1 dead, 38 sick at Greece baptism party: Maybe it was the feta

One person is dead and two are in critical condition amongst the 38 people who suffered food poisoning after a baptism party in Aspra Spitia, Viotia, in central Greece.

buffet food

buffet food

The baptism party was held on Saturday and afterwards 38 people were transferred to the hospital with severe gastroenteritis symptoms. Health experts claim it was salmonella that caused the mass food poisoning.

According to local website lamiareport.gr, a 55-year-old man died in the hospital while two others are in intensive care. The 23-year-old son of the man was transferred to an Athens hospital for treatment, while another guest is in intensive care at a Lamia hospital.

A guest who spoke to lamia.gr believes the salmonella was in a specific feta cheese because all the people who ate it ended up in the hospital, while those who didn’t eat the particular cheese showed no gastroenteritis symptoms whatsoever.

An outbreak of a possibly new Salmonella Enterica subspecies enterica serovar with the antigenic formula 11:Z41:E,N,Z15, Greece, March to May 2016

Between 24 March and 27 May 2016, eleven Salmonella spp. isolates with an unusual antigenic type were identified by the National Reference Laboratory for Salmonella and Shigella (NRLSS) in Greece.

salm.greeceThe antigenic type of the eleven isolates was 11:z41:e,n,z15, which is not referred to in the 9th edition of the White-Kauffman–Le Minor Scheme [1]. The isolates were cultured from stool and collected from ten patients with diarrhea; for one asymptomatic case, the sample was obtained during a routine test for acquiring a certificate for occupational use. However, the latter case reported having had gastroenteritis symptoms some weeks before. None of the isolates fermented malonate but all fermented dulcitol, indicating that they belong to Salmonella enterica subspsecies enterica [1]. All were susceptible to the laboratory routine panel of antimicrobial agents, including third generation cephalosporins and fluoroquinolones. Tests were performed using the disk diffusion method and breakpoints according to the European Committee on Antimicrobial Susceptibility Testing (EUCAST) were applied [2].The pulsed-field gel electrophoresis (PFGE) profiles, after digestion with XbaI according to PulseNet protocol [3], were indistinguishable in 10 of the 11 strains (one result of the last isolated strain is pending) (Figure 1).

According to the database of the NRLSS and of the Veterinary Reference Laboratory for Greece, the antigenic type 11:z41:e,n,z15 has never been identified before from animals, animal products or food samples.

All cases, defined as persons with diarrhoea with the new Salmonella enterica subsp. enterica serovar (n=10), were of Greek nationality (6 male, 4 female). Eight of the cases were children (15 months ̶ 3 years old) and two were adults (28̶ 60 years of age). Cases’ symptoms included diarrhoea (one case had bloody diarrhoea), vomiting and abdominal cramps, and three of them reported fever (≥38.0°C). Three cases reported relapse of symptoms and all cases will be followed up. Three of the identified cases reported a household contact with similar symptoms (another child in the same family). Investigation of the possible household clusters showed that they were most probably co-infected but none of the household contacts was laboratory-confirmed. In this report, only information for laboratory-confirmed cases is presented.

The majority of the cases (n=9) were scattered in the region of Attica, one case was identified in Kastoria in northern Greece, and another in Korinthos, central Greece. Only one case reported travel abroad to Torino, in Italy, five days before the symptom onset. This case stated developing symptoms before returning to Greece. Figure 2 presents the temporal distribution of cases by week of symptom onset.

The PFGE profile [4] was uploaded to the European Surveillance System (TESSy) operated by the European Centre for Disease Prevention and Control (ECDC) (ECDC_ID: f5f0517b-f809–4d2b-973f-3f9c520b9d77) and an urgent inquiry (UI) was launched via the ECDC’s Epidemic Intelligence Information System (EPIS) (UI-358). According to the ECDC food- and waterborne diseases curators, no isolates with a matching PFGE profile (XbaI.2460) have been reported to TESSy (personal communication, Saara M. Kotila, ECDC, 25 May 2016). Moreover, none of the 15 countries that replied to the UI had identified the new serovar in the past.

Three of the isolates were sent to the World Health Organization (WHO) Collaborating Centre for Reference and Research on Salmonella at Pasteur Institute in Paris, France, which is responsible for the validation of new serovars. According to Pasteur Institute, the isolates represent a putative new serotype of Salmonella enterica subsp. enterica (personal communication, Francois-Xavier Weill, Pasteur Institute, 26 May 2016).

