Published Date: 2011-05-04 15:38:40
Subject: PRO/AH/EDR> E. coli VTEC non-O157 - Japan: O111, raw beef, alert
Archive Number: 20110504.1378
E. COLI VTEC NON-O157 - JAPAN: O111, RAW BEEF, ALERT
A ProMED-mail post
ProMED-mail is a program of the
International Society for Infectious Diseases
Date: Wed 4 May 2011
Source: The Daily Yomiuri [edited]
The operator of a yakiniku [grilled meat] barbecue restaurant chain
linked to 2 recent cases of fatal food poisoning has admitted it had
not tested raw meat served at its outlets for bacteria, as required by
the health ministry, since 2009.
"We're not strict enough [about food safety]," Yasuhiro Kanzaka,
president of Foods Forus Co., which runs the Yakiniku-zakaya Ebisu
chain, said during a press conference Mon 2 May 2011, at the firm's
headquarters in Kanazawa.
Two 6-year-old boys died, one in Takaoka, Toyama Prefecture, and one
in the city of Fukui, after eating a raw-beef dish known as yukhoe at
Yakiniku-zakaya Ebisu outlets. Both boys were found to have been
infected with the O111 strain of _E. coli_.
The company said inspections of its stock showed the victims most
likely ate beef purchased 16 Apr 2011 from a meat distributor in
Itabashi Ward, Tokyo.
The Health, Labor and Welfare Ministry requires restaurants serving
raw meat to test samples of the meat for _E. coli_ bacteria, but this
standard is not backed by legislation.
The company said it had not conducted such tests at any of its
outlets since July 2009. "We'd never had a positive result [from a
bacteria test], not once. So we assumed our meat would always be
bacteria-free," Kanzaka said.
The boy in Takaoka ate raw beef at the chain's outlet in Tonami,
Toyama Prefecture, on 21 Apr 2011, according to the prefectural
government. The boy in Fukui ate in a Yakiniku-zakaya Ebisu outlet in
the city on 17 Apr 2011, according to the Fukui prefectural
Motoi Suzuki, MD, MSc
Department of Clinical Medicine
Institute of Tropical Medicine, Nagasaki University
Date: Wed 4 May 2011
Source: Monsters and Critics [edited]
Third person dies in Japan food poisoning outbreak
A woman died Wednesday of food poisoning linked to a raw meat dish at
a restaurant chain in central Japan, bringing the total number of
deaths in the past week to three, news reports said.
The woman had eaten yukhoe, similar to tartare, at the same
restaurant in Tonami, Toyama prefecture, where a 6-year-old boy had
fallen ill and died Friday after eating the same dish, Jiji Press
reported. The restaurant is run by Foods Forus Co, based in nearby
Another boy died a week ago in Fukui prefecture after eating the same
dish at another of the company's restaurants. Both boys were infected
with E coli 0-111 strain.
Jiji reported Tuesday that 56 other people were confirmed to be
suffering from food poisoning after eating the same dish at four of
the company's restaurants.
The company said at a news conference that it had failed for the last
years to conduct hygiene inspections of raw meat supplied for the
dish by a
[ProMED-mail thanks Dr Suzuki for the first posting above. He added
that there have been 58 patients including 3 fatalities, the 2 6-year
old boys and one 40s female so far.
Yukhoe refers to a variety of hoe (raw dishes in Korean cuisine),
which are usually made from raw ground beef seasoned with various
spices or sauces. It is basically a Korean steak tartare
This outbreak once again underscores the relevance of non-O157
strains of verotoxin-producing _E. coli_. Non-O157 isolates such as
O26, O45, and O111 can be obtained from sheep and cattle and, although
they cause as many as 30 percent of outbreaks of VTEC (1), appear to
be somewhat less (or at least more variably) virulent in a variety of
in vivo and in vitro assays (2-4).
