Infant Botulism Caused by Clostridium baratii Type F — Iowa, 2013

The U.S. Centers for Disease Control reports that in June 2013, a male newborn aged 9 days (delivered after a full-term pregnancy) was brought to a hospital emergency department with a 2-day history of constipation, fussiness, and poor feeding.

drooling-babyThe mother reported her son’s symptoms as excessive crying, reluctance to suck, and difficulty in swallowing milk. Within hours of arrival, the infant became less responsive and “floppy,” and was intubated for respiratory failure. Infant botulism was suspected and Botulism Immune Globulin Intravenous (Human) (BIG-IV), licensed for the treatment of infant botulism types A and B, was administered on hospital day 2. Results of preliminary stool studies were reported positive for botulinum toxin type F on hospital day 3. Clostridium baratii type F was subsequently isolated in stool culture.

National experience with type F botulism in newborns and infants indicates that rapid clinical improvement could occur even without the administration of anti-type F antitoxin. However, 3 days after treatment with BIG-IV the newborn continued to require ventilator support and showed no signs of clinical improvement. On hospital day 6, equine-derived botulism antitoxin heptavalent (A-G) (BAT) was administered to the boy, despite the limited experience reported for its use in pediatric cases. This is the second newborn treated with BAT in the United States; the first was treated in 2008 in Colorado (1).

Within 24 hours of BAT treatment, spontaneous movements of the newborn’s extremities increased. On hospital day 8 the endotracheal tube was removed. By the following day, the boy could tolerate oral feedings, had regained muscle tone and strength in his extremities, and had normal pupillary responses. The only adverse event associated with BAT treatment was an intermittent, low-grade fever that developed within 1 hour of BAT administration and lasted 72 hours. Blood, urine, stool, and cerebrospinal fluid bacterial cultures were otherwise negative. Contrast magnetic resonance imaging of his brain showed normal findings, and cerebrospinal fluid studies for herpes simplex virus and enterovirus also were negative. The newborn was discharged on hospital day 12. At the 2-week follow-up examination, his mother reported he was doing well: taking 100% of his feedings orally, exhibiting no residual weakness, and having normal bowel movements.

The parents reported feeding the newborn ready-to-feed and powdered formula from the same brand. No other solid or liquid foods or homeopathic remedies or supplements were given before symptom onset. No classic risk factors for infant botulism were reported, such as exposure to honey or soil. The parents reported strong winds and minor construction in the area surrounding their home. Pets present in the home included cats, turtles, fish, geckos, sugar gliders, and a mouse.

Environmental samples were collected from 1) feces from all animals in the home, 2) food and water from the turtle enclosure, 3) dust from the vacuum cleaner bag and the windowsill and ceiling fan closest to where the child slept, and 4) potting soil from the only indoor plant in the home. Although Clostridium species were isolated in several of the samples, none produced botulinum toxin.

Through 2012, only 13 cases of C. baratii type F infant botulism have been reported in the United States; this is the third confirmed case in Iowa. Extensive investigations for an environmental source of toxigenic C. baratii have been undertaken, including for all three cases in Iowa (2). Unlike typical infant botulism caused by C. botulinum (3), no source has been identified and prevention strategies remain unknown for C. baratii. While C. baratii infant botulism remains a rarely diagnosed disease, health care providers should maintain a high index of suspicion especially in very young infants who present with new onset floppiness or progressive respiratory failure.

Acknowledgment

Minnesota Department of Health Epidemiology and Public Health Laboratory.

1Division of Infectious Diseases, Department of Pediatrics, Blank Children’s Hospital, Des Moines, Iowa, 2Division of Acute Disease Prevention, Emergency Response, and Environmental Health, Iowa Department of Public Health, 3Infant Botulism Treatment and Prevention Program, California Department of Public Health (Corresponding author: Amaran Moodley, amaran.moodley@unitypoint.org, 515-241-8300)

References

Al-Sayyed B. A 3-day-old boy with acute flaccid paralysis. Pediatr Ann 2009;38:479–82.

Barash JR, Tang TWH, Arnon SS. First case of infant botulism caused by Clostridium baratii type F in California. J Clin Microbiol 2005;43:4280–2.

CDC. Botulism. Atlanta, GA: US Department of Health and Human Services, CDC; 2014. Available at http://www.cdc.gov/nczved/divisions/dfbmd/diseases/botulism/.

Me being a good Australian citizen: Queensland Health should make investigations into food poisoning outbreaks public

In The (Brisbane) Courier-Mail this morning:

In 2013, at least 50 people, mainly children, became ill with E coli O157 at the Ekka.

claudia.e.coli.petting.zoo.may.14Follow-up in the form of a publicly released formal report following an investigation? Nothing.

