The outbreak of E Coli induced Hemolytic Uremic Syndrome by those who ate salads in northern Germany is still a puzzle.

First they blamed Spain for dirty cucumbers (implications: Spaniards are not as clean as Germans). This has caused a lot of financial problems for Spanish farmers, and it doesn’t help that it’s now found it wasn’t the cukes at all.

Then they blamed bean sprouts from an organic farm in Bavaria.

Bean sprout related illness is not unknown:

Both Canadian and American health officials have frequently given warnings about the dangers of bean sprouts, which have been responsible for well over 40 food borne illnesses around the world caused by either E.coli or Salmonella bacteria in the last 35 years or so.

The largest outbreak linked to sprouts took place in Japan in 1996, when 6,000 people got sick and 17 died after eating radish sprouts contaminated with E.coli O157: H7.

Yes, and unlike cucumbers, bean sprouts are hard to clean in all their nooks and crannies with a simple spray of disinfectant.

Now the news stories are saying that the bean sprout theory isn’t true either. because the suspected farm in southern Germany has been found to have a clean bill of health.

But, as the article mentions, that this doesn’t prove a thing, since even if the supplier of the spouts is clean, the seeds they use may have had the E Coli on them. When the seed sprouts, the germ can spread on the individual spout and those nearby, and ultimately to the salad eater.

Like “traveler’s diarrhea”, this E coli is usually found in undercooked food (e.g. hamburgers) or in salads.

So if you are worried, avoiding a salad bar is good advice.

But this isn’t the only type of food poisoning you have to worry about: it’s summer, and we docs see a lot of post picnic diarrhea, usually cause by staph toxins in the potato salad or sour cream that was left out of the refrigerator too long.

So avoid undercooked food or food left out too long, especially dairy/mayonaisse type products, which can cause other types of food poisoning.

Many types of food poisoning is also spread by the “food/fingers/feces” route: so wash your hands, not only after using the rest room, but while handling food (e.g.if you cut up chicken contaminated with Salmonella, your hands can spread the germ to the other food, especially salads, that you touch later, while the germ on the chicken gets killed by cooking)

But there are some rumors that the E Coli causing the outbreak in Europe is a “new” strain that could be linked to bioterrorism.

Actually, it’s not a new strain, but related to a strain that caused an outbreak ten years ago. Personally I suspect it’s a simple sanitation break that allowed the germ to get into the salads.

Yet there are several reasons folks might worry about bioterrorism:

One, the last major outbreak of bioterrorism in the US was caused by a Hindu cult in Oregon, who decided to contaminate the local salad bars so folks would be too sick to vote in an upcoming election, so the cult could take over the city offices. The outbreak puzzled the CDC until a couple years later when someone confessed.

The second reason: it’s something that someone could cook up. The Oregon outbreak was grown by someone who has some knowledge, but didn’t work because it’s a bit hard to grow enough germs to do it properly.

That’s the real argument against bioterrorism: it’s not as easy as it sounds.

But as this comment on Jerry Pournelle’s blog points out, all it would take is a disgruntled graduate student: they DO have access to the proper equipment.

Which brings us around to a real case of bioterroism: the anthrax case. In that case, the two suspects, including the one they blamed it on, did have access to that strain of anthrax. It was a common, antibiotic sensitive strain that was used to devise vaccines for animals.

The problem? The one that the FBI blamed for the anthrax mailings had access to the germs, but not expertise or equipment needed to weaponize the spores (normal anthrax spores are large enough that they don’t float in the air, so if you handle the envelope with anthrax, it will probably only infect your hands….and even if you breathe them, they probably will stop at your throat and you will only end up with gastrointestinal anthrax.)

Anthrax spores like to “clump”, and so to “weaponize” them means getting them small enough to get into the lungs (usually by grinding, using specialized machines) and then adding something to stop them from reclumping (usually silicon, although there is a second method). This isn’t hard with the right equipment, but one of the technical problems would be the need to also have the proper protection equipment, so you don’t end up as the first casualty.

The researcher blamed did not have this expertise, but no one wants to reopen the case, especially since lots of bad guys, including Iraq, used the same strain to make anthrax vaccines (and it is telling that shortly after the US invaded, many of these scientists were assassinated by someone, as if someone was trying to keep them silent…no I’m not blaming the US, since it was probably Saddam’s folks who did it to keep them from talking to the Americans, so that Bush could then be blamed for not finding the WMD programs he claimed that Iraq had).

Back to E Coli.

Two problems with bioterrorism: One, you need to get the right germ, two you need to get it to the ones you want to poison.

The argument against this E Coli is that if it was actually bioterrorism, it would take some expertise to grow the strain.  It would be a lot easier to just get some Salmonella from a third world hospital lab than to bioengineer a new strain of E Coli.

That is why I doubt it is bioterrorism.

The second problem is you need to spread the disease properly. To kill lots of folks, this is the critical problem.

However, the spread of the disease could be done by an inexperienced terrorist, as the Oregon case shows, by simply dumping the germs onto a salad bar.

On the other hand, salad bar and sprout related diarrhea is a common problem, so as we say in medicine, when you hear hoofbeats, think horses not zebras, i.e. look for the simplest explanation.

I suspect they probably will trace the outbreak to contaminated seeds used for sprouting.

The irony is that the bean sprouts were from an organic farm. No, in this case, organic isn’t best.

Another problem: In the US, previous salmonella cases were suspected to be from Mexican farms, (again hygiene) and the invisible man in these cases is that often those working in farms and food production are immigrants: Mexicans in the US and North Africans/Asians/Eastern Europeans in Europe.

It’s not purely a hygiene problem with the immigrants: some will have been infected in their home country, and be “carriers”, and it only takes one lapse to infect the veggies or the seeds used for sprouts.

But the way to stop the disease is to clean the veggies properly. This means spraying with disinfectants (aka “chemicals) to clean them up…easy for tomatoes and cucumbers, harder to get into the nooks and crannies of bean sprouts, lettuce, or cabbage.

So how to make sure they are clean?

“Nuke’m”.

It’s well known that if you radiate fresh food, you can kill the germs, and the radiation goes right through the food, and doesn’t stay around to bother those who eat it.

Technology to the rescue, but one is waiting for someone in Europe to suggest this; one suspects the reason they won’t end up doing it is that the “back to nature, not bad modern tech foods” ideology is strong in some European countries.

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Nancy Reyes is a retired physician living in the rural Philippines. She blogs at Finest Kind Clinic and Fishmarket, and writes about medicine at HeyDoc Xanga blog.

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