1993 Jack in the Box E. coli outbreak

The 1993 Jack in the Box E. coli outbreak occurred when 732 people were infected with the Escherichia coli O157:H7 bacterium originating from undercooked beef patties in hamburgers.^[1][2][3] The outbreak involved 73 Jack in the Box restaurants in California, Idaho, Washington, Nevada, Louisiana, and Texas and has been described as "far and away the most infamous food poison outbreak in contemporary history."^[4][5][6] The majority of the victims were children aged under 10-years old.^[7][8] Four children died and 178 other victims were left with permanent injury including kidney and brain damage.^{[9][10][11][12][13]}

The wide media coverage and scale of the outbreak were responsible for "bringing the exotic-sounding bacterium out of the lab and into the public consciousness" but it was not the first E. coli O157:H7 outbreak resulting from undercooked patties. The bacterium had previously been identified in an outbreak of food poisoning in 1982 (traced to undercooked burgers sold by McDonald's restaurants in Oregon and Michigan) and prior to the Jack in the Box incident there had been 22 documented outbreaks in the United States resulting in 35 deaths.^[14]

Sources

Health inspectors traced the contamination to the restaurants' "Monster Burger" sandwich which had been on a special promotion (using the slogan So good it's scary!) and sold at a discounted price.^[14][15] The ensuing high demand "overwhelmed" the restaurants and the product was not cooked for long enough or at a high enough temperature to kill the bacteria.^[16] At a 1993 press conference the president of Foodmaker (the parent company of Jack in the Box) blamed Vons Companies Inc. (supplier of their hamburger meat) for the E. coli epidemic. However, the Jack in the Box fast-food chain knew about but disregarded Washington state laws which required burgers to be cooked to 155 °F (68 °C), the temperature necessary to completely kill E. coli. Instead, it adhered to the federal standard of 140 °F (60 °C). Had Jack in the Box followed the state cooking standard, the E. coli outbreak would have been prevented, according to court documents and experts from the Washington State Health Department.^[17] Subsequent investigation by the Centers for Disease Control and Prevention (CDC) identified five slaughterhouses in the United States and one in Canada as "the likely sources of [...] the contaminated lots of meat."^[18] In February 1998, Foodmaker agreed to accept $58.5 million from Vons and eight other beef suppliers to settle the lawsuit started in 1993.^[19]

Victims

171 people required hospitalization.^[20] The majority of the victims who presented symptoms and were clinically diagnosed (but not hospitalized) were children aged under 10 years old.^[7][8]

45 of the infected children required hospitalization, of whom 38 suffered serious kidney problems and 21 required dialysis.^[21]

4 children died:

• 6-year-old Lauren Beth Rudolph of Southern California, who died on December 28, 1992, due to complications of an E. coli O157:H7 infection later tied to the same outbreak.^{[22][10][23][24][25]}
• 2-year-old Michael Nole of Tacoma, WA, who died on January 22, 1993.^[26][27]
• 2-year-old Celina Shribbs of Mountlake Terrace, WA, who died on January 28, 1993. She became ill due to a secondary contact transmission from another child sick with E. coli.^[28][29]
• 17-month-old Riley Detwiler of Bellingham, WA, who died on February 20, 1993, following secondary contact (person-to-person) transmission from another child sick with E. coli. The 18-month-old boy who infected Riley had spent two days in the daycare center before a clinical laboratory could return the positive test results for E. coli. The first boy's mother suspected her son had E. coli, but did not tell the daycare staff for fear that he would be sent home. When the test results finally came in positive for E. coli, county health officials could not reach the child’s parents in the middle of the workday. Both of the first boy's parents worked at Jack in the Box, where they regularly fed their son hamburgers. Riley, on the other hand, had never eaten a hamburger.^[28][9][30]

Legacy

External video

"Chasing Outbreaks: How Safe is our Food?". Retro Report short film dated May 10, 2015, discussing the Jack in the Box outbreak and how it led to major changes in industry practices and government oversight of the food supply. (Duration: 11 mins 8 secs)

Sen. Richard Durbin [D-IL], addressing a congressional hearing on food safety in 2006, described the outbreak as "a pivotal moment in the history of the beef industry."^[31] James Reagan, Vice President of Research and Knowledge Management at the National Cattlemen's Beef Association (NCBA), said that the outbreak was "significant to the industry" and "the initiative that moved us further down the road [of food safety] and still drives us today."^[32] David Acheson, a former U.S. Food and Drug Administration Associate Commissioner for Foods, recently told Retro Report that "Jack in the Box was a wakeup call to many, including the regulators. You go in for a hamburger with the kids and you could die. It changed consumers' perceptions and it absolutely changed the behaviors of the industry."^[33]

As a direct result of the outbreak:

