Report on the circumstances leading to the 1996 outbreak of infection with E.coli 0157 in Central Scotland, the implications for food safety and the lessons to be learned.

Chapter 11 Research

11.1 As will be discerned from earlier chapters of this report, there is the potential for further research to fill gaps in knowledge about E.coli O157 and measures to identify and prevent infection with the organism. The issues surrounding the organism are complex.

11.2 We expect, and would encourage, that much further research on E.coli O157 and related issues will be proposed and taken forward. However, that needs to be targeted, prioritised and placed in the context of existing or planned programmes of research - otherwise there is the potential for duplication and the expenditure of large amounts of time and money to less than optimal effect.

Interim Report and Priority Recommendations

11.3 To help set the Central Scotland outbreak in context, and to help fill gaps in knowledge and existing or planned research, we recommended in our interim report research a) into the incidence/prevalence of E.coli O157 in Scottish cattle and other animals and the biology of its carriage; and b) to help forecast its likely future incidence/prevalence. The Secretary of State accepted these recommendations.

11.4 We also recommended further research into current DNA-based methods to help identify accurately the different strains of the organism (and hence its evolution and to assist in considering the implications). The aim is also to aid tracking of the animal source of infection and the identification, control and investigation of outbreaks. Again, that recommendation was accepted by the Secretary of State.

11.5 The ACMSF was consulted on these research proposals. It supports the proposals and has suggested that the collection of data on the prevalence of E.coli O157 in livestock should be planned on a UK basis; that research should take account of work already in hand; and that research proposals should be openly tendered and subject to peer review. It also suggests that research should cover not only DNA analysis but also other approaches.

11.6 We welcome the ACMSF's suggestions and we are pleased to note its support for our priority recommendations. We understand that the proposals are being taken forward and we welcome that.

Research Related to the Central Scotland Outbreak Data

11.7 In his response to our interim report, the Secretary of State noted the availability of substantial clinical information from the treatment of patients during the Central Scotland outbreak; and his intention to commission an analysis of that information to help develop knowledge and assist in the future management of outbreaks. The Secretary of State asked the Group to consider that issue further: we had in any event flagged up our intention to look further at the question of epidemiological research specific to the outbreak. We also note earlier in this report the need to look further at, for example, the issue of asympotomatic excretion of the organism.

11.8 Attached at Annex VIII to this report is a list of proposed topics for research which has been drawn up in response. It was prepared under the auspices of a Central Scotland E.coli O157 Project Research Group, formed to co-ordinate and present proposals to the Pennington Group and to the Chief Scientist's Office. It proposes research which can be answered either by using data collected in the course of the investigation and control of the Central Scotland outbreak or which can add to the value of data already collected.

11.9 We noted, but did not consider in any detail, these proposals. They require to be further worked up and discussed through the normal channels.

11.10 We are aware that Lanarkshire Health Board has agreed to make some funding available to pump-prime the need for further, urgent work to follow up cases related to the outbreak and to ensure that information and the prospects for further helpful research are not lost. We very much welcome that and hope that sympathetic consideration will be given by The Scottish Office to the need for any further funding necessary to take the approved research forward. Indeed, we suggest funds should be earmarked to ensure that this unique collection of information is fully utilised.

11.11 The Project Research Group's proposals are not intended to be exhaustive. We expect that other approaches will also be made to funding bodies for further work - whether related to the outbreak, seeking to capitalise on the outbreak data available, or of a more general nature. In this connection, we received a comprehensive literature review on E.coli O157, commissioned by SOAEFD and carried out by Dr David Jenkinson, which we believe will be extremely useful to those considering future research. During the course of our work, we also received many representations and much information relating to, for example, the benefits of particular approaches or proprietary equipment or techniques for identifying the organism or to assist in the prevention of contamination. There may well be benefits in research into, for example, the efficacy of particular bactericidal treatments to help sterilise equipment and prevent contamination in butchers' shops or end process treatments for meat. The outcome of research should also result in the dissemination of appropriate advice to the trade.

11.12 We believe that, in general, any further proposals for research should be subject to the normal processes for funding consideration and peer review. We would encourage, however, that funding bodies should give appropriate weight to the apparently growing threat which E.coli O157 represents to public health in the United Kingdom, the nature of the organism and the effects of infection with it.

Transmissibility of Infection to Man

11.13 We flagged up in our earlier report the possibility of further recommendations for research related to the transmissibility of the organism to man. We had some further, limited discussion about that and the factors likely to influence transmission and rates of human infection - notably carriage rates in cattle, sheep and man (including asymptomatic excreters) and, possibly a vital factor, the number of organisms that are carried in the intestines of individual animals or people.

11.14 Information on carriage rates in animals and man is incomplete and no information is available about the bacterial load of individual animals or people. Our earlier recommendations were intended to help fill gaps in knowledge about the incidence/prevalence of the organism in cattle and other animals in Scotland. Further research may be possible and appropriate on the other factors affecting transmission of the organism to, and between, the human population.

Recommendation

11.15 We recommend that any further proposals for research related to E.coli O157 should be subject to normal processes for funding consideration and peer review, but with appropriate weight given to the threat the organism represents to the public health.