Surely you can’t be cereus: Pay attention to temperature control, esp when cooking for large numbers

The aim of this study was to identify and characterise Bacillus cereus from a unique national collection of 564 strains associated with 140 strong-evidence food-borne outbreaks (FBOs) occurring in France during 2007 to 2014.

surely-you-cant-be-seriousStarchy food and vegetables were the most frequent food vehicles identified; 747 of 911 human cases occurred in institutional catering contexts. Incubation period was significantly shorter for emetic strains compared with diarrhoeal strains.

A sub-panel of 149 strains strictly associated to 74 FBOs and selected on Coliphage M13-PCR pattern, was studied for detection of the genes encoding cereulide, diarrhoeic toxins (Nhe, Hbl, CytK1 and CytK2) and haemolysin (HlyII), as well as panC phylogenetic classification. This clustered the strains into 12 genetic signatures (GSs) highlighting the virulence potential of each strain. GS1 (nhe genes only) and GS2 (nhe, hbl and cytK2), were the most prevalent GS and may have a large impact on human health as they were present in 28% and 31% of FBOs, respectively.

Our study provides a convenient molecular scheme for characterisation of B. cereus strains responsible for FBOs in order to improve the monitoring and investigation of B. cereus-induced FBOs, assess emerging clusters and diversity of strains.

Baccillus cereus-induced food-borne outbreaks in France, 2007 to 2014: Epidemiology and genetic characteristics

Eurosurveillance, Vol 21, Issue 48, 01 December 2016

http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=22657

68 sickened with Salmonella from a butcher in France, 2015

Thanks to my French friend, Albert Amgar, for sending this along.

traditionally-prepared-hamBetween Tuesday 1 September 2015 and Wednesday 2 September 2015, the health monitoring and emergency platform of the Regional Health Agency (ARS) of Haute-Normandie received reports of three suspected cases of collective food poisoning due to Salmonella.

These foodborne outbreaks were reported by local laboratories in the same geographical area of the Seine-Maritime (76) district. The first investigative elements contributed to identify that each of the three families had consumed traditionally-prepared ham purchased from the same delicatessen butcher within the 24 to 48 hours preceding the date of symptoms onset among the reported cases.

The epidemiological, microbiological and environmental investigations performed following this report identified a total of 68 cases, including 6 biologically confirmed cases. The results of the cohort study that followed indicated an association between the consumption of prepared meals which were purchased from a delicatessen butcher, and the risk of occurrence of salmonellosis.

Bacteriological analyses identified a strain of Salmonella typhimurium 4,12: i: – with the same Crispol type (CT 797), rarely identified until now. The veterinary survey highlighted several dysfunctions explaining a diffuse contamination of surfaces and tools in the premises and in the food produced by the butcher.

Investigation of a cluster of salmonellosis in the Seine-Maritime district linked to the attendance of a delicatessen butcher in September 2015

Rapport d’investigation. Saint-Maurice : Santé publique France ; 2016. 16 p.

N Nicolay, A Spillebout, M Blanchard, B Cottrelle

http://invs.santepubliquefrance.fr/Publications-et-outils/Rapports-et-syntheses/Maladies-infectieuses/2016/Investigation-de-cas-groupes-de-salmonelloses-en-Seine-Maritime-76-en-lien-avec-la-frequentation-d-un-charcutier-traiteur-septembre-2015

 

Salmonella in beefburgers in France

A prolonged outbreak of Salmonella enterica serotype Enteritidis occurred in northern France between December 2014 and April 2015.

sorenne-beef-burgerEpidemiological investigations following the initial notification on 30 December 2014 of five cases of salmonellosis (two confirmed S. Enteritidis) in young children residing in the Somme department revealed that all cases frequented the same food bank A. Further epidemiological, microbiological and food trace-back investigations indicated frozen beefburgers as the source of the outbreak and the suspected lot originating from Poland was recalled on 22 January 2015. On 2 March 2015 a second notification of S. Enteritidis cases in the Somme reinitiated investigations that confirmed a link with food bank A and with consumption of frozen beefburgers from the same Polish producer. In the face of a possible persistent source of contamination, all frozen beefburgers distributed by food bank A and from the same origin were blocked on 3 March 2015. Microbiological analyses confirmed contamination by S. Enteritidis of frozen beefburgers from a second lot remaining in cases’ homes. A second recall was initiated on 6 March 2015 and all frozen beefburgers from the Polish producer remain blocked after analyses identified additional contaminated lots over several months of production.

