Probably cilantro: Cyclosporiasis outbreak hits 358

The stories we could – and will — tell about implementing on-farm food safety programs for the past 15 years.

cilantro.slugs_.powell.10-300x225Don’t have a shit around fresh produce; don’t make the worker incentives such that they crap in the fields because they lose money if they go to the bathroom; provide decent handwashing facilities, and stop with nonsensical soundbites.

As of July 30, 2015 (11am EDT), the U.S. Centers for Disease Control and Prevention had been notified of 358 ill persons with confirmed Cyclospora infection from 26 states in 2015.

Most (199; 56%) ill persons experienced onset of illness on or after May 1, 2015 and did not report international travel prior to symptom onset.

Clusters of illness linked to restaurants or events have been identified in Texas, Wisconsin, and Georgia.

Cluster investigations are ongoing in Texas and Georgia.

Cluster investigations in Wisconsin and Texas have preliminarily identified cilantro as a suspect vehicle.

Investigations are ongoing to identify specific food item(s) linked to the cases that are not part of the identified clusters.

Previous U.S. outbreaks of cyclosporiasis have been linked to imported fresh produce, including cilantro from the Puebla region of Mexico. Read the related FDA Import Alert issued July 27, 2015.

The U.S. Food and Drug Administration, the Centers for Disease Control and Prevention (CDC) and state public health officials have identified annually recurring outbreaks (in 2012, 2013, and 2014) of cyclosporiasis in the United States which have been associated with fresh cilantro from the state of Puebla, Mexico. There is currently (in July 2015) another ongoing outbreak of cyclosporiasis in the United States in which both the Texas Department of State Health Services and the Wisconsin Department of Health Services and the Wisconsin Department of Agriculture, Trade and Consumer Protection have identified cilantro from the Mexican state of Puebla as a suspect vehicle with respect to separate illness clusters.

From 2013 to 2015, FDA, SENASICA, and COFEPRIS inspected 11 farms and packing houses that produce cilantro in the state of Puebla, 5 of them linked to the US C. cayetanensis illnesses, and observed objectionable conditions at 8 of them, including all five of the firms linked through traceback to the U.S. illnesses.

Conditions observed at multiple such firms in the state of Puebla included human feces and toilet paper found in growing fields and around facilities; inadequately maintained and supplied toilet and hand washing facilities (no soap, no toilet paper, no running water, no paper towels) or a complete lack of toilet and hand washing facilities; food-contact surfaces (such as plastic crates used to transport cilantro or tables where cilantro was cut and bundled) visibly dirty and not washed; and water used for purposes such as washing cilantro vulnerable to contamination from sewage/septic systems. In addition, at one such firm, water in a holding tank used to provide water to employees to wash their hands at the bathrooms was found to be positive for C. cayetanensis.

Based on those joint investigations, FDA considers that the most likely routes of contamination of fresh cilantro are contact with the parasite shed from the intestinal tract of humans affecting the growing fields, harvesting, processing or packing activities or contamination with the parasite through contaminated irrigation water, contaminated crop protectant sprays, or contaminated wash waters.

 

35 sick: raw is risky in rising temperatures in BC

A warning from the BC Centre for Disease Control about eating raw shellfish:

So far this summer, there have been an unprecedented number of shellfish-related illnesses thanks to the warm weather.

SUN0705N-Oyster7The majority of illnesses have been linked to eating raw oysters sourced in BC and served in restaurants.

Spokesperson Marsha Taylor says 35 people have become ill from eating the uncooked shellfish…

“We’re putting this message out both to the public that will also hit the restaurants and we’re also doing follow up with every restaurant to make sure they are aware of the issue and we’re inspecting the premises.”

Some illnesses have also been linked with raw oysters purchased or self-harvested.

Taylor says if you happen to get sick…

“People who are experiencing symptoms of the Vibrio Parahaemolyticus most often experience typical food-borne illness like nausea and vomiting, headaches, and feel pretty badly for a couple of days…but most people will recover on their own.”

To reduce risk of illness consumers are being told to eat only cooked shellfish.

