In a national public health story that continues to evolve, federal health officials are tracking the source of an E. coli O157:H7 outbreak that has affected people in 21 states. The suspected source of the multi-state illness outbreak is tainted organically-grown spinach from farms in central California, according to the U.S. Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration's (FDA) Center for Food Safety and Applied Nutrition.

E. coli is most commonly found in infected animal manure and causes severe bouts of diarrhea. Most healthy adults can recover completely within a week, although some can develop a form of kidney failure that can be fatal. The very young, the elderly and those with compromised immune systems are the most vulnerable to serious complication from infection. According to the CDC, E. coli O157:H7 causes an estimated 73,000 cases of infection annually in the U.S., including 61 deaths.

As of September 21, little more than one week after initial reports of illness, 131 people have been infected with the E. coli strain and one person has died. Two more deaths are suspected to be related to the outbreak. Of those interviewed by health officials, 80 percent reported eating packaged spinach. A source of some mystery for investigators is the fact that women currently make up 71 percent of those who were sickened by the outbreak.

State and federal investigators recently traced the spinach back to California producer Natural Selection Foods, an arm of Earthbound Farms. Natural Selection's spinach is sold under a number of brand names, including Earthbound Farm, Bellissima, Dole, O Organic, Superior, Compliments, Trader Joe's and President's Choice.

Among the suspected causes of the contamination is the water supply used to wash the spinach as it is harvested, a common entry point for bacterial contaminations. Questions have also arisen regarding proper levels of chlorine being used to disinfect the rinse water. Additionally, state and federal officials said they would look at sanitary conditions in bathroom and washing facilities for farm workers, fertilization techniques and equipment cleaning practices in processing plants.

The Water Quality & Health Council (WQ&HC) reminds consumers that food safety is not only the responsibility of growers and federal regulators, but a personal responsibility also. When preparing fresh produce or meat dishes of any kind, proper washing, handling, cooking and storage practices can help reduce risk of illness and the spread of infection. The WQ&HC offers its own food safety tips by clicking here. For the holidays or for everyday, food safety is everyone's responsibility.

For information from the CDC about E. coli, please go to:
http://www.cdc.gov/ncidod/dbmd/diseaseinfo/escherichiacoli-g.htm

The U.S. Environmental Protection Agency (EPA) is requesting public comments on a proposed approach for estimating the total "burden of disease" related to waterborne disease occurrences reported between 1971 and 2000. According to the EPA, an analysis combining the number of cases of waterborne disease, their severity and the associated economic effect offers a fuller picture of the impact of waterborne illness known as the "burden of disease". Based on recent estimates, federal health officials believe the impact of waterborne disease outbreaks are significantly underreported and undervalued.

Currently, information about U.S. waterborne disease outbreaks (WBDOs) is voluntarily reported by state, territorial and local public health agencies to the Centers for Disease Control and Prevention (CDC). CDC and EPA jointly maintain the WBDO database that summarizes the information collected. Underreporting of WBDOs is assumed, but the magnitude of underreporting is unknown. CDC made the first national estimate of waterborne disease in August, saying there were about 16.4 million of cases of acute gastrointestinal illness each year from drinking water.

The public comment period for the document, Approaches to Estimating the Waterborne Disease Outbreak Burden in the United States: Uses and Limitations of the Waterborne Disease Outbreak Surveillance System, is set at 30 days beginning September 15.

The draft report is available for review at:
http://cfpub.epa.gov/ncea/cfm/recordisplay.cfm?deid=158483

A study to be published in the November issue of the American Journal of Epidemiology, research reports that drinking water disinfection byproducts (DBPs) do not affect fetal survival. The findings by the University of North Carolina School of Public Health and Mount Sinai School of Medicine study contradicts previous research that suggested exposure to elevated levels of drinking water DBPs could cause pregnancy loss.

DBPs are created by the interaction of chlorine and organic material in water supplies during the disinfection process. The production of DBPs identified for health concern, including trihalomethanes (THM) and haloacetic acids (HAA) has lead researchers to conduct several epidemiological studies addressing potential human harm from the chemicals, including reproductive toxicity.

Between 2000-2004, the study's authors conducted research in three U.S. locations of varying DBP levels. They evaluated 2,409 women in early pregnancy to assess tap water DBP concentrations, water use, additional risk factors and pregnancy outcome. Based on 258 pregnancy losses, the finding did not show an increased risk of pregnancy loss in relation to the amounts of DBPs ingested.

To read an abstract or to purchase the full article, please visit, http://aje.oxfordjournals.org/cgi/content/abstract/kwj300v1

A United Nations envoy reports the organization believes that the global effort to fight bird flu (H5N1) and prepare for a threatened pandemic will cost more than the $1.9 billion already pledged. This evaluation comes as the World Health Organization (WHO) confirms that human fatalities from the H5N1 avian influenza strain have nearly tripled this year.

In recognition of recent data showing Indonesia is a potential flashpoint for H5N1 infection increases, the World Bank is finalizing an agreement with the Indonesian government on a $15 million grant to help prevent avian flu. Global health officials confirm Indonesia is in need of additional support, with more than half the 66 H5N1-related fatalities reported this year occurring in the Southeast Asian nation.

Additionally, Africa will require $760 million over the next three years to battle the virus, according to a report released in June by ALive Initiative, a coalition of international governmental organizations. The ALive report also notes that avian flu in Africa could spread very rapidly due to insufficient financial and logistical resources, weak veterinary services, lax border controls and government conflicts.

WHO reports that since 2003 the H5N1 virus has infected 246 people in 10 countries, killing 144.

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