Walla Walla Cases Prepared The State For This Outbreak -- Washington Became A Pioneer In Reporting, Cooking Standards

When Betty Bradley first learned about the E. coli outbreak that has gripped Western Washington, the painful memories came flooding back.

It was six years ago that her mother, a Walla Walla resident, died from the bacteria that havekilled two children, infected more than 300 people, and hospitalized nearly two dozen over the last two weeks.

At the time of Helen Hulser's death in 1986, E. coli was considered a rare and sometime fatal disease that had only been documented since 1982. But because of the Walla Walla outbreak, at the time the largest in the state, Washington became the first state to make it a requirement that cases of E. 0157:H7 be reported to county health departments.

The Walla Walla food-poisoning cases also prompted the state to change the cooking requirement on restaurant hamburgers. Restaurants here must cook the meat to an internal temperature of 155 degrees, the highest temperature requirement in the country.

Health experts credit the reporting requirement, which came a year after the Walla Walla illnesses, for the state's quick response in identifying of the recent E. coli epidemic and recalling the tainted meat

"Hats off to John Kobayashi," Group Health Cooperative infectious disease specialist Dr. Robert L. Thompson said of the state epidemiologist who worked to make E. coli a reportable disease.

Hulser, whose illness was linked to tainted meat at a Walla Walla Taco Time restaurant, was one of two elderly women who died in the 1986 outbreak that sickened 37 people.

Learning that her mother's death may have saved lives in the current epidemic, Bradley finds some solace. "Our family really feels for (the victims)," she said. "It makes me feel Mom isn't forgotten."

The Walla Walla episode illustrates how difficult it was, and is even today, to isolate what is still considered a rare bacterial strain.

"We heard about the outbreak purely by happenstance," said Dr. Stephen Ostroff, an epidemiologist with the Centers for Disease Control who was working with Kobayashi at the time. It was only because the ill Walla Walla women were sent to University of Washington hospital that scientists began to see how widespread the problem was. "In 1986 this was still considered a great curiosity," Ostroff said.

Scientific sleuthing found the Walla Walla cases were not isolated ones: The same bacterial strain was found at a nursing home in Dayton, a small farming community 50 miles away, and in Seattle. The implication: the tainted meat was distributed far beyond Southwest Washington.

But by the time scientists discovered the link, tracing the infected hamburger to its source became an impossible task.

"This investigation demonstrates the difficulty in recognizing outbreaks of E. coli 0157:H7, even in a small community and in spite of the dramatic clinical presentations, and highlights the need for improved surveillance of this pathogen in the United States," Ostroff and other investigators wrote in a 1990 paper on the Walla Walla illnesses published in the American Journal of Epidemiology.

Even though the outbreak was in a small community, it went undetected for two weeks, said Ostroff, and many other cases may have gone unnoticed.

Because no central reporting of the disease was required at the time, researchers had to ask laboratories and hospitals about patients exhibiting the symptoms of E. coli and even asked local media to help in the search.

The E. coli bacterium was found in a bag of raw ground beef at the fast-food restaurant. While it was not the same batch used during the outbreak of the disease, investigators said it came from the restaurant's usual supplier. The same supplier provided ground beef to the Dayton nursing home, and it was the only food in common between the two sites.

Records at the beef and dairy slaughterhouses which processed ground beef used at the restaurant and nursing homes were reviewed to try to find the source of the contamination. Stool samples and rectal swabs were taken from randomly selected cows on farms in southwest Washington and Oregon identified by slaughterhouse records.

While E. coli was detected in a handful of the swabs, investigators said it wasn't the same strain that was detected in the tainted meat.

There the trail grew cold. "We didn't find the exact same fingerprinting, but that's not to say if we'd looked four or five months earlier when the meat was processed we wouldn't have found it," Ostroff said.

In the Walla Walla case, 35 of those infected were found to be primary carriers and 27 of them had eaten at the Taco Time restaurant. Two became ill with secondary infections - the mother and grandmother of infected children.

Seventeen of the 37 were hospitalized, two had surgery, two died.

The Walla Walla outbreak was not the first in the state. Just months earlier, in April 1986, E. coli was blamed for the illnesses of six children at Fairchild Air Force Base near Spokane. A 2-year-old girl died after being infected with the bacterium, but health detectives were never able to pinpoint the source. It still remains a mystery, said Dr. Paul Stepak, an epidemiologist with the Spokane County Health Department.

While the close timing of the two outbreaks seemed peculiar, Ostroff said they were not connected. Fine "fingerprinting" of the bacterium showed the strains were not the same and, as far as he knows, the specific Walla Walla organism has not been seen again.

E. coli was first identified as a pathogen, or an organism that is able to cause a disease, after an 1982 outbreak in Oregon and Michigan. The organism was discovered after some two dozen Oregon residents became ill after eating at a McDonalds restaurant. No one died in that outbreak.

Three years later Group Health, in conjunction with the CDC, undertook the first population-control study of E. coli and its risk factors. Every stool submitted to Group Health's laboratory during 1985 was tested for the bacterium. Only two dozen cases were confirmed, said the cooperative's Thompson. The only common link was that ill patients were five times more likely to have eaten rare ground beef than those without the disease, Thompson said.

Another study was conducted by the CDC and the state Department of Health in 1987, the first year the state mandated the infection be reported to county health officials. In that year, 93 cases were reported - with the highest risk group children under age 5. Researchers speculate the number of E. coli cases was actually much higher. There was inadequate testing and reporting that inaugural year. Today, health officials say 150 to 200 state cases of the illness are reported each year in Washington state.

In mandating that E. coli cases be documented, the bacterium joined a list of about 50 communicable diseases, from measles to malaria, that must be be reported to county health departments.

"It's a feather in the cap of the state," said Ostroff of the CDC, pointing out that Washington is still one of only a handful of states with this reporting law. That, says medical scientists, makes it even more difficult to determine how widespread this bacterial epidemic really is.