Sprouts still suck; another outbreak sickens at least 115 with Salmonella

The prison warden told Paul Newman’s Cool Hand Luke in the 1967 film that “what we have here is a failure to communicate.”

coolhandlukeIt’s based on an authoritarian model and is the oldest excuse out there; all kinds of problems could be solved if everyone just communicated better, especially scientists and others.

The anti-authoritarian heros of great American movies like One Flew Over the Cuckoo’s Nest, The Blues Brothers and Stripes all found different ways to communicate, in unconventional ways.

The U.S. Centers for Disease Control reports a total of 115 persons infected with the outbreak strains were reported from 12 states. The number of ill people identified in each state was as follows: Connecticut (8), Maine (4), Maryland (6), Massachusetts (36), Montana (1), New Hampshire (6), New York (22), Ohio (3), Pennsylvania (18), Rhode Island (7), Vermont (3), and Virginia (1). The one ill person from Montana traveled to the Eastern United States during the period when exposure likely occurred. Since the last update on December 16, 2014, four additional cases were reported from Maryland (1), Massachusetts (1), New York (1), and Pennsylvania (1).

Illness onset dates ranged from September 30, 2014, to December 15, 2014. Ill persons ranged in age from younger than 1 year to 83 years, with a median age of 32 years. Sixty-four percent of ill persons were female. Among 75 persons with available information, 19 (25%) were hospitalized, and no deaths were reported.

This outbreak appears to be over. However, sprouts are a known source of foodborne illness. CDC recommends that consumers, restaurants, and other retailers always follow food safety practices to avoid illness from eating sprouts.

Erdozain, M.S., Allen, K.J., Morley, K.A. and Powell, D.A. 2012. Failures in sprouts-related risk communication. Food Control. 10.1016/j.foodcont.2012.08.022

http://www.sciencedirect.com/science/article/pii/S0956713512004707?v=s5

Abstract

Nutritional and perceived health benefits have contributed to the increasing popularity of raw sprouted seed products. In the past two decades, sprouted seeds have been a recurring food safety concern, with at least 55 documented foodborne outbreaks affecting more than 15,000 people. A compilation of selected publications was used to yield an analysis of the evolving safety and risk communication related to raw sprouts, including microbiological safety, efforts to improve production practices, and effectiveness of communication prior to, during, and after sprout-related outbreaks.

amy.sprouts.guelph.05Scientific investigation and media coverage of sprout-related outbreaks has led to improved production guidelines and public health enforcement actions, yet continued outbreaks call into question the effectiveness of risk management strategies and producer compliance. Raw sprouts remain a high-risk product and avoidance or thorough cooking are the only ways that consumers can reduce risk; even thorough cooking messages fail to acknowledge the risk of cross-contamination. Risk communication messages have been inconsistent over time with Canadian and U.S. governments finally aligning their messages in the past five years, telling consumers to avoid sprouts. Yet consumer and industry awareness of risk remains low. To minimize health risks linked to the consumption of sprout products, local and national public health agencies, restaurants, retailers and producers need validated, consistent and repeated risk messaging through a variety of sources.

Importance of epi: Outbreak of diarrheal illness caused by Shigella flexneri — American Samoa, May–June 2014

The U.S. Centers for Disease Control reports that on May 9, 2014, a physician at hospital A in American Samoa noticed an abnormally high number of children presenting to the emergency department with bloody diarrhea.

American Samoa.schoolBased on preliminary testing of stool specimens, Entamoeba histolytica infection was suspected as a possible cause. Shigella was also suspected in a subset of samples. On May 22, the American Samoa Department of Health requested assistance from CDC with the outbreak investigation. The goals of the investigation were to establish the presence of an outbreak, characterize its epidemiology and etiology, and recommend control measures. The CDC field team reviewed the emergency department log book for cases of diarrheal illness during April 15–June 13, 2014. During this period, 280 cases of diarrheal illness were recorded, with a peak occurring on May 10. Twice as many cases occurred during this period in 2014 compared with the same period in 2011, the most recent year for which comparable surveillance data were available. Cases were widely distributed across the island. The highest number of cases occurred in children aged 0–9 years. Across age groups, cases were similarly distributed among males and females. These patterns are not consistent with the epidemiology of disease caused by E. histolytica, which tends to cause more cases in males of all ages.

