125 now sick in multi-state Cyclospora investigation

The Center for Infectious Disease Research and Policy is reporting that U.S. federal health officials have joined with officials in 13 states to investigate a spike in Cyclospora illnesses, with 125 confirmed or probable cases reported and no specific food item implicated so far.

love.boat.cyclosporaTexas health officials have been investigating a recent surge of infections, and an outbreak investigation is underway in Maine, with Massachusetts also probing an increase in lab-confirmed cyclosporiasis cases, the CDC said in an e-mail to CIDRAP News. As of today, it said, those 3 states, 10 others, and New York City have reported cases. The other states are Connecticut, Florida, Georgia, Illinois, Maryland, Montana, New Jersey, New York, Oregon, and Tennessee.

News of a multistate increase in Cyclospora illnesses follows the recent launch of the investigation in Texas. Over the last months the Texas Department of State Health Services (TDSHS) has learned of 61 cases around the state, which prompted a recent alert to Texas healthcare providers. No common source has been identified.

CDC: Antibiotic resistance in foodborne germs is an ongoing threat

In a report that is sure to be interpreted by the political lenses of various groups, the U.S. Centers for Disease Control and Prevention reports that in 2012 that multi-drug resistant Salmonella decreased during the past 10 years and resistance to two important groups of drugs – cephalosporins and fluoroquinolones – remained low in 2012. However, in Salmonella typhi, the germ that causes typhoid fever, resistance to quinolone drugs increased to 68 percent in 2012, raising concerns that one of the common treatments for typhoid fever may not work in many cases.

chickenpurseAbout 1 in 5 Salmonella Heidelberg infections was resistant to ceftriaxone, a cephalapsorin drug. This is the same Salmonella serotype that has been linked to recent outbreaks associated with poultry. Ceftriaxone resistance is a problem because it makes severe Salmonella infections harder to treat, especially in children.

The data are part of the latest report of the National Antimicrobial Resistance Monitoring System (NARMS), a tri-agency surveillance system that has tracked antibiotic resistance in humans (CDC), retail meats (Food and Drug Administration), and food animals (U.S. Department of Agriculture) since 1996.  The report from CDC NARMS compares resistance levels in human samples in 2012 to a baseline period of 2003-2007. 

“Our latest data show some progress in reducing resistance among some germs that make people sick but unfortunately we’re also seeing greater resistance in some pathogens, like certain types of Salmonella,” said Robert Tauxe, M.D., M.P.H, deputy director of CDC’s Division of Foodborne, Waterborne, and Environmental Diseases. “Infections with antibiotic-resistant germs are often more severe. These data will help doctors prescribe treatments that work and to help CDC and our public health partners identify and stop outbreaks caused by resistant germs faster and protect people’s health.”

Among the other findings in the 2012 report:

*Campylobacter resistance to ciprofloxacin remained at 25 percent, despite FDA’s 2005 withdrawal of its approval for the use of enrofloxacin in poultry. Ciprofloxacin and enrofloxacin are both in the fluoroquinolone class of drugs.

*Shigella resistance to ciprofloxacin (2 percent) and azithromycin (4 percent) is growing. However, no Shigella strains were resistant to both drugs.

*Although fluoroquinolone resistance remained low in 2012, Salmonella enteritidis – the most common Salmonella type – accounted for 50 percent of infections resistant to the fluoroquinolone drug nalidixic acid, which is used in laboratory testing for resistance. Resistance to nalidixic acid relates to decreased susceptibility to ciprofloxacin, a widely used fluoroquinolone drug. Other work shows that many of the nalidixic acid resistant Salmonella enteritidis infections are acquired during travel abroad.

The full 2012 NARMS report is available on the CDC website at www.cdc.gov/narms/reports/annual-human-isolates-report-2012.html. For more information about NARMS,  visit www.cdc.gov/narms.