Outbreak of Salmonella Enteritidis linked to the consumption of frozen beefburgers received from a food bank and originating from Poland: Northern France, December 2014 to April 2015

Eurosurveillance, Volume 21, Issue 40, 06 October 2016

http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=22605

Norovirus strikes hundreds at obstacle race in France

In June 2015, near Nice in the Alpes-Maritimes department, an acute gastroenteritis (AG) outbreak occurred among participants of an obstacle race. An investigation in 2 phases was conducted to identify the source of infection and document the extent of the outbreak.

tough_mudder_16-340x227During phase 1, a message on Facebook asked the racers to report by email any symptoms. In phase 2, a retrospective study was conducted through an interactive questionnaire for all participants. Cross-sectional descriptive studies were conducted, completed by an analytical study of the potential risks factors. Microbiological and environmental investigations were conducted in order to identify the responsible agent. An analysis of antidiarrhoeal drugs reimbursements was conducted with data from the French national health insurance to confirm the epidemiological investigation.

During phase 1, on 8229 registered participants, at least 1001 adults reported an AG, which was resolved in 48H.

In phase 2, the risks factors of AG identified were due to: younger participants, first hour of departure time and ingestion of mud. Twenty stool specimens traced were negative for bacteriological research. Only 4 stool specimens were sent to the CNR of enteric viruses. They were all positive for Norovirus genogroup1 and genotype 2 (GI.2), strain of human origin.

Indicator bacteria were negative in the drinking water and positive in the muddy water. Outbreak origin was due to human transmission: a norovirus possibly introduced by stools or vomiting from one or more persons infected, transmitted through contaminated muddy water.

For the future, recommendations for the organisation of such events should be proposed. The risks related to these races should be assessed to guide health authorities and to guide organizers in their awareness of potential risks factors.

Investigation of an outbreak of acute gastroenteritis among participants of an Obstacle Adventure Race Alpes-Maritimes

S Giron, C Six

http://invs.santepubliquefrance.fr/Publications-et-outils/Rapports-et-syntheses/Maladies-infectieuses/2016/Investigation-d-une-epidemie-de-gastro-enterites-virales-survenues-apres-une-course-a-obstacles

17 sickened with Hepatitis E linked to undercooked pig-liver stuffing

Background – On 11 December 2013, 3 clustered cases of hepatitis E were reported on a coastal island in Brittany. Cases had consumed spit-roasted and stuffed piglet during a wedding meal. The raw stuffing was partly made from the piglet liver. Investigations were carried out to identify the source and vehicle of contamination, and evaluate the dispersion of the hepatitis E virus (HEV) in the environment.

spit-roast-pigMethods – A questionnaire was administered to 98 wedding participants who were asked to give a blood sample. Cases were identified by RT-PCR and anti-HEV serological tests. A retrospective cohort study was conducted among 38 blood sampled participants after the exclusion of participants with evidence of past HEV immunity. Relative risks (RR) with their 95% confidence intervals were calculated based on foods consumed at the wedding meal using univariate and multivariable Poisson regressions.

The human HEV strains were compared with the strains detected in the liquid manure sampled at the farm where the piglet was born and at the inlet of the island wastewater treatment plants.

Results – 17 cases, including 3 confirmed cases, were identified and 70.6% were asymptomatic. Acute HEV infection was independently associated with piglet stuffing consumption (RR=1.69 [1.04-2.73]). Human strains from the index cases, veterinary and environmental HEV strains were identical.