Laboratory confirmed cases were interviewed by telephone with a standard trawling questionnaire for investigating salmonellosis cases but no apparent epidemiological link has yet been identified. Cases were geographically scattered, had not travelled inside the country, did not have pets or contact with reptiles, and had not participated in any common activities. Based on the results from the trawling questionnaires, no food item emerged as possible source of the infections. Thus, it was decided to further investigate this salmonellosis cluster by performing an analytical study. Given the highly selective nature of food-borne case reporting and in order to reduce recall bias, a case–case study for the identification of possible risk factors was designed [5-7]. This study included a comparison group of Salmonella Enteritidis cases from the Greek Mandatory Notification System (MNS) matched by age (± 1 year), and place of residence. In order to increase the power of the study, the ratio of case–case 1:3 was decided.

A structured web-based trawling questionnaire, containing a long list of possible exposures (food and water consumption, exposures to animals, travel history, activities, etc.) was developed and distributed to all cases (both of unknown Salmonella serovar

According to some preliminary findings, a new Salmonella enterica sub. enterica serovar seems to have caused an outbreak in Greece over two months in the first half of 2016, with 10 cases (and one asymptomatic) as of 27 May. Reported cases are mostly children, however this may be influenced by the fact that laboratory tests are performed more frequently in children with gastroenteritis symptoms than in adults with the same symptoms. We cannot be sure about the geographical distribution of cases. The higher number of cases from Attica may be because more isolates are sent to the National Reference Laboratory from this region. Three cases reported relapse of symptoms. Data on the severity of the disease are also gathered and a case–case study is underway. Final results are pending.

We encourage other countries to contact authors in case of identifying isolates of the new serovar of Salmonella enterica susp. enterica with the antigenic type 11:z41:e,n,z15.

An outbreak of a possibly new Salmonella Enterica subspecies enterica serovar with the antigenic formula 11:Z41:E,N,Z15, Greece, March to May 2016

Eurosurveillance, Volume 21, Issue 25, June 2016, DOI: http://dx.doi.org/10.2807/1560-7917.ES.2016.21.25.30265

G Mandilara, K Mellou, K Karadimas, L Georgalis, M Polemis, T Georgakopoulou, A Vatopoulos

http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=22511

Whole-genome sequencing detection of ongoing Listeria contamination at a restaurant, Rhode Island, USA, 2014

Infection with Listeria monocytogenes, a foodborne bacterial pathogen, causes listeriosis, which can lead to severe illness, typically among persons with compromised immune systems and pregnant women and their fetuses.

listeria4The pathogen can survive at high salt concentrations and grow at refrigeration temperatures (1). These properties enable the bacteria to persist in food processing and food service establishments for extended periods. Listeriosis has a long incubation period (3–70 days), making exposure recall difficult.

Retail delicatessens are a potential source of L. monocytogenes because they hold ready-to-eat foods at refrigeration temperatures; however, a risk assessment by the United States Department of Agriculture’s Food Safety and Inspection Service suggests that thorough sanitization of food contact surfaces, proper maintenance of equipment and facilities, safe product handling practices, and good employee practices to avoid cross-contamination can help prevent listeriosis cases associated with retail food establishments (2).

Since 1998, PulseNet (http://www.cdc.gov/pulsenet/index.html) has used pulsed-field gel electrophoresis (PFGE) to look at genetic differences in L. monocytogenes subtypes and to identify outbreaks. However, distantly related strains can appear indistinguishable by PFGE; thus, greater differentiation may be needed to distinguish between outbreak and sporadic cases of listeriosis. Whole-genome sequencing (WGS) offers an opportunity to further discriminate between strains and identify outbreaks. WGS has historically been used retrospectively to provide additional insight into outbreak investigations (3). However, since September 2013, WGS has been performed on all clinical L. monocytogenes isolates identified in the United States by the Centers for Disease Control and Prevention (Atlanta, GA) and several state public health laboratories (4). L. monocytogenes is a good candidate for WGS because it causes a relatively rare condition that can result in serious illness, it has a small genome that is relatively easy to analyze, and epidemiologic surveillance and food regulatory program components for the bacterium are strong (5).

Data obtained from WGS has been analyzed using whole-genome multilocus sequence typing (wgMLST), a technique that examines allelic differences from thousands of loci, and ≈96% of L. monocytogenes coding sequences have been identified as loci in the wgMLST scheme (S. Stroika, Centers for Disease Control and Prevention, pers. comm., 2016 Jan 29). To discriminate between strains and identify outbreaks, alleles within the coding sequence (i.e., loci) are compared with ≈178 reference genomes. A unique combination of alleles at each locus specifies the sequence type, which enables comparison of isolates (6); the smaller the number of allelic differences between isolates, the more related they are.

