20 sick with campy linked to raw milk in Colorado

Jakob Rodgers of The Gazette reports that up to 20 people have been sickened from raw milk supplied by a ranch in Pueblo County, leading health officials to warn against drinking unpasteurized milk from the farm.

santa-barf_sprout_raw_milk7The outbreak of campylobacteriosis – an infection causing nausea and diarrhea – stems from raw milk distributed by Larga Vista Ranch, which is about 20 miles east of Pueblo, according to El Paso and Pueblo county health officials.

The infections highlight the dangers of drinking raw, unpasteurized milk, said Dr. Christine Nevin-Woods, El Paso County Public Health’s medical director.

“Sometimes people think that raw foods of all kinds are healthier,” she said. “But in this case, raw milk is very dangerous to be drinking.”

Since Aug. 1, health officials have confirmed 12 such cases and eight probable cases, according to the El Paso and Pueblo county health departments. Of those 20 people, half live in El Paso County, and half live in Pueblo County.

The infections stem from milk supplied by a herdshare program, which allows people to purchase stakes in livestock, such as cows or goats, and to receive a portion of each animal’s milk or meat.

Some of the people sickened were not part of the herdshare program. They received the milk from people who were part of it, which is now allowed, health officials said.

An after-hours call to the ranch by The Gazette was not returned.

Going public, Colorado-style: 16 sick with Salmonella at Oscar’s of Breckenridge

Kaeli Subberwal of Summit Daily reports that 16 employees and patrons at a popular Breckenridge taco bar came down with Salmonella poisoning in July. This outbreak led Summit County health officials to shut down the restaurant until the issue was addressed — a process that took six days.

Oscar’s of BreckenridgeMorgan Stovall had been working at Oscar’s of Breckenridge for only three shifts when the health inspectors arrived.

“I guess we knew we were getting a health inspection,” she said, “but we thought they would just come in and make sure we were using gloves and everything; but that health inspector came in with someone higher up who deals with outbreaks.”

The health inspection on July 15 was prompted by three cases of salmonella that were reported to the state health department after Oscar’s patrons went to their medical providers and were diagnosed with the foodborne illness.

“The only common exposure among the three confirmed illnesses is consuming food at Oscar’s restaurant during the week before becoming ill. Specifically, ill persons visited Oscar’s on July 1 and July 4,” read a letter from the Colorado Department of Public Health and Environment to Amy Wineland, the director of Summit County Public Health.

Though Oscar’s is back in business, some workers are still suffering the consequences of the outbreak.

“It’s been nearly 3 weeks, and I’m still testing positive,” employee Brittany Doyne wrote in an email. “I feel I should be compensated for all 3 of my jobs, not just Oscar’s. I’m missing out on thousands of dollars I would have earned had Oscar’s not gotten me sick. Nearly all of what little savings I have is gone now.”

How the sick employees are being compensated while out of work is unclear.

Typhoid fever spread from asymptomatic restaurant worker in Colorado

On September 11, 2015, a single case of typhoid fever, caused by Salmonella Typhi infection, was reported to the Colorado Department of Public Health and Environment (CDPHE).

symptoms_of_typhoid_feverBecause the patient (patient A) had symptom onset September 2 and had traveled internationally for 4 days 60 days before symptom onset, the case initially was thought to be travel-associated* (1,2).

On October 1, a second case of S. Typhi infection was reported in patient B, with symptom onset September 20. Patient B reported no international travel or contact with ill persons or known carriers. Patients A and B resided approximately 6 miles (10 kilometers) apart and had no discernible epidemiologic connection. Family members of patients A and B tested negative for S. Typhi. CDPHE and the Weld County Department of Public Health and Environment (WCDPHE) investigated to 1) determine whether these cases represented a larger outbreak, 2) identify common exposure sources, and 3) stop transmission. Investigators determined that the typhoid fever in both patients and in a third patient (patient C) was associated with eating in the same restaurant during a 5-day period.