Discussion – The outbreak was attributable to the consumption of an undercooked pig liver-based stuffing. After infection, the cases have probably become a temporary reservoir for HEV, which was detected in the island’s untreated wastewater.

Hepatitis E outbreak associated with the consumption of a spit-roasted piglet, Brittany (France), 2013

Épidémie d’hépatite E associée à la consommation d’un porcelet grillé à la broche, Bretagne, 2013. Bull Epidémiol Hebd. 2016;(26-27):444-9

Y Guillois, F Abravanel, T Miura, N Pavio, V Vaillant, S Lhomme, et al.

http://invs.santepubliquefrance.fr/beh/2016/26-27/2016_26-27_3.html

To use antibiotics or not: E. coli O80:H2 in France

Jenina Pellegren of Contagion Live writes that Enterohemorrhagic Escherichia coli (EHEC) are a subset of Shiga toxin–producing E. coli (STEC) that cause diarrhea and hemorrhagic colitis. The illness can progress to hemolytic uremic syndrome (HUS) in 5%-10% of cases.

maxresdefaultIn France between 2005 – 2014, a total of 54 patients were infected with EHEC O80:H2; 91% had HUS. Two patients had invasive infections and 2 died. Similar strains were found in Spain with all isolates belonging to the same clonal group.  

“Azithromycin decreased Shiga toxin in subinhibitory concentrations significantly. Ciproflaxacin increased it substantially and ceftriaxone had no major effect. The occurrence of bacteremia during EHEC infections warranted antibiotic treatment. However, antibiotics are not usually recommended because of the risk for worsening HUS, notably by the secretion of Shiga toxin (Stx). This represents a therapeutic challenge.”  

In 2011, an outbreak in Germany linked to EHEC O104:H4 underscored the potential benefit of certain antibiotics when HUS occurs, making the use of antibiotics a source of debate. To determine the incidence rate of HUS cases associated with the singular EHEC O80:H2, a study examined the effects of different antibiotics on Stx production in representative strains.  

During January 2005 – October 2014 The Centre National de Reference Associe Escherichia coli, in France, collected 57 different strains of EHEC O80:H2. Isolated from stool specimens of over 54 patients; 2 and 3 isolates each were recovered from 2 patients.  

According to the Center for Disease Control and Prevention (CDC) “Among the 53 patients for whom clinical data were available, 49 (91%) had HUS; 27 (51%) were male. Median age for these 48 patients was 1.2 years (range 0.2–39 years, interquartile range [IQR] 0.7–1.6 years). Only 1 adult HUS patient (a 39-year-old) was reported. The 5 (9%) non-HUS patients were largely older (1, 2, 6, 21, and 40 years old). Among HUS patients, fever was present in 45%; median leukocyte count was 13,000 cells/mm3 (data were not available for 14 patients), and 56% had leukocytosis (>11,500 leukocytes/mm3).”  

Several studies demonstrated that the effect of antibiotics on HUS depends on their class.  Ciprofloxacin raises the production and release of Stx in vitro and is associated with a higher mortality rate in pigs. Yet, other studies indicate azithromycin might decrease the production and release of Stx. However, during a 2011 outbreak of EHEC O104 infection in Germany, a patient treated by ciprofloxacin plus imipenem unexpectedly had a better prognosis.  

Despite promising in vitro results, the authors of the study could not advocate the use of these antibiotics for treatment of patients infected with EHEC O80:H2. While potentially promising, these findings are preliminary and require confirmation.

2 stricken with Listeria in France, unpasteurized cheese recalled

The Puillet cheese factory, located in Roanne, France withdrew its products from sale after detection of Listeria monocytogenes. Two people from the retirement home of Belmont-de-la-Loire have been infected.

camembert_franceListeria has been detected in Camembert cheese made from cow’s milk from a local dairy.