Largest botulism outbreak in 40 years in US: Botulism at church potluck in Ohio, 2015

The U.S. Centers for Disease Control reports that on April 21, 2015, the Fairfield Medical Center (FMC) and Fairfield Department of Health contacted the Ohio Department of Health (ODH) about a patient suspected of having botulism in Fairfield County, Ohio.

cannedpotatoes20091-300x214Botulism is a severe, potentially fatal neuroparalytic illness.* A single case is a public health emergency, because it can signal an outbreak (1). Within 2 hours of health department notification, four more patients with similar clinical features arrived at FMC’s emergency department. Later that afternoon, one patient died of respiratory failure shortly after arriving at the emergency department. All affected persons had eaten at the same widely attended church potluck meal on April 19. CDC’s Strategic National Stockpile sent 50 doses of botulinum antitoxin to Ohio. FMC, the Fairfield Department of Health, ODH, and CDC rapidly responded to confirm the diagnosis, identify and treat additional patients, and determine the source.

A confirmed case of botulism was defined as clinically compatible illness in a person who ate food from the potluck meal and had 1) laboratory-confirmed botulism or 2) two or more signs of botulism or one sign and two or more symptoms† of botulism. A probable case was a compatible illness that did not meet the confirmed case definition in a person who ate food from the potluck meal.

Among 77 persons who consumed potluck food, 25 (33%) met the confirmed case definition, and four (5%) met the probable case definition. The median age of patients was 64 years (range = 9–87 years); 17 (59%) were female. Among 26 (90%) patients who reported onset dates, illness began a median of 2 days after the potluck (range = 1–6 days).

Twenty-seven of the 29 patients initially went to FMC. Twenty-two (76%) patients were transferred from FMC to six hospitals in the Columbus metropolitan area approximately 30 miles away; these transfers required substantial and rapid coordination. Twenty-five (86%) patients received botulinum antitoxin, and 11 (38%) required endotracheal intubation and mechanical ventilation; no other patients died. Within 1 week of the first patient’s arrival at the emergency department, 16 patients (55%) had been discharged. Among 19 cases that were laboratory-confirmed, serum and stool specimens were positive for botulinum neurotoxin type A or Clostridium botulinum type A.

Interviews were conducted with 75 of 77 persons who ate any of the 52 potluck foods. Consumption of any potato salad (homemade or commercial) yielded the highest association with probable or confirmed case status (risk ratio [RR] = 13.9; 95% confidence interval [CI] = 4.6–41.8), followed by homemade potato salad (RR = 9.1; CI = 3.9–21.2). Of 12 food specimens collected from the church dumpster, six were positive for botulinum neurotoxin type A; five contained potato salad and one contained macaroni and cheese that might have been contaminated after being discarded.

The attendee who prepared the potato salad with home-canned potatoes reported using a boiling water canner, which does not kill C. botulinum spores, rather than a pressure canner, which does eliminate spores (2). In addition, the potatoes were not heated after removal from the can, a step that can inactivate botulinum toxin. The combined evidence implicated potato salad prepared with improperly home-canned potatoes, a known vehicle for botulism (3).

This was the largest botulism outbreak in the United States in nearly 40 years (Table). Early recognition of the outbreak by an astute clinician and a rapid, coordinated response likely reduced illness severity and facilitated early hospital discharge. This outbreak response illustrates the benefits of coordination among responders during botulism outbreaks. Close adherence to established home-canning guidelines can prevent botulism and enable safe sharing of home-canned produce (2).

Acknowledgments

Fairfield Medical Center, Lancaster, Ohio; Fairfield Department of Health, Lancaster, Ohio; Ohio Department of Health (ODH) Bureau of Infectious Diseases, Columbus, Ohio; ODH Bureau of Public Health Laboratory, Reynoldsburg, Ohio; ODH Office of Preparedness, Columbus, Ohio; Franklin County Public Health, Columbus, Ohio; Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC; Strategic National Stockpile, Office of Public Health Preparedness and Response, CDC; Office of Regulatory Affairs, CDC.

1Ohio Department of Health; 2Epidemic Intelligence Service, CDC; 3Division of Foodborne, Waterborne, and Infectious Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC; 4Fairfield Department of Health; 5Fairfield Medical Center.