Queensland Health has been warned repeatedly about Q fever outbreaks at the Ekka related to the birthing of goats. Again, follow-up? Nothing.

In 2013, at least 130 people, including 55 nursing home patients, were stricken by norovirus in Ipswich and on the Sunshine Coast. Follow-up? Nothing.

In November 2013, at least 220 people were felled by salmonella and one was killed at Melbourne Cup functions, all linked to raw egg-based dishes served by Piccalilli Catering. Follow-up? Nothing. I even wrote to then health minister Lawrence Springborg and received no response. I guess he was busy with Parliament.

In January this year, at least 130 diners were stricken with salmonella after dining at Brisbane’s Chin Chin Chinese Restaurant. Dozens were hospitalised. Follow-up? Nothing.

Last month, 250 teachers contracted salmonella at a conference and an additional 20 people were sickened on the Gold Coast from the same egg supplier. Follow-up? Nothing. Though, to be fair, Councillor Krista Adams, Brisbane City Council Lifestyle Committee chairwoman, was on ABC radio on Monday saying the Queensland Health investigation into the matter was ongoing.

As a food safety professor in Canada and the US who relocated to Brisbane four years ago to support my French professor wife, I look at these outbreaks and wonder: what does Queensland Health do? What does Safe Food Queensland do? I believe in science, however fallible it may be, and my church is the (ice) hockey arena.

I also believe in public disclosure, especially because these investigations are conducted on the Queensland tax dollar. These are hopelessly ineffective agencies, and I’ve seen a lot of agencies, but these are the worst, especially in terms of public disclosure. Not the people, but the structure and confines in which they work for a pay cheque.

Now we’re told that hundreds of Brisbane restaurants, cafes, bakeries and caterers operate below legal safety standards.

Brisbane City Council says it is waging war on shoddy operators in light of a jump in food poisoning outbreaks.

That’s a war of attrition.

sorenne.hockeyaug.14Instead, Brisbane, and Queensland, could make a few changes to hold the food purveyors accountable.

Mandate training; make restaurant inspection disclosures mandatory, rather than voluntary; and create a culture that values microbiologically safe food.

I was coaching an ice hockey game on the Gold Coast on the weekend and the restaurant we went to afterwards was advertising a petting zoo, at the restaurant.

This is a microbiologically horrible idea. Same with zoos at schools and in malls, such as the one at Fairfield.

Queensland is on track to record its worst year on record for salmonellosis, which has infected more than 2500 people, mostly in the southeast, since the start of the year. The state is also recording spikes in other gastrointestinal illness cases, such as campylobacter (1993), cryptosporidiosis (604) and yersiniosis (180).

Data from the council’s Eat Safe star-rating system shows almost 10 per cent of Brisbane’s 6000-plus food operators operate below legal safety standards.

Queensland taxpayers deserve answers to some basic questions about all of the aforementioned outbreaks: How did the outbreak occur? Was this commodity sourced from a food safety-accredited supplier? Did handling by the caterer contribute to this outbreak? What is Queensland Health’s policy on use of raw eggs in dishes to be consumed raw? Is this policy enforced? Is the investigation closed and, if so, why and when was it closed? Will an outbreak investigation report be created and publicised? Why was the previous update erased from the department’s website and on whose authority? What is its policy on making information public?

This isn’t CSI, with its groovy UV lights that make great television but lousy science. Publicly release all surveillance data on raw eggs in Queensland (or Australia), publicly release the menu items at the Brisbane Convention Centre and Grocer & Grind, on the Gold Coast, where two of their own chefs got sick, and tell chefs to stop using raw eggs in dishes they must craft from scratch, such as aioli or mayonnaise. This is nothing new and we have been documenting the problem for years because it is a global food safety embarrassment. The solutions are there. It’s time for leadership.

Dr Douglas Powell is a former professor of food safety in Canada and the US who shops, cooks and ferments from his home in Brisbane, Australia

Listeria in raw milk, again

Public health types got other things to do than police the raw milk biz, especially when there is an alternative – pasteurization.

raw.milk.claravale (1)New York State Agriculture Commissioner Richard A. Ball today warned consumers in Sullivan County and the surrounding area not to consume unpasteurized raw farm milk from the Richard Dirie Farm due to possible Listeria contamination.  The Dirie Farm is located at 1345 Shandelee Road, Livingston Manor, New York, 12758.

A sample of the milk, collected by an inspector from the department’s Division of Milk Control and Dairy Services on April 7, 2015 was subsequently tested by the Department’s Food Laboratory and discovered to be contaminated with Listeria monocytogenes.     

