Prevalence and Management of E. coli in America

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Prevalenceand Management of E. coli in America

Prevalence and management of E. coli in America

Hygiene is one ofthe primary factors that cause the outbreak of various diseases andinfections throughout the world. Escherichia coli is an infectionthat is spread through contaminated food, water and personal contact.It is popularly referred to as E. coil in medical spheres. NorthAmerica witnesses a significant number of outbreaks annually from thespread of contaminated foods. Understanding the epidemiology of thisbacterial infection is important as it helps in the prevention andmanagement efforts. E. coli is, nevertheless, a diverse group ofbacteria with most of the strains being harmless to the body. Asignificant number of these strains are harmful to the body as theycause diarrhea and other infections to the intestines. The prevalenceand management of E. coli significantly varies in America as comparedto other countries.


According toJahan (2012), foodborne illnesses comprise a wide array of illnessesthat are responsible for numerous morbidity rates across the world.Due to the significant mortality rates that it presents both indeveloped and developing nations, it is a serious public healthconcern challenging many countries. Helms et. al. (2003) asserts thatmany nations across the world find it difficult to determinemortality rates arising from foodborne illnesses causes in theirpopulation. World Health Organization (2011) characterizes foodborneillnesses as that arises from the ingestion of foodstuffs thatcontain bacteria, parasites, biotoxins, poisonous substances orviruses. Jahan (2012) further explicates that these foodborneillnesses affect developing nations more than the developed countriesand make it difficult for the world to achieve its set millenniumgoals. These developing nations suffer more from these foodborneillnesses due to the inability to access clean water, storing foodimproperly, and the lack of access to information concerning theseillnesses (World Health Organization, 2011).

Public healthsystems face most of the challenges when dealing with foodborneillnesses at the prevention stage. It is better to prevent theoutbreak of these diseases as opposed to managing such an outbreak(Newell et. al. 2010). Nonetheless, it is imperative to understandthat the food production process goes through a number of stagesbefore it reaches to the consumer (Newell et. al. 2010). Food is madeby the farmers and is sold to suppliers who process it. Thecontamination may occur at the production phase or when going throughthe numerous intermediaries. Newell et. al. (2010) further positsthat most of the disease outbreaks are easily traced back to foodhandlers who come to contact with the infection. It is thus prudentto give proper education and awareness to children, parents, andhealth care gives to protect people from such outbreaks.

E. coli was firstdiagnosed as a human pathogen in the year 1975 after a patientexhibited bloody diarrhea. This disease was later associated withground beef in 1982 after there was an outbreak of the illness (Smithet. al. 2005). The serotype is defined by its O and H antigens andsome non-O157 serotypes that manufacture verocytotoxins, which areknown as Shiga-like toxins due to the similarity of the toxinsproduced by Shigelladysenteriae. E. coli O157:H7 causes about 73, 500illnesses in the US due to a number of significant outbreaks acrossthe country and about 60 cases that arise from these infections(Doyle et. al., 2006). Doyle et. al., (2006) argues that a highnumber of E. coli cases are reported in the developed countries morethan the cases reported in the developing world. On the other hand,this is attributed to the lack of sophisticated diagnosislaboratories in the country. There has been lack of information onthe prevalence of E. coli cases as Doyle et. al., (2006) claims thatthere were about 1763 outbreaks that were reported in the UK from1992 to 2005 but only fifty-five of these outbreaks were published ina peer reviewed journal. Data from FoodNet propose that infectionsfrom E. coli O157:H7 are more sporadic in their form as opposed tothe outbreaks. The main causes of these sporadic infections are knownto arise from undercooked hamburgers and the exposure to infectedcattle and farms (Shillam et. al., 2002). Other sporadic infectionsare also known to arise from dining at table service restaurants andimmunosuppressive medications (Doyle et. al. 2006).

The main vehiclesfor infection of E. coli have changed over the years with the firstvehicle identified as ground beef (Rooney et. al. 2009).Unpasteurized milk and uncooked foods were later diagnosed assignificant vehicles of infection that lead to the outbreaks of theillness. Contaminated water has also been reported to be a majorvehicle of infection especially water that contained animal feces(Rooney et. al. 2009). Recent infections from the bacteria have alsooccurred to persons who visit zoos and animal farms as they come intocontact with infected animals (Smith et. al. 2004). Costa (2013)argues that E. coli is also often carried in sea food nevertheless,these infections are not dangerous in most of the cases. Thecontamination in sea food is mostly associated with poor hygiene andmay cause risk to consumers if it has diarrheagenic E. colipathogenic strains. The presence of non-pathogenic E. coli in fishshould be an alert to the public as the bacteria is an indication offecal contamination (Costa et. al. 2013).