Hypothesis-generating interviews with families of 13 patients did not reveal any common water, food, sewage, or event exposures. Eight participants reported having ill household contacts, with family contacts often becoming ill within 1–3 days after the participant’s illness onset. Six stool specimens were sent to CDC. All were negative for ameba, including E. histolytica, by multiple laboratory methods. All six specimens were also negative for Cryptosporidium and Giardia by a polymerase chain reaction test. However, an invasion plasmid antigen H (ipaH) gene sequence, a genetic marker of Shigella, was identified in four specimens. Additionally, seven Shigella isolates sent to the Hawaii Department of Health and CDC were identified as Shigella flexneri serotype 7 (proposed; also referred to as provisional 88-893 or 1c), and five shared an indistinguishable pulsed-field gel electrophoresis pattern.

american.samoa.peopleShigella causes an estimated 500,000 cases of shigellosis per year in the United States (1). Most persons infected with Shigella develop diarrhea (sometimes bloody), fever, and stomach cramps 1–2 days after they are exposed to the bacteria. The illness usually resolves in 5–7 days. Careful and frequent hand washing and strict adherence to standard food and water safety precautions are the best defense against shigellosis (2).

Together, epidemiologic and laboratory data suggest this was a shigellosis outbreak with person-to-person transmission. This investigation highlights the importance of building epidemiologic and laboratory capacity for enteric illnesses and enhancing basic hand hygiene and prevention strategies in U.S. territories.

Who doesn’t? Working when sick

Surveillance data indicate that handling of food by an ill worker is a cause of almost half of all restaurant-related outbreaks. The U.S. Food and Drug Administration (FDA) Food Code contains recommendations for food service establishments, including restaurants, aimed at reducing the frequency with which food workers work while ill. However, few data exist on the extent to which restaurants have implemented FDA recommendations.

sick.rest.workerThe Centers for Disease Control and Prevention’s Environmental Health Specialists Network (EHS-Net) conducted a study on the topic of ill food workers in restaurants. We interviewed restaurant managers (n = 426) in nine EHS-Net sites. We found that many restaurant policies concerning ill food workers do not follow FDA recommendations. For example, one-third of the restaurants’ policies did not specifically address the circumstances under which ill food workers should be excluded from work (i.e., not be allowed to work). We also found that, in many restaurants, managers are not actively involved in decisions about whether ill food workers should work. Additionally, almost 70% of managers said they had worked while ill; 10% said they had worked while having nausea or “stomach flu,” possible symptoms of foodborne illness.

When asked why they had worked when ill, a third of the managers said they felt obligated to work or their strong work ethic compelled them to work. Other reasons cited were that the restaurant was understaffed or no one was available to replace them (26%), they felt that their symptoms were mild or not contagious (19%), they had special managerial responsibilities that no one else could fulfill (11%), there was non–food handling work they could do (7%), and they would not get paid if they did not work or the restaurant had no sick leave policy (5%).

Data from this study can inform future research and help policy makers target interventions designed to reduce the frequency with which food workers work while ill.

 Managerial practices regarding workers working while ill

Journal of Food Protection, Number 1, January 2015, pp. 4-234, pp. 187-195(9)

Norton, D. M.; Brown, L. G.; Frick, R.; Carpenter, L. R.; Green, A. L.; Tobin-D’Angelo, M.; Reimann, D. W.; Blade, H.; Nicholas, D. C.; Egan, J. S.; Everstine, K.

http://www.ingentaconnect.com/content/iafp/jfp/2015/00000078/00000001/art00026

6 dead, 28 sick in outbreak of listeriosis linked to commercially produced, prepackaged caramel apples

The U.S. Centers for Disease Control and Prevention reports:

