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.

Listeria being sequenced to better understand food poisoning

Chances are you’ve heard of mapping genes to diagnose rare diseases, predict your risk of cancer and tell your ancestry. But to uncover food poisonings?

The nation’s disease detectives are beginning a program to try to outsmart outbreaks by routinely decoding the DNA of potentially deadly bacteria and viruses.

listeriaThe initial target is Listeria, the third-leading cause of death from food poisoning and bacteria that are especially dangerous to pregnant women. Already, the government credits the technology with helping to solve a listeria outbreak that killed one person in California and sickened seven others in Maryland.

“This really is a new way to find and fight infections,” said Dr. Tom Frieden, director of the Centers for Disease Control and Prevention.

With genome sequencing becoming faster and cheaper, the CDC is armed with $30 million from Congress to broaden its use with a program called advanced molecular detection. The hope is to solve outbreaks faster, foodborne and other types, and maybe prevent infections, too, by better understanding how they spread.

“Frankly, in public health, we have some catching up to do,” said the CDC’s Dr. Christopher Braden, who is helping to lead the work.

As a first step, federal and state officials are rapidly decoding the DNA of all the Listeria infections diagnosed in the U.S. this year, along with samples found in tainted foods or factories.

It’s the first time the technology has been used for routine disease surveillance, looking for people with matching strains who may have gotten sick from the same source.

The Listeria project began as officials were investigating some sick Maryland newborns and their mothers. Genome sequencing showed publix.deli.warningthose cases were linked to a California death, helping investigators determine which foods to focus on, said Dr. Robert Tauxe, CDC’s leading foodborne disease sleuth.

Standard tests prompted recall of the FDA’s suspect, a brand of Hispanic-style cheese. Last month, the government announced that sequencing also confirmed listeria from the recalled cheese matched germs from the patients.

“We expect to be able to match more and more of what we find in people to what we find in food,” as the project grows, Tauxe said.

40 years of U.S. Salmonella data now available

Forty years of data on a major cause of food poisoning now is available to the public, the food industry, and researchers in a new report from the Centers for Disease Control and Prevention (CDC). The data, collected by state and federal health officials, provides a wealth of information on Salmonella, the top foodborne cause of hospitalizations and deaths in the United States.

Available for hands-on web access for the first time, the Atlas of Salmonella in the United States, 1968-2011 summarizes surveillance data on 32 types of Salmonella isolates from p0326-salmonella-data-lgpeople, animals, and other sources. The information is organized by demographic, geographic and other categories.

“Salmonella causes a huge amount of illness and suffering each year in the United States. We hope these data allow researchers and others to assess what has happened and think more about how we can reduce Salmonella infections in the future,” said Robert Tauxe, M.D., deputy director of CDC’s Division of Foodborne, Waterborne and Environmental Diseases. “The more we understand Salmonella, the more we can make progress in fighting this threat all along the farm to table chain.”

CDC estimates that Salmonella bacteria cause more than 1.2 million illnesses each year in the United States, resulting in more than 23,000 hospitalizations and 450 deaths. Salmonella infections most often cause vomiting or diarrhea, sometimes severe. In rare cases, Salmonella illness can lead to severe and life-threatening bloodstream infections.

By providing data by age, sex, geography, and season of the year in a downloadable format, the Atlas allows users to view national trends in reported cases of human Salmonella infection over time, problems in specific geographic areas, sources of Salmonella, and the connection between animal and human health. In addition to reports of human infections, it includes reports of Salmonella in animals, the environment, and animal feeds, which can be sources of antibiotic resistant strains.  

Serotyping has been the core of public health monitoring of Salmonella infections for over 50 years. Now, scientists use DNA testing to further divide each serotype into more subtypes and to detect more outbreaks. With the next generation of sequencing technology, advancements continue as the laboratory can find information about the bacteria in just one test.

The data presented likely represent just the tip of the iceberg since many cases of human salmonellosis are not diagnosed and reported to the health department. This underreporting may occur because the ill person does not seek medical care, the health care provider does not obtain a stool culture for testing, or the culture results are not reported to public health officials.

