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In the Vegetarian & Vegan News...
   Daniel Maloney, MD | E. Coli.

Farm Animals and E. Coli --
Even Vegetarians Aren't Safe

by Daniel Maloney, MD

Several years ago our clinic's annual picnic was held at a large park with several sports fields, a pond, and a barn that contained ponies, chickens, pigs, and a calf. The calf was a really beautiful animal. I stared into those giant brown eyes and wondered how I could ever have eaten one. I fed it some hay and allowed it to lick my hand with its huge, rough tongue. I didn't think about it at the time, but I was risking my life.

Cattle, and to a lesser extent sheep and deer, are the natural reservoirs for a deadly new mutation of a common bacterium. Escherichia coli is found in the intestines of almost all mammals, and most types are harmless, or beneficial. As part of the normal flora of the human intestinal tract, E. coli plays a crucial role in food digestion by producing vitamin K from undigested material in the large intestine. The few strains that are pathogenic, or "disease-producing" have been linked to diseases in just about every part of the human body. Pneumonia, meningitis, and traveler's diarrhea are among the many illnesses that pathogenic strains of E. coli can cause.

Enterohemorrhagic E. coli, or EHEC, are types that produce a potent poison, known as Shiga toxin. They are called "enterohemorrhagic" because they can cause severe intestinal bleeding. Escherichia coli O157:H7 is the most common and severest form found in the US. These bacteria are shed in the feces of cattle. As few as forty or fifty bacteria are enough to cause disease in people, and cow feces can contain billions of organisms. They can be transmitted to people by undercooked ground beef, unpasteurized milk, and other foods contaminated by bovine feces. Outbreaks have been linked to contaminated apple cider, raw vegetables, salami, yogurt -- E. coli has even contaminated drinking water. Transmission from person-to person, particularly among children, is common.

Now we have to add direct animal-to-person transmission.


 



Anyone who has ever cared for a child with enterohemorrhagic E. coli knows what a nightmare it can be. The illness starts as a severe watery diarrhea and progresses to a bloody diarrhea with severe abdominal cramping. Internal bleeding in the skin, large intestines, and kidneys can develop. This can lead to anemia, kidney failure, or even, death.

You shouldn't have to worry about dying from drinking apple cider, going camping, or going to a petting zoo. But you do.

A recent report in Morbidity and Mortality Weekly Reports describes fifty-six cases of Escherichia coli O157 infection in Pennsylvania and Washington. These are the first outbreaks of this disease to be associated with the direct transmission of the bacteria from farm animals to humans. During the fall of 2000, 51 people with an average age of 4 years had diarrhea within ten 10 days of visiting a dairy farm in Pennsylvania. 16 were hospitalized and eight developed hemolytic-uremic syndrome. Of the 216 cattle on the farm, 28 (13%) were infected with the same type of E. coli that caused the disease in the children.

During the spring of 2000, five children in Washington ranging in age from 2 to 14 years developed bloody diarrhea that was proven to be caused by E. coli O157. Four of the children had visited a farm where they were encouraged to handle poultry, rabbits, and goats. A calf was kept in a pen and could be touched through a fence. One of the children was a sibling of a child who had visited the farm. Three of the children were hospitalized. Only five of the farm animals were tested for E. coli O157 and none were positive.

In May of 2000, twenty children were infected by E. coli O157 in New Aberdeenshire, Scotland, after camping in a muddy field that had been used as a sheep pasture. None of the children had direct contact with the animals, but the soil was found to be heavily contaminated.

The largest outbreak of E. coli O157 occurred in 1993, associated with contaminated hamburgers at Jack in the Box restaurants. There were 500 culture-confirmed cases and 100 probable cases in Washington State. About 150 of the cases were hospitalized and there were 45 cases of hemolytic-uremic syndrome, which causes internal bleeding and kidney failure, of which 28 required kidney dialysis. Three children died related to this outbreak.

E. coli O157 was first identified as a cause of human illness in 1982, but subsequent research has traced it back to Argentina in 1977. It quickly spread to cattle all over the world. It is estimated that 3 to 10% of all cattle carry the germ, and 20 to 50% of all herds have at least one infected member. E. coli O157 does not cause disease in cattle, sheep, or deer. Unlike other causes of food borne illness, it is just as common among "free range" cattle as among those penned in feedlots. There is currently no known farming practice that can prevent herds from becoming contaminated. Therefore, the World Health Organization and the Center for Disease Control recommend you assume that all cows carry E. coli O157, and that you take precautions accordingly.

If you visit a farm, make sure that you wash your hands well after any contact with animals, manure or soil. Don't eat or smoke before washing your hands well. Children, particularly children under five, are at greatly increased risk. If they are allowed to have contact with sheep, goats, or cattle at all, they must have one-to-one supervision and should wash immediately afterwards.

The CDC recommendations for farm visits can be found at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5015a5.htm.

The World Health Organization fact sheet on E. coli O157, including the "Golden Rules" for safe food preparation, can be found at http://www.who.int/inf-fs/en/fact125.html. Several articles about E. coli O157 can regularly be found here at VegSource in the "Mad Cow Corral."

My daughter's elementary school is next door to a pasture. Flooding is common here in South Texas, so the runoff could easily get onto her playground. The bottom line, unfortunately, is that cow feces have contaminated our entire world. Manure is spread on fruits, vegetables, and grains, even those labeled "organic." Not eating meat will reduce your chances of contracting E. coli O157, but as long as cattle and cow manure can be found practically everywhere, even vegetarians must be cautious.

Daniel Maloney is a pediatrician. He lives and works in The Woodlands, Texas, north of Houston, with his wife, Liz, and his two children, Ryan, 15, and Julie, 8. They will be coming to the VegSource e-vent weekend and hope to meet as many of you as possible.

 

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