Corresponding author: Carolyn L. McCarty, wmw8@cdc.gov, 614-728-6941.

References

Sobel J. Botulism. Clin Infect Dis 2005;41:1167–73.

National Center for Home Food Preservation, US Department of Agriculture. USDA complete guide to home canning, 2009 revision. Washington, DC: US Department of Agriculture; 2009. Available at http://nchfp.uga.edu/publications/publications_usda.htmlExternal Web Site Icon.

Sobel J, Tucker N, Sulka A, McLaughlin J, Maslanka S. Foodborne botulism in the United States, 1990–2000. Emerg Infect Dis 2004;10:1606–11.

*Botulinum neurotoxin and botulinum neurotoxin–containing species of Clostridium are subject to the select agent regulations (42 CFR Part 73).

†Symptoms of botulism include blurred vision, diplopia (double vision), dizziness, slurred speech, thick-feeling tongue, change in sound of voice, hoarseness, dry mouth, and dysphagia (difficulty swallowing). Signs of botulism include extraocular palsy (paralysis of eye muscles), ptosis, sluggishly reactive pupils, facial paralysis, palatal weakness, impaired gag reflex, musculoskeletal weakness or paralysis, and objective evidence of declining respiratory function.

Handwashing is never enough: Rise in infections tied to animal encounters in Kentucky

Northern Kentucky health officials are urging residents to wash their hands if they encounter animals at county fairs after seeing a surge in intestinal infections in the region.

goat.petting.zooThe Northern Kentucky Health Department has received reports of E. coli, campylobacteriosis and Salmonella in local residents in recent weeks.

Of the three illnesses, the Ccmpylobacteriosis infection, causing diarrhea, abdominal pain, nausea and fever, is the most prevalent. Thirty-five cases have been reported from January through the third week of July this year. That compares with 18 cases in the first seven months of 2014, health department records show.

Seven salmonella cases have been reported to the health department in both the first and second quarters of 2015, and fewer than five E. coli cases were reported in each quarter, according to health department records. The department is not seeing increases in the two illnesses but is advising hand-washing to prevent all three diseases, because it’s the best way to prevent getting sick.

Many of the recent cases in the region are still under investigation, said Kelly Giesbrecht, a regional epidemiologist for the health department. “However, animal exposure seems to be common” so far among those who’ve contracted the illnesses.

About half of those with the illnesses are children, she said.

Health officials have seen the diseases associated with several types of animals, Giesbrecht said. Among them: cows, calves, goats, reptiles, chickens, ducks and puppies.

“Areas around the animals can become contaminated as well, so it’s important to keep those as clean as possible, and wash hands if coming into contact with surfaces,” Giesbrecht said

petting1-791x1024petting2-791x1024

Cyclospora: Mexican cilantro contamination spurs partial U.S. import ban

I try to grow my own cilantro, but the birds and cats and skinks find it yummy.

So there’s not much left.

cilantro.slugs.powell.10And this is why I’m not a farmer.

As the Cyclospora count in Texas reached 203, some Mexican cilantro is being banned in the U.S. after health officials found human feces and toilet paper in growing fields from which herbs have been linked to hundreds of intestinal illnesses among Americans dating back to 2012.d

The Food and Drug Administration will detain Mexican cilantro at the border from April to August and won’t allow products from the state of Puebla, Mexico, into the U.S. without inspections and certification, according to an import ban dated Monday by the agency. Cilantro from other parts of Mexico will need documentation to prove the product isn’t from Puebla, about a two-hour drive southeast of Mexico City.

The cilantro is linked to outbreaks of cyclosporiasis, according to the alert. Last year, at

Since 2013, the FDA and Mexican authorities have inspected 11 farms and packing houses that produce cilantro from Puebla. At eight, health officials found bathrooms without soap, toilet paper or running water, in addition to the human feces and toilet paper in growing fields. Some had a complete lack of toilet facilities.

“Based on those joint investigations, FDA considers that the most likely routes of contamination of fresh cilantro are contact with the parasite shed from the intestinal tract of humans affecting the growing fields, harvesting, processing or packing activities or contamination with the parasite through contaminated irrigation water, contaminated crop protectant sprays, or contaminated wash waters,” the alert said.