CDPHE defined a case of typhoid fever as clinically compatible illness with isolation of S. Typhi during July 1–October 15 and identification of an isolate with one of two pulsed-field gel electrophoresis (PFGE) outbreak patterns that differed by one band. A carrier was defined as a person who had contact with patients, reported no recent illness, and had S. Typhi with either of the PFGE outbreak patterns in an isolate from a rectal swab or stool specimen. Case finding included searching PulseNet for other isolates that might have been associated with the Colorado cases (3). On October 13, CDPHE issued a health alert notification to clinicians, local public health authorities, and laboratories to be vigilant for additional cases and to encourage reporting. During October 1–9, CDPHE and WCDPHE used the Salmonella National Hypothesis Generating Questionnaire (4), credit card receipts, food recall, shopper card records, and social media to identify potential exposures shared by patients A and B during the 60 days preceding symptom onset. Investigators found that the two patients had fresh produce purchases from the same grocery stores and had six common restaurant exposures.

On October 19, CDPHE was notified of a third Weld Country resident who had tested positive for S. Typhi infection. Patient C had symptom onset September 15 and reported no recent travel or relation to patient A or B. Patient C was interviewed using the Salmonella questionnaire, and credit card receipts were reviewed. Patient C did not shop at the same grocery stores as patients A or B, but all three patients had eaten at restaurant A during August 16–20, 2015. Patients A and C were hospitalized. Isolates from patients B and C had indistinguishable PFGE patterns (pattern 2), and the isolate from patient A had a 1-band difference (pattern 1), which met the PFGE outbreak definition.

s.typhi.symptomsCDPHE hypothesized that a chronic S. Typhi carrier might be working in food service at restaurant A, where food is prepared using fresh ingredients. Possible transmission routes were investigated through environmental assessments and staff interviews; food service staff members were asked to be tested for S. Typhi. Environmental assessments performed on October 27 found no deficiencies in hand hygiene or other food handling issues. Administrators from restaurant A provided a list of all current and former employees who worked in food handling during August 10–August 20, 2015. These more conservative dates were chosen because food might have been served as many as 4 days after preparation, and because of concerns regarding the accuracy of credit card statement dates.

On October 28, current restaurant employees were confidentially interviewed at a local clinic by CDPHE and WCDPHE regarding international travel, symptoms, and work tasks. Because bacterial shedding can be intermittent, employees were requested to collect rectal swab specimens from themselves on October 28 and November 3 for culture and PFGE testing of isolates. All employees were allotted paid time to be interviewed and provide specimens. By October 29, a total of 28 (100%) current employees had responded and provided one or more rectal swab specimens. On October 30, CDPHE was notified by the state health laboratory that S. Typhi had been isolated from one employee. The isolate’s PFGE pattern was indistinguishable from outbreak pattern 1, the pattern of patient A.

Interviews with the infected restaurant worker revealed travel to a country with endemic typhoid fever 15 years earlier, but no recent symptoms, and no contact with any ill persons. The worker was excluded from food service work, treated with azithromycin for 28 days, and monitored with stool testing until three consecutive specimens obtained ≥1 month apart were negative for S. Typhi (2). Restaurant A agreed to keep the worker’s job open and allow him to return to work once he was no longer a carrier.

Typhi infection is a nationally notifiable condition; in Colorado, reporting is required within 24 hours of case detection. Notable clinical symptoms of typhoid fever include insidious onset of fever, and headache, constipation, chills, myalgia, and malaise (1). Unlike other Salmonella species, S. Typhi does not commonly cause diarrhea, and vomiting typically is not severe (1).

Typhi infection is endemic in many low-income countries; an estimated 22 million cases and 200,000 deaths occur each year (2). In the United States, approximately 5,700 cases of typhoid fever are reported annually; the majority occur among travelers (1). In Colorado during 2009–2014, on average, six cases of confirmed typhoid fever were reported annually; all cases were associated with international travel or attributed to a household member or close contact with a carrier. Humans are the only reservoir for S. Typhi; disease is transmitted via the fecal-oral route, typically by contaminated food or water. Chronic carriage occurs in 2%–5% of cases (1,2), and shedding of S. Typhi in chronic carrier stools can be intermittent.

