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Silas Mays rolled into his local McDonald's drive-thru at lunchtime on Monday, October 7th and ordered the usual: a Quarter Pounder, fries and a Sprite.
On Thursday morning, the stomach cramps were so intense that he could not stand to go to the bathroom.
“It was very painful. And every time I use the bathroom, there's blood,” said Silas, 17, of Grand Junction, Colorado. “It was scary.”
His mother, Lera Davidson, took him to the emergency room at St. Mary's Regional Hospital when the bloody diarrhea continued. The doctors took a stool sample, sent it to a lab for testing, and gave him IV fluids for cramps and pain medication. He said they kept him in the ER all day, but eventually sent him home.
Couldn't save anything. Even a small sip of water or a bite of a biscuit will send him running to the toilet and bleeding profusely.
The stool tested positive for a strain of E. coli bacteria, which is especially dangerous because it produces bacteria. Shiga poisonPenetrates and kills cells, causing tissue damage. This type of infection can be one of the worst problems hemolytic uremic syndromeEspecially for children and the elderly, it can cause kidney failure and even be fatal.
All 50 states are responsible for these infections caused by Shiga toxin-producing E. coli called STEC. Laboratories are required to notify their state health department when they detect coli.
A positive test result for any reportable foodborne illness from a series of routine steps by local and then state public health offices. These actions are played out quietly out of public view. But without this work, foodborne illness outbreaks may never be detected or traced back to a single contaminated ingredient, and many people will get sick and die.
“We treat every case that we receive as a potential outbreak. We investigate every case to try to prevent the spread of the disease and stop the source of the disease,” said Julie Hartshorn, Public Health Officer for Grand Junction, Mesa County.
Scientists at the US Centers for Disease Control and Prevention, who worked with the Colorado Department of Public Health and Environmental Protection to investigate the latest E. coli outbreak and investigate its cause, said it's noteworthy that these cases were quickly linked and resolved. to win
As part of an outbreak investigation by the CDC and the US Food and Drug Administration on October 22, 90 cases of STEC infection from 13 states have been linked to McDonald's Quarter Pounders. More than two dozen people were hospitalized and one person died.
Only 10 percent of the 6,000 E.coli infections genetically sequenced in the U.S. each year are linked to outbreaks, said Dr. Heather Carlton Roemer, branch chief of the Enteric Diseases Laboratory at the CDC in Atlanta.
“I feel like I'm one of the few jobs as a scientist where I can go home and say my work saves people's lives, because it does,” she said.
When you get the report In Silas' case, Hartshorne and two other Mesa County public health workers were working full tilt trying to figure out exactly why so many people in Grand Junction were getting STEC infections.
We see one or two of these STEC cases in a month, and we had an unusually large number. So immediately we were all concerned,” Hartshorne said.
The Mesa County Center previously had 11 cases linked to the outbreak, but Hartshorne said they called more people in their investigation. Some are not added to the official count until the bacteria in the stool is genetically sequenced by a state lab to confirm that the DNA fingerprint matches other outbreaks. That process takes time.
Even under the best of circumstances, most people find it difficult to remember important details about what they ate. So health departments try to work quickly, to catch people while their memories are fresh.
After reporting a foodborne illness, a specialist – preferably someone trained to conduct such detailed interviews – calls the sick person. They ask people to recall everything they ate for the past seven days, including all the ingredients in those foods. People were asked about recent travel and interactions with animals, including what treats they feed their pets.
The Mesa County team began calling for people with STEC infections the week of Oct. 7, three weeks before the CDC announced the diagnosis. Within two days, it turns out that most people they meet eat at McDonald's. The health department sent its environmental health team to the local restaurant, but they found no red flags.
“We realized that the problem is not how the food is prepared in the restaurant,” Hartshorne said. Employees were washing their hands, food was being prepared at the correct temperature, and surfaces were properly cleaned and disinfected.
