records . All the inspections that are done should be hazard analysis audit based .

The inspection techniques should include that whether the manager and the employees in the companies are well trained in the production of safe food to prevent from contamination .

The EHO's in their inspection should look after all the food safety systems followed in the company are correct or no and identify the problems and help them in solving it.

At the time of inspection the officer should tell all the employees the correct way of training , to follow the role of critical control points , cross contamination , personal hygiene .

The audit should be done in places were they use the techniques of cleaning with chemicals .

Code of practice 9 has set out some of the main objectives of the food hygiene inspection as :-

(i) Determine the scope of the business activities and food legislation which

applies to the business.

(ii)Gathering of the information thoroughly by recording the information by observations ,and discussions with food handlers, managers and proprietors.

(iii) Identifying potential hazards and risks to public health.

(iv) TO achieve safety food the effectiveness of process control is determined .

(v) Determining of the hazard analysis or HACCP-based food safety management system operated by the business.

(vi) Identification of specific breaches of food safety legislation.

(vii) "Considering of correct enforcement action to get compliance with food safety legal requirements.

(viii) Providing the advice and information to proprietors and food handlers .

(ix) Recommending of practical, good and better food hygiene practices, in accordance with Industry Guides .

(x) Promoting the continuous improvements in food hygiene standards by adopting good hygiene practices . "

HACCP (Hazard Analysis Critical Control Point):-

Hazard Analysis Critical Control point is a systematic preventive approach to food safety that identifies and monitors specific food safety hazards that affect the safety of food during each phase like rawmaterial procurement, manufacturing, distribution and usage

http://bis.org.in/forms/haccp.htm

HACCP can be applied throughout the food chain from the primary production to the final consumption and its implementation should be guided by scientific evidence of risks to human health . In addition to implementing HACCP for food safety it also provides some benefits . There are seven principles of HACCP which were accepted by the government agencies and food industries all over the world for making the food safe . they are:-

1. Identify the potential consumer health hazards .

2. Identify the control points were the identified hazards occur .

3. Establish critical limits for the potential hazards and safety measures .

4. Monitoring should be established to see whether the safety measures are working .

5. Establishment of appropriate response if the monitoring does not work .

6. Establish clear record keeping to document the HACCP system which include the records of hazards and their control methods .

7. Establish procedures to verify that the system is working properly .

http://www.food.gov.uk/foodindustry/meat/haccpmeatplants/

For having a good plan and control on food safety there is HACCP plan like record keeping, which includes all the processes and procedures that are followed during critical control point monitoring, any deviations, corrective actions etc., http://www.haccp.ca/haccp-plan.aspx

HACCP has been developed in the early days as a microbiological safety programmes in the US manned space programmes. This system is one of the main process which allow us to focus on the safety of food and allow us not to go things done wrong and prevent from the problems getting occurred. Its an effective method and helps in processing of the safe product. The HACCP is almost applicable to everyone starting from the primary producer to the consumer. The main reason for using HACCP is used when anything or any of the process goes wrong in the food companies, and this HACCP is used in most of the companies due to some of the external pressures made by the media , governments to make the food safe for the consumers to eat.

http://books.google.co.uk/books?id=8jPE0gv5ayUC&pg=PP1&dq=haccp#v=onepage&q=&f=false

www.Meat processing: improving qualitBy Joseph Kerry, David Ledward 2002

BENEFITS IN USING HACCP (HAZARD ANALYSIS CRITICAL CONTROL PRORAMME):-

1. It is one of the most effective method of increasing food safety.

2. Reduces the risk of manufacturing and selling of unsafe products.

3. The quality of the product that has been obtained is of high quality.

4. Reduces the risk of food borne diseases.

Some benefits have been identified (Taylor, 2001) which are described below:-

1. The employees and the owners will gain confidence in the food safety measures during their discussion with the food inspectors, auditors, consumers .