The Rhode Island Department of Health (RIDOH) attempts interviews and, when applicable, conducts environmental investigations for all reports of listeriosis. Each year during 2011–2013, RIDOH received ≈3 reports of listeriosis, most of which were sporadic cases. However, in November 2014, a cluster of cases was detected from laboratory reports and examined using WGS in conjunction with epidemiologic, laboratory, and environmental investigations. Isolates were confirmed to be L. monocytogenes and submitted for PFGE analysis. The Centers for Disease Control and Prevention performed WGS on clinical isolates; the Food and Drug Administration performed WGS on food isolates.

The Investigation

During October 27–November 5, 2014, RIDOH’s Center for Acute Infectious Disease Epidemiology was notified of 3 L. monocytogenes–infected persons residing in the same city. The 3 case-patients were all non-Hispanic white persons >60 years of age; 2 had an immunocompromising condition. Interviews conducted by the Center for Acute Infectious Disease Epidemiology identified a single common restaurant visited by the 3 patients. RIDOH’s Center for Food Protection performed inspections and collected food and environmental samples at the establishment.

listeria.cdc.jul.14PFGE analysis showed that clinical L. monocytogenes isolates from the 3 case-patients shared an identical, common PFGE pattern (Figure). To determine the relationship between the isolates, RIDOH collaborated with federal partners to conduct WGS. Results of wgMLST showed that the isolates were closely related (0–5 allelic differences) (Figure) and a close genetic match (median allelic differences 4) to a clinical isolate from a 2013 patient, who was reinterviewed and reported eating at the same restaurant. A sliced prosciutto sample from the restaurant tested positive for L. monocytogenes, and PFGE patterns for this isolate matched those for isolates from the 2013 and 2014 case-patients. Results of wgMLST showed that the isolate from the prosciutto differed by 0–5 alleles (median 3) from the 2014 clinical samples and by 0–11 alleles (median 4) from the 2013 clinical sample. Sequences for the isolates were uploaded to GenBank (7) (clinical isolates: accession nos. SAMN02400177, SAMN03253348–49, SAMN03253359; isolate from prosciutto: accession no. SAMN03218571).

A total of 10 food and environmental food samples were initially collected from the restaurant. Swab samples were obtained from the food slicer, preparation tables, and walk-in cooler. Environmental investigation of the restaurant identified issues related to control of L. monocytogenes: the temperature of the refrigerated unit that held sliced meat and other food items was elevated (52°F [11°C]), and cleanliness issues were observed with the preparation tables and slicer. An additional 19 environmental samples were later collected from the establishment; however, the refrigerated unit and preparation tables had been replaced, so additional swab samples could not be collected from those surfaces. The sample of sliced prosciutto was the only L. monocytogenes–positive sample identified at the restaurant; however, just 1 of the 2014 case-patients reported eating prosciutto (in an antipasto salad) at the restaurant. Other foods reported included green salad and coleslaw.

RIDOH tested a sample of prosciutto from an unopened package from the establishment and collaborated with the Food Safety and Inspection Service to see if the processing plant had recently tested positive for L. monocytogenes. The sample tested negative, and no positive tests had been reported at the plant in at least 1 year.

Conclusions

Epidemiologic, environmental, and laboratory investigation results implicated a restaurant with sanitation issues and improper sliced meat storage as the likely source of a multiyear listeriosis outbreak. A long incubation period makes WGS an effective technology to use during listeriosis outbreak investigations and to identify outbreak-associated cases originally believed to be sporadic cases. This technology can help overcome difficulties associated with investigating listeriosis cases and can be useful for the investigation of other pathogens. In this investigation, WGS (wgMLST) helped link the 2013 listeriosis case, which was originally believed to be a sporadic case, to the 2014 outbreak. Furthermore, given that the 4 isolates had a common PFGE pattern, this technology increased confidence that the restaurant, which was the only common restaurant among the 4 patients, was the source of the outbreak. The allelic differences observed are consistent with slow, spontaneous mutation occurring over a long period due to persistent contamination.

There is no set number of allelic differences used to determine whether clusters of cases are part of actual outbreaks (8). Thus, WGS is not sufficient by itself to identify outbreaks and must be performed in conjunction with epidemiologic, laboratory, and environmental investigations (8,9). In the investigation we describe, WGS was used in this supporting role. The close relationship that WGS showed between the clinical isolates and the isolate from meat provides additional evidence that the restaurant was the likely source of contamination for the cases in 2013 and 2014.

Our findings support the need to control L. monocytogenes at retail food establishments. Storing meat at <41°F (5°C) can prevent ≈9% of listeriosis cases (2). In addition, retail delicatessens and food establishments can prevent L. monocytogenes–associated illnesses among customers by controlling cross-contamination, cleaning and sanitizing food contact surfaces, and eliminating environmental niches.