In Australia, researchers from the Australian National University’s Research School of Biology tested more than 90 packages of chicken bought from several Canberra retailers for the presence of E. coli. 

chicken.south.parkProfessor of microbial population biology and evolution, David Gordon, said almost 200 samples were found to contain E. coli and of those, about two-thirds were discovered to be antibiotic-resistant.

Just four strains of E. coli were found to be resistant to antibiotics known as fluoroquinolone, which were not used by Australia’s poultry industry, he said. 

Professor Gordon said the E. coli strains researchers found were rare in the samples. 

He said it was unlikely the strains of fluoroquinolone-resistent E. coli were in the chicken before slaughtering, and the “most logical, although not necessarily true, explanation for their presence in poultry is post-processing contamination.”

An ACT Health spokeswoman said although the directorate had not seen the study, the presence of resistant bacteria in chicken meat highlighted the importance of good food handling and preparation when eating chicken, including thorough cooking and cleaning of food-preparation surfaces. 

“This is important to prevent bacterial food-borne illness regardless of whether bacteria are resistant to an antibiotic,” she said. 

An Australian Pesticides and Veterinary Medicines Authority spokeswoman said the authority was responsible for the assessment and registration of veterinary medicines, including antibiotics, in Australia.

She said fluoroquinolones have never been registered for use in food-producing animals in Australia.

“State and territory governments are responsible for controlling the use of pesticides and veterinary medicines beyond the point of retail sale,” she said.

‘Safety’s our greatest priority’ Restaurant association don’t take too kindly to CDC norovirus report

The U.S. Centers for Disease Control and Prevention (CDC) issued a Vital Signs report this week stating that most norovirus outbreaks from contaminated food occur in food service settings.

The report prompted the National Restaurant Association, the leading business association for the restaurant industry, to release the following statement: “For the restaurant and foodservice industry, there is no greater priority than food safety and our customers’ and employees’ well-being,” said Scott DeFife, executive vice president for policy and government affairs, National Restaurant Association.

norovirus-2“The National Restaurant Association and foodservice operators take food safety very seriously. In its report, the CDC notes the demonstrated success of training and certification of kitchen managers in preventing norovirus outbreaks, which we support and encourage. Through the National Restaurant Association’s ServSafe food preparation training program, over 5.6 million foodservice workers across the U.S. have been trained in the safe handling and serving of food. The program provides specific recommendations on ways to prevent norovirus, including proper hand washing and exclusion of sick employees.

“The National Restaurant Association supports the FDA Food Code, which also details these prevention measures, and we believe more states should move to fully adopt the FDA Food Code.

“In addition, the National Restaurant Association played an active and constructive role in developing the Council to Improve Foodborne Outbreak Response (CIFOR) guidelines, released last year in partnership with state, local and federal public health officials and other industry stakeholders.

“We agree with many of CDC’s suggestions as to what can be done. However, we believe that some of the language is misleading and that norovirus is not common in the industry, as the report claims. The report shows that the overwhelming majority of norovirus outbreaks during the studied time period were non-foodborne. Restaurants serve 130 million meals each day, and while any instance is serious, there are very few instances of norovirus contamination.” 

New US CDC data on foodborne disease outbreaks

Outbreaks provide important insights into how germs spread, which food and germ combinations cause illnesses, and how to prevent infections. Public health and industry use outbreak data to create information on prevention, education, and policy.

foodborne-disease-data_d250pxCDC has a long history of summarizing outbreak reports from local and state health departments. CDC collects outbreak data and makes it available to the public. Tracking and reporting outbreak data is the first step towards prevention.

Highlights of New Reports:

CDC published two new reports for 2011 and 2012. The data from these reports help show the human impact of foodborne disease outbreaks.

