Authorities in Germany have declared an outbreak of norovirus among schoolchildren, first noted in late September, officially over after an apparent failure by catering operators to prepare frozen strawberries properly prior to their consumption.
The strawberries in question had been imported from China and were reportedly supplied by a catering company – said to be a distribitor to foodservice giant Sodexo – in ten different locations across Germany.
Sources in the fresh produce trade indicated that lessons learned from the recent E coli outbreak in northern Germany had helped minimise the impact on the industry as a whole, with communication said to have been more coordinated and timed to reduce the spread of rumour and conjecture.
Comforting words for the 11,200 kids and their families who were barfing.
Last year it was sprouts that sickened some 4,400 and killed 53 in an outbreak centered in Germany; now the number of children that have fallen ill with vomiting and diarrhea after eating food from school cafeterias and daycare centers has risen from about 4,500 to 8,400.
Authorities in Berlin and the surrounding eastern German states reported the new gastroenteritis cases Saturday, while laboratory investigations to determine the exact cause of the outbreak were still under way.
Berlin’s health department says the sicknesses are moderate and most children recover within two days without requiring to be hospitalized.
In Saxony state, at least 16 cases of norovirus, a mostly food- or water-borne illness, were proven, according to German news agency dapd.
The government-affiliated Robert Koch Institute said Friday that all facilities where the illness occurred likely received food from a single supplier.
German health authorities say at least 6,500 German children and teenagers have fallen ill with diarrhea and vomiting that health authorities say has likely been caused by a foodborne virus in meals delivered to schools and daycare centers.
The Robert Koch-Institut says it was alerted to a sudden surge in gastroenteritis cases that began late Tuesday in Berlin and surrounding regions.
The institute said in a statement late Thursday that laboratory investigations are under way to determine the exact cause of the outbreak.
Raw sprouts are the poster child for failures in what academics call, risk communication.
I’ve been thinking about this for a long time.
About 1999, graduate student Sylvanus Thompson started working with me on risk analysis associated with sprouts. He got his degree and went on to rock-star status in the food safety world with the implementation of the red-yellow-green restaurant inspection disclosure program with Toronto Public Health, but we never published anything.
I remember frantically flying to Kansas City to hang out with this girl in Manhattan (Kansas) I’d met a couple of weeks before, in the midst of the 2005 Ontario raw sprout outbreak that sickened over 700; Jen Tryon, now with Global News, interviewed me at the airport, with me wearing a K-State hockey shirt (that’s the joke; there is no hockey at K-State, and I was still employed by Guelph; and I was going to hang out with this girl).
After the German E. coli O104 outbreak that killed 53 people last year and sickened over 4,000, along with the ridiculous public statements and blatant disregard for public safety taken by sandwich artist Jimmy John’s in the U.S., I figured we really needed to publish something.
The basic conclusions:
• raw sprouts are a well-documented source of foodborne illness;
• risk communication about raw sprouts has been inconsistent; and,
• continued outbreaks question effectiveness of risk management strategies and producer compliance.
Sprouts present a unique food safety challenge compared to other fresh produce, as the sprouting process provides optimal conditions for the growth and proliferation of pathogenic bacteria. The sprout industry, regulatory agencies, and the academic community have been collaborating to improve the microbiological safety of raw sprouts, including the implementation of Good Manufacturing Practices (GMP), establishing guidelines for safe sprout production, and chemical disinfection of seed prior to sprouting. However, guidelines and best practices are only as good as their implementation. The consumption of raw sprouts is considered high-risk, especially for young, elderly and immuno-compromised persons (FDA, 2009).
Sol Erdozain, now a graduate student in psychology at Kansas State University, took the lead on this one. Kevin Allen, now a prof-type and hockey goon at the University of British Columbia (that’s blue-eyes, right) who used to take great pleasure firing pucks off my head – even though he is also a goalie – weighed in with his microbiology expertise, Katija Morley (nee Blaine) made our arguments more coherent, and I pestered everyone. Because I should have published something like this 12 years ago.
Writing is hard.