2. By the use of this HACCP principle there is less wastage.

3. Increased level of control results in product consistency and even there is an improvement in the traceability.

4. HACCP can bring reduced insurance cost by providing a basis for defence against litigations. (Taylor, 2001)

http://books.google.co.uk/books?id=--J0iHdmPtwC&pg=PA7&dq=haccp+benefits#v=onepage&q=haccp%20benefits&f=false

Some of the safety precautions that have been taken during the outbreak of E.coli 0157 are as follows :-

  • The food business people should ensure that all the systems and procedures they follow are capable of preventing the contamination or cross contamination of the food with the E.coli 0157 .
  • All the food business people must get into the grips with the food safety management based very clearly on the seven key HACCP principles , and should be sure that it is the core part of the way they run their business .
  • All the food business in wales should be made available of additional resources to ensure that they understand the way to use the HACCP approach and have an effective documented food safety management system which is embedded in working culture and practice .
  • The principles underlying the Butcher's licensing scheme that was introduced in the year 1996 E.coli outbreak , should guide food hygiene measures in the businesses processing raw meat and unwrapped ready to eat foods .
  • The food standards agency should review all its practices and should be able to generate new practices in food safety where needs are identified .
  • The FSA ( Food Standard Agency) should be able to remove the confusion that exists in the mind of the food business people about how to remove or prevent from the cross contamination from the surfaces and equipments .
  • The HACCP plan that is done should be audit based .
  • The National Assembly for wales should consider the Hugh Pennington's recommendations and should it should monitor and consider for implementing it .
  • Discussion should be done with the employees about the food hygiene during the inspection visits .
  • The food business organisations who supply the highly risk food i.e; raw and cooked meat to the public sectors they should be subjected to individual food hygiene audits .

http://wales.gov.uk/ecolidocs/3008707/summaryen.pdf?skip=1&lang=cy

According to Anon, 1997 the recommendations made by the pennington report was on the food safety and in implementing the Hazard Analysis Critical Control Programme.(Anon, 1997)

http://books.google.co.uk/books?id=2LyckiERaYMC&pg=PA59&dq=pennington+report+on+e.coli+outbreak&lr=#v=onepage&q=pennington%20report%20on%20e.coli%20outbreak&f=false

The recommendations made by the Hugh Pennington and its group cover the places like the Farm and the E.coli0157 in livestock , hygiene practices followed in the slaughter houses , meat premises , butcher shops , Food hygiene at the point of consumption , Enforcement , Surveillance , Research , Arrangement in handling ad controlling outbreak . The government needs to make awareness among the farm people so that to help the people from getting contact from the animals and prevent from the contamination by the bacteria and even he also recommended to review the code of practice 9 which was mostly related to food safety hygiene inspections in the high risk areas .

http://www.scotland.gov.uk/library/documents-w4/pgr-a3.htm

Hugh Pennington has made three recommendations to control the outbreak of E.coli based on the codes of practices under the Food Safety Act 1990 which relates mostly to the Food hazard warning system .

http://books.google.co.uk/books?id=5a1ub6Q_0rEC&pg=PA316&dq=pennington+report+on+e.coli+outbreak#v=onepage&q=pennington%20report%20on%20e.coli%20outbreak&f=false

The Meat Hygiene Service for animals was established in the year 1997 on march 20 , which deals mainly with the cleanliness of the animals . The government tells that the animals that are slaughtered should be clean and free from the faecal matter to prevent from contamination of food . The government welcomes the pennington group for providing various recommendations for long term food safety by means of following the principles of Hazard Analysis Critical Control Programme . The government supports for bringing the HACCP in EU food safety legislation and agrees to implement the liscencing arrangements all over the UK which are not covered by the meat product regulation 1994 and its conditions should be as recommended by the pennington group .

