Clinician Alert: E. coli O157:H7 Outbreak linked to Ground Beef

November 11, 2019

UPDATED NOV. 18, 2019: New Seasons expanded recall to include in-house ground beef and ground beef products sold at all New Seasons Markets in Oregon, Washington and California, in bulk from the meat cases and packaged from grab-and-go cases. This includes “Packed On” dates of Oct. 19  to Nov. 15, 2019, and “Sell By” dates starting Oct. 23 up to and including Nov. 18, 2019.

On November 9th, New Seasons Markets announced a recall of all fresh in-house ground beef and ground beef products (meat loaf, meat balls, hamburger patties) after the Oregon Health Authority identified three matching, lab confirmed E. coli O157:H7  diarrhea cases among Portland metro residents; one additional presumptive case has also been identified. The four cases’ illnesses began on 10/27/19 or 10/28/19.  

New Seasons Market locations include not only the Portland OR/Vancouver WA region but also Seattle, WA and San Jose, CA. The press release from New Seasons can be found here. Since this outbreak was first recognized late on 11/8/19, the case count could grow and details about implicated food items may change.

About E. coli O157:H7

This pathogen can cause bloody diarrhea that is complicated by Hemolytic Uremic Syndrome, also known as HUS, in 10-15% of cases an average of 7 days after the onset of diarrhea. HUS is classically characterized by hemolytic anemia, thrombocytopenia and renal failure; other complications include seizures, stroke, coma, bleeding, pancreatitis, severe colitis and cardiomyopathy.  HUS can occur at all ages but children and the elderly appear particularly susceptible. The death rate from HUS is approximately 10%.

Clinicians role to limit outbreak

Identify Cases. In the setting of this outbreak, patients with acute onset of bloody diarrhea and abdominal pain should be promptly evaluated with a fecal GI PCR panel- those in use in the Portland metro area can quickly detect Shiga-toxin producing E. coli (STEC); E. coli O157 is an STEC. 

Monitor for development of HUS. Serial CBC w platelets, BUN, and Creatinine measurements will be needed to identify HUS. For children, arrange for REPEATED outpatient or ED follow up evaluations to assess ongoing fluid status and lab monitoring until the risk for HUS has completely passed, typically 12 to 14 days after illness onset. Consider hospital admission for patients unable to tolerate oral fluids or with presence of risk factors associated with HUS. Metro area Pediatric Nephrologists are ready to help manage any children with possible HUS:

  • Legacy One Call (800) 500 9111 or (503) 413 2175

  • OHSU Physician Advice and Referral Service (800) 245 6478 or (503) 494 4567 

Prevent Complications of HUS by Hydration. Early, aggressive hydration with isotonic fluid before HUS develops may prevent oliguric kidney injury and the need for dialysis; in addition hydration decreases the frequency of neurologic complications. During this outbreak, lab diagnosis of STEC should be considered presumptive outbreak-associated E. coli O157 and prompt consultation for on-going management.

Other recommendations

  • Avoid antibiotic therapy for patients presenting with STEC acute gastroenteritis.

  • Avoid antimotility agents as they delay bacterial clearance.

  • Use opioids with caution due to antimotility side effects .

  • Avoid NSAIDS due to renal hypoperfusion.

  • Report Cases Promptly. Please report confirmed or suspected STEC or E. coli O157 cases to the patient’s county of residence.

Public health contacts

Clackamas County: 503-655-8411

Multnomah County: 503-988-3406

Washington County: 503-846-3594

Clark County: 564-397-8182