
DATE: Saturday, July 19, 1997               TAG: 9707190286

SECTION: FRONT                   PAGE: A1   EDITION: FINAL 

SOURCE: BY MARIE JOYCE, STAFF WRITER 

                                            LENGTH:  118 lines

STATE STALKS E. COLI OUTBREAK IN JUNE AND EARLY JULY, 38 VIRGINIANS FELL ILL - AT LEAST 24 WITH THE SAME STRAIN.

Virginia Health Department workers are hunting for the source of a mysterious statewide outbreak of infection with E. coli O157:H7, the food-borne bacteria that caused the notorious contamination of Jack in the Box hamburgers four years ago, and more recently was linked to unpasteurized apple juice.

The bacteria sent 15 Virginians to the hospital last month, but no one has died and no one has suffered the most serious complication, hemolytic uremic syndrome, which can cause kidney failure.

There were 32 reported cases this June, compared with 11 in June 1996.

While health officials believe most cases are related, they have yet to find a link among the victims. The people are spread over the state - no two live close enough to have the same telephone exchange.

Their ages range from 15 months to 68 years. They are equally divided between male and female. They include an office worker, a stock broker, a social worker, retirees, a homemaker, a furniture refinisher and a bus driver. Some say they eat every meal in restaurants. Some of the children only eat what their parents cook at home.

And while the bacteria are usually associated with undercooked meat, one of the victims is a vegetarian.

``So far we can't find anything in common that's obvious,'' such as a single restaurant, said Dr. Mary Winnett, one of the state health officials in Richmond searching for the source.

``The thing we worry about in a case like this: Is there a distributor, anything like that?''

The people made sick include two in Virginia Beach, three in Williamsburg and one in Isle of Wight County.

The state regularly gets reports of sporadic episodes of E. coli O157:H7 infection. But health officials became concerned when the numbers spiked last month. And so far, the July numbers are running ahead of last year - six for the first two weeks of July 1997. Last year, there were just six cases for the entire month.

``There are always going to be some cases. This is above normal,'' said Winnett.

Some recent cases may not be part of the outbreak, and some were reported too late for adequate testing. But tests done in 28 of the cases showed that 24 were the same type of E. coli O157:H7, and two others were extremely close, said Winnett. E. coli O157:H7 is one strain of hundreds of the bacterium Escherichia coli. Most strains live harmlessly in the intestines. Some cause urinary tract infections.

Sometimes, even people who get the O157:H7 strain never get sick enough to see a doctor, so their cases never get reported.

Since it was first identified in 1982, it has been most often associated with eating undercooked, contaminated ground beef. That was the culprit in the Jack in the Box cases in the Northwest in 1994, in which several children died.

However, health officials everywhere are seeing more cases associated with eating vegetables and fruits, possibly because the bacteria are spread in fertilizer, said Winnett.

The first steps in the health department's investigation, such as interviewing people who got sick, failed to find a link. So workers are moving to a more complex and time-consuming technique called a ``case control'' study.

This involves comparing those who got sick with a control group of people who did not, much as a scientist would use a control group when testing a new drug. Health officials interview the control group about what they ate around the time that their counterparts got sick, hoping that a pattern will emerge.

This is easy when the outbreak occurs at one place, like a wedding banquet, said Dr. Denise Benkel, with the state health department. Officials can show each guest a menu, mark what he ate, and figure out which food all the sick people ate and all the healthy people avoided. But finding a control group in a widespread outbreak is tricky.

Health officials need to compare each victim with three people of the same age and sex who live nearby.

To do that, they take each victim's area code and the first five digits of his phone number. Then they randomly generate the last two digits and start calling, hoping to find a neighbor who matches the description. This process has kept a dozen or so workers in the Richmond offices well into the evening, hoping to catch people at home. So far, they've found 13 people for the controlgroup.

``We have to make a lot of phone calls before we find someone,'' said Winnett. ILLUSTRATION: Staff Graphic by John Earle, The Virginian-Pilot

Virginia E. Coli cases in June and early July 1997

For complete copy, see microfilm

Side Bar

E. coli 0157:H7 is most often associated with eating undercooked,

contaminated ground beef. But infection also can occur after

drinking raw milk, and drinking or swimming in sewage-contaminated

water.

There have been cases caused by person-to-person contact in

families and child-care centers, since bacteria in the stools of

infected people can be passed to another person when hand-washing is

inadequate.