Number and Causes of Outbreaks

*1,632 foodborne disease outbreaks, 29,112 illnesses, 1,750 hospitalizations, and 68 deaths

*793 outbreaks caused by a single, confirmed pathogen

*Most common causes of outbreaks:

*Norovirus: 41% of reported outbreaks

*Salmonella: 25% of reported outbreaks

Number and Causes of Outbreak-Related Illnesses

*18,880 (65%) outbreak-related illnesses caused by a single, confirmed pathogen

*1,501 (8%) resulted in hospitalization

*Most common causes of outbreak-related illnesses:

*Norovirus: 46% of outbreak-related illnesses

Salmonella: 34% of outbreak-related illnesses

Setting of Outbreaks

Among the outbreaks with a single known food preparation setting, foods were prepared most- commonly at or by:

*Restaurants, specifically sit-down dining style restaurants: 60% of outbreaks,

*Caterers or banquet facilities: 13% of outbreaks

*Homes: 13% of outbreaks

Germs and Foods

*Pathogens and foods responsible for the most outbreak-related illnesses, hospitalizations, and deaths in 2012:


*Salmonella in fruits (446 illnesses)

*Salmonella in fish (425 illnesses)

Salmonella in chicken (345 illnesses)


*Salmonella in chicken (109 hospitalizations)

*Salmonella in fruits (55 hospitalizations)

*Salmonella in fish (55 hospitalizations)


*Listeria in dairy (5 deaths)

*Campylobacter in chicken (4 deaths)

*Among the 192 outbreaks attributed to a food composed of ingredients from a single food category, the categories most often implicated:

*Fish (16%)

*Vegetable row crops (12%)

*Dairy (10%, nearly all unpasteurized)

Campylobacter Outbreaks on the Rise since 2009

The number of outbreaks caused by Campylobacter increased from 15 outbreaks in 2009 to 25 in 2010, 30 in 2011, and 37 in 2012. During 2011 and 2012, 37 outbreaks were linked to foods; unpasteurized (raw) milk was responsible for the largest number of outbreaks.

CDC: Norovirus outbreaks most often linked to infected food handlers

In 1929 Dr. John Zahorsky wrote about children developing sporadic cases of vomiting, supplemented by watery diarrhea each year between November and May – and over 30 years of clinical practice, he coined the term winter vomiting sickness. According to a 1950 Time Magazine article, Dr. Zahorsky was a pediatrician working extolling the virtues of good sanitation during birth and infant care – one of the fathers of disease prevention.m63e0603a1f1
In 1968, one of these winter vomiting sickness outbreaks occurred in an elementary school in Norwalk, OH. Teachers and students were both affected, with 32% of the primary cases spreading illness to others in their families and homes. After a collaborative investigation with researchers from NIH and Walter-Reed Army medical center a causative agent was found in the feces of the ill — a 27nm sized virus particle. Zahorsky’s illnesses then took on the name Norwalk. Since then, the name has morphed to Norwalk and Norwalk-like viruses, which begat noroviruses.
Often linked to cruise ships in popular culture, noro really is linked much more often to food handlers in food service. According to fellow NoroCORE collaborator Aron Hall and colleagues in this week’s MMWR, noroviruses are the leading cause of reported foodborne disease outbreaks nationally and most often linked to restaurants – with contamination occurring from infected food workers.
During 2009–2012, a total of 4,318 norovirus outbreaks were reported to NORS (the national outbreak reporting system -ben) , resulting in 161,253 illnesses, 2,512 hospitalizations, and 304 deaths. Foodborne transmission was the primary mode reported in 1,008 (23%) norovirus outbreaks, representing 48% of the 2,098 foodborne outbreaks reported with a single suspected or confirmed cause during the 4-year study period. Other primary transmission modes reported among the 4,318 norovirus outbreaks included person-to-person (2,976 [69%]), environmental (15 [0.35%]), waterborne (11 [0.26%]), and unknown transmission mode (308 [7%]). In 158 (16%) of foodborne norovirus outbreaks, secondary transmission through one of these other modes was reported. Norovirus outbreaks were most common in winter, with 2,394 (55%) occurring during December–February (Figure 1). Among foodborne norovirus outbreaks, 398 (39%) occurred during December–February, compared with 1,996 (60%) of nonfoodborne norovirus outbreaks.
Outbreak data (above, exactly as shown) demonstrates that winter vomiting virus is a fitting moniker.

