As her parents Mark and Donna watch proudly, Martha Moenning, 2, squeals with delight as her sister Mary, 6, gives her a shove on the swing. Nearby, her brother Samuel, 4, his feet jangling with silver spurs, chases Ruby, his Dalmatian dog, around the yard with a cap gun.
The rain is moving in on their southern Minnesota farm on this late June day, but the Moenning family rejoices in its togetherness — they have weathered worse storms.
Just a year ago in mid-August, Martha was fighting for her life against E. coli O157:H7. Her tiny body was being ravaged by this dangerous, often lethal, strain of bacteria that infects an estimated 73,000 people and kills an average of 61 of them each year, according to the U.S. Centers for Disease Control. The most vulnerable are children, the elderly and those with weakened immune systems.
Initially, Mark and Donna thought Martha's onset of diarrhea was normal for a teething child. And at only 16 months of age, Martha was too young to tell her parents what was wrong.
The blond-haired, brown-eyed toddler with the sparkplug personality seemed so content during the day, Donna recalls, but she would scream all night from what the Moennings later learned were stomach cramps from the intensifying E. coli infection.
After 10 days of painful symptoms and several visits to the doctor, test results finally revealed Martha was suffering from E. coli O157:H7.
The Moennings rushed their daughter to the Mayo Children's Hospital in nearby Rochester, MN. Doctors immediately hooked Martha up to intravenous fluids to avoid dehydration and overworking her kidneys — and began running frequent blood tests.
“Everyone said, ‘Be prepared to stay for a long time,’” Donna recalls, the anguish being relived in her eyes. “But they never said how long.”
E. coli 0157:H7 can cause severe cramping, vomiting and bloody diarrhea in its most vulnerable victims. The infection can progress into the dangerous hemolytic uremic syndrome (HUS), which destroys red blood cells and can lead to kidney failure. Some survivors of HUS may eventually develop long-term kidney disease or neurological or pancreatic problems.
“Martha just progressively got worse in the hospital,” Donna says. “They told us: ‘There's no medication we can give her. Her body is going to have to fight this off.’ That's really scary.”
Martha had lost 5 lbs., a significant drop for a 16-month-old who only weighed 24 lbs. to begin with. And her blood hemoglobin dropped to dangerous levels the second night as her body entered the dreaded state of HUS.
Doctors hurried to give her a blood transfusion to help her body fight the infection.
“It was the three hours during the transfusion when the weight of what we were living through really hit us,” recalls Mark, tears welling in his eyes. “That was the hardest part.”
Even with the best care, HUS patients have a 5% mortality rate, according to www.about-ecoli.com.
“At that point, we asked everybody to pray for Martha and to ask God to give her the strength to fight through this,” Donna says. “We literally saw the answer to prayer when her numbers slowly started to climb.”
Unlike many E. coli patients, Martha did not need kidney dialysis or a second transfusion. She was released from the hospital after five days, returning frequently for followup blood tests.
She slowly recovered in the following months, but it was late September before the E. coli was completely out of her system, October before she slept through a night and December before her blood levels were back to normal. It wasn't until Martha celebrated her second birthday in April 2003 that she finally weighed 25 lbs. again.
Today, Martha is a healthy toddler and doctors say she won't experience any long-term effects from the infection. But last August's events are still fresh in the Moennings' minds.
“It's heart wrenching because it affects the little ones and, in our case, she couldn't tell us what was going on,” Donna says. “Many little children just don't make it. We could have so easily lost her.”
E. coli O157:H7 often is associated with eating undercooked ground beef or ready-to-eat foods contaminated by raw beef. But last August, with only four front teeth coming in, Martha was just starting to eat solid food.
“E. coli was the last thing I would have thought of,” Donna says.
The bacterium has an incubation period of three to nine days, so the Moennings retraced their steps in the days and weeks preceding Martha's first symptoms.
The family visited a county fair, pushing Martha in a stroller through the cattle barns. Perhaps it was there that she touched an infected animal or dirty rail.
Or, she might have touched Mark's manure-soiled overshoes as they sat inside one rainy night.
Finally, like many small children, Martha also sucks her thumb, making it difficult to determine what might have been on her hand, Donna notes.
The Moennings still don't know the source of the infection, but they know their lives have been changed by Martha's illness.
Promoting An Industry Initiative
Now, Donna and Mark understand the dangers of E. coli from both a personal and professional level. Donna was the director of public relations for the Beef Industry Council of the National Livestock and Meat Board when the initial Jack in the Box outbreak of E. coli O157:H7 killed three children in 1993.