This investigation highlights the potential for chronic S. Typhi carriers to cause illness in other persons, even years after infection. When cases of typhoid fever not associated with travel are detected, rapid and thorough interviewing is essential. Social media posts and credit card receipts to detect common exposures can be useful. The high cooperation rate among workers at the restaurant, which is rare in foodborne outbreak investigations, was attributed to the restaurant’s support and accommodation, demonstrating the importance of collaboration among local public health, state public health, public health laboratories, patients, and industry for successful investigations.

Typhoid fever outbreak associated with an asymptomatic carrier at a restaurant ― Weld County, Colorado, 2015

MMWR Morb Mortal Wkly Rep 2016;65:606–607. June 2016, DOI: http://dx.doi.org/10.15585/mmwr.mm6523a4.

Jessica Hancok-Allen, Alicia B. Cronquist, JoRene Peden, Debra Adamson, Nereida Corral, Kerri Brown

http://www.cdc.gov/mmwr/volumes/65/wr/mm6523a4.htm?s_cid=mm6523a4_x

‘Oversimplified method’ Colorado seeks to ban letter grades

A Colorado House Bill aiming to update restaurant inspection regulations has Weld County leaders again fighting for local control.

qr.code.rest.inspection.gradeHouse Bill 1401, introduced late last week, would ban summarizing inspection results with a letter, number or any other “oversimplified method.”

County leaders overhauled the inspection page online in late 2014. Among the updates was a change in grading. Instead of using ambiguous words to rate a restaurant’s safety level, they began using an A-F system.

“It makes it much easier for the citizens of Weld County to look at a restaurant to see how they’re doing,” said Mike Freeman, chairman of the Board of Weld County Commissioners. “People don’t know what ‘critical’ is.”

The inspection process never changed; state law would forbid that. The update changed only how information was presented to the public.

Although various restaurant owners attended meetings to criticize the rule change, county leaders say they believe the change has been a boon to residents. Not only is the A-F grading system more transparent, it encourages restaurant owners to step up, Freeman said.

“They don’t want to see Ds and Fs,” he said. “It’s a very positive impact.”

Within the last year, Weld County saw 50 percent fewer inspections receiving an F, Environmental Health Director Trevor Jiricek wrote in a letter. Inspections getting either a D or an F dropped to 19 percent from 28 percent.

Web traffic on the new inspection page increased 100 percent over that time, Jiricek wrote. Leaders say it’s because residents can actually glean something from the page now.

The use of restaurant inspection disclosure systems as a means of communicating food safety information

Filion, K. and Powell, D.A. 2009. Journal of Foodservice 20: 287-297.

The World Health Organization estimates that up to 30% of individuals in developed countries become ill from food or water each year. Up to 70% of these illnesses are estimated to be linked to food prepared at foodservice establishments.barf.o.meter_.dec_.12-216x300-216x3001-216x300

Consumer confidence in the safety of food prepared in restaurants is fragile, varying significantly from year to year, with many consumers attributing foodborne illness to foodservice. One of the key drivers of restaurant choice is consumer perception of the hygiene of a restaurant. Restaurant hygiene information is something consumers desire, and when available, may use to make dining decisions.

Filion, K. and Powell, D.A. 2011. Designing a national restaurant inspection disclosure system for New Zealand. Journal of Food Protection 74(11): 1869-1874

The World Health Organization estimates that up to 30% of individuals in developed countries become ill from contaminated food or water each year, and up to 70% of these illnesses are estimated to be linked to food service facilities. The aim of restaurant inspections is to reduce foodborne outbreaks and enhance consumer confidence in food service. Inspection disclosure systems have been developed as tools for consumers and incentives for food service operators. Disclosure systems are common in developed countries but are inconsistently used, possibly because previous research has not determined the best format for disclosing inspection results. This study was conducted to develop a consistent, compelling, and trusted inspection disclosure system for New Zealand. Existing international and national disclosure systems were evaluated.larry.the_.cable_.guy_.health.inspector-213x300-213x3001-213x300

Two cards, a letter grade (A, B, C, or F) and a gauge (speedometer style), were designed to represent a restaurant’s inspection result and were provided to 371 premises in six districts for 3 months. Operators (n = 269) and consumers (n = 991) were interviewed to determine which card design best communicated inspection results. Less than half of the consumers noticed cards before entering the premises; these data indicated that the letter attracted more initial attention (78%) than the gauge (45%). Fifty-eight percent (38) of the operators with the gauge preferred the letter; and 79% (47) of the operators with letter preferred the letter. Eighty-eight percent (133) of the consumers in gauge districts preferred the letter, and 72% (161) of those in letter districts preferring the letter. Based on these data, the letter method was recommended for a national disclosure system for New Zealand.