Wanna see me feed a mouse to my snake? 37 sick, again, with Salmonella from feeder rodents

Not the best pickup line from the movie, Almost Famous, but it captures what some of my teenage friends were doing at the time.

After an outbreak linked to feeder mice was reported in April 2012, a new outbreak has now been reported by the U.S. Centers for Disease Control.

almost.famous.band_.featuredCDC is collaborating with public health officials in many states, the U.S. Food and Drug Administration Coordinated Outbreak Response and Evaluation Network (FDA CORE), and the FDA Center for Veterinary Medicine (FDA CVM) to investigate an outbreak of human Salmonella Typhimurium infections linked to contact with frozen feeder rodents used to feed pet reptiles. FDA CVM is the regulatory authority for animal feeds (which includes pet food), animal drugs, and veterinary devices.

Public health investigators are using the PulseNet system to identify cases of illness that may be part of this outbreak. PulseNet, the national subtyping network of public health and food regulatory agency laboratories coordinated by CDC, obtains DNA “fingerprints” of Salmonella bacteria through diagnostic testing with pulsed-field gel electrophoresis, or PFGE, to identify cases of illness that may be part of this outbreak. This PFGE pattern has been seen before in PulseNet and in the past typically caused 4-8 cases per month during January to April.

A total of 37 persons infected with the outbreak strain of Salmonella Typhimurium have been reported from 18 states from January 11, 2014 to May 13, 2014. The number of ill persons reported from each state is as follows: Alabama (1), Arizona (2), California (7), Illinois (1), Kentucky (1), Maryland (1), Michigan (2), Minnesota (1), Missouri (2), Montana (3), New Jersey (3), New Mexico (1), North Carolina (1), Ohio (4), Oregon (2), Pennsylvania (3), South Dakota (1), and Texas (1).

Among 32 persons with available information, dates that illnesses began range from January 11, 2014 to April 21, 2014. Ill persons range in age from younger than 1 year to 69 years, with a median age of 21 years. Fifty-nine percent of ill persons are female. Among 34 persons with available information, 5 (15%) report being hospitalized. No deaths have been reported.

Epidemiologic, laboratory, and traceback investigations conducted by officials in local, state, and federal public health, veterinary, agriculture, and regulatory agencies indicate that contact with frozen feeder rodents used to feed pet reptiles is a likely source of this outbreak of human Salmonella Typhimurium infections. Frozen feeder rodents may include mice, rats, or other rodents of different sizes and ages. Frozen feeder rodents are used to feed some pet reptiles and amphibians.

In interviews, ill persons answered questions about foods eaten and animal contact during the week before becoming ill. Twenty-one (66%) of 32 ill persons interviewed reported contact with multiple types of reptiles, including snakes and lizards. Seventeen of the 21 ill persons reporting reptile exposure were able to provide information about what the reptile was fed. Fifteen (88%) of these 17 ill persons reported exposure to frozen feeder rodents.

The Oregon State Public Health Laboratory isolated the outbreak strain of Salmonella Typhimurium in one sample of unused frozen mice, packaged by Reptile Industries, Inc. and sold under the brand name Arctic Mice at PetSmart, collected by the Oregon Department of Public Health from an ill person’s home.

OLYMPUS DIGITAL CAMERAFDA has evaluated sales and shipping records, and traceback activities have identified Reptile Industries, Inc. as the common source of frozen feeder rodents purchased by ill persons. Testing conducted by FDA isolated the outbreak strain in two samples of frozen feeder rodents collected during an FDA investigation at the Reptile Industries facility.

In the absence of a voluntary recall from Reptile Industries, Inc., FDA issued a warning to pet owners who have purchased frozen rodents packaged by Reptile Industries, Inc. since January 11, 2014 that they have the potential to be contaminated with Salmonella. Reptile Industries, Inc. packages frozen rodents for PetSmart stores nationwide and are sold under the brand name Arctic Mice.