http://www.reading.ac.uk/foodlaw/uk/PENNING.HTM

FOOD STANDARD AGENCY (WALES):-

The FSA was established in the year 2000 under the Food Standard Act 1999 . The main objective and functions of the FSA is to protect the public health from the contaminated food . At the time of E.coli 0157 outbreak in wales there was only six staff in the FSA which include two environmental health officers which have included all local authority environment issues and microbiological food safety with some responsibilities like training and support to enforcement officers , performing monitoring and audit , and managing the response to the incidents and controlling them . in carrying out some of the monitoring functions the FSA has got some powers to:-

  • Set some standards of performance in relation to the enforcement of food law.
  • Monitor the performance of enforcement authorities .
  • Collect information from the local authorities relating to the food law enforcement and inspect any record .
  • The information is published by monitoring through the local authorities performance in enforcing food legislation .
  • To make the reports for individual authorities and to provide some guidance in improving the performance .

According to the section 6 of the 1999 Act gives the FSA the functions of :-

1. Assisting and developing of the new policies which are related to the food safety and or interests of consumers related to the food safety in the development by the public authorities .

2. Providing advice , information and assistance to public authorities in respect of matters that are connected with the food safety or in other interests of consumers in relation to the food safety .

The enforcement division of FSA wales has the responsibility of monitoring and seeing all the food law enforcement activities that are made by all the welsh local authorities and it also provide advice , training and support to the enforcement officers in the authorities .

Professor Hugh Pennington has made many of the recommendations to be hygiene in the various places of meat handling like in slaughter houses , in the places of consumption , butcher shops , farm and livestock places like , the meat hygiene service should provide or implement the scoring for the clean and dirty animals and ensure that surgeons in that place of working should be well educated and trained in that field , the meat hygiene service should also take care of improving new technologies of hygiene in places of intestine removal , by the support of the government departments and some of the industries . In the public slaughter houses the workers should be given training about the hygiene principles during the slaughter and the MHS should enforce on the handling of the carcasses, even the HACCP should be enshrined in the places of transportation , slaughter houses . The first and the main thing that was recommended is that the workers in the food industries , were the food is handled should be aware of the existing bacteria and they should know about the nature of the disease . http://www.scotland.gov.uk/library/documents-w4/pgr-02.htm

OUTBREAK

The major outbreak of E.coli 0157 first took place in the Scotland during the year 1982 and the second largest outbreak took place in wales in 2005 . The incidence of E.coli 0157 is higher in the U.K when compared with other European countries . in the Europe U.K has accounted for about 78% of E.coli 0157 infections .

Below table shows the number of E.coli 0157 outbreaks in European countries in the year 2005: -

Country                Number of Cases
England and Wales      950
Scotland               166
Ireland                108
France                 74
Germany                73
The Netherlands        54

General outbreaks on Infectious Intestinal Disease associated with Butchers' Premises, England and Wales, 1995 to 2004 :-

Year           Number of Outbreaks
1995           8
1996           3
1997           4
1998           2
1999           4
2000           5
2001           3
2002           0
2003           0
2004           1
            

The microbiological testing made has proved that about 118 cases of E.coli 0157 were found positive and confirmed in the south wales . The following table shows the outbreak of the E.coli 0157 from the start to the finish .

Timeline of Confirmed Cases, South Wales Outbreak :-Tmber of

Confirmed Cas

Date of meeting           Number of confirmed cases
16 september 2005         Outbreak declared
20 september 2005         11
23 september 2005         26
29 september 2005         81
 3 october   2005         99
 7 october   2005        101
11 october   2005        103
18 october   2005        111
27 october   2005        114
Total at end of outbreak 118
            

Total at end of

the Outbreak118

E. coli0157:H7 is observed as the food borne pathogen in 1982 during the outbreak of bloody diarrhea which has been associated with the consumption of the contaminated hamburgers . After the outbreak in the year 1982 and in the following ten years about thirty of E.coli 0157:H7 were observed in U.S. . There was an outbreak of E. coli 0157 in the food during the years 1995 and 1996 which has been occurred in England and Wales . By the survey done by the authors about 9 outbreaks have been taken place and 88 people were infected in 1995 whereas in 1996 there were about 10 outbreaks took place and the number of people affected were 92 .