 

Colorado preschools upset over state’s new chicken ban

Boulder County preschools and child care centers that keep chickens are protesting a new state rule that bans live chickens, ducks and other poultry.

chicken.pen.childcareAt Niwot’s Shepherd Valley Waldorf, the eggmobile — a mobile coop that houses about 100 chickens — is now on a nearby property owned by parents and the chicken lessons are on hold.

“In preschool and kindergarten, they’re learning through experiences,” said Ruth Godberfforde, Shepherd Valley’s outreach and admissions director. “Taking care of chickens is a wonderful, purposeful activity. We want to keep that connection with nature and animals.”

An online petition to repeal the new rule has garnered more than 2,000 signatures. The campaign also is supported by Temple Grandin, a well known Colorado State University agriculture professor.

The state regulations, which went into effect Jan. 14, ban licensed child care centers from keeping live poultry on site or bringing them into classrooms. Live birds are still allowed in classrooms where children are older than 5.

The ban is designed to protect young children from salmonella, a bacteria that’s often carried by poultry and causes diarrhea, vomiting and fever, according to state health department officials.

Young children are considered especially at risk because their immune systems are still developing, making it more likely they’ll need to be hospitalized. Plus, young children often put their fingers and other objects in their mouths. increasing the likelihood that they’ll get sick.

Colorado routinely has one or more outbreaks each year of salmonella that are associated with live poultry, said Therese Pilonetti, unit manager for the state health department’s Division of Environmental Health and Sustainability.

In a typical outbreak associated with live poultry, young children make up half of all cases, she said.

Opponents to the ban say the state doesn’t have any evidence linking a salmonella outbreak in Colorado to chickens at a child care facility. Instead, they say, any risks are mitigated by good health practices like washing hands after being around the birds.

“We’ve had animals in different capacities over the last 20 years,” Shepherd Valley’s Godberfforde said. “We follow all the health and safety guidelines and have never had any issues.”

Disclosure and sick leave: Colorado lawmaker wants restaurants to post notice if workers are not given five paid sick days

A Colorado lawmaker is proposing a “Scarlet Letter” of sorts for statewide restaurants.

Disclosure_Still2_SnapseedState Sen. Jessie Ulibarri, D-Westminster, wants to require restaurant owners to have to post a notice on their door if they do not give their employees five paid sick days.

“If employees are not offered paid time off when they’re sick, then we, as the public, should know,” said Ulibarri. “If we know there’s dairy in our food or gluten in our food, we should know if there’s influenza in our food.”

He said his bill is not in response to the recent Chipotle health scare, but rather a few workers in his House district who have said they’ve had to decide between working sick and getting paid or staying home and risk their bills and their jobs.

“When there’s an economic incentive to show up to work sick, it can endanger the health of all of us,” said Ulibarri. “I’ve followed this issue and received some information from the Colorado Department of Public Health and Environment, which indicated in fact, most of the major food outbreaks are due to sick employees, not listeria or E.coli.”

Denver7 checked with CDPHE and was told that about half of all food-borne outbreaks are caused by Norovirus and not by E.coli, Listeria or other bacterial infections.

“It’s very easy for illness to be spread through a worker who’s ill,” said Brian Hlavacek, Environment Health Director for Tri-County Health Department, which covers Adams, Arapahoe and Douglas Counties. “Certainly it’s a problem that sometimes workers often work while ill.”

20 sickened at Subway: Colorado norovirus outbreak in BV serves as warning

Local health officials said they hope a norovirus outbreak in Buena Vista that left approximately 20 people ill in mid-November will serve as a reminder to area restaurants and food providers to be extra cautious.

norovirusThe Mountain Mail reports Chaffee County Public Health received complaints from five people saying they were ill after eating food from the Subway in Buena Vista, according to a restaurant inspection report.