The Salmonella group of bacteria has more than 2,500 different serotypes, but fewer than 100 cause the vast majority of infections in people. Older adults, people with weakened immune systems, and children under five years old have a higher risk for Salmonella infection. Infections in these groups can be more severe, resulting in long-term health consequences or death.

To access the Atlas, please visit http://www.cdc.gov/salmonella/reportspubs/salmonella-atlas/index.html. For more information on Salmonella, please visit: http://www.cdc.gov/salmonella/

Pukefest aboard Royal Caribbean’s Explorer of the Seas

How could I resist that headline, as my parents head for Florida for a cruise?

Cruise Law News reports there is an outbreak of gastrointestinal sickness of a large percentage of cruise passengers aboard Royal Caribbean’s Explorer of the Seas cruise ship.

The U.S. Centers for Disease Control and Prevention announced that 281 passengers (9.21% of total passengers) are suffering from norovirus type vomit cruiseof symptoms. The symptoms include vomiting, nausea, headaches and diarrhea.

The pro-cruise site Cruise Critic calls the problem a “small outbreak” but the truth is that 9% is a high percentage.  It is not unusual for passengers not to report the illness in order to avoid being quarantined in the cabin or for crew members who rely on tips to keep working after they are ill. The total numbers are often under-reported. In addition to sick passengers, 22 crew members are reportedly ill according to the CDC. The CDC website states that an environmental health officer and an epidemiologist will board the ship in St. Thomas, USVI on January 26, 2014 to conduct an epidemiologic investigation. 

Deadly outbreaks: How medical detectives save lives threatened by killer pandemics, exotic viruses, and drug-resistant parasites

Atif Kukaswadia writes in this review on Public Health Perspectives blog: Anyone who follows my writing knows that I’m a big proponent of using stories to talk about science. We’ve discussed how you can use science fiction teach science, zombies to talk about disease outbreaks, and my TEDx talk discussed using principles of storytelling in how we discuss science. So when I was asked to review (see disclaimer below) Dr sandwichAlexandra Levitt’s new book “Deadly Outbreaks: How Medical Detectives Save Lives Threatened by Killer Pandemics, Exotic Viruses and Drug-Resistant Parasites,” I jumped on the opportunity.

The CDC has a program known as the Epidemiologic Intelligence Services, where individuals trained in fields such as epidemiology, medicine, statistics and veterinary sciences come together to identify causes of diseases. For an overview of the EIS, check out this review of “Inside the Outbreaks” by Travis Saunders over at Obesity Panacea. The EIS was set up Alexander Langmuir, who has been profiled on the blog, and their work has been instrumental in learning about, and thus containing, disease outbreaks all over the world. Dr Levitt is well positioned to speak on these issues, having worked at the CDC since 1995, although it should be noted that this was written in her free time, not as part of her position at the CDC.

The book is comprised of 7 distinct chapters, each one covering a unique disease outbreak. In an almost “House-ian” style, the EIS agent will hear about an outbreak, go into an area, and then have to uncover what it is that is causing people to get sick, often with very little information to go on. I’m going to keep the details deliberately vague, as part of the joy of reading the book is guessing what is causing the outbreak, and following the train of thought of the investigators.

Another thing I really enjoyed about the book was how Dr Levitt deals with all important stakeholders, and talks about their history. One chapter deals with a Native American population that has undergone a disease outbreak, and does a great job explaining the history of these people. This is very pertinent information, as the problems of going into this community are a direct result of how these communities have been treated historically, and everything from the equipment you bring in, to the name of the disease, has to be cleared by elders and community leaders. The history of a group is something public health practitioners need to be aware of and sensitive to in order to work with these people to identify causes of disease, and this was illustrated well in this book.