On April 9, 2015, the producer was notified of a preliminary positive test result. He volunteered to suspend raw milk sales until the sample results were confirmed.  Further laboratory testing, completed on April 15, 2015, confirmed the presence of Listeria monocytogenes in the raw milk sample.  The producer is now prohibited from selling raw milk until subsequent sampling indicates that the product is free of harmful bacteria.

To date, the department knows of no illnesses associated with this product.

Illegal Chinese meat imports in Holland

Police and food safety inspectors have raided two business premises and two private homes in Zuid-Holland province in an investigation into illegal meat imports from China.

la-fi-mo-china-cofco-20140228-001There has been an EU-wide ban on importing most types of meat from China for human consumption since 2002 because of concerns about drug residues. Officials seized ‘hundreds of boxes’ of meat and meat products during their search, as well as documents and files. The meat is now being tested, the inspectors said in a statement on Wednesday. The investigators are also trying to establish how the meat was brought into the country and what has happened to previous shipments.

145 sickened: 80 victims compensated over E. coli outbreak in Ireland

Belfast Crown Court heard on Wednesday that compensation was paid to around 80 people by Moviehouse Cinema Limited – the parent company of the former Flicks restaurant at the Cityside complex, which was voluntary closed two days after the second outbreak emerged.

flicks.belfastThe payments ranged from £3,000 to £12,000.

Moviehouse Cinema Limited, which was represented in court by its managing director Michael McAdam, admitted a total of 11 separate food hygiene offences.

They included failing to ensure that food handlers were supervised and instructed, failing to ensure that staff toilets were kept clean, and keeping food at a temperature which was likely to support the growth of pathogenic micro-organisms or the formulation of toxins.

The court heard that Flicks Restaurant was at the centre of two outbreaks of E. coli in 2012 – one in August which affected four people and a second outbreak detected in October where there were 141 confirmed cases.

12 sick: E. coli leafy greens cone of silence, again

The Public Health Agency of Canada is collaborating with federal and provincial public health partners to investigate an outbreak of Escherichia coli O157:H7, commonly called E.coli, with a possible link to leafy greens. A specific product has not been identified yet, and the investigation is ongoing.

lettuce.skull.e.coli.O145At this time, the risk to Canadians is low. However, Canadians are reminded to follow safe food handling practices to avoid illness. (WTF are Canadians supposed to do with leafy greens?)

There have been 12 cases of E. coli with a matching genetic fingerprint reported in Alberta (9), Saskatchewan (1), Ontario (1), and Newfoundland and Labrador (1). The illness onset dates range from March 13 to March 31, 2015.

Based on the investigation findings to date, exposure to leafy greens has emerged as a possible source of illness. Leafy greens can include all varieties of lettuces and other green leaf vegetables such as kale, spinach, arugula, or chard. The Canadian Food Inspection Agency’s investigation into the food source is ongoing. If products are identified, the Agency will inform the public and ensure that they are promptly removed from the marketplace.

The following tips will help you reduce your risk of infection with E. coli or other food-borne illnesses:

Wash fresh fruits and vegetables before eating them, clean counters and cutting boards and wash your hands regularly.

Bullshit. Packaged leafy greens are not to be re-washed.

Australian taxpayers and growers are led up a garden path

(I and others applied for this, but knew it was an inside job. Here is the take from Australian Food News)

lettuce.skull.e.coli.O145The Fresh Produce Safety Centre (FPSC), which is an organisation established with government and industry support in 2013, has announced the winning tender bid for the conduct of a literature review of fresh produce safety research.

The announcement has produced some skepticism from commentators about the whole bureaucratic process involving the Fresh Produce Safety Centre’s role in improving the current Australian food safety regime for fresh produce.

The principal industry sector group supporting the establishment of the Fresh Produce Safety Centre has been the Produce Marketers Association Australia New Zealand (PMA A-NZ), which is the representative body of importers and international traders of fruit and vegetables.

The major supermarkets and food safety audit organisations already follow and monitor their own very strict food safety protocols at all points in the supply chain. Commentators are therefore asking why it ought be necessary for the FPSC to be ‘reinventing the wheel’.

Incidentally, the winning tender bid is a team consisting of TQA Australia Inc, RMCG, and the Institute of Environmental Science and Research in New Zealand, in concert with the Food Safety Centre at the University of Tasmania. The project has the support of the NSW Food Authority, Pip Fruit New Zealand, Golden State Foods and Snap Fresh Foods, and Fresh Select.

