September 29, 2010

Fruit compote linked to VTECH outbreak

Region offers suggestions to reduce risk of e-coli outbreaks

Fruit compote may be the most likely culprit which sickened visitors to the Russian pavilion at Folklorama this past August, according to a report published by the Winnipeg Health Region.

The report details the probable cause of the verotoxigenic E-coli and its effect on 37 people who either attended the pavilion or who fell victim to secondary spread of the E-coli bacterium. Only three of the total 40 cases were not linked to the pavilion. In addition, the report offers a number of recommendations designed to reduce the risk of E-coli outbreaks in the future.

Further Reading
VTEC Outbreak 2010 Report
Fact sheet on e-coli
Region issues e-coli alert (August 18, 2010)

According to the "VTEC Outbreak 2010 Report," each person who was treated was interviewed to find the common connection with the pavilion. A study was then undertaken to determine the identity of the specific food item which was contaminated with E-coli, with 33 out of 34 people who attended the pavilion taking part.

Five patients were hospitalized with one case admitted to ICU and seventeen people visited an emergency room. There was one case of hemolytic uremic syndrome. VIP tour group attendees who had not been ill were asked to volunteer to be controls in the study.

The study looked at foods such as borscht, meatballs, a rice dish, and Russian juice (fruit compote). These four items were served together on the "Russian Combination platter." Analysis narrowed down the mostly likely choice to the compote over other sources, partially because the compote was served with both the vegetarian and non-vegetarian platters.

The most plausible source of contamination of the compote juice could have either been from cross-contamination from raw or undercooked ground beef - which is the most common source of E-coli in food products - which was also being handled at the same time in the kitchen or from E-coli contaminated apples used to make the compote.

Interviews with the kitchen staff revealed that most of the food was cooked in a pressure cooker. However, the compote juice was cooked in a separate pot. It was prepared by adding washed, unpeeled apples, blueberries and blackberries to boiling water. The fruit was bought fresh from a supermarket in Winnipeg.

Once boiled for five to 10 minutes, the compote juice was decanted into large 10-litre plastic pails. The boiled compote was then refrigerated until served cold. A new batch of compote was made every day. The only other food item that may have been cooked in the same pot was rice. The fruit was washed before boiling, kitchen staff wore gloves and practiced proper hand washing, and pots were washed and sanitized between use.

Verotoxigenic E-coli is a bacterium most commonly found in the intestines of cattle and other animals. It is most likely that the source of E-coli in this outbreak was related to handling of raw ground beef in the kitchen, with cross-contamination of other food products, but the investigators were unable to confirm this hypothesis. Although Russian pavilion food handlers tried their best to maintain high standards, it is plausible that at some time from August 3 to 5, cross-contamination of other foods in the kitchen, specifically the compote, may have occurred.

Although the majority of recent E-coli outbreaks have been linked to ground beef, it is not entirely uncommon to link an outbreak to apple juice (cider) that has not been properly pasteurized. Apples that are picked off the ground on a farm can become contaminated with manure containing E-coli, leading to the potential for the spread of E-coli from eating contaminated apples.

But since the compote juice should have been brought to a boil in its preparation at the pavilion, it should have met the equivalent standards of pasteurization and should not have been contaminated with E-coli during the cooking phase of its preparation.

Pavilion staff worked very hard to provide hot fresh food to all attendees, but they were under great pressure to serve food quickly to large numbers of people. Although kitchen staff were very diligent in adhering to strict food handling procedures, temperature monitoring of cooked foods was not always possible due to the extreme time restrictions. According to pavilion staff, none of the pavilion volunteers and performers who repeatedly consumed food and beverages, including compote juice, reported any illness.

The report made a number of recommendations:

  • Food handling certification should be encouraged for food handlers working at Folklorama.

  • Food outlets that apply for temporary licensing, such as Folklorama pavilions, should strictly adhere to a set menu. Any variations or deviations from the established menu should be well documented including appropriate, timely notification of public health inspectors.

  • Policies should be developed to guide pavilions concerning best practices when kitchens run out of menu food items due to unexpected high demands. For example, should the kitchen prepare more food (possibly items that are not on the established menu depending on what is available at the time in the kitchen) or should they be instructed to stop serving menu items as the kitchen runs out of those foods?

  • Food preparation should follow best practices, including internal temperature confirmation (71°C for ground beef products). This becomes especially important when demand on the kitchen is extremely high and there is great pressure to get product out of the kitchen and onto the food line.

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