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Drinking
Water Contaminants - Escherichia Coli, E. Coli
One of hundreds of strains of the bacterium
Escherichia coli, E. coli O157:H7 is an emerging cause of food borne and waterborneillnesses.
Although most strains of E. coli are harmless and live in
the intestines of healthy humans and animals, this strain produces a powerful
toxin and can cause severe illness.
E. coli O157:H7 was first recognized as a cause of
illness during an outbreak in 1982 traced to contaminated hamburgers. Since
then, most infections are believed to have come from eating undercooked ground
beef.
However, some have been waterborne. In 1999, people
became sick after drinking contaminated water in Washington County, New York
and from swimming in contaminated water in Clark County, Washington.
Information about the health effects of E. coli O157:H7,
and actions you can take to protect yourself and your family from E. coli
infection is provided below.
What is E. coli and where does it come from?
E. coli is a type of fecal coliform
bacteria commonly found in the intestines of animals and humans.
E. coli is short for Escherichia coli.
The presence of E. coli in water is a strong indication
of recent sewage or animal waste contamination. Sewage may contain many
types of disease-causing organisms.
What are fecal coliforms?
Fecal coliforms are bacteria that are
associated with human or animal waste.
Presence of fecal coliforms in water may not be directly
harmful, and does not necessarily indicate the presence of feces, however it
does indicate an increased likelihood of harmful pathogens in the
water.
How does E. coli or other fecal coliforms get
in the water?
E. coli comes from human and animal
waste.
During rainfalls, snow melts, or other types of
precipitation, E. coli may be washed into creeks, rivers, streams, lakes, or
groundwater.
When these waters are used as sources of drinking water
and the water is not treated or inadequately treated, E. coli may end up in the
drinking water.
What are the health effects of E. coli
O157:H7?
E. coli O157:H7 is one of hundreds of strains
of the bacterium E. coli.
Although most strains are harmless and live in the
intestines of healthy humans and animals, this strain produces a powerful toxin
and can cause severe illness.
Infection often causes severe bloody diarrhea and abdominal
cramps; sometimes the infection causes non-bloody diarrhea.
Frequently, no fever is present. It should be noted
that these symptoms are common to a variety of diseases, and may be caused by
sources other than contaminated drinking water.
In some people, particularly children under 5 years of
age and the elderly, the infection can also cause a complication called hemolytic
uremic syndrome, in which the red blood cells are destroyed and the kidneys
fail. About 2%-7% of infections lead to this complication.
In the United States, hemolytic uremic syndrome is the
principal cause of acute kidney failure in children, and most cases of
hemolytic uremic syndrome are caused by E. coli O157:H7.
Hemolytic uremic syndrome is a life-threatening condition
usually treated in an intensive care unit. Blood transfusions and kidney
dialysis are often required.
With intensive care, the death rate for hemolytic uremic
syndrome is 3%-5%.
How long does it take for these symptoms of
E. coli O157:H7 infection to occur?
Symptoms usually appear within 2 to 4 days,
but can take up to 8 days. Most people recover without antibiotics or
other specific treatment in 5-10 days.
There is no evidence that antibiotics improve the course
of disease, and it is thought that treatment with some antibiotics may
precipitate kidney complications.
Antidiarrheal agents, such as loperamide (Imodium),
should also be avoided.
What should I do if I have any of the above
symptoms?
Consult with your physician. Infection
with E. coli O157:H7 is diagnosed by detecting the bacterium in the stool.
Most laboratories that culture stool do not test for E.
coli O157:H7, so it is important to request that the stool specimen be tested
on sorbitol-MacConkey (SMAC) agar for this organism.
All persons who suddenly have diarrhea with blood should
get their stool tested for E. coli O157:H7.
Are there groups of people who are at greater
risk of getting any of the symptoms?
Children under the age of five, the elderly,
and people whose health is weakened (i.e., people who have long-term illnesses
such as cancer or AIDS) are at greater risk of severe illness.
What should these people who are at greater risk
do? Are there any additional precautions they should take?
People who
are at greater risk should consult with their doctor or health care provider
and follow the instructions provided.
How will I know if my water is safe?
If you get your water from a public water system, then
your water system is required by law to notify you if your water is not
safe.
How is water
treated to protect me from E. coli?
The water can be treated using chlorine, ultra-violet light, or ozone,
all of which act to kill or inactivate E. coli.
Systems
using surface water sources
are required to disinfect to ensure that all bacterial contamination is
inactivated, such as E. coli.
Systems
using ground water sources are not required to disinfect, although many of them
do.