CDC’s National Antimicrobial Resistance Monitoring System (NARMS) laboratory conducted antibiotic resistance testing on Salmonella Typhimurium isolates collected from three ill persons infected with the outbreak strain; all isolates were pansusceptible (susceptible to all antibiotics on the NARMS panel). NARMS is a U.S. public health surveillance system that tracks antibiotic resistance in foodborne and other enteric bacteria found in people, raw meat and poultry, and food-producing animals. NARMS is an interagency partnership among CDC, FDA, the U.S. Department of Agriculture (USDA), and state and local health departments. The NARMS human surveillance program at CDC monitors antibiotic resistance in Salmonella and several other bacteria isolated from clinical specimens and submitted to NARMS by public health laboratories.

CDC and state and local public health partners are continuing laboratory surveillance through PulseNet to identify additional ill persons and to interview ill persons about foods eaten and animals they had contact with before becoming ill.

Don’t kiss that turtle, stop touching that bearded dragon and stop touching yourself: CDC reports 132 sick in multistate outbreak of human Salmonella Cotham

The U.S. Centers for Disease Control and Prevention is collaborating with public health, veterinary, and agriculture officials in many states and the U.S. Department of Agriculture National Veterinary Services Laboratories (NVSL) to investigate an outbreak of Salmonella Cotham infections linked to contact with pet bearded dragons purchased from multiple stores in different states.

bearded_dragon_picBearded dragons are popular pet lizards, native to Australia (sure, blame Australia), that come in a variety of colors. Public health investigators are using the PulseNet system to identify cases of illness that may be part of this outbreak.

On January 22, 2014, CDC was notified by the Wisconsin Department of Health Services of a cluster of Salmonella Cotham infections with a high proportion of ill persons reporting exposure to pet reptiles. Since 2012, there have been 12 ill persons infected with Salmonella Cotham in Wisconsin, and 10 (83%) of 12 persons reported contact with pet bearded dragons. Wisconsin receives funding under the CDC FoodCORE (Foodborne Diseases Centers for Outbreak Response Enhancement) program. These centers work together to develop new and better methods to detect, investigate, respond to, and control multistate outbreaks of foodborne diseases.

Salmonella Cotham is a rare serotype. Searching historical Salmonella databases, CDC determined that Salmonella Cotham represents only 0.01% of all human isolates in the United States since 1963. Before this outbreak, typically less than 25 Salmonella Cotham infections were reported to PulseNet annually. Given the rarity of the Cotham serotype and the information gathered by Wisconsin, CDC conducted a search of PulseNet for all Salmonella Cotham infections reported since 2012.

As of April 21, 2014, a total of 132 persons infected with the outbreak strain of Salmonella Cotham have been reported from 31 states since February 21, 2012. The number of ill persons identified in each state is as follows (listed in alphabetical order): Arizona (4), California (21), Colorado (2), Florida (3), Georgia (1), Idaho (3), Illinois (6), Kansas (6), Kentucky (4), Maryland (3), Massachusetts (1), Michigan (5), Minnesota (3), Missouri (7), Nebraska (1), Nevada (3), New Hampshire (1), New Jersey (3), New York (10), North Carolina (2), Ohio (1), Oregon (2), Pennsylvania (5), South Carolina (1), South Dakota (1), Tennessee (5), Texas (6), Utah (3), Virginia (3), Washington (4), and Wisconsin (12).

Among 132 persons for whom information is available, dates that illnesses began range from February 20, 2012 to April 1, 2014. Ill persons range in age from less than 1 year to 79 years, with a median age of 2 years. Fifty-eight percent of ill persons are children 5 years of age or younger. Fifty-one percent of ill persons are female. Among 67 ill persons with available information, 28 (42%) have been hospitalized. No deaths have been reported.

