Epi works: Over 300 sickened from crypto on pre-cut salad greens in UK, 2012

In May 2012, people in England and Scotland started getting sick with Cryptosporidium. In June, 2012, the UK Health Protection Agency first announced 267 people were sick with Cryptosporidium across four areas of the UK, double the normal rate.

lettuce.harvestTen months later, HPA said the crypto that sickened about 300 people was most likely linked to eating pre-cut bagged salad products which were likely to have been labeled as ‘ready-to-eat.’

The outbreak was short lived and the numbers of cases returned to expected seasonal levels within a month of the first cases being reported. Most of those affected had a mild to moderate form of illness and there were no deaths associated with the outbreak.

During the investigation, an initial link was found between illness and pre-cut spinach. When specific retailers were included in the analysis, the strongest association with infection was found to be with consumption of ready to eat pre-cut mixed salad leaves from a major supermarket chain.

In this analysis, exposure to pre-cut spinach only reached conventional levels of significance for one retailer – a second major supermarket chain. A link to spinach from a number of other retailers was also suggested but these were not statistically significant. Together these findings suggest that one or more types of salad vegetables could have been contaminated.

Dr Stephen Morton, regional director of the HPA’s Yorkshire and the Humber region and head of the multi-agency Outbreak Control Team, said, “Our findings suggest that eating mixed leaf bagged salad was the most likely cause of illness. It is however often difficult to identify the source of short lived outbreaks of this type as by the time that the outbreak can be investigated, the affected food and much of the microbiological evidence may no longer be available

Dr Alison Gleadle, director of food safety at the FSA, took the opportunity to further confuse consumers, stating, “We’d like to remind everyone of our usual advice to wash all fruits and vegetables, including salad, before you eat them, unless they are labeled ready-to-eat.”

lettuce.skull.e.coli.O145But wasn’t this outbreak linked to ready-to-eat salads? How is that advice of any use? Could have offered some details, like, additional washing of ready-to-eat products is largely ineffective. FSA is refocusing its efforts on farm management to limit such contamination, before it happens.

A spokesthingy from retailer Morrisons said, rather defensively, “Morrisons is not the source of this outbreak. We have received no complaints of illness and no Morrisons products have tested positive for Cryptosporidia.

“The HPA’s claim is based solely on statistics, not testing. The very same statistics also implicated products from other retailers that the HPA recognize as ‘implausible’.”

Why doesn’t Morrison’s say what they do to enhance the safety of products they sell rather than trash epidemiology?

In the scientific paper on the outbreak, McKerr et. al reported a widespread foodborne outbreak of Cryptosporidium parvum in England and Scotland in May 2012. Cases were more common in female adults, and had no history of foreign travel. Over 300 excess cases were identified during the period of the outbreak. Speciation and microbiological typing revealed the outbreak strain to be C. parvum gp60 subtype IIaA15G2R1.

METHODS: Hypothesis generation questionnaires were administered and an unmatched case control study was undertaken to test the hypotheses raised. Cases and controls were interviewed by telephone. Controls were selected using sequential digit dialling. Information was gathered on demographics, foods consumed and retailers where foods were purchased.

RESULTS: Seventy-four laboratory confirmed cases and 74 controls were included in analyses. Infection was found to be strongly associated with the consumption of pre-cut mixed salad leaves sold by a single retailer. This is the largest documented outbreak of cryptosporidiosis attributed to a food vehicle.

An outbreak of cryptosporidium parvum across England & Scotland associated with consumption of fresh pre-cut salad leaves, May 2012

PubMed

McKerr C1, Adak GK2, Nichols G3, Gorton R4, Chalmers RM5, Kafatos

PLoS One, 2015, doi: 10.1371/journal.pone.0125955. eCollection 2015.

http://www.ncbi.nlm.nih.gov/m/pubmed/26017538/

Parasites at retail: Not so much (cause testing don’t tell ya much)

Cyclospora and Cryptosporidium are protozoan parasites which infect humans, primarily through contaminated food and water. Cyclospora is endemic in a number of subtropical and tropical countries. Cryptosporidium infection can be found in people worldwide. Cyclospora and Cryptosporidium infections can cause mild to severe gastrointestinal (GI) symptoms including, but not limited to, diarrhea, weight loss, cramping, flatulence, nausea, fatigue and low grade fever.

basil.salmonellaCyclospora and Cryptosporidium were ranked 13th and 5th, respectively, out of 24 parasites in overall global ranking for their public health importance by a Food and Agriculture Organization of the United Nations/World Health Organization (FAO/WHO) expert committee (September 3 to 7, 2012). Produce such as fresh herbs and berries have been identified in the past as sources of Cyclospora and Cryptosporidium contamination in Canada. This survey focused on fresh herbs, berries, green onions and mushrooms.