A 2013 cyclosporiasis outbreak in 25 states was linked to Puebla cilantro as well as salad mix from Taylor Farms de Mexico that was sold to Olive Garden and Red Lobster, both then owned by Darden Restaurants Inc. The FDA and Mexican officials found conditions at Taylor Farms de Mexico in Guanajuato met food safety protocols, the FDA said.

Botulism in canned tomatoes in Russia

Botulinum toxin F was found in industrially canned tomatoes linked to a case of botulism. It was registered in the republic of Mariy El, the branch of Rospotrebnadzor reported (Federal agency for protection of consumer rights and human wellbeing).

PomidorkaThe man had eaten tomatoes “Pomidorka” produced by LLC “Agro-Invest” (Kabardino-Balkaria) series 055N 5 N from 17/09/14. The staff of the Rospotrebnadzor have withdrawn this product from the store “Pyaterochka.”

Mycobacterium marinum cluster linked to handling shrimp in Canada

Health officials with the Haliburton, Kawartha, Pine Ridge District Health Unit (HKPR) continues their investigation into a cluster of six cases of an unusual skin infection that appears to be associated with handling raw shrimp in the Campbellford area.

aquaculture-shrimp-matters-shutterstock_87364793Preliminary lab reports suggest the infections are caused by the slow growing bacterium, Mycobacterium marinum.

The HKPR District Health Unit has investigated five of six cases of the infection with people from the Campbellford area, and all seem to be associated with handling shrimp grown at a local shrimp farm.

Health officials did not name the shrimp farm in question.

Students in Philippines food poisoning incident released from hospital

Some of the students downed by a food poisoning incident in Calamba, Laguna on Friday have been discharged from the hospital, “News TV Live” reported Saturday.

cupckakesAt least 400 pupils from Real Elementary School on Friday fell ill after eating cupcakes and ice candy served after a story-telling activity.

The event was organized by the Haribon Foundation and sponsored by AMS Electronic Corporation, which also provided the food given to the students.

After eating the snacks, the victims experienced dizziness, stomach ache, and were vomiting.

Samples of the cupcakes and ice candy have already been sent to the Food and Drug Administration for toxicology testing.

2 sick from crypto linked to raw milk in Tenn

The Tennessee Department of Health is investigating multiple cases of residents who fell ill from consuming raw milk.

colbert.raw.milkThe health department launched the investigation after confirming two Chattanooga-area cases of cryptosporidiosis, a gastrointestinal disease from a parasite that lurks in contaminated water or unpasteurized milk. Both cases are linked to a dairy cow share program, which the state legalized in 2009, allowing greater access to raw milk.

“Consuming raw milk in the belief it’s healthier than pasteurized milk is a perilous risk that shakes off the possibility of a range of serious and occasionally fatal illnesses for the individuals and anyone they share it with,” John Dreyzehne, TDH commissioner, said in a news release. “Our best choice for healthy, nutritious milk is the pasteurized kind. Even if one believes there are health benefits, an upside, is it worth gambling on the downside risk of a serious illness, especially in a child?”

Since the state legalized cow share programs, reports have increased of disease and outbreaks linked to raw milk consumption. In 2013, nine Tennessee children became extremely sick with E. coli after drinking raw milk. Five of those required hospitalization and three developed severe, life-threatening kidney problems.

100 workers sickened in Vietnam: Having a food safety conference doesn’t help

Nearly 100 workers of a footwear company in HCM City’s Thu Duc District were rushed to hospitals on Wednesday evening allegedly for food poisoning.

vietnam.ngo_docThe workers reportedly suffered from stomach ache, vomiting and diarrhea after having dinner before the late shift.

Nguyen Thanh Binh, a doctor at the Emergency Department of Thu Duc District Hospital said that the workers displayed symptoms of food poisoning.

This food poisoning case occurred just a day before a conference in northern Thai Nguyen Province on food safety at collective canteens organised by the health ministry.

Deputy Health Minister Nguyen Thanh Long told the conference that more than 1,000 workers have been hospitalised for food poisoning after having meals at collective canteens in industrial zones and export processing zones each year.