**5. Different pathotypes of** *E. coli* **and outbreaks**

If we take a general look at the incidence and epidemiology of disease-causing *E. coli* pathotypes, we see many cases and outbreaks. For example; annual incidences of 31 primary pathogens were estimated in a study conducted in the USA in 2011. It is estimated that these 31 pathogens caused 6.6–12.7 million diseases; 39,500–75,700 hospitalizations and around 700–2300 mortalities. In another study conducted in the USA between 2003 and 2012, it was reported that foodborne outbreaks caused 4928 diseases, 1272 hospitalizations, 299 cases of HUS diagnosed by a physician and 33 deaths. The primary contamination sources were listed as 55% foodborne, 10% animal contact, 10% human-to-human transmission, 4% waterborne and 11% unknown reasons [28, 30]. In another study conducted in Argentina, O157:H7 STEC was detected 25.5% and non-O157 STEC was detected in 52.2% of the raw meats analyzed in terms of STEC. Argentina is one of the countries with the highest HUS incidence rates [31].

In meat products, non-O157 STEC prevalence varies between 2.4 and 30.0% for minced meat, 17.0 and 49.2% for sausage and 8.6 and 49.6 in meat put up for sale. When STEC contamination reports verifying that the STEC O157 prevalence had ranged between 0.2 and 27.8% for the last 30 years were assessed in terms of STEC O157 and non-O157 presence in bovine meat, non-O157 STEC rates were observed to be ranging between 2.1 and 70.1% [32]. Besides, EHEC serotypes were reported to stay alive for 9 months in −80°C and that they were not affected by the storage conditions of pieces of meat frozen in −20°C. *E. coli* is reported to be directly associated with consumption of undercooked meat. It is known that, especially meat and milk are very suitable environments for verotoxigenic *E. coli* and this microorganism produces significant amounts of verotoxins in contaminated meat kept in 37°C [33]. In studies, it was reported that the foods that are generally responsible for foodborne outbreaks were: meat and meat products, fish and seafood, chicken products, liver, ice cream, raw milk, rice meals, pasta and pasta salad, peanut, flour, cold sandwiches, fruit juices and raw fruits and vegetables [23]. In another study, it was stated that undercooked or uncooked hamburger, non-pasteurized fruit juices, raw vegetables contaminated with cow manure and infected cows are important sources of *E. coli*. For example; there were at least four deaths and over 500 laboratory approved infections were observed in an *E. coli* outbreak in 1993, related to hamburgers bought from a fast-food chain [6, 23]. The outbreak in the west of USA between 1992 and 1993 caused by *E. coli* O157:H7 that affected over 700 people and the outbreak in Japan in 1996 that affected over 8000 people and killed two people can be listed among the outbreaks caused by *E. coli* O157:H7. Foodborne outbreaks caused by *E. coli* O157:H7, O111:NM (non-motile) and STEC serotypes were reported in many countries such as Australia, Canada, Japan, USA, many European countries and North Africa [34].

In a study conducted on children's nursery in Japan between 2010 and 2013, it was detected that 68 of 1035 outbreaks were of EHEC origin. It is known that 30 of the 68 outbreaks (46%) were foodborne [35]. It is also known that there were two EIEC outbreaks reported in England in June of 2014. These cases are rare in England. However, it is emphasized that EIEC has a capacity to cause large and potentially serious gastrointestinal outbreaks in Europe and that it should be considered as a potential pathogen in foodborne outbreaks [36]. In 2011 (between May 1st and July 4th) 2971 STEC related gastroenteritis cases including 18 deaths and 845 HUS cases including 36 deaths were reported along with laboratory approval, among 3816 cases reported to the public health officials in Germany. Moreover, the number of HUS cases during outbreaks was reported to be approximately 70 times the figures that corresponds to the same period of previous years [37]. In another report from Germany, a case-control study was conducted with 26 patients with HUS and 81 control cases. The incidence of the disease was associated with kale consumption in the univariate analysis and with kale and cucumber consumption in the multivariate analysis. Twenty-five percent of the cases reported eating kale and 88% reported eating a salad [38]. In another case in Scotland in 1994, 71 cases were reported including 1 death and 11 HUS cases due to non-pasteurization of milk. In an *E. coli* O111 outbreak in Australia, 200 cases were reported including 23 HUS cases and 1 death due to a kind of sausage made from minced meat. The failure in chlorination of Municipality waters also caused outbreaks. In an outbreak in 2000 among campers in Aberdeenshire, 20 cases were reported due to the environmental exposure to the camp area contaminated by sheep manure. Among this group of campers, the number of people that the number of cases who had not washed their hands before meals was almost 9 times bigger than the number of people who became ill. It is a

**95**

sible hazards for food [17, 44];

1.Conduct hazard analysis

3.Establish critical limits

2.Identify critical control points (CCP)

*Escherichia coli and Food Safety*

**6. Conclusion**

*DOI: http://dx.doi.org/10.5772/intechopen.82375*

well-known fact that all *E. coli* outbreaks cause high costs for countries in addition to the severity of the infection and the damage it leaves on people [39].

Along the food chain, controllability and traceability are of great importance for ensuring the consumer safety and for foods to be protected from biological, physical and chemical hazards starting from the field to the moment of consumption. Consumers constitute the last ring of the food safety. The purchasing power and consciousness of consumers help ensure food safety and are the most important factors for protection and prevention against risks. Prevention of *E. coli* infections require not only developing new vaccines but also providing uncontaminated water and food. Food production companies should pay close attention to the cleanliness of their application areas and the disinfection of the running water. People who work in food facilities and services, should be given frequent trainings on hygiene so as to prevent *E. coli* contaminations. During travels from developed countries to developing countries, unsafe foods and foods that are sold out in the open should be avoided; packaged and labeled drinking water and beverages should be consumed [2, 40]. Cooking food at the right temperatures can ensure inactivation of *E. coli* as the factor is sensitive to high temperatures. While the meat is cut into pieces, the microorganisms on the surface of the meat reach the inner sections and can stay alive if a sufficient heat treatment is not applied, turning it into a risk factor for public health. Similarly, there are some potential risks in raw milk. It poses a risk if

not pasteurized. *E. coli* can be inactivated with pasteurization [15, 41, 42].

Biological protection precautions are also very important. It is claimed that 8.0 log10 cfu/g lactic acid bacteria causes a 1.6 log10 cfu/g decrease in *E. coli* O157:H7; EHEC O157 multiplies by growing in the damaged Fuji apple, yet *Candida oleophila* may be effective in controlling this pathogen in these damaged apples. Decreasing this risk of contamination caused by farms, slaughterhouses, food producers and consumers is very important for protection from the pathogen *E. coli* O157:H7 strain, which can also be transmitted through food and water. Under the Food and Drug Administration (FDA), Meat Inspection Act and other regulations the food industry is responsible for producing safe foods that meet national standards, identify critical control points from production to consumption, and have good production practices. Hazard analysis and critical control points (HACCP) is a management system in which food safety is addressed through the analysis and control of biological, chemical and physical hazards for raw material production, procurement and packaging, distribution and consumption [2, 17, 40, 43].

Under the HACCP, the term hazard refers to any substance or condition that has the potential to cause adverse health effects and that is unacceptable. These hazards can be caused by the biological, chemical or physical contamination in the raw material, semi-processed or finished food product. Hazard analysis is defined as the assessment of the severity of the hazard and the likelihood of it happening. HACCP is a system managed based on seven principles to identify, assess and control poswell-known fact that all *E. coli* outbreaks cause high costs for countries in addition to the severity of the infection and the damage it leaves on people [39].