If I have a private well, how can I have it tested for E.
coli?
If you have a privatewell, you should have your water tested periodically.
Typically,
the lab will first test for total coliforms, which is a group of related
organisms that is common in both the environment and in the gut of
animals.
If the
sample is positive for total coliforms, the lab will determine whether E. coli
is also present.
E. coli is
a type of total coliform that is closely associated with recent fecal
contamination. Few E. coli strains cause disease.
However,
the presence of any E. coli in a water sample suggests that disease-causing organisms, are also
likely to be present. One of the strains of E. coli that causes disease is E.
coli O157:H7.
EPA does not believe it necessary for an
owner of a private well to test specifically for this organism under normal
circumstances.
If E. coli
O157:H7 is present in your well, it is highly likely that other strains of E.
coli are also present. If a well is E. coli-positive, regardless of
strain, you should not drink the water unless it is disinfected.
Several
tests are available for determining whether E. coli O157:H7 is present, but
they are somewhat more expensive than the standard E. coli tests and many labs
may not have the expertise or supplies to perform these tests.
If my well is contaminated with E. coli, what can I do to
protect myself?
If your well tests positive for E. coli, do not drink the
water unless you boil it for at least one minute at a rolling boil, longer if
you live at high altitudes.
You may
also disinfect the well according to procedures recommended by your local
health department.
Monitor
your water periodically after disinfection to make certain that the problem
does not recur.
If the
contamination is a recurring problem, you should investigate the feasibility of
drilling a new well or install a point-of-entry disinfection unit, which can
use chlorine, ultraviolet light, ozone, or reverseosmosis systems.
What can I do to protect myself from E. coli
O157:H7 in drinking water?
Approximately 89 percent of Americans are
receiving water from community water systems that meet all health-basedstandards.
Your public water system is required to notify you if,
for any reason, your drinking water is not safe. If you wish to take extra
precautions, you can boil your water for one minute at a rolling boil, longer
at higher altitudes.
If you draw water from a private well, have your well
tested for total coliforms and E. coli contamination. If your well tests
positive for E. coli, there are several steps that you should take:
(1) begin boiling all water intended for
consumption,
(2) disinfect the well according to
procedures recommended by your local health department, and
(3) monitor your water quality to make
certain that the problem does not recur. If the contamination is a
recurring problem, you should investigate the feasibility of drilling a new
well or install a point-of-entry disinfection unit, which can use chlorine,
ultraviolet light, or ozone.
The Centers for Disease Control and
Prevention (CDC) suggests other actions that you may take to prevent E. coli
infection. These include:
· Avoid swallowing lake or pool water while swimming.
· Thoroughly cook ground beef and avoid un-pasteurized
milk.
· Make sure that persons with diarrhea,
especially children, wash their hands carefully with soap after bowel movements
to reduce the risk of spreading infection, and that persons wash hands after
changing soiled diapers.
Anyone with a diarrhea illness should avoid swimming in
public pools or lakes, sharing baths with others, and preparing food for
others.
· Cook all ground beef and hamburger
thoroughly. Because ground beef can turn brown before disease-causing bacteria
are killed, use a digital instant-read meat thermometer to ensure thorough
cooking.
Ground beef should be cooked until a thermometer inserted
into several parts of the patty, including the thickest part, reads at least
160ºF.
Persons who cook ground beef without using a thermometer
can decrease their risk of illness by not eating ground beef patties that are
still pink in the middle.
· If you are served an undercooked hamburger or
other ground beef product in a restaurant, send it back for further cooking.
You may want to ask for a new bun and a clean plate, too.
· Avoid spreading harmful bacteria in your
kitchen. Keep raw meat separate from ready-to-eat foods. Wash hands, counters,
and utensils with hot soapy water after they touch raw meat.
Never place cooked hamburgers or ground beef on the
unwashed plate that held raw patties. Wash meat thermometers in between tests
of patties that require further cooking.
· Drink only pasteurized milk, juice, or cider. Commercial juice with an
extended shelf-life that is sold at room temperature (e.g. juice in cardboard
boxes, vacuum sealed juice in glass containers) has been pasteurized, although
this is generally not indicated on the label. Juice concentrates are also heated
sufficiently to kill pathogens.
· Wash fruits and vegetables thoroughly,
especially those that will not be cooked. Children under 5 years of age, immune-compromised
persons, and the elderly should avoid eating alfalfa sprouts until their safety
can be assured. Methods to decontaminate alfalfa seeds and sprouts are being
investigated.
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