104 sickened: increase in Vibrio parahaemolyticus infections associated with consumption of Atlantic coast shellfish — 2013

I don’t eat raw oysters. This is why.

The U.S. Centers for Disease Control reports Vibrio parahaemolyticus (Vp) is found naturally in coastal saltwater. In the United States, Vp causes an estimated 35,000 domestically acquired foodborne infections annually (1), of which most are attributable to consumption of raw or undercooked shellfish. Illness typically consists of mild to moderate Raw oystersgastroenteritis, although severe infection can occur. Demographic, clinical, and exposure information (including traceback information on implicated seafood) for all laboratory-confirmed illnesses are reported by state health departments to CDC through the Cholera and Other Vibrio Surveillance system. Vp isolates are distinguished by serotyping (>90 serotypes have been described) and by pulsed-field gel electrophoresis (PFGE).

Vp serotypes O4:K12 and O4:K(unknown) comprise the Pacific Northwest (PNW) strain and, within the United States, had not been associated with shellfish outside the Pacific Northwest before 2012. During May–July 2012, Vp of the PNW strain associated with shellfish from Oyster Bay Harbor in New York caused an outbreak of 28 illnesses in nine states. Simultaneously, Vp of the PNW strain caused an outbreak of illnesses on a cruise ship docked on the Atlantic Coast of Spain; illness was associated with cooked seafood cooled with ice made from untreated local seawater. All Vp isolates from ill persons in the U.S. and Spanish outbreaks that were further subtyped were indistinguishable by PFGE (2).

In 2013, this same indistinguishable strain was traced from shellfish consumed by ill persons to a larger area of the U.S. Atlantic Coast, causing illness in 104 persons from 13 states during May–September (Figure). The median age of patients was 51 years (range = 22–85 years); 62% were male. Six (6%) patients were hospitalized; none died. Multiple outbreaks appeared to be occurring, accounting for many of these illnesses. Illness was associated with consumption of raw shellfish and seafood traceback was reported for 59 (57%) illnesses. Of these illnesses, 51 (86%) involved seafood that could be definitively traced to a single harvest area. The implicated harvest areas were located in Connecticut (20 illnesses), Massachusetts (15), New York (10), Virginia (four), Maine (one), and Washington (one). The remaining eight illnesses with traceback information involved seafood that could not be definitively traced to a single harvest area (locations reported included harvest areas of the Atlantic Coast of the United States and Canada). In response to the illnesses, four Atlantic Coast states closed implicated harvest areas; two issued shellfish recalls (3). The number of foodborne Vp cases in the United States traced to Atlantic Coast shellfish was threefold greater in 2012 and 2013 compared with the annual average number reported during 2007–2011.

This PNW strain is possibly becoming endemic in an expanding area of the Atlantic Ocean. The mechanisms for this introduction are not known. During the 2014 Vibrio season, beginning in the spring, clinicians, health departments, and fisheries departments should be prepared for the possibility of shellfish-associated diarrheal illness caused by this strain SUN0705N-Oyster7again. Appropriate actions, such as quick closure of implicated harvest areas, will help prevent additional illnesses. The Interstate Shellfish Sanitation Conference maintains a list of shellfish harvest area closures and recalls.* Clinicians seeking an etiology of diarrhea in a patient who has recently consumed raw or undercooked shellfish should notify the microbiology laboratory that Vp is suspected; the use of special culture media (thiosulfate citrate bile salts sucrose) facilitates identification of Vibrio species. Consumers can reduce their risk for Vp infection by avoiding eating raw or undercooked shellfish, especially oysters and clams.†

References

Scallan E, Hoekstra RM, Angulo FJ, et al. Foodborne illness acquired in the United States—major pathogens. Emerg Infect Dis 2011;17:7–15.

Martinez-Urtaza J, Baker-Austin C, Jones JL, Newton AE, Gonzalez-Aviles GD, DePaola A. Spread of Pacific Northwest Vibrio parahaemolyticus strain. N Engl J Med 2013;369:1573–4.