• E. coli O157:H7 was upgraded to become a reportable disease at all state health departments^[34]
• the Food and Drug Administration (FDA) increased the recommended internal temperature for cooked hamburgers from 140 °F (60 °C) to 155 °F (68 °C)^[4][34]
• the USDA's Food Safety and Inspection Service (FSIS) introduced safe food-handling labels for packaged raw meat and poultry retailed in supermarkets, alongside an educational campaign alerting consumers to the risks associated with undercooked hamburgers^[4][34] The labels and the educational campaign came with criticism and objection from the industry.^[9]
• the FSIS introduced testing for E. coli O157:H7 in ground meat^[4]
• the United States Department of Agriculture (USDA) reclassified E. coli O157:H7 as an adulterant in ground beef^[35]
• the USDA introduced the Pathogen Reduction and Hazard Analysis and Critical Control Point (PR/HACCP) program^{[4][35][36][37]}
• the NCBA created a task force to fund research into the reduction of E. coli O157:H7 in cattle and slaughterhouses^[4]
• Jack in the Box completely overhauled and restructured their corporate operations around food safety priorities, setting new standards across the entire fast food industry.^[32]
• Parents of victims formed STOP Foodborne Illness (formerly Safe Tables Our Priority, or S.T.O.P.), a national non-profit organization dedicated “to prevent Americans from becoming ill and dying from foodborne illness” by advocating for sound public policy, building public awareness, and assisting those impacted by foodborne illness.^[38]
• Parents of the victims played key roles in spreading awareness and advocating for change - speaking directly to President Bill Clinton, meeting with Vice President Al Gore, testifying before the Clinton Healthcare Task Force, working with the Secretary of Agriculture, and discussing food safety issues with lawmakers in Washington, D.C.^[39][40]
• Some parents, including Dr. Darin Detwiler (who lost his son, Riley, to E. coli and hemolytic-uremic syndrome during the outbreak) later served as regulatory policy advisors to the USDA for meat and poultry inspection. Dr. Detwiler is now a Professor of Food Policy and the Director of Regulatory Affairs of Food and Food Industry at Northeastern University.^[41]

See also

• List of food contamination incidents
• STOP Foodborne Illness
• 1996 E. coli case from Odwalla juice