The outbreaks ofE. coli today receive almost instant media coverage causing a highlevel of anxiety in the general population (Smith-Palmer et. al.2005). The federal government manages these outbreaks through thehelp of various government agencies such as the CDC, FDA, theDepartment of Agriculture and the Environmental Protection Agency. Anumber of regulations, directives and guidelines are given to dealwith the outbreaks. There are two ways in which the governmentagencies deal with these outbreaks i.e. through surveillance andregulations. The surveillance is done through a number oforganizations that work with the private and the public health sectorto identify some of the risks that may lead to an outbreak. They alsoensure the proper handling of food in public eating facilities suchas restaurants. These organizations also help to understand thechanging nature of these infections and deduce ways to deal withthem.


The study willincorporate aspects qualitative methods of data collection to collectand analyze the information necessary for the study.


The study wasconducted on a hundred participants who were drawn from a number ofpublic and private organizations across the country. Theseparticipants gave their experiences with the E. coli outbreaks inmajor cities across the country while data from organizations wouldhelp to analyze the prevalence of these outbreaks over the last tenyears. The data is drawn from seven representatives of the CDC andother seven representatives of the Food and Drugs administration(FDA). The other participants in the study are drawn from the variouspublic health agencies across the country. The age of theparticipants was not a consideration for the study since it is theirexpertise and experience that was necessary for the research. Thirtyparticipants will also be drawn from the members of the public whohave had an experience with an E. coli outbreak in the last tenyears. The period for data collection spanned over six months whiledata analysis was undertaken in three months to deduce the resultsand conclusions of the study.


The study usesdifferent instruments to collect and analyze data over the studyperiod. It employs the use of interviews to acquire data from theparticipants. Interviews are chosen for the study since they presentan excellent way for the interviewer to acquire an in-depth knowledgeof the subject. The representatives of the government agencies, tenpublic health workers, and ten member of the public are interviewedto give the experiences they have in managing outbreaks of E. coli.The interview consists of open ended questions that will give theinterviewer the chance to engage the subjects and seek betteranswers. The use of an open ended form of interviewing will alsoallow the interviewer to clarify any questions or issues that theymay have while carrying out the interview.

The research alsorelies on the use of questionnaires to acquire information from theparticipants. A total of seventy questionnaires are given to theremaining participants who also pen down some of their experienceswith the E. coli outbreaks over the last few years. Thequestionnaires are useful in the study since they can collectinformation from a large number of people in the shortest timepossible. It consists of structured questions that will give theresearchers the exact information that they need. Thesequestionnaires were dispatched and administered over a span of onemonth after which they were collected and analyzed. Only fifty-sixquestionnaires were returned for the study with only about tenquestionnaires that were not returned. Nonetheless, thesequestionnaires were enough to deduce the necessary information thatthe study sought. Data from government agencies will be an importantsource of information for inquiring about the prevalence of E. colioutbreaks in the last decade. The study will seek official data fromthe, World health Organization, CDC and FDA which publishes reportson the outbreaks of epidemics across the country. These agencies willalso provide information on how the government manages the epidemicsand some of the challenges that they face when dealing with foodbornedisease outbreaks.


Data collectiontook a period of six months’ while the analysis of the informationcollected would eventually span over three months. An advertisementin the dailies was important in helping to draw up participantsespecially from the general public. Official requests made to thegovernment agencies to seek participants and data for the study werealso successful. The participants who agreed to the research gave outtheir addresses where the questionnaires were sent to them. Theparticipants were expected to take up to a month to fill and returnthe questionnaires to the study team. This period will give themample time to give out information and will ensure that a majority ofthe participants will return the questionnaire forms.

Since there arethirty-four interviewees, the study will interview eight of them eachmonth for duration of five months. The participation in theinterviews was voluntary and the instructions for filling the formsand the interviews were given out during the study. Secondary datafrom the government agencies will also be collected during the firsttwo months of the study. The data collected through the six months ofstudy was analyzed over the remaining three months. Information fromthe questionnaires and the interviews will be assessed and the commonthemes in the data will be noted. Data from the government agencieswill also be assessed through the Statistical Package for the SocialSciences software. There were little data quality and ethical issuesarising in the research. Since the issues in the study are notsensitive, it was not necessary to keep the identity of theparticipants confidential. Nonetheless, a significant number ofparticipants urged the researchers to conceal their identities in theresearch. Most of the data gathered had similar themes therebyauthenticating the data quality received from the participants.

Results anddiscussions

The data from thegovernment agencies revealed that there are E. coli outbreaks everyyear in the country. The E. coli O157 strain was found to be the mostprevalent infection in the E. coli outbreaks that were reported.These outbursts mainly arose from foodstuffs from animals and plants.For example, in June 2016 E. coli O121 and O126 were reported in anumber of states. There was an outbreak of Shiga toxin-producingEscherichia coli (STEC) that led to the recalling of a number offlours produced by General Mills (CDC, 2016b). The CDC, food anddrugs administration, and various states investigated the outbreak ofE. coli after 46 people were reported to have STEC infections in 21states. Thirteen of these patients were hospitalized with one personreported to have hemolytic uremic syndrome, which is a type of kidneyfailure (CDC, 2016b). Nevertheless, no deaths were reported in theoutbreak. The CDC recommended that restaurants and hotels not to usethe recalled flours.