Mr. Barkley is a public health epidemiologist at the Center for Food Protection, Rhode Island Department of Health. His research interests include understanding risk factors of foodborne illness associated with retail food establishments.

Acknowledgment

We thank the Rhode Island State Laboratory for performing confirmatory L. monocytogenes testing on clinical and food samples and for coordinating PFGE and WGS testing; the Massachusetts William A. Hinton State Laboratory for performing PFGE testing of the clinical and food samples; and the Centers for Disease Control and Prevention and Food and Drug Administration for performing WGS of clinical and food samples, respectively.

References

  1. Ferreira V, Wiedmann M, Teixeira P, Stasiewicz MJ. Listeria monocytogenespersistence in food-associated environments: epidemiology, strain characteristics, and implications for public health. J Food Prot. 2014;77:150–70.DOIPubMed
  2. United States Department of Agriculture, Food Safety and Inspection Service. Best practices guidance for controllingListeria monocytogenesin retail delicatessens. June 2015 [cited 2016 Feb 1].http://www.fsis.usda.gov/wps/wcm/connect/29d51258-0651-469b-99b8-e986baee8a54/Controlling-LM-Delicatessens.pdf?MOD=AJPERES
  3. Le VT, Diep BA. Selected insights from application of whole-genome sequencing for outbreak investigations. Curr Opin Crit Care. 2013;19:432–9. DOIPubMed
  4. Centers for Disease Control and Prevention. Advanced molecular detection (AMD). AMD projects: learning from Listeria [cited 2015 Oct 23]. http://www.cdc.gov/amd/project-summaries/listeria.html
  5. Jackson B, Jackson K, Tarr C, Evans P, Klimke W, Kubota K, Improving detection and investigation of listeriosis outbreaks using real-time whole-genome sequencing. Presented at: IDWeek 2014; Philadelphia, PA, USA; 2014 Oct 8–12.
  6. Larsen MV, Cosentino S, Rasmussen S, Friis C, Hasman H, Marvig RL, Multilocus sequence typing of total-genome-sequenced bacteria. J Clin Microbiol. 2012;50:1355–61. DOIPubMed
  7. Benson DA, Clark K, Karsch-Mizrachi I, Lipman DJ, Ostell J, Sayers EW. GenBank. Nucleic Acids Res. 2015;43:D30–5.DOIPubMed
  8. Jackson B. Everything in sequence: listeriosis outbreak investigations in the era of WGS. Presented at: Integrated Foodborne Outbreak Response and Management (InFORM) 2015 Conference; Phoenix, AZ, USA; 2015 Nov 17–20.
  9. Leekitcharoenphon P, Nielsen EM, Kaas RS, Lund O, Aarestrup FM. Evaluation of whole genome sequencing for outbreak detection of Salmonella enterica.PLoS One. 2014;9:e87991. DOIPubMed

Whole-genome sequencing detection of ongoing Listeria contamination at a restaurant, Rhode Island, USA, 2014

Emerging Infectious Diseases, Volume 22, Number 8, August 2016

Jonathan S. Barkley , Michael Gosciminski, and Adam Miller

http://wwwnc.cdc.gov/eid/article/22/8/15-1917_article

E. coli O157 outbreak linked to salad, Bristol, UK

Public Health England has issued an alert about the increase in the number of cases of E.coli O157 infection involving people eating salad then being taken ill.

lettuce.skull.e.coli.O145No individual salad item or supplier has yet been identified, and PHE is working with environmental health officers in Bristol, South Gloucestershire, North Somerset and B&NES to try to trace the source of the outbreak.

Mike Wade, director of Health Protection for PHE South West said, “We also urge people to remove any loose soil before storing vegetables and thoroughly wash all vegetables, fruit and salad items that will be eaten raw.”

Not quite.

But it’s a good blaming consumers strategy.

No children have been affected to date.

20 years of PulseNet: The national molecular subtyping network for foodborne disease surveillance

The U.S. Centers for Disease Control reports PulseNet is celebrating 20 years of public health achievements in transforming the way foodborne disease outbreaks are detected and investigated.

pulse-net-20-200PulseNet is a national surveillance network of federal, state, and local public health laboratories that work together to detect foodborne disease outbreaks by connecting DNA fingerprints of bacteria that cause illness. The network facilitates the early identification of common sources of foodborne outbreaks and helps regulatory agencies identify areas where implementation of new measures are likely to improve the safety of the food supply.