  • CDC is collaborating with public health officials in several states and with the U.S. Food and Drug Administration (FDA) to investigate an outbreak of Listeria monocytogenes infections (listeriosis) linked to commercially produced, prepackaged caramel apples. Listeria can cause a serious, life-threatening illness.
  • caramel.appleOn January 6, 2015, Bidart Bros. of Bakersfield, California voluntarily recalled Granny Smith and Gala apples because environmental testing revealed contamination with Listeria monocytogenes at the firm’s apple-packing facility.
  • Consumers should not eat any recalled Granny Smith and Gala apples produced by Bidart Bros., and retailers should not sell or serve them.
  • Consumers who are buying or have recently bought Granny Smith or Gala apples can ask their retailers if the apples came from Bidart Bros.
  • The information CDC has at this time indicates that commercially produced, prepackaged caramel apples may be contaminated with Listeria and may be causing this outbreak.
  • Happy Apples, California Snack Foods, and Merb’s Candies each announced a voluntary recall of commercially produced, prepackaged caramel apples after hearing from Bidart Bros., an apple supplier, that there may be a connection between Bidart Bros. apples and this listeriosis outbreak.
  • Investigators are continuing to work to determine if any other brands or types of commercially produced, prepackaged caramel apples are linked to illnesses.
  • CDC continues to recommend that U.S. consumers do not eat any commercially produced, prepackaged caramel apples, including plain caramel apples as well as those containing nuts, sprinkles, chocolate, or other toppings, until more specific guidance can be provided.
  • Although caramel apples are often a fall seasonal product, contaminated commercially produced, prepackaged caramel apples may still be for sale at grocery stores and other retailers nationwide or may be in consumers’ homes.
  • As of January 8, 2015, a total of 32 people infected with the outbreak strains of Listeria monocytogenes had been reported from 11 states.
  • Thirty-one ill people have been hospitalized, and six deaths have been reported. Listeriosis contributed to at least three of these deaths.
  • Ten illnesses were pregnancy-related (occurred in a pregnant woman or her newborn infant), with one illness resulting in a fetal loss.
  • Three invasive illnesses (meningitis) were among otherwise healthy children aged 5–15 years.
  • To date, 23 (88%) of the 26 ill people interviewed reported eating commercially produced, prepackaged caramel apples before becoming ill.
  • The Public Health Agency of Canada (PHAC) has identified 2 cases of listeriosis in Canada with the same pulsed-field gel electrophoresis (PFGE) patterns as seen in the U.S. outbreak.
  • PHAC is working with its provincial and territorial partners to determine the source of these illnesses.
  • This investigation is rapidly evolving, and new information will be provided as it becomes available.

Cruise ship sickness/norovirus outbreaks lowest in 14 years

The number of gastrointestinal illness (GI) outbreaks, including norovirus and enterotoxigenic E. coli, on cruise ships fell to the lowest level in 14 years in 2014.

vomit cruiseThe CDC (Centers for Disease Control and Prevention) website contains detailed reports about the outbreaks on cruise ships from 1994 to 2015. The CDC considers it an outbreak anytime 3% or more of the passengers and crew members report diarrheal symptoms onboard a vessel of at least 100 passengers on sailings that are 3 days or longer.

There were nine reported outbreaks of GI on 7 different cruise ships in 2014, tying 2013 with the lowest number of outbreaks since 2001. When you take into consideration that the number of cruise ships is at a record high, this past year saw the lowest percentage of outbreaks on cruise ships since 2001.

Tetrodotoxin poisoning outbreak from imported dried puffer fish — Minneapolis, Minnesota, 2014

The U.S. Centers for Disease Control reports that on June 13, 2014, two patients went to the Hennepin County Medical Center Emergency Department in Minneapolis, Minnesota, with symptoms suggestive of tetrodotoxin poisoning (i.e., oral paresthesias, weakness, and dyspnea) after consuming dried puffer fish (also known as globefish) purchased during a recent visit to New York City.

puffer.fish.dec.14The patients said two friends who consumed the same fish had similar, although less pronounced, symptoms and had not sought care. The Minnesota Department of Health conducted an investigation to determine the source of the product and samples were sent to the Food and Drug Administration (FDA) Center for Food Safety and Applied Nutrition for chemical and genetic analysis.

Genetic analysis identified the product as puffer fish (Lagocephalus lunaris) and chemical analysis determined it was contaminated with high levels of tetrodotoxin. A traceback investigation was unable to determine the original source of the product. Tetrodotoxin is a deadly, potent poison; the minimum lethal dose in an adult human is estimated to be 2–3 mg (1). Tetrodotoxin is a heat-stable and acid-stable, nonprotein, alkaloid toxin found in many species of the fish family Tetraodontidae (puffer fish) as well as in certain gobies, amphibians, invertebrates, and the blue-ringed octopus (2). Tetrodotoxin exerts its effects by blocking voltage-activated sodium channels, terminating nerve conduction and muscle action potentials, leading to progressive paralysis and, in extreme cases, to death from respiratory failure. Because these fish were reportedly purchased in the United States, they pose a substantial U.S. public health hazard given the potency of the toxin and the high levels of toxin found in the fish.

