................................................................................................................................ Escherichia coZi 0 1 5 7 outbreak in Australian
VETERINARY
JOURNAL
Japan:lessons for Australia KA BETTELHEIM Victorian Infectious Disease Reference Laboratory, Fairfield, Victoria 3078
T EDITOR JOUKO KOPPINEN
ASSOCIATE EDITORS KL HUGHEB,AK SUTHERLAND
EDITORIALCOMWlTEE NORMAN ANDERSON. GLENN BROWNING COLIN CHAPMAN. ROBIN CONDRON. JOHN DUFTY. TREVOR FARAOHER. KEITH HUOHEB. JOUKO KOPPINEN. ALAN UWTHER, CARL PETERSON. SANDY SUTHERUND. ANDREW TURNER --
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he 1996 outbreak, caused by enterohaemorrhagic Esrherirhiu roli (EHEC) 0157 started in Hiroshima, where by mid-June 65 cases of food poisoning were reported in an elementary school. When the last case was reported in August, the total number ofcases was 9578, with mortality of 11 people and more than 90 diagnosed cases of haemolytic uraemic syndrome, a serious disease caused by bacterial toxins. As an effect of the outbreak, sales of foodstuffs, especially raw meat and other perishables, plummeted. Supermarket chains withdrew meats that can be served uncooked. The atmosphere was at times close to panic, classrooms being fumigated and sales of disinfectants soaring. The source of the epidemic was never exactly determined. The main culprit was probably inadequate handling of school lunches. The investigations revealed that hamburgers, salad components, sea eel sushi and soup, beef, liver and cow intestines yielded EHEC 0157:H7. The same serotype was found in 248 patients in about 20 prefectures of Japan. Most strains produced both Verotoxin 1 and 2, but a few produced Verotoxin 2 only. Studies indicated a great diversity of types and suggested that these E roli are widespread in Japan. A preliminary report of the outbreak suggested at least two toxin phenotypes of EHEC 0 1 57:H7 may have been involved.' The Japanese outbreak was the largest recorded. In 1993 to 94 a multi-state outbreak in USA, ascribed to EHEC 0 1 5 7 , involved about 700 people.' An epidemic of bloody diarrhoea in about 20,000 people in a refugee camp in Malawi may have been caused by EHEC or possibly Shigellu strains.' EHEC 0 1 5 7 have been present in Australia for many years. In addition other serotypes of EHEC are found, for instance 0 1 1 1:H-, the most prominent type in the 1995 South Australian outbreak which caused haemolytic uraemic syndrome in 23 people and led to the death of a young girl.' While Australians probably eat less raw or undercooked meat and fish than the Japanese, salads, rare steaks and uncooked seafood can easily become vehicles for EHEC and there is always the possibility of poor handling of foodstuffs. Australia is a major exporter of foods, including meat, vegetables and other products, which may become contaminated with EHEC. While the Japanese epidemic was not associated with Australian meat, it caused a significant reduction in sales. Undcr the mood of the outbreak, the finding of EHEC in Australian products would probably have led to a blanket ban on our meat exports. The 'tainted' label would be very difficult to avoid on other markets as well. The costs of foodborne diseases are notoriously difficult to estimate. EHEC 0 1 57 infection is estimated to be the fourth most costly foodborne disease in Canada and USA,5 not counting the cost of possible litigation. The Center of Disease Control estimates that in USA up to 20,000 people get sick of E roli 0 1 57:H7 alone, and about 500 die of it each year. As I am writing this, there is a serious outbreak continuing in Scotland, with considerable mortality and links to farm animals. EHEC is carried by healthy farm animals."' We must investigate the distribution of EHEC bacteria in our environment, the range of types present and our readiness to combat the effects of future outbreaks.
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1. Watanabe H, Wada A, lnagaki Y, Itoh K, Tamura K. Outbreaks of enterohaernorrhagic Escherichia coli 0157:H7 infection by two different genotype strains in Japan. Lancet 1996;348:831-832. 2. Center of Disease Control and Prevention. Update: multistate outbreak of Escherichia coli 0157 infections from hamburgers - western United States. Morb Mortal Wk/y Rep 1993;42:258-263. 3. Paguet C, Perea W, Grimont F, Collin M. Guillod M. Aetiology of haemorrhagic colitis epidemic in Africa. Lancet 1993;342:175. 4. Cameron S, Walker C, Beers M. Rose N, Anear E. Enterohaemorrhagic Escherichia colioutbreak in South Australia associated with consumption of mettwurst. Comm Dis lntel 1995;19:70-71. 5. Todd ECD. Costs of acute bacterial foodborne diseases in Canada and the United States. lnternat J Food Microbiol 1989;9:313-326. 6. Beutin L, Geier D, Steinruck H, Zimmermann S. Scheutz F. Prevalence and some properties of Verotoxin (Shiga-like toxin) -producing Escherichia coli in seven different species of healthy domestic animals. J Clin Microbiol 1993;31:2483-2488. 7. Sidjabat-Tambunan H, Bensink JC. Verotoxin-producing Escherichia coli from the faeces of sheep, calves and pigs. Aust Vet J 1997;75. In press.
Auct f i t / Vol75, No 2, February 1997