References

1. Schlosser 2001, p. 198.
2. Nestle 2010, p. 73.
3. "Other big E.Coli outbreaks". South Wales Echo. Cardiff. 11 March 2008. p. 9. ProQuest document ID 342321106.
4. Golan et al. 2004, p. 10.
5. Hanlon, Michael (21 May 2001). "The making of a modern plague". Daily Mail. London. p. 30. ProQuest document ID 321207886.
6. Denn, Rebekah (13 May 2011). "Poisoned author Jeff Benedict examines the current state of food safety in the US". The Christian Science Monitor. Boston, MA. Retrieved 8 July 2013.
7. Hunter 2009.
8. Schlosser & Wilson 2006, p. 180.
9. Detwiler, Darin. "Do Meat and Poultry Handling Labels Really Convey Safety?". Food Quality and Safety. Wiley Periodicals, Inc. Retrieved June 4, 2014.
10. Roberts 2008, p. 182.
11. Rogers, Lois (16 April 1995). "Killer in beef spreads alarm". The Times. London. p. 1. ProQuest document ID 318273338.
12. Sylvester, Rachel (11 June 1995). "Children risk death from burger bug". The Sunday Telegraph. London. p. 9. ProQuest document ID 309266408.
13. "Foodmaker". Financial Times. London. 25 February 1998. p. 1. ProQuest document ID 248542525.
14. Drexler 2009, p. 81.
15. Manning 2010, p. 10.
16. Green, Emily (6 June 2001). "The Bug That Ate The Burger". Los Angeles Times. Los Angeles. Retrieved 7 July 2013.
17. Porterfield, Elaine; Berliant Mcclatchy, Adam (June 17, 1995). "Jack In The Box Ignored Food Safety Regulations, Court Documents Say". The Spokesman-Review Co. The Spokesman-Review. Retrieved 5 June 2014.
18. Davis 1993, p. 258-263.
19. "Jack in the Box gets $58 mil in E. coli case". Hawaii, Inc. The Star Bulletin. February 25, 1998. Retrieved 14 June 2015.
20. "Food Safety and the Civil Justice System" (PDF). American Association for Justice. Washington, D.C. 2015. Retrieved November 25, 2015.
21. Huemer, Richard P.; Challem, Jack (1997). The Natural Health Guide to Beating Supergerms. New York: Pocket Books. p. 8. ISBN 978-0-671-53764-7.
22. Marler, Bill (December 24, 2012). "20 Years Later – Remembering the First E. coli Victim". Food Poison Journal. Retrieved November 25, 2015.
23. Rogers, Lois (16 April 1995). "Killer in beef spreads alarm". The Times. London. p. 1. ProQuest document ID 318273338.
24. Sylvester, Rachel (11 June 1995). "Children risk death from burger bug". The Sunday Telegraph. London. p. 9. ProQuest document ID 309266408.
25. "Foodmaker". Financial Times. London. 25 February 1998. p. 1. ProQuest document ID 248542525.
26. "Jack in the Box's Worst Nightmare". The New York Times. New York. February 6, 1993. Retrieved November 25, 2015.
27. Heberlein, Greg; King, Warren; Blake, Judith; Miller, Margaret (January 22, 1993). "Boy Dies From Tainted Meat - 2-Year-Old Is First Victim Of Food Poisoning". The Seattle Times. Seattle. Retrieved November 25, 2015.
28. "17-Month-old Is 3d Child to Die Of Illness Linked to Tainted Meat". The New York Times. New York. February 22, 1993. Retrieved November 25, 2015.
29. Kelley, Tina (July 7, 1996). "Chronology Of E. Coli Outbreak". The Seattle Times. Seattle. Retrieved November 25, 2015.
30. Andrews, James (January 22, 2013). "Jack in the Box E. coli Outbreak: Riley Detwiler's Story". Big Y Foods. Springfield, MA. Retrieved November 25, 2015.
31. Food Safety: Current Challenges and New Ideas to Safeguard Consumers: Hearing Before the Committee on Health, Education, Labor, and Pensions, United States Senate, 109th Cong. 76 (15 November 2006) (statement of Senator Dick Durbin).
32. Andrews, James (11 February 2013). "Jack in the Box and the Decline of E. coli". Food Safety News. Seattle, WA. Retrieved 8 July 2013.
33. Michels, Scott; Magratten, Drew (10 May 2015). "Chasing Outbreaks: How Safe Is Our Food?". Retro Report. Retrieved 15 July 2015.
34. Benedict 2011, p. xi.
35. Roberts 2008, p. 183.
36. Golan et al. 2004, p. 14.
37. Pathogen Reduction; Hazard Analysis and Critical Control Point (HACCP) Systems, 61 Fed. Reg. 38806 (1996).
38. News Desk (April 21, 2011). "Name Change for Food Safety Advocacy Group STOP". Food Safety News. Seattle. Retrieved February 21, 2015.
39. Balter, Joni (January 9, 1994). "Darin Detwiler: He Lost Son To E. Coli, Now Is Hellbent On Making It To Olympia". The Seattle Times. Retrieved June 5, 2014.
40. King, Warren (February 25, 1993). "E. Coli Victim Leaves Legacy Of Awareness". The Seattle Times Company. The Seattle Times. Retrieved 5 June 2014.
41. Canaday, Autumn. "USDA Press Release No. 0186.04: Veneman Names New Member to National Advisory Committee on Meat and Poultry Inspection". USDA. USDA Office of Communications. Retrieved 5 June 2014.

Bibliography

• Benedict, Jeff (16 May 2011). Poisoned: The True Story of the Deadly E. coli Outbreak That Changed the Way Americans Eat. Buena Vista, VA: Inspire Books. ISBN 9780983347804.
• Davis, M. (16 April 1993). "Update: Multistate Outbreak of Escherichia coli O157:H7 Infections from Hamburgers - Western United States, 1992-1993". Morbidity and Mortality Weekly Report (MMWR). Atlanta, GA: Centers for Disease Control and Prevention. 42 (14).
• Drexler, Madeline (23 December 2009). Secret Agents: The Menace of Emerging Infections (Revised ed.). New York, NY: Penguin Books. ISBN 9780143117179.
• Golan, Elise; Roberts, Tanya; Salay, Elisabete; Caswell, Julie; Ollinger, Michael; Moore, Danna (April 2004). "Food Safety Innovation in the United States: Evidence from the Meat Industry". Agricultural Economic Report. United States Department of Agriculture (831).
• Hunter, Beatrice Trum (2009). Infectious Connections. Laguna Beach, CA: Basic Health Publications. ISBN 9781591202448.
• Manning, Shannon D. (1 April 2010). Escherichia Coli Infections (2nd ed.). New York, NY: Chelsea House Publishers. ISBN 9781604132533.
• Nestle, Marion (2 July 2010). Safe Food: The Politics of Food Safety (2nd Revised ed.). Berkeley, CA: University of California Press. ISBN 9780520266063.
• Roberts, Paul (2008). The End of Food. London: Bloomsbury Publishing. ISBN 9780747588818.
• Schlosser, Eric (2001). Fast Food Nation. London: Penguin Books. ISBN 9780141006871.
• Schlosser, Eric; Wilson, Charles (2006). Chew On This: Everything You Don't Want to Know About Fast Food. New York, NY: Houghton Mifflin Harcourt. ISBN 9780618593941.

External links