Arizona warned health workers
of possible E. coli terror strike
Arizona authorities were sufficiently concerned about the potential for E. coli terrorism to issue a warning to health workers, according to a public document found on the internet.

The possibility that food supplies might be deliberately contaminated with a vicious form of E. coli known as the O157:H7 serotype was raised in a circular to health professionals updated in August 2004. That strain, though not as lethal as the O104:H4 strain that broke out in Germany and France in May, can bring about severe health effects, including kidney failure.
http://www.azdhs.gov/phs/edc/edrp/pdf/escherichiacoliset.pdf
(That link was taken down after this story appeared.)

"In a terrorist attack, E. coli would most likely occur due to intentional contamination of food or water supplies," according to Arizona's Office of Public Health Emergency Preparedness and Response, adding: "In addition aerosolization could be a possibility."

Authorities and media have cooperated to say nothing about the probabilities of terrorism or of escape from a laboratory, in the recent O104:H4 outbreak that has killed 50 and sickened 4,000, many suffering permanent kidney damage or failure. They have also cooperated to shield the food distributors involved in selling suspect fenugreek seed from being publicly named.

The strain is, like the O157:H7 strain, quite rare. But the O104:H4 serotype has evolved to acquire immunity to a wide range of antibiotics and has acquired the DNA of the plague pathogen, according to experts.

The possibility that the O104:H4 pathogen is a genetically engineered strain that may have escaped from a laboratory is passed over in silence. However, potential escapes are a serious concern for scientists.

One theory of the 1977 Russian influenza pandemic is that the virus escaped from a research center, according to S.J. Flint and her colleagues in Principles of Virology published by the American Society for Microbiology in 2000.

The devastating Ebola virus came perilously close to escaping a research facility in Washington, D.C., it has been reported. Deaths of researchers infected by Marburg virus are also on record.

Below is a "quick view" copy of the Arizona circular:

Escherichia Coli O157:H7
Bioterrorism Agent Profiles for Health Care Workers
Causative Agent: Escherichia coli serotype O157:H7 is a gram-negative, rod-shaped bacterium
that produces Shiga toxin(s). This rare variety of E.coli produces large quantities of potent toxins
that cause severe damage to the lining of the intestines, leading to hemorrhagic colitis.
Routes of Exposure: Ingestion of contaminated food or water is the main route of exposure, but
direct person-to-person contact can also spread infection.
Infective Dose & Infectivity: May be as few as 10 organisms. All people are believed to be
susceptible to hemorrhagic colitis, but young children and the elderly appear to progress to more
serious symptoms more frequently.
Incubation Period: The incubation can be from 2 to 8 days, but it usually ranges from 3 to 4 days.
Clinical Effects: The illness is characterized by severe cramping (abdominal pain) and diarrhea
which is initially watery, but becomes grossly bloody. Occasionally vomiting occurs. Fever is
either low-grade or absent. The illness is usually self-limited and lasts for an average of 8 days.
Some individuals exhibit watery diarrhea only.
A severe clinical manifestation of E. coli O157:H7 infection is hemolytic uremic syndrome (HUS).
Up to 15% of those with bloody diarrhea from E. coli 0157:H7 can develop HUS, which can lead to
permanent kidney failure.
Lethality: The overall mortality rate for E. coli O157:H7 is <1%. For those who develop HUS, the
death rate is between 3-5%.
Transmissibility: The major source of transmission is the consumption of raw or undercooked
ground beef. Other sources of transmission include unpasteurized milk and juice, alfalfa sprouts,
lettuce, dry-cured salami, and contact with infected animals. Waterborne transmission can occur
by swimming in or drinking inadequately chlorinated water such as that found in contaminated
lakes and swimming pools. The organism is easily transmitted from person-to-person when proper
hand washing techniques are not used.
Primary Contamination & Methods of Dissemination: In a terrorist attack, E. coli would most
likely occur due to intentional contamination of food or water supplies. In addition aerosolization
could be a possibility.

Secondary Contamination & Persistence of organism: Secondary transmission can result from
exposure to the stool of patients with overt disease. Diarrheal fluids are highly infectious. The
period of infectivity of stool is typically a week or less in adults but 3 weeks in one-third of children.
Prolonged carriage of E. coli O157:H7 in the stool is uncommon.
Decontamination & Isolation:
Patients – No decontamination necessary. Patients can be treated with standard
precautions, with contact precautions for diapered or incontinent patients. Hand washing is of
particular importance.
Equipment & other objects – 0.5% hypochlorite solution (one part household bleach and
nine parts water), EPA approved disinfectants, and/or soap and water can be used for
environmental decontamination.
Laboratory Testing: Clinical laboratories can screen for E. coli O157:H7 in stool samples by
using sorbitol-MacConkey agar.
Therapeutic Treatment: Most people recover without specific treatment in five to ten days. For
uncomplicated cases, rehydration may be all that is required. Fluid and electrolyte replacement is
important when diarrhea is watery or there are signs of dehydration. Antibiotics are often avoided
in E. coli O157:H7 infections, since some evidence suggests that antibiotic treatment may
precipitate complications such as HUS.
Prophylactic Treatment: No vaccine is available to prevent E. coli O157:H7 infections.
Differential Diagnosis: Salmonella, Shigella, Campylobacter, Yersinia enterocolitis, and bacterial
food poisoning may show similar signs and symptoms.
References:
Chin J. Control of Communicable Diseases Manual, Seventeenth Edition, American Public Health
Association; 2000.
Foodborne Pathogenic Microorganisms and Natural Toxins Handbook, Center for Food Safety and
Applied Nutrition, U.S. Food and Drug Administration http://vm.cfsan.fda.gov/~mow/intro.html
For more information call (602) 364-3289
Updated August 2004 Page 5.20
Arizona Department of Health Services
Division of Public Health Services
Office of Public Health Emergency Preparedness and Response
ESCHERICHIA

Updated August 2004 Page 5.19
Arizona Department of Health Services
Division of Public Health Services
Office of

Correction: A previous version of this story contained an error mischaracterizing the plague pathogen as a virus.
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