Listeria outbreak from caramel apples has killed four; 23 sick

Four people have died from a Listeria outbreak linked to prepackaged caramel apples, according to the U.S. Centers for Disease Control and Prevention.

0b1d2d18d5851e7b175ba98f98488433At least 28 people in 10 states have become sick due to the bacterial infection. Twenty-six have been hospitalized. Five of the patients have died, although one death was not linked to Listeria.

Nine of the illnesses were linked to pregnancy, affecting either a pregnant woman or a newborn. The outbreak also has been linked to three cases of invasive meningitis — a dangerous inflammation of the lining of the brain or spinal cord — in healthy children ages 5 to 15.

More than 80% of patients said they ate commercially produced, prepackaged caramel apples before becoming sick, according to the CDC. There is no link to home-made caramel apples or fresh produce. Health officials are working to try to identify a specific brand or type of caramel apple.

For now, however, the CDC advises people to avoid all prepackaged caramel apples.

CDC is collaborating with public health officials in several states and with the U.S. Food and Drug Administration (FDA) to investigate an outbreak of Listeria monocytogenes infections (listeriosis) linked to commercially produced, prepackaged caramel apples. Listeria can cause a serious, life-threatening illness.

The information CDC has at this time indicates that commercially produced, prepackaged caramel apples may be contaminated with Listeria and may be causing this outbreak.

Out of an abundance of caution, CDC recommends that U.S. consumers do not eat any commercially produced, prepackaged caramel apples, including plain caramel apples as well as those containing nuts, sprinkles, chocolate, or other toppings, until more specific guidance can be provided.

Although caramel apples are often a fall seasonal product, contaminated commercially produced, prepackaged caramel apples may still be for sale at grocery stores and other retailers nationwide or may be in consumers’ homes.

This investigation is rapidly evolving. New information will be provided as it becomes available.

As of December 18, 2014, a total of 28 people infected with the outbreak strains of Listeria monocytogenes have been reported from 10 states.

26 ill people have been hospitalized. Among the 26 people hospitalized, five deaths have been reported. Listeriosis contributed to at least four of these deaths.

Nine illnesses were pregnancy-related (occurred in a pregnant woman or her newborn infant).

Three invasive illnesses (meningitis) were among otherwise healthy children aged 5–15 years.

To date, 15 (83%) of the 18 ill people interviewed reported eating commercially produced, prepackaged caramel apples before becoming ill.

At this time, no illnesses related to this outbreak have been linked to apples that are not caramel-coated and not prepackaged or to caramel candy.

Investigators are working quickly to determine specific brands or types of commercially produced, prepackaged caramel apples that may be linked to illnesses and to identify the source of contamination.

This investigation is rapidly evolving, and new information will be provided as it becomes available.

87 now sick with Salmonella from sprouts

The U.S. Centers for Disease Control and Prevention reports:

  • As of December 2, 2014, a total of 87 people infected with the outbreak strains of Salmonella Enteritidis have been reported from 11 states.

      amy.sprouts.guelph.05   Twenty-seven percent of ill persons have been hospitalized. No deaths have been reported.  

  • CDC’s National Antimicrobial Resistance Monitoring System (NARMS) laboratory conducted antibiotic resistance testing on Salmonella Enteritidis isolates collected from three ill persons infected with the outbreak strains.

         All three isolates were susceptible to all antibiotics tested on the NARMS panel.

  • Collaborative investigation efforts of state, local, and federal public health and regulatory agencies indicate that bean sprouts produced by Wonton Foods, Inc. are the likely source of this outbreak.

         In interviews, 42 (78%) of 54 ill persons reported eating bean sprouts or menu items containing bean sprouts in the week before becoming ill.

  • Wonton Foods, Inc. continues to cooperate with state and federal public health and agriculture officials.
  • On November 21, 2014, Wonton Foods, Inc. agreed to destroy any remaining products while they conducted thorough cleaning and sanitization and implemented other Salmonella control measures. On November 24, the firm completed cleaning and sanitization and restarted production of bean sprouts. The firm resumed shipment on November 29, 2014

         Contaminated bean sprouts produced by Wonton Foods, Inc. are likely no longer available for purchase or consumption given the maximum 12-day shelf life of mung bean sprouts.