http://www.about-ecoli.com/

http://books.google.co.uk/books?id=GLQnAQAACAAJ&dq=pennington+report+on+e.coli+outbreak

In the year 1996, in November month due to the outbreak of the E.coli ther were 18 deaths and 500 people were fallen sick. http://books.google.co.uk/books?id=oUUgcV-wr6wC&pg=PA92&dq=pennington+report+on+e.coli+outbreak#v=onepage&q=pennington%20report%20on%20e.coli%20outbreak&f=false

There were some regulations made in handling the unwrapped food at the butchers shops to prevent from the outbreak of the disease by the E.coli i.e., The Food Safety (Butcher's shop) amendment regulation in 2000. They have amended the Food Safety Regulation 1995 to require the annual licensing by the local authorities for handling the unwrapped raw meat in England at the retail butchers shops and even at all the raw meat selling places. http://archive.food.gov.uk/dept_health/pdf/butcher1.pdf

By some of the scientists in the previous research it was found that they have made some recommendations ( management of cases of E.coli0157:H7) to prevent the spread of the disease that is from the E.coli in the schools and nurseries. They have told that if the spread of the disease in the nursery is from one person to the other then the nursery should be closed (i.e; two cases in the nursery). If the spread is of single case in the school ( child over 5 years age) then the child is excluded from the school till the child is found free from the symptoms for 48 hours and the case and contact should be managed according to the national guide lines. They also identified that the E.coli 0157 has been found in 6 samples of meat , i.e; four from the cooked sliced lamb and turkey , one from the poultry and the other from the frozen joint of raw meat.

http://new.wales.gov.uk/ecolidocuments/LHB/LHB.00016.pdf

Professor hugh pennington has told that the main cause of the outbreak of the E. coli 0157 in food is mainly due to the carelessness of the William Tudor on the food safety by which it led to 157 cases and there was a death of a five year old boy in the year 2005 in wales. The professor also mentioned that the main cause of the outbreak is due to the environmental health officers who made less effective inspections due to the butcher's dishonesty (William tudor).

The professor in his report has made 24 recommendations to prevent from the continuous outbreak of the E. coli in food in 44 schools in the south wales. A five year child named manson jones died in October 2005 because of the food contamination . Due to the death of jones and even for not taking proper food safety precautions ,William tudor was jailed for 12 months in September 2007. the professor also told that the path of infection in most of the cases of the outbreak was contaminated cold meat which has been supplied to schools meals by the john tudor and son under the contract. He mentioned that the food effect is mainly due to the cross contamination i.e; improper handling of the meat( raw and cooked meat).

Hugh pennington in his report have made some recommendations to prevent the outbreak and said most of the food business in wales to understand and use the HACCP and follow the food management practices properly.

Some of the recommendations made by the professor are that all food business contracting for the public bodies for the supply of the high risk foods (raw and cooked meats) must be checked for food hygiene.

Hugh pennington also told that the recommendations made by him should be monitored and implemented by the national assembly of wales.

http://www.independent.co.uk/life-style/health-and-families/health-news/one-butcher-to-blame-for-fatal-ecoli-outbreak-1649048.html

National public health service has made screening for 50 children in the nursery nearly after three years after the death of the five year old boy and it has found that about more than 150 members were affected with the E.coli in the south wales valley. The public health officials have identified four new cases of E.coli0157 in the year 2006. the national public health service for wales has confirmed that two adult contracts also were found with the E.coli infection.

http://news.bbc.co.uk/1/hi/wales/mid/7467198.stm

In Due to the outbreak of the E.coli in the central Scotland in year 1996 there were some implications made for the recommendations that are made by the professor Hugh pennington in the research . The government has established a separate group under the chairmanship of Hugh pennington to examine the situations leading to the outbreak and identify the implications for food safety. The Pennington group has provided 32 recommendations for the control of the E.coli outbreak in april 1997 which has been accepted by the UK government on 11th june 1997. This implementation was made by the food standard agency of wales January 2007.