In analyzing the genetic and phenotypic profiles of non-O157 groups,
it has been found that they belong to their own lineages and have
unique profiles of virulence traits different from O157 (5). The
serogroups appearing to be most prominent are O111, O26, O128, and
O103 (6), the former serotype being the implicated strain in this
If a laboratory is using sorbitol-MacConkey (sMAC) plates to identify
VTEC by virtue of O157's inability to ferment sorbitol, the non-O157
strains will be missed. In a 3-year pediatric study from the
University of Washington, USA (7), 1851 stool samples were processed
for sorbitol fermentation as well as toxin production by EIA (enzyme
immunoassay), and 28 strains of O157 were found along with O103 (4
strains), O118 (2 strains), O111 (2 strains), and 3 other strains.
Clinically, the O157 infections had a higher frequency of bloody
stools, fecal leukocytes, and abdominal pain with shorter symptom
duration. 5 (18 percent) of O157 infections developed HUS (hemolytic
uremic syndrome); none of the non-O157 strains did. Since toxin assay
did not identify all O157 strains found on sMAC plates, the
investigators did not advocate performing toxin assay alone. Non-O157
can produce hemolytic-uremic syndrome, as demonstrated by a cluster of
O121 cases associated with a lake in Connecticut, USA (8).
Since toxin assays are not uniformly performed in many areas, and
most cases do not produce HUS, it is likely that cases due to non-O157
strains are being missed. How frequent this phenomenon will become
over time is unclear.
Because of the higher risk of morbidity and mortality in VTEC
infections treated with antimicrobials (9), antimicrobials should not
be used for known acute cases.
Whether antimicrobials were used in these fatal cases is not stated.
1. Hussain HS, Omaye ST: Introduction to the food safety concerns of
verotoxin-producing _Escherichia coli_. Exp Biol Med 2003; 228(4):
331-2; available at
2. Blanco J, Blanco M, Blanco JE, et al: Verotoxin-producing
_Escherichia coli_ in Spain: prevalence, serotypes, and virulence
genes of O157:H7 and non-O157 VTEC in ruminants, raw beef products,
and humans. Exp Biol Med 2003; 228: 345-51; available at
3. Law D, Kelly J: Use of heme and hemoglobin by _Escherichia coli_
O157 and other Shiga-toxin-producing _E. coli_ serogroups. Infect
Immun 1995; 63(20): 700-2; available at
4. Tzipori S, Wachsmuth KI, Smithers J, Jackson C: Studies in
gnotobiotic piglets on non-O157:H7 _Escherichia coli_ serotypes
isolated from patients with hemorrhagic colitis. Gastroenterology
1988; 94(3): 590-7; abstract available at
5. Schmidt H, Geitz C, Tarr PI, et al: Non-O157:H7 pathogenic
Shiga-toxin producing _Escherichia coli_: phenotypic and genetic
profiling of virulence traits and evidence for clonality. J Infect Dis
1999; 179(1): 115-23; available at
6. Bettelheim KA: Role of non-O157 VTEC. Symp Ser Soc Appl Microbiol
2000; (29): 38S-50S; abstract available at
7. Klein EJ, Stapp JR, Calusen CR, et al: Shiga toxin-producing
_Escherichia coli_ in children with diarrhea: a prospective
point-of-care study. J Pediatr 2002; 141(2): 172-7; available at
8. McCarthy TA, Barrett NL, Hadler JL, et al: Hemolytic-uremic
syndrome and _Escherichia coli_ O121 at a lake in Connecticut, 1999.
Pediatrics 2001; 108(4): E59; available at
9. Iijima K, Kamioka I, Nozu K: Management of diarrhea-associated
hemolytic uremic syndrome in children. Clin Exp Nephrol 2008; 12(1):
16-9; abstract available at
http://www.springerlink.com/content/02284n422l6700l7/. - Mod.LL]
[Takaoka and Fukui can be located via the HealthMap/ProMED-mail
interactive map of Japan at http://healthmap.org/r/0Ona. -