The presence of bacteria was detected after 2 people from the retirement home of Belmont-de-la-Loire, returned after a meal on June 23, 2016. The investigation by the DDPP Loire (Department for Protection of Populations) revealed that the infection had come from cheese consumed during the meal.

The manager of the dairy remains dubious: “We do not know where it comes from or how it could be contaminated. It’s been over 20 years since we started (the business) and it never happened before. It is really hurting our business.”

Don’t reveal our dirty secrets, beg French chefs

As a postscript to our recent trip to France, friend of the barfblog.com Albert Amgar, who we had the extraordinary pleasure of meeting, forwarded a note from a French colleague who argued that “I think that too much information on albert(food safety) problems creates uselessly an alarming climate of insecurity.”

Fail.

I have a vague understanding of this class-based approach to disclosure.

In 1994, as a graduate student, I was invited to a pre-G7 summit in Naples, Italy. The idea was to bring in a scientist and a journalist from each of the G7 countries to discuss medical conditions and whether patients should be told.

I was the scientist and journalist from Canada.

There was a lot of posturing from the Italian hosts, a lot of drinking and eating, and very little work.

It was a lovely weekend.

The Americans, the Brits and me (the Canadians)  agreed on full disclosure.

The other countries, including France, said their patients couldn’t handle it.

Guess things haven’t changed much.

According to The Times Paris on July 20, 2016, government wants to tell diners the truth by publishing results of health and safety inspections on the agricultural ministry’s website – chefs are aghast.

They are even more appalled at a proposal to stick a label in the window of their restaurants that will say whether hygiene is ‘very satisfactory’ ‘satisfactory’ , to improve’ or ‘to be corrected urgently’. Given that only a few restaurants are likely to be deemed ‘very satisfactory’ , the profession fears for its reputation.

Restaurateurs are campaigning to prevent the plan from being implemented next month. Hubert Jan, chairman of the Union of Hotel Trades and Industries, said that his members were already losing money because of France’s poor economic performance and terrorism fears. ‘The profession, which was badly hit by a fall in custom after the terror attacks, does not need to be thrown to the lions and stigmatised.’

The scheme was drawn up amid increasing concern over restaurant hygiene. In summer 2013, health inspectors ordered the closure of 252 establishments. In Paris, 321 were shut last year. Among the concerns of inspectors were sushi leƞ in the sun, broken fridges and food past sell-by date. The agriculture ministry tried out its ‘transparency of food hygiene’ programme in the capital, testing 367 restaurants. 34% were deemed to have a good level of hygiene, 54% were ‘acceptable’ and 8% were told they had to improve. The figures alarmed restaurateurs, who say that the ratings could be posted on internet guides and remain there even after failings have been rectified. They also fear diners will shun establishments with a label on their doors, unless it says ‘very satisfactory’.

Don’t take the brown acid: No more diarrhea tablets at Glastonbury 2016

Coldplay is enough to induce diarrhea for me.

Hear’s hoping my Dr. Maths friend from the train in France wasn’t caught up in the gastro outbreak that has hit Glastonbury Festival goers – and there’s some bad news for revelers – the onsite pharmacies have run out of diarrhea relief tablets.

Although hopes are high that medication will be delivered to the site’s pharmacies later today, anyone who is unwell can get help from the festival medical centres.

And regardless of if you’re feeling ill or not, people are being reminded to wash hands carefully with soap and water or anti-bacterial hand gel after using the toilet and before eating or handling food.

Meet barfblog’s French correspondent

Had the pleasure of finally meeting Albert Amgar, mirobiologist and frequent French correspondent for barfblog.com.

albertWe had lunch, hung out in his family’s apartment, toured old Paris and found out there really are other people in the world who have to have a couple of hours on the internet just to talk about food safety stuff.

Amy said the similarities were somewhat overwhelming.

I thought it was great.

Albert said France was terrible at public disclosure.

Oui.