Finally, at a more stylistic level, a conscious decision the author makes is to provide context for the characters. For example, in Chapter 1 the “protagonist” is eagerly anticipating her wedding, and at one point goes for dinner and discusses this with a colleague while talking about the case at hand. In a later chapter, the author describes Dr Stacy Holzbauer, a veterinarian, as someone whose “plan was to become a Sopranos_season3_episode01large-animal veterianian, marry a cowboy, live on a ranch on the Great Plains, and raise cowboys,” a vivid and charming description. While she did become a veterinarian, she then pursued a MPH and now does brilliant public health work. This makes the characters that much more fleshed out and human, rather than being 2-dimensional and alien, a welcome respite from the socially awkward, comically inept, and often evil, scientist of television and film. At points I found this transition jarring, but it adds to the overall feel of the book, and I think helps the book connect with the general public.

And the general public, especially those with an interest in public health, is the target audience. I would recommend this book to those interested in learning more about public health, both from an infectious disease epidemiology.WATER PUMP3_Page_4standpoint, as well as from a practical, i.e. how do we actually investigate disease outbreaks, standpoint. It’s written for a lay audience, and avoids jargon and delving too far into statistics or biology, which makes it easy and straightforward to follow. If you’re considering pursuing an MPH and want to do “shoe leather epidemiology,” it’s a must read.

From 8 to 1: US shutdown hampers foodborne illness tracking

The U.S. government shutdown is, according to NPR, pushing the nation’s food safety system to its limits.

There is normally a team of eight people overseeing Pulsenet, the critical foodborne illness tracking database. Centers for Disease Control Director Tom Frieden said pulsenetpost-shutdown, there’s only one. Some research and reference labs have gone from a staff of 80 to 2, and staff at the 20 quarantine stations dotted along the country’s borders and ports has been reduced by 85 percent.

The CDC is currently monitoring about 30 clusters of foodborne illnesses around the country, which is typical at any given time. About half the CDC staffers involved in surveillance and outbreak response have also been furloughed.

Probably poop and pee in that pool

Sorenne has been taking swimming lessons at this huge outdoor pool complex for over a year, and even with all the babies, I haven’t seen poop in the pool.

But it happens, as shown by all those summertime Cryptosporidium outbreaks pool.pooplinked to pools, and according to CDC, it happens a lot.

So in honor of the ninth annual Recreational Water Illness and Injury Prevention Week, the U.S Centers for Disease Control has concluded that 58% of water samples from public pools tested positive for E. coli, bacteria commonly found in human feces.

CDC says its findings indicate that swimmers are contaminating the water either through “fecal incidents” in the pool, or because they haven’t showered properly and the germs remain on their body when they enter the water.

The results are based on 161 filter samples from public swimming pools in the Atlanta area.

And there’s not just poop in the pool; 59% of water samples also tested positive for Pseudomonas aeruginosa, which can cause skin rashes and ear infections.

Here’s what the CDC recommends swimmers do to stay healthy and keep others healthy – whether swimming in a pool, lake, river or ocean (or using a hot tub):

– Stay out of swimming water when you have diarrhea.

– Shower with soap before swimming.

– Take children for bathroom breaks every 60 minutes.

– Wash your hands with soap after using the toilet or changing diapers.

sorenne.pool.sep.12– Avoid changing diapers next to the pool.

– Avoid swallowing the water.

And according to NPR, the CDC knows you pee in the pool, too. The nitrogen in urine depletes free chlorine in pool water, making it harder to kill germs. Nitrogen also converts the chlorine into a form that irritates the eyes and lungs. So stop doing that.

Keep doing same thing, expect different result? Crazy. Foodborne illness in US up slightly in 2012

The annual FoodNet data is out, which pundits will view through their own political filters to reach a pre-ordained conclusion, usually involving the need for regulations, edumucation, and technology.

My filter is: are more people barfing?

Yes.

It can be depressing to write the same thing ever year – nothing’s changed, and if anything, getting worse. So maybe try something different.
vomit.salmBut that would require imagination, creativity and commitment, the things that get stifled in any kind of bureaucracy.

Foodnet tracks the barfing.

