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.

 

STECs in shellfish, France

Shiga toxin-producing Escherichia coli (STEC) and enteropathogenic E. coli (EPEC) strains may be responsible for foodborne infections in humans.

Twenty-eight STEC and 75 EPEC strains previously isolated from French shellfish-harvesting areas and their watersheds and belonging to 68 distinguishable serotypes were characterized in this study.

bourdain_ss_brittany-journal_004_596x334High-throughput real-time PCR was used to search for the presence of 75 E. coli virulence-associated gene targets, and genes encoding Shiga toxin (stx) and intimin (eae) were subtyped using PCR tests and DNA sequencing, respectively.

The results showed a high level of diversity between strains, with 17 unique virulence gene profiles for STEC and 56 for EPEC. Seven STEC and 15 EPEC strains were found to display a large number or a particular combination of genetic markers of virulence and the presence of stx and/or eae variants, suggesting their potential pathogenicity for humans. Among these, an O26:H11 stx1a eae-β1 strain was associated with a large number of virulence-associated genes (n = 47), including genes carried on the locus of enterocyte effacement (LEE) or other pathogenicity islands, such as OI-122, OI-71, OI-43/48, OI-50, OI-57, and the high-pathogenicity island (HPI). One O91:H21 STEC strain containing 4 stx variants (stx1a, stx2a, stx2c, and stx2d) was found to possess genes associated with pathogenicity islands OI-122, OI-43/48, and OI-15. Among EPEC strains harboring a large number of virulence genes (n, 34 to 50), eight belonged to serotype O26:H11, O103:H2, O103:H25, O145:H28, O157:H7, or O153:H2.

Molecular profiling of Shiga toxin-producing Escherichia coli and enteropathogenic E. coli strains isolated from French coastal environments

Appl. Environ. Microbiol. July 2016 vol. 82 no. 13 3913-3927, DOI: 10.1128/AEM.00271-16

Balière, A. Rincé, S. Delannoy, P. Fach and M. Gourmelon

http://aem.asm.org/content/82/13/3913.abstract?etoc

 

Over 100 sick from French oysters: Norovirus outbreak in Denmark and Sweden

I don’t eat raw oysters, I don’t eat much of raw anything.

french.guard.monty.pythonNorovirus in oysters from France has sickened more than 100 people in Denmark and Sweden.

Livsmedelsverket (The National Food Agency, Sweden) said there was a number of different outbreak clusters in early February in which a total of 70 people were suspected to be ill.

Fødevarestyrelsen (The Danish Veterinary and Food Administration) said there had many different notifications, some from restaurants, in which around 60 people has been sickened.

Both countries posted notifications via the RASFF portal.

A spokesman from Livsmedelsverket said there was a link to one wholesaler in Sweden which has received two batches of oysters from a company in France