The objective of this survey was to determine the occurrence and distribution of Cyclospora and Cryptosporidium contamination in fresh produce such as herbs, berries, mushrooms and green onions. A total of 1,590 samples were analyzed for the presence of Cyclospora and 1,788 samples were analyzed for Cryptosporidium. Samples were collected at retail from various regions across Canada between May 2011 and March 2013.

raspberryOf the samples analyzed for Cyclospora, none were positive for the parasite. Of the samples analyzed for Cryptosporidium, six samples of green onions, one sample of parsley, and one sample of mushroom were positive, however, the analytical method used to detect the parasites in the samples cannot determine if the parasite is viable and potentially infectious. It is important to note that there were no reported illnesses associated with the consumption of the products found to be positive for Cryptosporidium. Positive results are followed up by the Canadian Food Inspection Agency (CFIA). In this case, because of the perishable nature of the products and the time elapsed between sample pick up and the completion of analysis, the fresh product was no longer available on the market when the parasite was detected. As such, no direct follow up was possible. This information was used to inform CFIA’s programs and inspection activities.

The Canadian Food Inspection Agency regulates and provides oversight to the industry, works with provinces and territories, and promotes safe handling of foods throughout the food production chain. However, it is important to note that the food industry and retail sectors in Canada are ultimately responsible for the food they produce and sell, while individual consumers are responsible for the safe handling of the food they have in their possession. Moreover, general advice for the consumer on the safe handling of foods is widely available. The CFIA will continue its surveillance activities and inform stakeholders of its findings.

Try harder: UK petting farm ‘doing all it can’ after E. coli outbreak

The owners of a petting farm at the centre of a parasitic disease outbreak that has left dozens ill said they are working with the local authority to investigate its cause.

swithern.farmIan and Angela Broadhead, who run Swithens Farm, in Rothwell, Leeds, have reassured visitors that their “health, safety and welfare” is of “utmost importance” to them as they continue to work with public health experts.

The petting farm has been linked to 29 cases of cryptosporidiosis, and two cases of E.coli O157.

The Broadhead family said: “As a small family-run business the health, safety and welfare of our visitors is of utmost importance to us all.

handwash.UK_.petting.zoo_.09Between January and May 2015 around 130 people were affected by outbreaks of cryptosporidiosis linked to petting farms in England.

PHE has advised all visitors to wash their hands after touching animals.

Handwashing, however, is never enough.

A table of petting zoo outbreaks is available at http://barfblog.com/wp-content/uploads/2016/05/Petting-Zoo-Outbreaks-Table-5-5-16.xlsx

Best practices for planning events encouraging human-animal interations

Zoonoses and Public Health 62:90-99

Erdozain , K. KuKanich , B. Chapman and  D. Powell, 2015

http://onlinelibrary.wiley.com/doi/10.1111/zph.12117/abstract?deniedAccess

Educational events encouraging human–animal interaction include the risk of zoonotic disease transmission. ‘It is estimated that 14% of all disease in the USA caused by Campylobacter spp., Cryptosporidium spp., Shiga toxin-producing Escherichia coli (STEC) O157, non-O157 STECs, Listeria monocytogenes, nontyphoidal Salmonella enterica and Yersinia enterocolitica were attributable to animal contact. This article reviews best practices for organizing events where human–animal interactions are encouraged, with the objective of lowering the risk of zoonotic disease transmission.

petting1-791x1024

petting2-791x1024 

31 sick: More than just an ‘upset tummy’ Another petting zoo, another E. coli /crypto outbreak

An outbreak of E.coli and parasitic disease cryptosporidiosis at a Leeds petting farm has led to more than 30 people falling ill.

swithens.farm.2Public health experts have launched an investigation into the outbreak, which has been linked to Swithens Farm, in Rothwell, Leeds.

A total of 29 cases of cryptosporidiosis have so far been confirmed.

Two cases of E. coli O157 have also been reported. All those affected visited Swithens Farm from the beginning of March onwards.

Public Health England (PHE) has been drafted in to deal with the issue and the owners of the farm voluntarily closed the facility for a period after the outbreak became apparent.

