Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: SUNDAY, June 11, 1995 TAG: 9506130002
SECTION: NATIONAL/INTERNATIONAL PAGE: A-1 EDITION: METRO
SOURCE: Knight-Ridder Tribune
DATELINE: KANSAS CITY, KAN. LENGTH: Long
Five-year-old Jesse Fendorf runs around his house with his blue and red Power Ranger rings on, kicking, giggling and whooping for a chocolate Popsicle.
In a rare moment of calm, he whispers, ``I was close to dying. I was eating too much hangabur.'' He runs away, laughing. ``I don't want to die, though.''
Last October, Jesse Fendorf ate a hamburger contaminated with a deadly bacteria - the same one responsible for a devastating 1993 Jack in the Box outbreak in the Pacific Northwest that left four children dead and at least 700 others sick.
Most Americans, including Jesse's parents, thought the 1993 outbreak was a one-time freak thing. They were wrong.
In the past two years, scientists at the Centers for Disease Control have recorded 50 outbreaks in 23 states of what some call ``the hamburger disease.'' They estimate the bacteria is responsible for as many as 20,000 illnesses and an estimated 200 to 500 deaths every year in this country alone.
``I hate to use the word, but in some ways it's becoming an epidemic,'' said Glenn Morris, the first medical doctor to serve in the meat inspection service of the Department of Agriculture. ``We're seeing a major upswing ... and we're not smart enough to understand why. It's very humbling to realize how little we know.''
``Don't let anyone tell you this is rare,'' said Dr. Patricia Griffin, of CDC's foodborne and diarrheal diseases branch. She calls the food poisoning a major emerging infectious disease.
The culprit is called Escherichia coli O157:H7, a new and lethal strain of a common bacteria that resides in every human gut. It is found in cow feces. People become sick when they ingest food or water contaminated with bacteria-infested feces.
Scientists disagree on how new the strain is. But they all agree that the more they look for it - in people, in cattle, on feedlots and on dairy farms - the more they are finding it.
More outbreaks have been traced to ground beef contaminated with E. coli than to any other food. Others have been associated with unpasteurized apple cider, salad bars and water - in each case cross contamination with cow feces or the drippings of raw beef juice have been the suspect sources.
New research suggests the illness is spread most frequently by person-to-person contact - in day-care centers, nursing homes and home kitchens.
It doesn't take much to be lethal. You must consume millions of microscopic salmonella organisms to become sick, but fewer than 100 E. coli organisms can kill a child, scientists estimate. Some put the number as low as one to 10 organisms.
Three to five days after ingesting the bacteria, those poisoned experience bloody diarrhea and severe abdominal cramps. For 5 to 15 percent of the victims, a toxin produced by the bacteria breaks through the intestinal wall within a week. It gets into the bloodstream and begins to severely damage or destroy major organs, one at a time: the kidney, the lungs, the pancreas, the heart, the brain.
It is an incurable illness called Hemolytic Uremic Syndrome, or HUS. It was once considered a rare disease. Now it is the leading cause of kidney failure in children.
The first E. coli outbreaks were recorded in 1982, at McDonald's restaurants in Oregon and Michigan, but USDA, the meat industry and most scientists and doctors didn't pay much attention. It took the public outcry after the 1993 Jack in the Box outbreak before things began to change.
Now, in a move to make food safer from ``farm to fork,'' USDA is working to overhaul its meat inspection system for the first time in a century - a move that may be stalled by the new Republican Congress' efforts to curb new regulations. Fast-food restaurants such as McDonald's are beginning to require their suppliers of raw beef to test for the bacteria. And some slaughter plants are struggling to clean up what by its very nature is a decidedly messy process.
But much remains in question.
USDA's changes won't go into effect until 2000, if at all. In the meantime, inspectors have no way to find the invisible bacteria, making the USDA stamp of approval virtually meaningless.
While some slaughter plants are making changes, others are not. And critics of McDonald's say testing huge one-ton vats of raw ground beef for one to 10 E. coli colonies is ludicrous: even if a test is negative, there is no assurance that the virulent bacteria is not in the meat.
``Think of it as guerrilla warfare,'' said Dr. Marguerite Neill, head of infectious diseases at Brown University School of Medicine. ``You don't know where it's coming in next.''
In the past two years, millions of dollars have been spent on research to understand the elusive bacteria, to develop a vaccine for cattle that carry it and to test drugs to keep people from developing HUS. But answers are years away.
