E-Learning and public health: bureaucrats tackled the e.Coli outbreak by posting letters

by Andrew Rosthorn

 

Beansprouts

On March 28 this year, the Canadian Broadcasting Corporation asked the assistant professor of food microbiology at the University of British Columbia to test 44 packages of bean sprouts.

 

The sprouts were shipped in pre-cooled containers by overnight couriers from shops and supermarkets in Halifax, Regina, Toronto, Winnipeg to the Vancouver laboratory of Dr Kevin Allan.

 

He soon reported that ‘93% of sprout products were positive for enterococci’, a bacteria found in human and animal faeces.

 

‘Significant variation was observed in enterococci contamination; only 13% of leafy greens were contaminated whilst 93% of sprout products were positive for enterococci. From these samples, 34% of recovered enterococci were identified as Enterococcus faecium, 15% as Enterococcus faecalis and the remainder Enterococcus spp. Total microbial loads were highest in sprouts, with 78% of the samples being too numerous to count.’

 

Organisms like E. coli and salmonella that used to be associated solely with poultry and beef are now almost as frequently associated with leafy green vegetables.

He warned the CBC investigators: ‘Although high levels of microorganisms in sprouts were expected, the extensive detection of enterococci and potential significance are not well documented in scientific literature’.

 

Since 2004, the USA has used Enterococcus spp. as the federal indicator for pollution of public beaches by human pathogens from city sewage.

 

Dr Allen said the bacteria he found ‘come from our intestinal tract. And we don't want the contents of our intestinal tract on our food.

 

‘Sprouts are particularly susceptible to contaminants because they are grown in moist, warm environments, which are ideal for the rapid growth of bacteria.

 

‘Personally, I don't consume sprouts and I would not feed them to my children, either.’

 

Back in 2010 he told the Vancouver Sun: ‘If we look at the past decade, we can see a change in the epidemiology of food-borne disease, more specifically within the category of ready-to-eat foods.

 

Scanning Electron Micrograph of Vancomycin Resistant Enterococci.

‘Part of the problem is that ready-to-eat foods are supposed to be ready to eat, so unlike poultry and your beef and your eggs, with salads and sprouts there is no cooking and so no pathogen-killing step. … Organisms like E. coli and salmonella that used to be associated solely with poultry and beef are now almost as frequently associated with leafy green vegetables. That is a tremendous shift from 20 years ago.’

 

A persistent 2010 salmonella food poisoning outbreak in Scotland, prompted Edinburgh City Council and the Food Standards Agency to warn the public: ‘Bean sprouts that are labelled “ready to eat” can be eaten uncooked, as long as they are consumed within the “use-by” date. However, bean sprouts not labelled “ready to eat” should be cooked thoroughly until they are piping hot all the way through.

 

Dr Allen’s March 2011 report was ominous: “Enterococcus spp. are inherently resistant to some antibiotics, and are known for their ability to acquire and subsequently disseminate antibiotic resistance genes to other bacteria. As such, the observed high levels of contamination in sprouts (93%), as well as herbs (79%) and spinach (50%), warrants further investigation, and may present an issue in the dissemination of antimicrobial resistance through foodborne means.”

 

Germany’s public health system, run by half a dozen federal institutions, sixteen state health authorities and the prestigious Robert Koch Institute in Berlin, was blamed by the medical journal The Lancet for reacting too slowly.
Within two months the disastrous North German outbreak had killed 37 people and left 3,200 Europeans from 24 countries suffering serious and long term E coli sickness.

 

They had eaten bean sprouts at 26 restaurants and cafes supplied by the Gärtnerhof Bienenbüttel organic farm near Hamburg, managed by a vegetarian, Klaus Verbeck, who declared the ‘salad sprouts are grown only from seeds and water and they aren't fertilised at all. There aren't any animal fertilisers used in other areas on the farm either.’

 

A quarter of the victims developed the haemolytic uraemic syndrome that affects the blood, the kidneys and the nervous system.

 

Lothar Beutin, head of the national E. coli lab at the Federal Institute for Risk Assessment in Berlin [BfR] stated that the source of the E. coli strain producing the deadly Shiga toxin appears to be human: ‘I don't think the strain came from animals, because we have never seen an aggregative strain in animals. There could be another environmental reservoir, but it is hard to imagine.’

 

At least a hundred of the surviving victims will need a kidney transplant or have to undergo lifelong dialysis.
Germany’s public health system, run by half a dozen federal institutions, sixteen state health authorities and the prestigious Robert Koch Institute in Berlin, was blamed by the medical journal The Lancet for reacting too slowly: ‘Coordination of the German public health response seems to have been utterly absent.’

 

Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, said the German effort had been ‘erratic’ and ‘a disaster’, too slow to conduct detailed interviews with patients and ‘follow the data’.

 

He likened the response to ‘looking at camera footage of a traffic intersection today, to see what caused an accident three weeks ago’.

 

The Russian government also blamed the European Union’s long-established Rapid Alert System on Food and Feed (RASFF) for imposing an economically disastrous and confusing alert notification for ‘innocent’ Spanish cucumbers. Despite World Trade Organisation rules the Russians swiftly banned the import of all fresh vegetables from all 27 EU countries.

 

Karl Lauterbach, an SPD member of the German Bundestag who is also professor of health economics and epidemiology at Cologne University, said at least a hundred of the surviving victims will need a kidney transplant or have to undergo lifelong dialysis.

 

Electronic alerts have been used for years in Britain by the Chartered Institute of Environmental Health (CIH), pioneers of the use of eLearning for dealing with fast moving food problems and the training of food industry professionals.
He deplored the handling of the outbreak and promised an investigation of reports that many infection alerts took over a week to be registered because some of the German bureaucrats had sent them in by post.

 

‘We will investigate in the health committee how many infections could have been avoided if an electronic alert system had been used.’

 

Electronic alerts have been used for years in Britain by the Chartered Institute of Environmental Health (CIH), pioneers of the use of eLearning for dealing with fast moving food problems and the training of food industry professionals.

 

Low-temperature electron micrograph of a cluster of E. coli bacteria, magnified 10,000 times. Each individual bacterium is oblong shaped.In November 2010 CIEH delivered their own nationwide alert about a persistent British outbreak of Salmonella Bareilly, also linked to contaminated bean sprouts, which made “it important for caterers and people who buy bean sprouts to eat at home, to ensure that these products are properly prepared and cooked until they are piping hot unless they are clearly labelled as “ready-to-eat”.’

 

CIEH, unlike many continental public health organisations, deals with food safety at all levels, from the accreditation of inspectors to the training of new recruits among the grass roots of the human food chain.

 

As a registered charity, it operates not only as a professional body and an  accreditation centre but also, runs a knowledge  lab, a worldwide training organisation and a campaigning group.

 

Through 10,000 worldwide registered training centres, it now uses e-learning techniques to prepare candidates for qualifications in ‘basic, low-risk health and safety or food safety knowledge’.

 

Aurion Learning developed the new Level 1 Food Safety Awareness e-learning course for CIEH in 2010, with high levels of interactivity and games with ultra-high quality images and films designed as an induction programme ‘for those preparing to enter the workplace for the first time’.

 

These e-learning packages include video games and animation but also carry instant reports and training records, administered through an interactive hub that handles the varying needs of learners from many nations with different educational standards.

 

CIEH director Des Hancox said, ‘Increasingly high staff turnover means that employers are constantly in need of something that addresses the demands of a mobile workforce working flexible hours. Food safety training is no different. As a champion of vocational skills development, we see that eLearning will be vital for meeting government targets for growth in apprenticeships.’


 

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