  • CDC recommends that consumers, restaurants, and other retailers always practice food safety for sprouts.

         Children, older adults, pregnant women, and persons with weakened immune systems should avoid eating raw sprouts of any kind (including alfalfa, clover, radish, and mung bean sprouts).

         Cook sprouts thoroughly to reduce the risk of illness. Cooking sprouts thoroughly kills any harmful bacteria.

  • This investigation is ongoing, and CDC will update the public when more information becomes available.

344 now sickened says CDC: Multistate outbreak of human Salmonella infections linked to live poultry in backyard flocks

  • As of September 23, 2014, a total of 344 persons infected with the outbreak strains of Salmonella Infantis, Salmonella Newport, or Salmonella Hadar have been reported from 42 states and Puerto Rico.
  • campy.chicken31% of ill persons have been hospitalized, and no deaths have been reported.
  • Epidemiologic, laboratory, and traceback findings have linked this outbreak of human Salmonella infections to contact with chicks, ducklings, and other live poultry from Mt. Healthy Hatcheries in Ohio.
  • 78% of ill people reported contact with live poultry in the week before their illness began.
  • Findings of multiple traceback investigations of live baby poultry from homes of ill persons have identified Mt. Healthy Hatcheries in Ohio as the source of chicks and ducklings. This is the same mail-order hatchery that has been associated with multiple outbreaks of Salmonella infections linked to live poultry in past years, including in 2012 and 2013.
  • CDC’s National Antimicrobial Resistance Monitoring System (NARMS) laboratory conducted antibiotic resistance testing on Salmonella isolates collected from 11 ill persons infected with the outbreak strains of Salmonella Infantis or Newport. Of the 11 isolates tested:
  • Two (18%) were drug resistant (defined as resistance to one or more antibiotics).
  • Nine (82%) were pansusceptible (susceptible to all antibiotics tested).
  • Mail-order hatcheries, agricultural feed stores, and others that sell or display chicks, ducklings, and other live poultry should provide health-related information to owners and potential purchasers of these birds prior to selling them. This should include information about the risk of acquiring a Salmonella infection from contact with live poultry.
  • Read the advice to mail-order hatcheries and feed stores and others that sell or display live poultry.
  • Consumers who own live poultry should take steps to protect themselves:
  • Always wash your hands thoroughly with soap and water right after touching live poultry or anything in the area where these birds live and roam.
  • Do not let live poultry inside the house.

Not cute with 300 sick from Salmonella linked to live poultry in backyard flocks

The U.S. Centers for Disease Control and Prevention reports that as of August 5, 2014, a total of 300 persons infected with the outbreak strains of Salmonella Infantis, Salmonella Newport, or Salmonella Hadar in 42 states and Puerto Rico, up from 251 in late June.

OLYMPUS DIGITAL CAMERA• 31% of ill persons have been hospitalized, and no deaths have been reported.

  • Epidemiologic, laboratory, and traceback findings have linked this outbreak of human Salmonella infections to contact with chicks, ducklings, and other live poultry from Mt. Healthy Hatcheries in Ohio.

• 80% of ill people reported contact with live poultry in the week before their illness began.

  • Findings of multiple traceback investigations of live baby poultry from homes of ill persons have identified Mt. Healthy Hatcheries in Ohio as the source of chicks and ducklings. This is the same mail-order hatchery that has been associated with multiple outbreaks of Salmonella infections linked to live poultry in past years, including in 2012 and 2013.
  • CDC’s National Antimicrobial Resistance Monitoring System (NARMS) laboratory conducted antibiotic resistance testing on Salmonella isolates collected from 11 ill persons infected with the outbreak strains of Salmonella Infantis or Newport. Of the 11 isolates tested:

• Two (18%) were drug resistant (defined as resistance to one or more antibiotics).

• Mail-order hatcheries, agricultural feed stores, and others that sell or display chicks, ducklings, and other live poultry should provide health-related information to owners and potential purchasers of these birds prior to selling them. This should include information about the risk of acquiring a Salmonella infection from contact with live poultry.

◦  Read the advice to mail-order hatcheries and feed stores and others that sell or display live poultry.

◦  Consumers who own live poultry should take steps to protect themselves such as handwashing and no live poultry inside the house.