``We have just as good a chance of having another E. coli incident next week as we did two years ago,'' said Keith Oleson, assistant director for food safety issues with the General Accounting Office, the investigative arm of Congress.
Although the organism is found in small amounts in livestock - from 1 to 3 percent - the U.S. beef industry is so centralized that meat from one infected cow mixed into a one-ton vat of ground beef can contaminate the whole lot.
Without proper refrigeration - USDA has no temperature control regulations on the transport of beef - deadly bacteria can double their numbers every four hours.
Within days, that contaminated lot could be shipped to six or seven different states and wind up in fast-food burgers, supermarket packets or in your refrigerator at home.
And the season is just beginning. While much remains unknown about E. coli, one thing is clear: most outbreaks occur in the summer, when parents are outdoors barbecuing more and buying burgers from fast-food restaurants.
Jesse Fendorf is a typical case of E. coli poisoning - one of a number of victims never officially counted by the Centers for Disease Control.
Only 33 states even look for E. coli, up from two states in 1987. Some states, such as Kansas, where the Fendorfs live, report to the CDC only outbreaks, not isolated cases such as Jesse's. Nine states report HUS cases.
Although E. coli poisoning hits all people of all ages, the very young, like Jesse, the very old and those with damaged immune systems are the most susceptible.
Like many parents, Sonya and Jay Fendorf don't really know how Jesse became sick. They had eaten at fast-food hamburger and taco restaurants on several different nights. And Jay had cooked him a hamburger at home. He agonizes sometimes, thinking that the two inner coils of the burner were not working at the time. Maybe he didn't cook it well enough.
A recently released three-year Canadian study of 1,500 children with E. coli poisoning, found that person-to-person contact is the most common source of illness. The lethal bacteria can live in kitchen towels, sponges and on plates, utensils and toys at day care centers or at home.
According to Canadian researchers, if Jay made hamburger patties, wiped his hands on a towel, then later used the towel to wipe Jesse's face, he could have exposed Jesse to the illness. Or if he put the cooked burgers back on the same plate where the raw patties had been. Or if he handled raw meat, then ripped up lettuce for salad without washing his hands, he could have contaminated the entire salad.
Jesse's illness began with explosive bloody diarrhea and stomach cramps. But doctors initially misdiagnosed it. They said he had the flu and sent him home.
Within days, Jesse had lost all color and was in the intensive care unit with full-blown HUS. He was on dialysis because his kidneys had failed. He received blood transfusions because he was anemic. A seizure convulsed his entire body. Fluid surrounded his lungs. His veins collapsed. After a month and a half in the hospital, where he spent his fifth birthday, and $75,000 in unpaid bills, doctors don't know how he recovered.
Jesse Fendorf still has his kidneys and his blood is checked every three months. He had to learn how to walk again. Because he's so young, his parents will never know if his cognitive abilities were damaged.
Stephanie Rock, of Palm Beach, Fla., has permanent pancreas, kidney and liver damage from her 1993 struggle with E. coli. Now 7, she has constant gastrointestinal problems. She has night terrors of the time when her veins collapsed and doctors held her down and jammed her with needles.
Damian Heersink was 11 when he became ill. He had three open-heart surgeries and countless ministrokes. Now 15, he no longer has a lining on his heart. He lost 30 percent of his lungs.
``He's cut from his sternum all way down to his pubic area,'' said his mother, Mary Heersink. ``Sometimes I see him getting out of a swimming pool or the shower and I'm just shocked all over again. It looks like the very same cut that one would make on a carcass. I thought, we're butchering our kids.''
USDA is trying to toughen meat inspection laws for the first time since 1906, when Upton Sinclair wrote his expose on the meat industry, ``The Jungle,'' but the move comes as the new Republican Congress is working to dismantle regulations, new and old alike.
Two years ago, Nancy Donley of Chicago watched as E. coli toxins destroyed every major organ and turned the brain of her 6-year-old son, Alex, to mush. A few weeks ago, she watched lawmakers vote to exempt duck-hunting and air-safety regulations from the proposed regulatory moratorium - but not USDA's food safety regulation. She began to cry.
``Every `No' vote felt like a death sentence,'' she said. ``It just destroyed me.''
In Kansas City, Jesse Fendorf's wispy, white-blond hair is finally growing back over his forehead. He had pulled most of it out during his stay in the hospital last fall. His mother worries that he still talks of dying, that he screams when he smells rubbing alcohol, that he has had another bout of bloody diarrhea, and that he still begs for hamburgers.
When she asks him where he wants to go for dinner, he leans over and whispers, ``McDonald's.''
by CNB