In 2009-2010, a process had been initiated by Food Standards Australia New Zealand (FSANZ) to incorporate food safety primary production and processing standards for horticultural produce into the Australia New Zealand Food Standards Code (Food Standards Code). However, the PMA and some of the major produce importers opposed the inclusion in the Food Standards Code of a set of food safety standards for their industry sector. Ultimately, the Federal Government relented and the FSANZ process for developing a new mandatory food safety standard was aborted.

The reasons given at the time for the abandonment of the proposals included: the fact that the majority of horticulture product grown in Australia is already grown under a food safety scheme, and that a better understanding of those products that were not grown under a food safety scheme was required before further regulation should be considered.

FSANZ proposed a collaboration between the horticulture industry and government – with suggested measures such as “targeted guidance, codes of practice, education materials and training” and better through-chain traceability measures.

The PMA took the initiative to establish the concept of a ‘fresh produce safety centre’ with government and industry backing.

Some commentators are now consider the whole process a ‘waste of time and industry resources, and taxpayer funds’, especially for growers, supermarkets and other operators in the horticultural supply chain within Australia.

Meat (and science) mythologies

My latest for Texas A&M’s Center for Food Safety:

HomePage_Soliloquy_powellsworld_aprilOn September 11, 1998, the journal Science published a paper by Cornell and U.S. Department of Agriculture science-thingies that concluded the key to reducing E. coli O157 in cattle was to feed them hay instead of grain beginning five days before slaughter.

The PR writers and journalists had a hay day, saying “a simple change in cattle diets in the days before slaughter may reduce the risk of E. coli infections in humans” or this N.Y.Times headline, “E. coli bacteria can be eliminated from cattle, researchers find.”

Food safety isn’t that simple.

Science isn’t that simple.

Michael Osterholm, director of the Center for Infectious Disease Research and Policy and professor in the School of Public Health at the University of Minnesota wrote in 2007 that the frequently cited Cornell study, was “based on a study of three cows rotated on different diets and for which the researchers did not even test for E. coli O157:H7. Unfortunately, the authors extrapolated these incredibly sparse results to the entire cattle industry.”

In 1998, I helped Dale Hancock of Washington State University anchor an evidence-based response that was also published in Science, but the damage was done.

In the subsequent 17 years, the data on cattle feeding and E. coli risk has been a mess, and open to citation to prove one’s pre-existing viewpoint – that’s why the Internet exists.

As my former Canadian and Kansas colleague David Renter wrote in Sept. 2006,

powell.food.safe.apr.15“Cattle raised on diets of ‘grass, hay and other fibrous forage’ do contain E. coli O157:H7 bacteria in their feces as do other animals including deer, sheep, goats, bison, opossum, raccoons, birds, and many others.

“Cattle diet can affect levels of E. coli O157:H7, but this is a complex issue that has been and continues to be studied by many scientists.  To suggest switching cattle from grain to forage based on a small piece of the scientific evidence is inappropriate and irresponsible.”

Simplistically attacking one facet of livestock production may be politically expedient, but instead provides a false sense of security and ignores the biological realities of E. coli O157:H7. In 1999, for example, 90 children were felled at a fair in London, Ont. The source was a goat at a petting zoo.

Although there have been numerous outbreaks of shiga-toxin producing E. coli involving other ruminants – sheep, deer, goats, elk — the critics and the fashionably fashionable keep going back to cattle, especially feedlot cattle.

The San Francisco Chronicle recently joined the food pornographers at the N.Y. Times, and endless organic propaganda by saying – 17 years after the original, unrepeated study — that grass-fed beef is safer.

There is no evidence to prove this.

There’s some social media amplification going here, just like with the anti-vaxxers and raw milk fans.

I’m not sure how to address all the allegedly scientific nonsense that is out there.

I used to be a proponent of take it head on, but over time, it got tiring. Data has never convinced anyone who didn’t want to be convinced.

Dr. Douglas Powell is a former professor of food safety at the University of Guelph in Canada and Kansas State University in the U.S., who shops, cooks and ferments from his home in Brisbane, Australia.

 

 

It’s gross: fish and chip shop owner fined for sanitation issues

I was explaining to an American friend what a chip butty was this weekend. The oh-so-British delicacy of white bread, butter and french fries all wrapped up into an artery stopping sandwich. The butty was a menu favorite of my grandfather (who introduced me to it when I was a kid) and you could only get one at real pubs (the ones that show Manchester U on Saturday mornings and illegally serve beer before 11) or traditional fish and chip shops.

Like the Nevill Street Chippy in Southport (that’s in England).JS61352288

According to the Liverpool Echo, Chippy owner Kim Paskin was recently fined for breaching local sanitation rules following an inspection.