A similaroutbreak occurred earlier on in March 2016 after 11 people wereinfected with the strain of Shiga toxin-producing Escherichia coliO157 (CDC, 2016). These patients who were reported to be ill werefrom Minnesota and Wisconsin, no one developed kidney failure andthere were also no reported deaths. The source of the infections wasreported to arise from sprouts that are produced by Jack &amp TheGreen Sprouts of River Falls (CDC, 2016). Collective efforts from thestate, public and federal health agencies were able to contain theoutbreak and made a number of recommendations. PulseNet, a network offood regulatory agencies and other health stakeholders coordinated bythe CDC was useful in identifying the illnesses associated with thisoutbreak (CDC, 2016). Sprouts are known to be a major cause offoodborne illnesses and the involved authorities recommended that thesprouts to be handled with care in restaurants and hospitals.

The rest of thedata from subsequent years revealed that there was an average ofthree outbreaks each year of the Shiga toxin-producing Escherichiacoli strains. In most of the cases, only a few of the infectedpatients were hospitalized and there were very few cases of deathsreported from E. coli (CDC, 2016c). Data from Rocourt (2003) revealsthat the US shows a higher number of outbreaks of the E. coli O157than other OECD countries. Nonetheless, the high number may also meanthat a country has an excellent surveillance system that enables itto detect and report the outbreaks (Rocourt, 2003).

(Rocourt,et. al., 2003)

The interviewsfrom the public health workers revealed that they faced a lot ofchallenges when dealing with foodborne illnesses. Since the diseaseis spread through contaminated food, it is difficult to control theillness especially if these foods are served in public eating areas.By the time the health agencies discover the source of the infection,a number of people would already have been infected. The challengesin managing foodborne illnesses that were identified in the studyinclude the difficulty in identifying the specific infection,difficulty in knowing the extent of the spread, tourism, inability toidentify and isolate the infected foodstuffs and lack of control overthe hygiene of the population. The people who have been infected bythe bacteria infection reported to receive help from the healthagencies and most were able to recover from the infections withoutfurther damage to the body. On the contrary, a small percentage(about 3%) of the participants reported to know someone who died fromthe foodborne infection.


The CDC, which isthe body mandated to deal with these foodborne illnesses reported tohave a variety of surveillance systems to identify, prevent andmanage foodborne illnesses such as E. coli. FoodNet is the principlesurveillance tool that the health sector uses to identify foodborneoutbreaks. The CDC partners with ten states, the FDA and theFederal’s Department of Agriculture to prevent and manage foodborneillnesses. It studies the changing nature of these outbreaks andresponds to the new strains of illnesses arising from contaminatedfood and water. Other surveillance systems include PulseNet andElectronic Foodborne Outbreak Reporting System (eFORS).

Though the US hasconstant reports of foodborne illnesses, the mechanisms paced toidentify and manage these epidemics are useful in meeting thechallenges faced in containing foodborne illnesses. The surveillancesystems in the country will help to identify and recommend healthsolutions to the infected populations. Companies such as Generalmills whose foods are identified to be contaminated are able to dealwith this through recalling the foodstuffs sold during a specificperiod. The technological systems in the country make the treatmentof these illnesses to be easier than in developing countries where anumber of deaths are reported from foodborne illnesses. Theprevalence of food borne illnesses especially from E. coli in the USwas thus found to be higher than those of other countries butmanagement of the outbreaks was better due to excellent healthcaresystems. There are also better systems and methods that the healthagencies use to manage the outbreaks thereby reducing the risksassociated with foodborne illnesses. This risk was found to be higherin other countries.


Foodborne illnessoutbreaks occur in the United States annually due to a number ofreasons. The contamination of food occurs at different parts of theproduction process, presenting numerous challenges in theidentification and management of the outbreaks. E. coli is abacterial infection that is transmitted through contaminated food andwater. As much as these foodborne illnesses cause a high rate ofmorbidity across the world, developed countries such as the US hasinstituted measures to deal with such outbreaks (Shukla et. al.1995). The study seeks to compare the prevalence of E. coli in the USand other countries while also highlighting some of the challengesthat these countries face in managing the E. coli outbreaks.Prevalence is seen to be higher in the United States but themanagement of E. coli was found to be better due to the advancementsin technology and healthcare systems than in other countries. Thehigh prevalence of E. coli in the US is attributed to a goodsurveillance system that is able to detect and manage the outbreaks.The lack of data on the outbreaks in other countries may be a reasonwhy prevalence is seen to be higher in the US than other OECDcountries.


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