CDC. Increase in Vibrio parahaemolyticus illnesses associated with consumption of shellfish from several Atlantic coast harvest areas, United States, 2013. Atlanta, GA: US Department of Health and Human Services, CDC; 2013. Available at http://www.cdc.gov/vibrio/investigations/index.html.

* Available at http://www.issc.org/closuresreopenings.aspx.

† Additional information available at http://www.cdc.gov/vibrio/investigations/vibriop-09-13/advice-consumers.html.

 CDC MMWR 63(15);335-336

Anna E. Newton, Nancy Garrett, Steven G. Stroika, Jessica L. Halpin, Maryann Turnsek, Rajal K. Mody

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6315a6.htm?s_cid=mm6315a6_e

27 sick with Yersinia and Campylobacter from raw milk in Finland

The first results from milk samples at a farm in Askola, Finland taken April 7 revealed Yersinia pseudotuberculosis and Campylobacter jejuni.

The number of people who drank milk from Uljaan tilamaito and experienced symptoms has still increased in Porvoo and in the neighboring municipalities (Askola, Lovisa, Borgnäs colbert.raw.milkand Sipoo). There are now 19 confirmed cases of Yersinia. Campylobakterier have so far been isolated from a total of eight people. Investigations are still ongoing for about twenty people.

Uljaan tilamaito pulled away all unpasteurized milk from the shops in early April.

What’s wrong with Australian recall notices: Sprout Garden alfalfa and onion sprouts

The food safety recall notices issued by Food Standards Agency – Australia/New Zealand don’t say much.

Below is the notice but what I’d want to know is: what kind of E. coli; how was it found; is anyone sick; should people eat raw sprouts?

AlfaOnionFrontToo much for the communication geniuses on taxpayer salaries.

Belmore Bean Factory Pty Ltd has recalled Sprout Garden Alfalfa and Onion Sprouts from the Sydney Markets (Flemington) and fruit and vegetable stores in NSW due to E.coli contamination. Food products contaminated with E.coli may cause illness if consumed. Consumers should not eat this product and should return it to the place of purchase for a full refund. Any consumers concerned about their health should seek medical advice. 

Is there a better name for cross-contamination: kitchen cutting boards remain a source of multidrug-resistant bacteria after use

After handling raw poultry, hands of food preparers and cutting boards remain a source of transmission for multi-drug resistant bacteria, such as E. coli that produce extended-spectrum beta-lactamases (ESBLs). The study of household and hospital kitchens was published in the May issue of the journal Infection Control and Hospital Epidemiology.

Dan Aykroyd Plays Julia Child“The spread of multidrug-resistant bacteria has been associated with the hospital setting, but these findings suggest that transmission of drug-resistant E. coli occurs both in the hospital and households,” says Andreas Widmer, MD, lead author of the study. “Our findings emphasize the importance of hand hygiene, not only after handling raw poultry, but also after contact with cutting boards used in poultry preparation.”

Researchers from University Hospital in Basel, Switzerland collected and examined 298 cutting boards (154 from University Hospital and 144 from private households) after preparation of various meats (i.e., poultry, beef/veal, pork, lamb, game and fish) and before being cleaned. They also collected 20 pairs of gloves from hospital kitchen employees after they handled raw poultry. These samples were tested for the presence of ESBL-producing Enterobacteriaceae, a family of gram-negative bacteria that includes Salmonella, E. coli and Klebsiella.

In testing the cutting boards, researchers found that 6.5 percent of hospital cutting boards used in preparation of poultry were contaminated with ESBL-producing E. coli. For boards used in households, researchers found ESBL-producing E. coli cutting.board.chicken.nov.13on 3.5 percent of these surfaces. They also found that 50 percent of the hospital kitchen gloves were contaminated with this drug-resistant E. coli.

The researchers found that none of the cutting boards used in preparing beef/veal, pork, lamb, game or fish were contaminated with any ESBL-producing bacteria. They also found that the meat’s country of origin did not play a factor in the presence of bacteria on any of the surfaces.

