REDUCING ESCHERICHIA COLI O157 RISK IN RURAL COMMUNITIES

Lead Research Organisation: University of Aberdeen
Department Name: Inst of Biological and Environmental Sci

Abstract

This RELU (Rural Economy and Land Use) project brings together the disciplines of geography, sociology, economics, medicine, microbiology, ecology and food science to carry out the research needed to advise a range of stakeholders with the scientific information needed to reduce the risk of human Escherichia coli O157 infection in UK rural communities.



 Current outbreaks of human diseases and food safety concerns caused by food borne pathogens such as E. coli O157 flag a serious lack of knowledge and understanding about the factors which determine the numbers and spread of these human food-borne pathogens in rural and agricultural environments. The pathogens mainly enter the food chain from faecal contamination of meat products, but there are an increasing number of outbreaks linked to direct contact with contaminated water, soil and livestock. This project studies the key pathogen E. coli O157 which has been identified by the Food Standards Agency as posing a major risk to human health. It is also a threat to visitors and tourists in countryside areas. Through 6, integrated work packages, and the use of 2 case study areas (NE Scotland and N Wales), the research will provide information to ensure rural policies minimise the risks to rural communities from E. coli O157.

Publications

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Edwards-Jones G (2010) Does eating local food reduce the environmental impact of food production and enhance consumer health? in The Proceedings of the Nutrition Society

 
Description The main findings of the research were obtained through a variety of social and natural science methods.

A questionnaire of farmers, rural visitors and residents found that:

• People think about protecting themselves indoors rather than outdoors

• Awareness is highest in farmers particularly in the Grampian region and lowest in visitors to the two areas

• Most (83 per cent) identified E. coli O157 as a severe disease however a relatively high proportion of farmers in Grampian (25 per cent) described it as mild

• Knowledge of symptoms was similar between groups



Antibodies from blood and saliva were measured to give an estimate of exposure and potential immunity of individuals to this pathogen. Results showed that there were a relatively high percentage of people with antibodies (12 per cent) but the levels were not found to be higher in Grampian.



Studies were carried out investigating E. coli O157 in a range of soils. It was shown that the organism was able to adapt and survive in low nutrient conditions and it took longer to revive the pathogen the longer it was left in soil. Further, higher population densities remained viable in Scottish soils and at lower temperatures which may be part of the reason why E. coli O157 has a higher incidence in Scotland.



Descriptive epidemiology found that twice as many cases per head of population occurred in rural compared with urban areas. The disease was most common in young rural children and hence this group is the one where education about the disease should be targeted. It was unclear why the disease was four-fold higher in Grampian than Wales. The findings from risk assessment and epidemiological models indicated that food and the environment as sources of infection were probably more important than private water supplies.



The health care and out-of-pocket costs of the disease were estimated to be approximately £6,000 per case in England/Wales. Assuming these costs are representative of Scotland, the cost to the UK would have been approximately £7.5 million in 2010. Actual costs will be higher because of the long term effects of disease on individuals.



Thirty interventions that could reduce human disease were evaluated by expert opinion, risk assessment, financial cost and views of farmers and consumers. The two interventions that scored best for both effectiveness and by expert opinion were to encourage farmers and farm visitors to wash hands following contact with farm animals and vaccination of cattle to control pathogen colonisation and faecal excretion of E. coli O157. Hand washing was also strongly supported by both farmer and consumer focus groups. It was estimated it would cost £7-8 million per year to implement at farms, including petting farms across Scotland and Wales. A potential vaccine met with a mixed response from consumers and farmers who were concerned about the cost (£14-28 million per year). Other interventions that were assessed included treatment of private water supplies and ensuring that foods such as beefburgers were cooked properly.
Exploitation Route Throughout the project there was stakeholder engagement. Indeed stakeholders were interviewed, completed questionnaires and provided key expertise and co-production of knowledge with academics. Dissemination of results to stakeholders has been achieved through presentations at expert committees and to individuals. During the project there have been numerous press articles detailing particular aspects of the research. The project also contributed evidence to the independent investigation of the Godstone petting farm outbreak.