http://new.wales.gov.uk/ecolidocuments/FSA/FSA.07786.pdf

Recent research was made on the outbreak of Escherichia coli 0157 in the North wales ,(Wrexham) in four cases . All were found effected with the same type of the verocytotoxin producing E.coli 0157 pathogen which belongs to the phage 2 type . In all the four cases who were investigated by the National public health officers for wales are females ( aged 3, 23, 32, 32) . These people all were found affected with the haemolytic uramic syndrome. When the environmental health officers from Wrexham county borough council have visited the food outlet they have found so many unsafety priniciples, like the employers were not trained properly in handling the food and there was no equipment for hand washing . The research made by the people have found 24 isolates of verocytotoxin E.coli 0157 in the welsh laboratory until 3rd august 2009 . Before the cases mentioned in the research there were only 2 sporadic infections with PT2 and neither was from North wales .

http://www.eurosurveillance.org/images/dynamic/EE/V14N32/art19300.pdf

According to the christoper J.I payne, etal the outbreak of the verocytotoxin-producing E.coli 0157 in north wales is due to the visit of the people to the open farms were there is no cleanliness and eating the food that have been in contact with the animals like goats and cows . They have found that the cause of the disease is of zoonotic type causing gastrointestinal illness . The authors have made research by investigating about how the disease has spread in the open farms and they have made some case control studies and used some methods to control the outbreak of the disease . The first report with the infection of the E.coli in a person who has visited the open farm in the north wales was made subjected to the communicable disease control team and then later the farm was investigated and operated in a good way and later after six days other two cases visited the farm and even they were found with the positive culture E.coli and then the farm was closed. These all cases were found with the hemolytic uremic syndrome or E.coli culture positive diarrhea . In their study the controls were selected from children who are below the age of 15 and who visited the farm on and after may 31st and the other children were excluded . After the selection of the controls their parents were interviewed for what happened and made questionaires like date of visit , areas of visit, food consumption , hand washing , time spent with the animal . and the contact of the child with the animal was reported as cuddling, kissing, bottle feeding, feeding by hand and the risk of illness is calculated. The strains were identified by biochemical and serological tests . Atlast from the above mentioned technique , the authors have made some recommendations to get prevented from the outbreak of the disease ( from E.coli 0157) . A total of 17 primary cases and 7 secondary cases were determined and all the isolates are identified as phage 2 type verocytotoxin 2 type . They have found that the increase in the spread of the disease is through the ice cream and the cotton candy which was supplied on the bank holiday in that farm . The main reason is no proper handling of food, improper washing facilities and due to the direct contact of the child with the animal , the disease has spread . The authors finally recommended that the use of sticky and sweet foods should be sold in clean areas or else the use of these type of foods should be discouraged and even they told that there should be hand washing facilities available in the farm exit areas , they also recommended that the hands should be washed before and after eating .