Meanwhile, Mark, as a longtime board member of the Minnesota Beef Council (MBC), has been active in that state's five-year push for the irradiation of all ground beef in the U.S. He's also is a National Cattlemen's Beef Association board member.
Their daughter's potentially fatal battle with E. coli 0157:H7 has reinforced the couple's advocacy of preventive measures in the beef industry.
“With both of us being involved in the industry, we've been talking about the issues. Then, all of a sudden, we had to live the issue,” Donna says. “You realize how critical everything you can do is.”
Mark agrees. “I feel very strongly that we have to use the measures that are most readily acceptable now or most effective now.”
The MBC has been in the national forefront in promoting irradiation as a tool to fight E. coli, Mark says. The technology uses electron-beam, radiant energy to eliminate potentially dangerous microorganisms on meat, and it's the only known method to eliminate E. coli bacteria in raw meat, USDA says.
Other measures also have been developed or are under development. These include technologies like steam pasteurization of carcasses and pre-harvest water treatments for animals at processing plants.
Current research includes development of vaccines to reduce cattle's shedding of E. coli, as well as feed probiotics for competitive exclusion. Other research shows that chlorinating water troughs reduces the transmission of the organism.
But there isn't time to wait for research when a patient is suffering from an E. coli infection, Mark says.
“When it happens, you literally have minutes to hours,” Mark says. “You don't have the luxury of hoping for this or that process or something new to happen.”
Some on-farm methods have been developed to prevent E. coli. For instance, changing the feeding practices for market-ready cattle on the farm and at the packer could reduce the bacteria, according to USDA's Agricultural Research Service.
But Mark isn't entirely sold on on-farm prevention.
“I think the industry is a little too hopeful of something that can happen on the farm to take this thing away,” he says. “It appears most on-farm interventions are at best only 50% effective.
“Overall, I'm not satisfied, especially after this experience, that we've come far enough after the Jack in the Box incident posed one of the first major implications to the beef industry,” Mark says.
“The bottom line is that we need to do the things that will do the most good for the most people immediately, while continuing to work on the rest,” Mark says. “Let's show the consumer what we can do right now.”
Practicing Farm Safety
After experiencing Martha's illness, the Moennings advise other families to exercise caution on the farm.
“Be aware of the risks,” Mark says.
Donna makes her children wash their hands frequently when they're playing or helping their dad on the farm.
“After you've been through it and see a child laying lifeless in the hospital, you don't take it lightly anymore,” she says. “You just don't underestimate the power of bad bacteria.”
She also stresses safe food handling to prevent cross-contamination that can occur during meal preparation.
“It's being smart,” Donna says. “You know the risk when you get into a car, so you put your seatbelt on. You know the risks (of E. coli), so you wash your hands. You cook food properly. It's being smart about what you know and not taking things for granted or too lightly that the risks are out there.”
Tips for preventing an E. coli O157:H7 infection
Cook all ground beef and hamburger thoroughly to 160∞ F. Don't eat ground beef patties that are still pink in the middle.
If you are served an undercooked ground beef product in a restaurant, send it back for further cooking. Ask for a new bun and a clean plate.
Keep raw meat separate from ready-to-eat foods.
Wash hands, counters and utensils with hot soapy water after they touch raw meat.
Never place cooked hamburgers or ground beef on the unwashed plate that held raw patties.
Wash meat thermometers in between tests of patties that require further cooking.
Drink only pasteurized milk, juice or cider.
Wash fruits and vegetables thoroughly.
Drink municipal water that has been treated with chlorine or other effective disinfectants.
Avoid swallowing lake or pool water while swimming.
Wash your hands with soap after changing soiled diapers or after bowel movements.
People with a diarrhea should avoid swimming in public pools or lakes, sharing baths with others and preparing food for others.
For more information, visit the U.S. Centers for Disease Control (CDC) at www.cdc.gov/ncidod/dbmd/diseaseinfo/escherichiacoli_g.htm or the USDA's Food Safety and Inspection Service Web site at www.fsis.usda.gov. For more advice on cooking ground beef, visit the U.S. Department of Agriculture Web site at http://www.fsis.usda.gov/OA/topics/gb.htm. For more on irradiation, visit http://beef-mag.com/ar/beef_biosecurity_ information_2/index.htm.
Source: U.S. Centers for Disease Control