The Foodborne Diseases Active Surveillance Network (FoodNet) conducts surveillance in 10 U.S. sites for all laboratory-confirmed infections caused by selected pathogens transmitted commonly through food to quantify them and monitor their incidence. This report summarizes 2012 preliminary surveillance data and describes trends since 1996:

• 19,531 infections, 4,563 hospitalizations, and 68 deaths associated with foodborne diseases were reported in 2012;

• for most infections, incidence was highest among children aged <5 years;

• the percentage of persons hospitalized and the percentage who died were highest among persons aged ≥65 years;

• in 2012, compared with the 2006–2008 period, the overall incidence of infection was unchanged, and the estimated incidence of infections caused by Campylobacter and Vibrio increased.

• estimated incidence of infection was higher in 2012 compared with 2006–2008 for Campylobacter (14% increase; confidence interval [CI]: 7%–21%) andVibrio (43% increase; CI: 16%–76%) and unchanged for other pathogens;

• among 2,318 (34%) Campylobacter isolates with species information, 2,082 (90%) were C. jejuni, and 180 (8%) were C. coli;

• among 496 (90%) serogrouped STEC non-O157 isolates, the most common serogroups were O26 (27%), O103 (23%), and O111 (15%);

• among 6,984 (90%) serotyped Salmonella isolates, the top three serotypes were Enteritidis, 1,238 (18%); Typhimurium, 914 (13%); and Newport, 901 (13%); and,

• among 183 (95%) Vibrio isolates with species information, 112 were V. parahaemolyticus (61%), 25 were V. vulnificus (14%), and 20 were V. alginolyticus (11%).

In 2012, the incidence of infections caused by Campylobacter and Vibrio increased from the 2006–2008 period, whereas the incidence of infections caused byCryptosporidium, Listeria, Salmonella, Shigella, STEC O157, and bureaucratYersinia was unchanged. These findings highlight the need to continue to identify and address food safety gaps that can be targeted for action by the food industry and regulatory authorities.

After substantial declines in the early years of FoodNet surveillance, the incidence of Campylobacter infection has increased to its highest level since 2000.Campylobacter infections are more common in the western U.S. states and among children aged <5 years. Although most infections are self-limited, sequelae include reactive arthritis and Guillain-Barré syndrome. Associated exposures include consumption of poultry, raw milk, produce, and untreated water, and animal contact.

Most foodborne illnesses can be prevented. Progress has been made in decreasing contamination of some foods and reducing illness caused by some pathogens, as evidenced by decreases in earlier years. Collection of comprehensive surveillance information further supports reductions in foodborne infections by helping to determine where to target prevention efforts, supporting efforts to attribute infections to sources, guiding implementation of measures known to reduce food contamination, and informing development of new measures. Because consumers can bring an added measure of safety during food storage, handling, and preparation, they are advised to seek out food safety information, which is available online.

Incidence and Trends of Infection with Pathogens Transmitted Commonly Through Food — Foodborne Diseases Active Surveillance Network, 10 U.S. Sites, 1996–2012

Morbidity and Mortality Weekly

April 19, 2013 / 62(15);283-287

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6215a2.htm?s_cid=mm6215a2_x

Increased recognition of non-O157 shiga toxin–producing E. coli infections in U.S.2000–2010: Epidemiologic features and comparison with E. coli O157 infections

Background: Shiga toxin–producing Escherichia coli (STEC) are an important cause of diarrhea and the major cause of postdiarrheal hemolytic uremic syndrome. Non-O157 STEC infections are being recognized with greater frequency because of changing laboratory practices.

Methods: Foodborne Diseases Active Surveillance Network (FoodNet) site staff conducted active, population-based surveillance for laboratory-salmonella.hamburger.patty.recallconfirmed STEC infections. We assessed frequency and incidence of STEC infections by serogroup and examined and compared demographic factors, clinical characteristics, and frequency of international travel among patients.