http://origin.cdc.gov/ncidod/eid/vol9no5/pdfs/02-0237.pdf

A report has been provided by the outbreak control team about the largest outbreak of verotoxin positive E.coli 0157 infection in south wales . They have made a lot of investigation on the outbreak of the disease in food . The outbreak control team has decided to control the outbreak of the disease after they have been informed about the children affected with the bloody diarrhea in the hospital and the tests that were made by the microbiologists from the affected child has found the positive result of verotoxin providing E.coli 0157 and most of the people effected by this disease are the primary school children who are aged between 4-10 years . After the discussion made by all the members of the outbreak control team they have decided that there was an outbreak of the disease , then they have started investigation on the disease like how it has been spread and made recommendations to get controlled from the disease . the outbreak control team has made various types of investigations like epidemiological investigation , microbiological investigation ( which was done on humans, food stuff , environment , water ) , environmental investigations which included supply of cooked meat , school investigations ( school kitchens, school milk , school meal ). In the epidemiologic investigation the outbreak control team has told that the people showing the symptoms of the verotoxin positive E.coli 0157 even in the absence of the symptoms is also considered as a case . Only the people affected with the phage type 21/28 are considered, others were excluded . In the meeting conducted during the outbreak they have sent the letters to all the schools to take some precautions if the people are suffering from bloody diarrhea . all the cases of the people were contacted by their respective environmental health departments . The OCT members have took some interviews and passed questionaires to the households and the collected report was submitted to the OCT team . In the epidemiologic investigation there were 157 case meetings among which 118 were confirmed by the microbiological tests as verotoxin positive E.coli 0157 , of these 109 were of phage 21/28 and three were of phage 32 , one of phage RNDC and the other one is of 1 and four are untypable . 44 schools were affected among which 31 cases were admitted to hospital, 2 adults and 9 children were transferred to the tertiary centres and there was a death of one 5 year old boy . Three secondary schools in bridgend were effected with primary cases and this has happened due to the supply of the sliced meat that was served cold which was ready to eat in the primary and secondary schools . A case control study was done in the supply of meat to schools . From 17 of 25 control schools and 16 of 22 case schools data was collected , by this data about 31 individuals were effected with the disease in the 17 case schools . They have also investigated the school kitchens . The Local Authority Environmental health officers have found difficulties with some of the schools during the outbreak because they were not able to comply the hygienic advice provided . The OCT has no statutory power to enforce the advice where it was not being complied .

After seeing all these cases the outbreak control team has made recommendations for controlling the outbreak of the E.coli in the food. In the case of immediate outbreak of the disease the cold cooked meat and sliced meat should be quarantined and it should be removed. Control in the school is done by advicing the teachers on cleaning measures if the children are faecal contaminated and advicing everyone to hand wash . The main thing to be done in the school when the child is found effected with the disease then the child should be kept far from the other people and he should be taken to the hospital to get free from the disease ( i.e; in primary case which is through sliced meat that was supplied to schools ) .

The welsh assembly government has asked OCT to provide some recommendations to prevent from the outbreak of the disease to the people , so they have provided some recommendations which are as follows :-

1. All the schools should be reviewed by the Local Authority food procurement policy and even in some local authority premises like care homes .

2 . Regulations followed in the meat industry should be reviewed along the entire food chain , i.e; from farm to fork.

3 . Major Outbreak Plan and Major Food Outbreak Plans in Wales should be reviewed.

4 . The responsibilities for the protection of the health in the Wales should be reviewed and this review should include improving and considering the mechanism of hygiene in the schools and other local authority places and should provide health protection services .

5 . The important information that was spread by the national communications system in Wales should be reviewed.

6 . All the agencies involved should consider their response to the outbreak and should identify areas that are infected and improve them .

7 . Consideration should be given to whether the Assembly Communicable

Disease Control Committee should be re-established.

8 . Minimum national standards in the school environment should be developed for providing food hygiene .

9 . A good code of practice should be developed by all the health professionals who have the responsibility to ensure that the individuals with the disease receive an advice in getting control of the disease

(http://www.wales.nhs.uk/sites3/Documents/719/E%20coli%20O157%20OCT%20report.pdf

According to Todd etal ; the clinical features of the E.coli were observed when the outbreak has taken place they have mentioned some symptoms that have been seen in the infected people . Symptoms that are seen in the infected person are fever , bloody diarrhoea , diarrhoea , abdominal pain , vomiting ,asymptomatic infection . They have made some clinical findings to prevent from the effect of the pathogen in the food .

http://books.google.com/books?id=rQmZK-NLnQkC&pg=PA394&dq=outbreak+of+E.coli+in+wales#v=onepage&q=outbreak%20of%20E.coli%20in%20wales&f=false

http://www.wales.nhs.uk/documents/e-coli-e.pdf

http://www.wales.nhs.uk/sites3/news.cfm?orgid=719&contentid=7415

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