A recent economic evaluation of PulseNet activities suggests that the network prevents at least 270,000 illnesses from infection with Salmonella, E. coli, and Listeria and saves an estimated $500 million each year. In 2013, PulseNet began using whole genome sequencing (WGS) to detect outbreaks caused by Listeria, the most deadly foodborne pathogen. PulseNet is quickly expanding the use of WGS in state laboratories and has begun using WGS in investigations of other foodborne pathogens such as Campylobacter, E. coli, and Salmonella. With incorporation of WGS and other advanced molecular detection methods, PulseNet will continue to improve foodborne disease detection and identify outbreaks faster and with more accuracy.

Additional information regarding CDC’s Advanced Molecular Detection initiative is available at http://www.cdc.gov/amd/. Additional materials on the 20th anniversary of PulseNet, including success stories from state public health laboratories and fact sheets are available at the CDC PulseNet website.

Raw cat food recalled

We returned to Australia, last night, staying up until 2 or 3 a.m.

sorenne.cat.trip.jun.16No hockey for me at 6 a.m. Saturday morning.

The seven hours in the air from Paris to Dubai, then 13 hours from Dubai to Brisbane, plus all the waiting, is a tad overrated.

This was Sorenne at noon Saturday, as we were going to go get some stuff.

She missed her cat.

And apparently sleep.

We do not feed any pets raw food.

Radagast Pet Food, Inc. (Portland, OR) has announced a voluntary recall of four lots of frozen Rad Cat Raw Diet products, sold in 8oz., 16oz., and 24oz. tubs, and free 1oz sample cups, due to the potential to be contaminated with Salmonella and/or Listeria monocytogenes.

Pets with Salmonella or Listeria monocytogenes infections may be lethargic and have diarrhea or bloody diarrhea, fever and vomiting. Some pets may have only decreased appetite, fever and abdominal pain. Infected but otherwise healthy pets can be carriers and infect other animals or humans. If your pet has consumed the recalled product and has these symptoms, please contact your veterinarian.

5_cupsThe FDA third party contracted lab found two lots of Grass-Fed Beef tested positive for Listeria monocytogenes, one lot of Free-range Chicken tested positive for Listeria monocytogenes, and one lot of Free-range Turkey tested positive for Salmonella and Listeria monocytogenes. As a precautionary measure, we are voluntarily recalling three products produced in these four lots.

All affected lot codes 62384, 62361, 62416, and 62372 and Best By dates are located on the lid of all products packaged in tubs and on the bottom of the sample cups.

The following recalled products were distributed in western Canada and all US States except in HI and MS.

Please do not return any of these recalled products to the retailer and dispose in a secure garbage receptacle. For refund claims, fill out all sections of our Consumer Claims Form which can be found on our website www.RadFood.com disclaimer icon and return this form only to the retailer where you purchased the product for a refund. Consumers may call Radagast Pet Food, Inc. for assistance in filling out the Claim Form.

Denmark says; Give us your poop

They could have just gone to France. This is Sorenne beside a doodie at a subway stop yesterday.

sorenne.france.poop.jun.16Hvidovre Hospital near Copenhagen is looking for healthy faeces donors that can help build a stockpile of stools to be used to fight bacteria.

Faeces from healthy people has proven to be a good weapon against recalcitrant bacteria when typical antibiotics fail. Since 2014, over 60 patients at the hospital have been treated with faeces donated by family members to combat clostridium bacterium that often do not respond to common antibiotics.

Demand is increasing, so Andreas Munk Petersen, the chief physician at Hvidovre Hospital thinks it is a good time to get some poop on the shelves.

“There are some age limits, but if you are otherwise healthy and have no diseases and are not severely overweight, you be a donor,” Petersen told DR Nyheder.

The hospital hopes to develop a ‘faeces bank’ similar to today’s blood banks so that a regular stream of contributors are available to help spread the treatment method further.

 

Food safety raid on flour, curry powder units

I never knew what masala was until Sorenne really liked the Indian chicken takeaway.

sorenne.jacques.jun.16So I’ve been trying to recreate the dish at home.

Guess it can suck at food safety too.

Food safety officials inspected 21 large-scale manufacturing units making curry, masala powders and flour on Wednesday. Six of the units were issued improvement notices while a fine of Rs.75,000 was imposed on five others.

Officials collected 20 statutory samples of curry powders and 36 surveillance samples for quality checks.

Food safety officials closed down a Nirapara roller flour mill at Attingal where raw materials like wheat were found to be stored in unhygienic and unclean conditions.

In Palakkad district, food safety officials seized and sealed stocks of cumin, coriander and turmeric from the Aanakkara Food Processing and Export Pvt. Ltd., as these were found to be sub-standard.