Reference: Sarah Tschudin-Sutter, Reno Frei, Roger Stephan, Herbert Hächler, Danica Nogarth and Andreas F. Widmer. “Extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae – a threat from the kitchen.” Infection Control and Hospital Epidemiology [35:5] (May 2014).

Source: Society for Healthcare Epidemiology of America (SHEA) 

Farm management, hygiene, weather all affect E. coli rates in spinach

The likelihood that a crop of leafy greens will be contaminated by E. coli, an indicator of fecal contamination, before harvest is strongly influenced by both farm management and environmental factors, according to a study spotlighted on the cover of the new issue of the journal Applied and Environmental Microbiology.

The work, led by Dr. Renata Ivanek and her lab in the Department of Veterinary Integrative Biosciences (VIBS) at the Texas A&M College of Veterinary Medicine & spinachBiomedical Sciences (CVM), was a collaborative effort between researchers at Texas A&M University, Colorado State University, Texas Tech University, and Texas A&M AgriLife Extension Service.

In this study, the research team cross-referenced environmental data with information from participating farms in multiple test areas. Then, the team determined how three groups of factors—farm management, location, and weather—affect spinach contamination with E. coli. The team studied spinach samples from 12 farms in Colorado and Texas and compared variables including the local temperature, precipitation, wind speed, soil characteristics, proximity to roads and water bodies, and such farm management practices as the farm workers’ hygiene and manure application practices.

Overall, the study found that farm management, location, and weather factors should be considered jointly in developing agricultural methods and interventions that reduce the threat of E. coli contamination at the pre-harvest level. The odds of spinach contamination decreased to approximately 1 in 17 with implementation of good hygiene practices for farm workers, but they increased to approximately 4 in 1 for every millimeter increase in the average amount of rain in the month before harvest. Furthermore, applying manure fertilizer on the field increased the odds of contamination to approximately 52 in 1.

“Hygiene practices and fertilizers used are relatively easy to change,” Ivanek said. “The challenge, however, will be to use the information about how rainfall affects produce safety into an intervention, or plan, that growers could implement on a daily basis.”

WTF? New Zealand dairy cleared to sell raw milk after Campylobacter outbreak, two kids get E. coli from different NZ raw milk

As Village Milk Timaru in New Zealand begins selling raw milk after being linked to seven Campylobacter illnesses, at least two Timaru pupils have contracted E. coli following school trips, with raw milk being a possible cause.

colbert.raw.milkWho serves raw milk to schoolkids? They don’t have the choice adults do.

South Canterbury medical officer of health Dr Daniel Williams said, “All the children that have been sick have drunk raw milk, but it has not been confirmed what caused the illnesses yet.”

The pupils did not visit the Timaru farm of Stuart and Andrea Weir, which has been at the center of an ongoing Campylobacter investigation.

“We have had a clean run of at least five consecutive days. That gives us enough confidence to resume our operations in Timaru,” chief executive Mark Houston said.

“We don’t want to speculate or point fingers. We understand South Canterbury is a bit of a haven for Campylobacter.” 

Kids don’t get to choose: more illness with more raw milk in US

An alliance of food activists and anti-regulation libertarians is battling to legalize raw, unpasteurized milk, despite warnings from health officials about the rising toll of illnesses affecting adults and children alike.

Kimberly Kindy of The Washington Post writes that as the popularity of raw milk has grown, so too have associated outbreaks. They have nearly colbert.raw.milkdoubled over the past five years, with eight out of 10 cases occurring in states that have legalized sales of the unpasteurized product, according to Centers for Disease Control and Prevention data. Public health officials have also documented how pathogens in raw milk have produced kidney failure in more than a dozen cases and paralysis in at least two.

The CDC, which analyzed more than a decade of outbreak data, said the chance of getting sick as part of an outbreak caused by raw milk is 150 times greater than from pasteurized milk. The agency reported that 796 people in 24 states had become sick after consuming raw milk between 2006 and 2011, the latest years for which complete data are available.