The petting farm has since reopened and its owners say “every effort is being taken to ensure that visitors are not put at risk.”

Dr Mike Gent, consultant in communicable disease control with Public Health England, said, “People may be tempted to use hand gels and wipes during a farm visit and after touching animals but, although they remove visible dirt and contamination, they may not be effective in removing the germs found on farms.”

Ian and Angela Broadhead, who run Swithens Farm, have released a statement explaining that they are working with the council after becoming aware that “there have been some children with upset stomachs.”

A table of petting zoo outbreaks is available at http://barfblog.com/wp-content/uploads/2016/05/Petting-Zoo-Outbreaks-Table-5-5-16.xlsx

Crypto in the US

Cryptosporidium is the leading aetiology of waterborne disease outbreaks in the United States. This report briefly describes the temporal and geographical distribution of US cryptosporidiosis cases and presents analyses of cryptosporidiosis case data reported in the United States for 1995–2012.

cryptoThe Cochran–Armitage test was used to assess changes in the proportions of cases by case status (confirmed vs. non-confirmed), sex, race, and ethnicity over the study period. Negative binomial regression models were used to estimate rate ratios (RR) and 95% confidence intervals (CI) for comparing rates across three time periods (1995–2004, 2005–2008, 2009–2012). The proportion of confirmed cases significantly decreased (P < 0·0001), and a crossover from male to female predominance in case-patients occurred (P < 0·0001). Overall, compared to 1995–2004, rates were higher in 2005–2008 (RR 2·92, 95% CI 2·08–4·09) and 2009–2012 (RR 2·66, 95% CI 1·90–3·73). However, rate changes from 2005–2008 to 2009–2012 varied by age group (Pinteraction < 0·0001): 0–14 years (RR 0·55, 95% CI 0·42–0·71), 15–44 years (RR 0·99, 95% CI 0·82–1·19), 45–64 years (RR 1·47, 95% CI 1·21–1·79) and ≥65 years (RR 2·18, 95% CI 1·46–3·25).

The evolving epidemiology of cryptosporidiosis necessitates further identification of risk factors in population subgroups. Adding systematic molecular typing of Cryptosporidium specimens to US national cryptosporidiosis surveillance would help further identify risk factors and markedly expand understanding of cryptosporidiosis epidemiology in the United States.

Evolving epidemiology of reported cryptosporidiosis cases in the United States, 1995–2012

E. Paintera1 c1, J. W. Garganoa2, J. S. Yodera2, s. A. Colliera2 and M. C. Hlavsaa2

a1 Epidemic Intelligence Service Officer, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging Zoonotic and Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA

a2 Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging Zoonotic and Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA

Epidemiology and Infection, Volume 144, Issue 8, June 2016, pages 1792-1802, DOI: http://dx.doi.org/10.1017/S0950268815003131

http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=10299145&utm_source=Issue_Alert&utm_medium=RSS&utm_campaign=HYG

It’s not a virus or bacterium, it’s a parasite: 7 positive, 16 sick with crypto after visit to Welsh petting farm

A Monmouthshire farm has cancelled a series of open day visits for primary school children following the outbreak of a diarrhea-causing virus.

powell.namePublic Health Wales along with Torfaen and Monmouthshire councils are continuing to investigate an outbreak of cryptosporidium associated with Coleg Gwent’s farm in Usk.

Seven people have tested positive for cryptosporidium and 16 others are suspected of having the bug after regular attendance at the farm or contact with those who have.

Heather Lewis, consultant in health protection for Public Health Wales, said: “We are continuing to work with Coleg Gwent, who have written to all students who may have been on the farm in March.

“As a precaution, Coleg Gwent have also cancelled a series of open days which were due to take place with invited primary schools from Tuesday, April 12 to Friday, April 15.”

A spokesman from Public Health Wales said: “Good hand washing after coming into contact with farm animals, their bedding or dirty equipment including clothing is of the utmost importance in preventing infection with cryptosporidium.

“There is no reason for anyone to avoid visiting petting farms as long as they ensure that anyone who has touched animals, thoroughly washes their hands with hot water and soap immediately afterwards and before eating, as hand sanitisers or alcoholic gels should not be solely relied upon.”

Handwashing is never enough.

Welsh farm investigated after visitors test positive for crypto

A Monmouthshire farm is being investigated after a number of visitors tested positive for a microscopic parasite that causes a diarrheal disease.