The potential impacts on government policy include evidence for underpinning the decision making process. For example the findings that visitors in rural areas were less aware of the risks from E. coli O157, as well as the general view of it being an indoor rather than outdoor risk indicates that there is a requirement for educational information at petting farms and at locations in the countryside frequented by visitors. Further, the information on hand washing is supported by both consumers and farmers as well as being backed up by evidence of its effectiveness from risk assessment and so should be encouraged for use by countryside users.
The findings of the work are being published in the scientific press and also presented at international conferences and scientific meetings in the UK. The project has managed to combine both technical and lay views of risk on E. coli O157 for the first time. The techniques used are applicable to other gastrointestinal pathogens and other infectious diseases.
Sectors Agriculture, Food and Drink,Environment,Healthcare

URL http://www.abdn.ac.uk/reluecoliproject
 
Description The findings have been shared with other scientists through scientific conferences and meetings. We reported the findings to the Food Standards Agency and DEFRA which they will have used to inform their views on policy. It is difficult to directly identify the direct impact of the findings however we did discuss the results of our work which will have informed the VTEC E. coli O157 action plan for Scotland.
First Year Of Impact 2010
Sector Agriculture, Food and Drink,Healthcare
Impact Types Societal

 
Description Advice on processing aids in the food industry to Scottish Government
Geographic Reach National 
Policy Influence Type Gave evidence to a government review
 
Description Citation in Food Standards Scotland Risk Assessment on STEC
Geographic Reach National 
Policy Influence Type Citation in other policy documents
Impact The FSS risk assessment was used to assess the safety of cheese in a food incident. The information from the cited paper helped to underpin the general background information on E. coli O157 in Scotland.
URL https://app.researchfish.com/getform/0/influence-on-policy-and-practice?action=add&zone=portfolio&de...
 
Description Scottish Health Protection Network: Campyobacter
Geographic Reach National 
Policy Influence Type Membership of a guideline committee
 
Description FSS Research Programme
Amount £229,972 (GBP)
Organisation Government of Scotland 
Department Food Standards Agency (FSA), Scotland
Sector Public
Country United Kingdom of Great Britain & Northern Ireland (UK)
Start 11/2015 
End 03/2017
 
Description Food Standards Agency Open Application
Amount £11,000 (GBP)
Organisation Government of Scotland 
Department Food Standards Agency (FSA), Scotland
Sector Public
Country United Kingdom of Great Britain & Northern Ireland (UK)
Start 09/2012 
End 04/2013
 
Description OECD Co-operative Research Programme Sposnsorship of Conferences
Amount € 30,000 (EUR)
Organisation Organisation for Economic Co-operation and Development OECD 
Sector Public
Country France, French Republic
Start 01/2013 
End 12/2013
 
Description RESAS Innovation tender
Amount £190,409 (GBP)
Organisation Scottish Government Rural and Environment Science and Analytical Services Division (RESAS) 
Sector Public
Country United Kingdom of Great Britain & Northern Ireland (UK)
Start 04/2016 
End 03/2017
 
Description Research
Amount £229,972 (GBP)
Organisation Government of Scotland 
Department Food Standards Agency (FSA), Scotland
Sector Public
Country United Kingdom of Great Britain & Northern Ireland (UK)
Start 11/2015 
End 03/2017
 
Title Best/Worst scaling of interventions 
Description Expert opinion on the effectiveness and practicality of environmental interventions to reduce human exposure to Escherichia coli O157. The intervention list was compiled from published research and an initial expert consultation was undertaken to reduce the set of 99 interventions to a more manageable list of 30 interventions. Then experts selected the most and least effective measures from 12 sets of 5 interventions, followed by selecting the most and least practical measure in each set. 
Type Of Material Database/Collection of data 
Year Produced 2012 
Provided To Others? Yes  
Impact These data are available via the UKDA at the website below. I am not aware of any impact as of yet. 
URL http://relu.data-archive.ac.uk/explore-data/search-browse/Project/?ID=RES-229-25-0012
 