But people still got sick after eating there, leading them to think the food may have been contaminated before it got to the restaurant, Hartshorne said. “So we thought this issue could be more extensive.”
They were right.
At the regional level, The Colorado Department of Public Health and Environment has been receiving reports of STEC from across the state.
Sometimes, local health departments such as Mesa County conduct their own foodborne illness interviews, and sometimes cities and rural areas rely on the state health department for such assistance.
Alaina Young, an epidemiologist who runs the state agency's four-member enteric disease interview team, is responsible for scheduling those interviews, and she's often the first to sound the alarm about STEC cases, said superintendent Rachel Jervis, who calls herself a “scientist … of diarrhea” on LinkedIn.
“Okay, can you look at previous years' data? Jervis, who manages the Foodborne, Enteric, Waterborne and Wastewater Disease Program at the Colorado Department of Health, wants to get the numbers.
In the early days of October The agency reported more STEC cases than usual during the month, Jervis said.
On Oct. 10, the same day Silas got sick, the agency emailed the CDC that it suspected a STEC outbreak and that many of the people interviewed said they had eaten fast food and ground beef.
Jervis said they also reached out to neighboring states to ask if they were seeing an increase in cases. “Some have had the same experience; some haven't,” she said.
On October 11, CDC received the first genetic sequences from Colorado through the PulseNet system. The DNA fingerprints from the cases were remarkably similar, Jervis said, with only one gene mutation differing between them.
PulseNet is a system that collects and analyzes more than 60,000 genomes collected from people with foodborne illness each year. Each genome contains each letter of the instructions needed to build the bacteria or virus that causes the disease. Each month, the PulseNet system sifts through enough data to fill the Library of Congress.
“Imagine that you're putting together a 5,000-piece puzzle, and you're comparing that puzzle across multiple cases to see if one piece, one piece, is different, because that tells us things,” Carlton Romer said.
Normally, the scientists who manage the PulseNet system will be the first to connect cases that are epidemiological investigations.
In the case of the STEC outbreak linked to McDonald's Quarter Pounders, however, Jr. and her team of epidemiologists manning the phones in Colorado were the first to link the cases to the tried-and-true methods of epidemiology.
This type of case study dates back to the mid-1800s by Dr. John Snow, who is often considered the father of modern epidemiology. He stopped the cholera epidemic in London Looking for contaminated water from a single pump that is making people sick.
As more E.coli sequences are fed into PulseNet, the team at the CDC can see genomes with similar DNA fingerprints popping up in other states, suggesting that a common food being widely distributed is making people sick.
The CDC team worked with the Colorado Department of Health. Developing secondary questions specifically asking about certain fast food restaurants, the menus available at those restaurants, and the consumption of beef or onions. The supplemental questionnaire was 13 pages long.
“The best practice for these additional outbreak surveys is to have as few interviews as possible, because it helps people identify commonalities, and these additional interviews are recommended by the state health department,” Jervis said.
Davidson tried to answer the Mesa County staff's questions for Silas as his condition worsened, with bloody diarrhea every minute or so, and he was too ill to be of much help. But when she was initially interviewed, she didn't know her son had eaten at McDonald's.
“You're really thinking about everything you've eaten in a week,” Davidson says. “I could put together the meals I cooked, but it was challenging to put together where he was with his girlfriend, eating and stuff like that.
When state investigators returned to conduct more interviews on Oct. 12, he asked her to find the receipt for the beef she bought and check bank statements for any information that would help fill in the blanks.
It wasn't until there were news reports of his relationship with McDonald that Silas remembered his lunch there.
Later, they found a line on their bank statement indicating a purchase by McDonald's on October 7th.
“When you're asked something specific, your memory jogs,” says Jervis. We've had cases where they've called back and said, 'You know what, after I talked to you, I went back and looked at my credit card statement, and I went to McDonald's that day.'
Still, the number of official cases is undercounted. There are people who are sick but not sick…