CDC and FDA officials say 55 percent of the victims are younger than 18 and got the beverage from a parent or guardian.

Europe assesses the risk of Salmonella and Norovirus in leafy greens

Rainfall, use of contaminated water for irrigation or contaminated equipment are among the factors that cause contamination of leafy greens with Salmonella and Norovirus. These are some of the findings of EFSA’s latest opinion on risk factors that contribute to the contamination of leafy greens at different stages of the food chain. The BIOHAZ Panel has lettuce.skull.e.coli.O145recommended that producers use good agricultural, hygiene and manufacturing practices to reduce contamination. The Panel has also proposed specific microbiological criteria at primary production.

Leafy greens eaten raw as salads are minimally processed and widely consumed foods. Risk factors for leafy greens contamination by Salmonella spp. and Norovirus were considered in the context of the whole food chain including agricultural production and processing. Available estimates of the prevalence of these pathogens (together with the use of Escherichia coli as an indicator organism) in leafy greens were evaluated. Specific mitigation options relating to contamination of leafy greens were considered and qualitatively assessed. It was concluded that each farm environment represents a unique combination of numerous characteristics that can influence occurrence and persistence of pathogens in leafy greens production. Appropriate implementation of food safety management systems, including Good Agricultural Practices (GAP), Good Hygiene Practices (GHP) and Good Manufacturing Practices (GMP), should be primary objectives of leafy green producers. The relevance of microbiological criteria applicable to production, processing and at retail/catering were considered. The current legal framework does not include microbiological criteria applicable at primary production which will validate and verify GAP and GHP. It is proposed to define a criterion at primary production of leafy greens which is designated as Hygiene Criterion, and E. coli was identified as suitable for this purpose.

A Process Hygiene Criterion for E. coli in leafy green packaging plants or fresh cutting plants was considered and will also give an indication of the degree to which GAP, GHP, GMP or HACCP programs have been implemented. A Food Safety Criterion for Salmonella in leafy greens could be used as a tool to communicate to producers and processors that Salmonella should not be present in the product. Studies on the prevalence and infectivity of Norovirus are limited, and quantitative data on viral load are scarce making establishment of microbiological criteria for Norovirus on leafy greens difficult.

Over 100 sickened; Salmonella linked to unlabeled Mexican-style cheese in Illinois

The Illinois Department of Public Health issued a warning Thursday, saying 100 people have contracted Salmonella linked to illegally manufactured Mexican-style cheeses.

Health departments in Cook, DuPage, Boone, Fayette, Kane, Lake, LaSalle, Macon, Marion, McHenry, Vermillion, Washington and Will counties have reported about 100 mexican.style.cheesecases of Salmonella believed to be associated with the cheese since July 2012, according to a statement from the department.

IDPH is working to identify the manufacturer of the contaminated cheese, according to the department.

Many cases have reported consuming Mexican-style cheese obtained from worksites, including factories, and at train stations, from street vendors and from relatives and friends, the department said. The cheese is not labeled and is often wrapped in aluminum foil.

‘Tip of iceburg’ 7 sick from Campylobacter linked to NZ raw milk

A recent outbreak of Campylobacter in Timaru, New Zealand, has been blamed on raw milk.

Seven people have been confirmed as having Campylobacter after purchasing raw milk from a farm on the outskirts of Timaru.

South Canterbury Medical Officer of Health Dr Daniel Williams believes the seven cases colbert.raw.milkare the tip the iceberg.

”Drinking raw milk is risky for your health. It can contain disease-causing bacteria and other organisms which can lead to gastroenteritis and other illnesses, some of which can be life-threatening,” Dr Williams said.

Dr Williams said even drinking raw milk from suppliers with the highest hygiene and safety standards can be dangerous as any raw cow milk can contain bugs.

New Zealand legislation allows producers to sell up to five litres of raw milk daily at the farm gate to buyers who purchase it for themselves or their family.