Title E. coli O157 Disease Maps 
Description E.coli O157 incidence in Grampian and Wales, assessed from human cases of the disease (from data collected from Foresterhill hospital and Health Protection Wales) and from the general population (derived from Scottish and English/Welsh census data). Data for Grampian are presented as number of cases, population and incidence (/100,000 people) at postcode district level for the period 1997-2008. 
Type Of Material Database/Collection of data 
Year Produced 2012 
Provided To Others? Yes  
Impact These data are available via UKDA. I am not aware of any impact as of yet. 
URL http://relu.data-archive.ac.uk/explore-data/search-browse/Project/?ID=RES-229-25-0012
 
Title E. coli O157 Risk assessment models 
Description Three process based quantitative risk assessment models were developed to determine the risk of E. coli O157 infection from water, food and the environment. These models are written in Excel using the @RISK add in and utilise the Monte Carlo technique. 
Type Of Material Computer model/algorithm 
Year Produced 2012 
Provided To Others? Yes  
Impact The models were made available to the scientific community by request on publication in Rotariu et al., Epidemiol. Infect. (2012), 140, 1414-1429. We have not yet received arequest for the models. 
 
Title E. coli O157 infectivity in the environment 
Description Experiments conducted on the survival and persistence of E. coli O157 in 8 soils from Grampian and N Wales at 2 temperatures, using microbiological culture and measurement of the cells' energy level. 
Type Of Material Database/Collection of data 
Year Produced 2012 
Provided To Others? Yes  
Impact Data are available from UKDA. As of yet I am not aware of any impact. 
URL http://relu.data-archive.ac.uk/explore-data/search-browse/Project/?ID=RES-229-25-0012
 
Title E. coli O157 risk maps 
Description Risk maps showing areas of high risk of O157 infection 
Type Of Material Database/Collection of data 
Year Produced 2012 
Provided To Others? Yes  
Impact Data are available from UKDA. As of yet I am not aware of any impact. 
URL http://relu.data-archive.ac.uk/explore-data/search-browse/Project/?ID=RES-229-25-0012
 
Title Private Water supply Data 
Description Data from local councils on number and location of properties with private water supply in Grampian and Wales, representing a potential risk. 
Type Of Material Database/Collection of data 
Year Produced 2012 
Provided To Others? Yes  
Impact Data are available from UKDA. As of yet I am not aware of any impact. 
URL http://relu.data-archive.ac.uk/explore-data/search-browse/Project/?ID=RES-229-25-0012
 
Title Seroprevalence data 
Description Faecal screening of target populations. 
Type Of Material Database/Collection of data 
Year Produced 2012 
Provided To Others? Yes  
Impact These data re available via the UKDA website. I am not aware of any impact currently. 
URL http://relu.data-archive.ac.uk/explore-data/search-browse/Project/?ID=RES-229-25-0012
 
Title Stakeholder risk perception survey 
Description Questionnaire amongst farmers, non-farming rural residents, visitors and food chain workers in Grampian and north Wales, to ascertain awareness of E. coli O157, and attitudes to and knowledge and understanding of associated risk in two rural areas. 
Type Of Material Database/Collection of data 
Year Produced 2012 
Provided To Others? Yes  
Impact These data are available via the UKDA website. I am not aware of any impact as of yet. 
URL https://www.researchfish.com/getform/0/research-database-models?action=add&zone=portfolio&delegate
 
Description Presentation to Roslin Inst Edinburgh 25th October 2016 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Postgraduate students
Results and Impact A presentation to the BBSRC Roslin Institute in Edinburgh entitled: A pot-pourri of GI pathogen anecdotes: Campylobacter, STEC and Anisakiasis
Year(s) Of Engagement Activity 2016
 
Description VTEC, Next Generation Sequencing, Genomic Evolution and Dissemination: The nuts and bolts; Introduction and development of NGS" Oral, VTEC, Boston, USA 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact "VTEC, Next Generation Sequencing, Genomic Evolution and Dissemination: The nuts and bolts; Introduction and development of NGS" Oral, VTEC, Boston, USA
Year(s) Of Engagement Activity 2015