Results: During 2000–2010, FoodNet sites reported 2006 cases of non-O157 STEC infection and 5688 cases of O157 STEC infections. The number of reported non-O157 STEC infections increased from an incidence of 0.12 per 100,000 population in 2000 to 0.95 per 100,000 in 2010; while the rate of O157 STEC infections decreased from 2.17 to 0.95 per 100,000. Among non-O157 STEC, six serogroups were most commonly reported: O26 (26%), O103 (22%), O111 (19%), O121 (6%), O45 (5%), and O145 (4%). Non-O157 STEC infections were more common among Hispanics, and infections were less severe than those caused by O157 STEC, but this varied by serogroup. Fewer non-O157 STEC infections were associated with outbreaks (7% versus 20% for O157), while more were associated with international travel (14% versus 3% for O157).

Conclusions: Improved understanding of the epidemiologic features of non-O157 STEC infections can inform food safety and other prevention efforts. To detect both O157 and non-O157 STEC infections, clinical laboratories should routinely and simultaneously test all stool specimens submitted for diagnosis of acute community-acquired diarrhea for O157 STEC and for Shiga toxin and ensure that isolates are sent to a public health laboratory for serotyping and subtyping.

376 sickened; pet frogs linked to salmonella outbreak in kids

More reasons for the parents at school to hate me. 376 reasons.

Small water frogs marketed and sold as pets are linked to an outbreak of Salmonella infections from 2008 to 2011, according to a report from the U.S. Centers for Disease Control and Prevention (CDC).

The report published in Pediatrics on Monday found the infection sickened 376 people in 44 U.S. states and sent 29 percent of those infected to the african.dwarf_.frog_.storyhospital – mostly children.

“This was the first Salmonella outbreak associated with aquatic frogs, and in this case the frogs are often marketed as good pets for kids,” said Shauna Mettee Zarecki, the study’s lead author from the CDC in Atlanta.

“The majority of people didn’t realize there were any risks from these amphibians or other amphibians, like turtles and snakes,” she added.

While most people hear about Salmonella-contaminated food, Zarecki said reptiles and amphibians also carry the bacteria. Humans can become infected after handling the animals, cleaning their containers or coming in contact with contaminated water.

In the new report, Zarecki and her colleagues write that researchers from the CDC – along with state and local health departments – investigated an outbreak of Salmonella infections, mostly among children, in 2008.

By early 2009, the number of cases returned to normal before the researchers could find a cause. The investigation was started again when five more children were infected with the same strain of Salmonella in Utah later that year.

To find what was behind the outbreak, the researchers interviewed people who were infected with that strain of Salmonella from January 2008 through December 2011. They asked each person what animals and food they were exposed to in the week before they got sick.

They then compared the data from 18 people with that strain of the bacteria to 29 people who were infected with a different type of Salmonella.

Overall, they found 67 percent of the people in the new outbreak were exposed to frogs during the week before their illness, compared to 3 percent in the comparison group.

The majority of people who came in contact with a frog during the week before they got sick remembered the type – an African dwarf frog.

The investigation eventually led to an African dwarf frog breeding facility in Madera County, California. There, researchers found the same strain of the bacteria in the facility’s tank water, tank cleaning equipment, water filters and floor drains.

The facility started distributing frogs again in June 2011, after the owner voluntarily shut down the operation and instituted cleaning measures.

The researchers write, however, that African dwarf frogs can live for five to 18 years, which means infected frogs may still be in homes and continue to cause illness.

“The important consideration with any aquatic pet is to provide adequate filtration to keep the water clean and perform regular partial water changes,” Brooks-Brothers-Dresses-Kermit-the-Frog-for-The-Muppets-02said Dr. Nicholas Saint-Erne, a veterinarian for PetSmart, Inc., in a statement to Reuters Health.

“If these aquariums are in homes, children under five (years old) shouldn’t be allowed to clean the aquarium,” said Zarecki, adding that also applies to people with weakened immune systems.

“Pets are wonderful. We think they’re a great learning tool for children, but some pets just aren’t appropriate for children or individuals,” she added.