On March 25, 2014, CDC sent a questionnaire to the states involved in the investigation to obtain more detailed information from ill persons about recent contact with reptiles. In interviews, ill persons answered questions about contact with animals and foods consumed during the week before becoming ill. To date, CDC has received a total of 31 completed questionnaires. Twenty-seven (87%) of 31 persons interviewed reported contact with reptiles or their environments before becoming ill. When asked about the type of reptile, 25 (81%) of 31 persons reported contact with lizards; of these 25 persons, 21 (84%) specifically reported contact with bearded dragons, a type of lizard. The percentage of ill persons in this outbreak reporting contact with a reptile is substantially higher than the percentage of U.S. households that reported owning a pet reptile in a survey conducted in 2013-2014 by the American Pet Products Association (5.6%). State and local health departments are continuing to interview ill persons.

The Oregon State Public Health Laboratory has isolated the outbreak strain of Salmonella Cotham from samples from a pet bearded dragon and its terrarium (habitat) collected from an ill person’s home in Oregon.

Lynne Terry of The Oregonian reports Oregon scientists cracked the case after a baby in Marion County got sick. Emilio DeBess, a Public Health Division epidemiologist, decided to investigate. Taking time on his lunch hour in early April, he visited the home and collected nine samples, swabbing two bearded dragons and the surrounding environment. Eight samples turned up positive for the rare strain involved in the outbreak.

DeBess said the baby, who is less than 1 years old, had no contact with the reptiles, which are kept by the parents. The baby was not even allowed in the same room.

Hey kids, the snails are back: CDC releases 2013 FoodNet data

That’s the tagline from a Far Side cartoon and what immediately came to mind upon reading yet again that reductions in foodborne illness were stagnant for 2013.

There were successes, failures and shifting profiles of what foods lead to foodborne illness, because whatever Americans choose to eat, under whatever production system, some smart bug is going to figure out how to flourish.

And the FoodNet data remains the best and most publicly available surveillance data in the world; that’s right, best in the world.

The Foodborne Diseases Active Surveillance Network (FoodNet) monitors the incidence of laboratory-confirmed infections caused by nine pathogens transmitted commonly through food in 10 U.S. sites, covering approximately 15% of the U.S. population. This report summarizes preliminary 2013 data and describes trends since 2006. In 2013, a total of 19,056 infections, 4,200 hospitalizations, and 80 deaths were reported. For most infections, incidence was well above national Healthy People 2020 incidence targets and highest among children aged <5 years. Compared with 2010–2012, the estimated incidence of infection in 2013 was lower for Salmonella, higher for Vibrio, and unchanged overall. Since 2006–2008, the overall incidence has not changed significantly. More needs to be done.

Yes, more needs to be done. Part of that involves abandoning archaic communications and invoking current, compelling and credible food safety messages using a variety of media, at the places where people make food decisions – whether it’s the local market or the megalomart.

cdc.fbi.annual.13The complete report is available at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6315a3.htm?s_cid=mm6315a3_e

Incidence and trends of infection with pathogens transmitted commonly through food — Foodborne Diseases Active Surveillance Network, 10 U.S. sites, 2006–2013.

CDC MMWR 63(15);328-332

Stacy M. Crim, Martha Iwamoto, Jennifer Y. Huang, Patricia M. Griffin, Debra Gilliss, Alicia B. Cronquist, Matthew Cartter, Melissa Tobin-D’Angelo, David Blythe, Kirk Smith, Sarah Lathrop, Shelley Zansky, Paul R. Cieslak, John Dunn, Kristin G. Holt, Susan Lance, Robert Tauxe, Olga L. Henao


WTF? 524 now confirmed sick with Salmonella linked to Foster Farms chicken

This is why microbial food safety should be marketed so consumers have a choice.

As of April 7, 2014, the U.S. Centers for Disease Control reports a total of 524 people have been infected with seven outbreak strains of Salmonella Heidelberg from 25 states and Puerto Rico, since March 1, 2013.

Foster-Farms-Chicken-BreastCDC says it is working closely with the U.S. Department of Agriculture to assess interventions implemented at Foster Farms facilities to prevent future illnesses.

But people keep getting sick. And what are these interventions?

The lack of information, the lack of a recall despite continued illnesses, is sorta mind-numbing.

Just cook it doesn’t cut it.