Lab tests on samples from the five individuals all tested positive for norovirus.

Public Health estimates roughly 20 people, mostly students at Buena Vista High School, might have fallen ill in the outbreak.

An investigation by Chaffee County Environmental Health Manager Victor Crocco, who declined to name the restaurant, found that one employee reported feeling ill the day after the illness was originally reported.

Subway manager Brandon Alexander said he did not recall any of the employees being sick around the time of the outbreak.

Crocco’s investigation led him to conclude a sick employee, and not a larger food contamination, most likely caused the contamination.

Alexander said he doesn’t remember anything like this happening in his 8 years at the restaurant.

9 sickened with E. coli O157 in Oct. 2013 linked to imported cucumbers served at Jimmy John’s in Denver

I’m sure university departmental meetings across the U.S. continue to chomp down on catered Jimmy John’s sandwiches, even though they have a terrible food safety record:

cucumber282 sick from Norovirus in Garden City, Kansas, in 2014;

29 sick from E. coli O26 on clover sprouts in early 2012; and,

140 sick from Salmonella on alfalfa sprouts in 2011.

Now, the Colorado Department of Public Health & Environment reports that in Oct. 2013, an outbreak of E. coli O157:H7 sickened nine people, including 1 probable case and 8 laboratory-confirmed cases with matching pulsed-field gel electrophoresis (PFGE) and multiple-locus variable number tandem repeat analysis (MLVA) patterns from E. coli O157:H7 isolated from stool.

All 9 cases reported eating sandwiches at Denver-area Jimmy John’s locations in early October 2013. The outbreak investigation consisted of case finding and interviews, 2 separate case-control studies, environmental investigations, produce traceback, and laboratory testing.

348sThe results of this investigation indicate that consumption of Jimmy John’s sandwiches containing cucumbers imported from Mexico was the likely cause of the outbreak. To our knowledge, this is the first E. coli O157:H7 outbreak associated with cucumbers reported in the United States. Public health and food safety officials should be aware that cucumbers may be contaminated with E. coli O157:H7, which could cause sporadic E. coli O157:H7 infections as well as outbreaks. As of the date of this report, no other cases of E. coli O157:H7 with the PFGE pattern combination seen in this outbreak were reported in Colorado. 

Hepatitis A incident leads Colorado restaurant to make vaccinations for staff mandatory

Ft. Collins Colarodo is home of New Belgium beer, Colorado State University, and a restaurant that has been stung by having a food handler test positive with Hepatitis A. According to thedenverchannel.comTortilla Marissa’s North of the Border Cafe is closed until public health folks give them the okay to reopen.TortillaMarissas_1403912791692_6553175_ver1.0_640_480

A food worker employed at restaurant at 2635 S. College Ave., tested positive for Hepatitis A, a disease that might be passed to others through food directly handled by the employee before any symptoms appeared, according to the Larimer County Department of Health and Environment.

Officials said diners who consumed food or drinks — either dine-in or take-out — from the restaurant in the past 14 days could benefit from getting a Hepatitis A vaccination or Immune Globulin injection to reduce the risk of illness.

Shots can be obtained from private health care providers or at two special clinics the Health Department will be holding on Sunday and Monday specifically for those potentially exposed  to Hepatitis A through the restaurant.

According to a statement released by the restaurant, they are making Hep A vaccinations mandatory for their staff.

We have instituted some new procedures including all future staff will be required to get an Hepatitis A vaccination before being allowed to work at Tortilla Marissa’s;  we have written a new employee sick policy based on best practices from around the country; and created some new systems in the kitchen. All of these practices exceed the standards set by the Larimer County Health Department as we are committed to our patrons health.

Health fair attendees stricken with food poisoning

The Rio Grande County Public Health Department in Colorado is investigating an outbreak of food poisoning possibly linked to food that was served at the 9Health Fair in Monte Vista on Saturday, April 5. 9Health Fair says the food at the fair was supplied by the Kiwanis Club.

vomit.toiletPublic Health Department Director Emily Brown says they have sent samples to the state lab and expect results by the beginning of next week. Brown estimates about 30 cases were reported by volunteers and participants. Brown says that it doesn’t appear the illness is spreading.