A recent outbreak of food-borne illnesses and deaths due to eating undercooked hamburgers underscores the need for improved preventive measures by consumers, health professionals, and government officials.
As a result of the outbreak last January, in which more than 500 people became ill and four children died from Escherichia coli O157:H7 infections in the states of Washington, Idaho, California, and Nevada, (1,2) FDA has changed its recommendations for cooking ground beef. FDA now recommends that all parts of ground beef products should reach at least 155 degrees F when cooked. At this temperature, ground beef will not be pink at the center, and juices will be clear.
These recommendations form part of FDA's retail food protection program, a cooperative effort that provides advice to state and local food regulatory agencies and industry on the proper handling, cooking, holding, and storage of food.
E. coli 0157:H7 is a rare strain of the E. coli bacteria, which is more virulent than strains usually found in the intestines of humans and animals. It was first isolated in 1975 and was identified as a human pathogen in 1982, following two outbreaks of severe bloody diarrhea traced to contaminated ground beef.'
Although most cases have been associated with eating under- cooked ground beef, other food, including roast beef, raw milk, and apple cider,(3) have been implicated as well. Person-to-person transmission has also been reported.(4) Although it has not been determined at what level of contamination E. coli 0157:H7 becomes hazardous, it may be quite low.
Physicians should be alert to symptoms of foodborne illnesses in order to diagnose, treat, and report them quickly and appropriately. Infection with E. coli 0157:H7 is often not recognized because clinical laboratories do not routinely culture stool for this pathogen and clinicians may not be aware of symptoms associated with infection.'
Usual symptoms include diarrhea (often bloody) and abdominal cramps. Fever is infrequent. Children, the elderly, and immune-compromised individuals are at the highest risk for acute hemorrhagic colitis, and, occasionally, the complication of hemolytic uremic syndrome (HUS). HUS, occurring in 2% to 5% of cases, is characterized by hemolytic anemia, thrombocytopenia, renal failure, and a fatality rate of 3% to 5%.
According to the national Centers for Disease Control and Prevention, when infections with E. coli 0157:H7 are identified, health professionals should report them to local health departments so that appropriate public health action can be taken if necessary to prevent further cases.
FDA and the U.S. Department of Agriculture, in conjunction with three food industry associations, have produced a brochure entitled "A Consumer Guide to Safe Handling and Preparation-Ground Meat and Poultry." The brochure emphasizes the three points for the safe eating of ground meat and poultry: keep it cold; keep it clean; and cook it thoroughly. Single copies (which can be photocopied) are available from: USDA, Food Safety and Inspection Service, Room 1165 South, Washington, DC 20250.
Single copies of a reprint from FDA Consumer magazine entitled "The Unwelcome Dinner Guest: Preventing Food-Borne Illness" are available from FDA's Office of Consumer Inquiries, HFE- 88, 5600 Fishers La., Rockville, MD 20857.
For further information, see the FDA Medical Bulletin article "Preventing Food-Borne Diseases in Nursing Homes," April 1992.
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