Coleg Gwent’s farm in UskPublic Health Wales, Torfaen County Borough Council and Monmouthshire County Council are investigating an outbreak of cryptosporidium at Coleg Gwent’s farm in Usk.

Three people have tested positive for cryptosporidium and eight others are under investigation after a regular attendance at the farm.

“All the confirmed cases had direct contact with the lambs at the college farm. As part of our investigations, we are checking on all those whom we believe had contact with these animals and Coleg Gwent is co­operating fully with our investigations.

 

But it’s such a cute lamb: 46 sickened with crypto at UK petting farm

A case-control study was conducted to investigate an outbreak of 46 cases of cryptosporidiosis in visitors to a petting farm in England.

amy_s_lamb_aug_12(1)Details of exposures on the farm were collected for 38 cases and 39 controls, recruited through snowball sampling. Multivariable logistic regression identified that cases were 5·5 times more likely than controls to have eaten without washing their hands [95% confidence interval (CI) 1·51–19·9, P = 0·01] and 10 times less likely to report being informed of risk of infection on arrival (odds ratio 0·10, 95% CI 0·01–0·71, P = 0·02).

An uncommon Cryptosporidium parvum gp60 subtype (IIaA19G1R1) was identified in a lamb fecal sample and all subtyped cases (n = 22). We conclude that lack of verbal advice and non-compliance with hand washing are significantly associated with a risk of cryptosporidiosis on open farms. These findings highlight the public health importance of effectively communicating risk to petting farm visitors in order to prevent future outbreaks of zoonotic infections.

Cryptosporidiosis outbreak in visitors of a UK industry-compliant petting farm caused by a rare Cryptosporidium parvum subtype: a case-control study

Epidemiology and Infection, Volume 144, Issue 5, April 2016, pages 1000-1009, DOI: http://dx.doi.org/10.1017/S0950268815002319 

Utsi, S. J. Smith, R. M. Chalmers, and S. Padfield

http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=10216122&utm_source=Issue_Alert&utm_medium=RSS&utm_campaign=HYG

A table of petting zoo outbreaks is available at http://barfblog.com/wp-content/uploads/2014/04/Petting-Zoo-Outbreaks-Table-4-8-14.xlsx.

Best practices for planning events encouraging human-animal interactions

Zoonoses and Public Health 62:90-99, 2015

G. Erdozain , K. KuKanich , B. Chapman  and D. Powell

http://onlinelibrary.wiley.com/doi/10.1111/zph.12117/abstract?deniedAccess

Educational events encouraging human–animal interaction include the risk of zoonotic disease transmission. It is estimated that 14% of all disease in the US caused by Campylobacter spp., Cryptosporidium spp., Shiga toxin-producing Escherichia coli (STEC) O157, non-O157 STECs, Listeria monocytogenes, nontyphoidal Salmonella enterica and Yersinia enterocolitica were attributable to animal contact. This article reviews best practices for organizing events where human–animal interactions are encouraged, with the objective of lowering the risk of zoonotic disease transmission.

petting.zoo_.guidelines

petting2

Cryptosporidium in Ireland’s water supply

There seems to be a lot of Cryptosporidium in Ireland.

Irish Water has identified cryptosporidium contamination in Carraroe’s public supply in Connemara.

cryptoThe discovery came as ten thousand homes and businesses in Cork were issued with boil water notices over fears of contaminated drinking water.

The State utility has advised some 4,700 people dependent on the public supply in Carraroe to boil their water until further notice.

This follows a similar notice issued for Leitir Móir/Tír an Fhia in south and west Connemara in January.

Sinn Féín senator Trevor Ó Clochartaigh has criticised Irish Water for failing to upgrade the Carraroe scheme when it was directed to by the Environmental Protection Agency (EPA).

“This supply has been substandard for years and the EPA have indicated for the last number of years that there has been insufficient protection for cryptosporidium, ”Senator Ó Clochartaigh said.

Pasteurization works, and don’t eat poop: 70 sickened with crypto from cow shit in cider

The cause of the cryptosporidiousis from the Pike County Fall Color Drive in apple cider is now known.

powell_kids_ge_sweet_corn_cider_00A test done by the CDC on environmental and human specimens has confirmed that this illness was due to cow manure contamination.

This unpasteurized apple cider was made on a private family farm in Adams County specifically for family consumption and sale at the Pike County Fall Color Drive October 17-18.

This cider was not produced at a licensed cider manufacturer or orchard.

Cattle were on the farm near the site of the apple cider press.