They found the inside of the microwave that was used to heat up mushy peas and beans to be coated in grime, as well as the can opener being covered in ‘brown grime’ and the top lid of the chest freezer in the potato preparation room to be covered in flour and ‘not sufficiently cleaned or maintained.’JS61351526

Cigarette butts were found on the floor of a food storage area – indicating that people were smoking on the premises – where canned drinks and cans of beans and peas were kept.

The prosecution for Sefton Council noted a ‘tennis-ball sized hole’ in the wall which led out onto the yard, which inspectors said would be an access point for vermin into the kitchen and preparation areas – although there was no evidence to suggest there were any on the premises.

These are all nasty, but only one foodborne illness risk factors showed up:

Inspectors also found insufficient hand washing facilities, with the bottom of the wash basin covered in grime and no soap or hand drying facilities available.

The other stuff fits the yuck factor category, but no handwashing sink/equipment/soap is bad news.

 

 

 

The hands have it: Food safety through handwashing

Handwashing is simple.

handwash_south_park(2)Science says otherwise.

Despite endless statements to just wash hands to be safe — in the kitchen, in food service, at the petting zoo —  little research has been done to quantify what actually works when it comes to handwashing.

U.S. government recommendations for 15-20 seconds of handwashing under vigorously flowing water after a potential contamination event may not be practical in a food service environment.

Dr. Donald Schaffner, a professor of food safety at Rutgers University, and colleagues, have attempted to add some science to the discussion.

“Many people seem to have strongly held opinions about handwashing, says Schaffner, “but the research base for those opinions is lacking. Our research begins to dispels some popular beliefs about handwashing.”

The researchers showed that even a minimal handwash (5 seconds, no soap) can remove about 90 per cent of bacteria on hands.

Further, the research showed that towel drying was much more effective than other methods because of the friction involved in physically removing bacteria from hands.

Schaffner says “Everyone has an opinion about handwashing, but our research is beginning to provide real data to help inform sensible policy.” 

 Contact: Dr. Donald Scaffner

schaffner@aesop.rutgers.edu

732-982-7475

Abstract

Quantifying the effect of hand wash duration, soap use, ground beef debris, and drying methods on the removal of Enterobacter aerogenes on hands

Journal of Food Protection®, Number 4, April 2015, pp. 636-858, pp. 685-690(6)

Jensen, Dane A.;Danyluk, Michelle D.; Harris, Linda J.;Schaffner, Donald W.

http://www.ingentaconnect.com/content/iafp/jfp/2015/00000078/00000004/art00007

Hand washing is recognized as a crucial step in preventing foodborne disease transmission by mitigating cross-contamination among hands, surfaces, and foods.

This research was undertaken to establish the importance of several keys factors (soap, soil, time, and drying method) in reducing microorganisms during hand washing. A nonpathogenic nalidixic acid–resistant Enterobacter aerogenes surrogate for Salmonella was used to assess the efficacy of using soap or no soap for 5 or 20 s on hands with or without ground beef debris and drying with paper towel or air. Each experiment consisted of 20 replicates, each from a different individual with ∼6 log CFU/ml E. aerogenes on their hands. A reduction of 1.0 ± 0.4 and 1.7 ± 0.8 log CFU of E. aerogenes was observed for a 5-s wash with no soap and a 20-s wash with soap, respectively. When there was no debris on the hands, there was no significant difference between washing with and without soap for 20 s (P > 0.05). Likewise, there was no significant difference in the reductions achieved when washing without soap, whether or not debris was on the hands (P > 0.05). A significantly greater reduction (P < 0.05) in E. aerogenes (0.5 log CFU greater reduction) was observed with soap when there was ground beef debris on the hands. The greatest difference (1.1 log CFU greater average reduction) in effectiveness occurred when ground beef debris was on the hands and a 20-s wash with water was compared with a 20-s wash with soap. Significantly greater (P < 0.05) reductions were observed with paper towel drying compared with air (0.5 log CFU greater reductions).

Used paper towels may contain high bacterial levels (>4.0 log CFU per towel) when hands are highly contaminated. Our results support future quantitative microbial risk assessments needed to effectively manage risks of foodborne illness in which food workers’ hands are a primary cause.

 Quantifying the effect of hand wash duration, soap use, ground beef debris, and drying methods on the removal of Enterobacter aerogenes on hands

01.apr.15

Journal of Food Protection®, Number 4, April 2015, pp. 636-858, pp. 685-690(6)

Jensen, Dane A.;Danyluk, Michelle D.; Harris, Linda J.;Schaffner, Donald W.

http://www.ingentaconnect.com/content/iafp/jfp/2015/00000078/00000004/art00007

handwash_infosht-2-7-08 copy (1)