From November 2010 into 2011, an outbreak linked to raw sprouts in the U.S. and involving sandwich franchise Jimmy John’s sickened 140 people. This was the third sprout related outbreak involving this franchise, yet the owner of the Montana Jimmy John’s outlet, Dan Stevens, expressed confidence in his sprouts claiming that because the sprouts were locally grown they would not be contaminated. By the end of December 2010 a sprout supplier, Tiny Greens Farm, was implicated in the outbreak. Jimmy John’s owner, John Liautaud, responded by stating the sandwich chain would replace alfalfa sprouts with clover sprouts since they were allegedly easier to clean. However, a week earlier a separate outbreak had been identified in Washington and Oregon in which eight people were infected with Salmonella after eating sandwiches containing clover sprouts from a Jimmy John’s restaurant. This retailer was apparently not aware of the risks associated with sprouts, or even outbreaks associated with his franchisees.
In late December 2011, less than one year after making the switch to clover sprouts, Jimmy John’s was linked to another sprout related outbreak, this time it was E.coli O26 in clover sprouts. In February 2012, sandwich franchise Jimmy John’s announced they were permanently removing raw clover sprouts from their menus. As of April 2012, the outbreak had affected 29 people across 11 states. Founder and chief executive, John Liautaud, attempted to appease upset customers through Facebook stating, “a lot of folks dig my sprouts, but I will only serve the best of the best. Sprouts were inconsistent and inconsistency does not equal the best.” He also informed them the franchise was testing snow pea shoots in a Campaign, Illinois store, although there is no mention regarding the “consistency” or safety of this choice.
Despite the frequent need for sprout-based risk communication, messaging with industry and public stakeholders has been limited in effectiveness. In spite of widespread media coverage of sprout-related outbreaks, improved production guidelines, and public health enforcement actions, awareness of risk remains low. Producers, food service and government agencies need to provide consistent, evidence-based messages and, more importantly, actions. Information regarding sprout-related risks and food safety concerns should be available and accurately presented to producers, retailers and consumers in a manner that relies on scientific data and clear communications.
Erdozain, M.S., Allen, K.J., Morley, K.A. and Powell, D.A. 2012. Failures in sprouts-related risk communication. Food Control. 10.1016/j.foodcont.2012.08.022
Nutritional and perceived health benefits have contributed to the increasing popularity of raw sprouted seed products. In the past two decades, sprouted seeds have been a recurring food safety concern, with at least 55 documented foodborne outbreaks affecting more than 15,000 people. A compilation of selected publications was used to yield an analysis of the evolving safety and risk communication related to raw sprouts, including microbiological safety, efforts to improve production practices, and effectiveness of communication prior to, during, and after sprout-related outbreaks. Scientific investigation and media coverage of sprout-related outbreaks has led to improved production guidelines and public health enforcement actions, yet continued outbreaks call into question the effectiveness of risk management strategies and producer compliance. Raw sprouts remain a high-risk product and avoidance or thorough cooking are the only ways that consumers can reduce risk; even thorough cooking messages fail to acknowledge the risk of cross-contamination. Risk communication messages have been inconsistent over time with Canadian and U.S. governments finally aligning their messages in the past five years, telling consumers to avoid sprouts. Yet consumer and industry awareness of risk remains low. To minimize health risks linked to the consumption of sprout products, local and national public health agencies, restaurants, retailers and producers need validated, consistent and repeated risk messaging through a variety of sources.
There was this one time, Chapman came to Manhattan (Kansas) and lasted one quarter of a Kansas State football game before rushing home with explosive diarrhea.
My whiny kid didn’t help either.
He spent the rest of the visit holed up downstairs, sucking back Gatorade and sitting on the toilet.
When he got back to North Carolina he had the wherewithal to donate a stool sample, and eventually found out he was part of a state-wide antibiotic-resistant campylobacter outbreak.
In light of the German-based E. coli O104 outbreak in raw sprouts last year, researchers in Germany and Sweden are now calling for all stool samples from patients with diarrhea to be tested for enteropathic E. coli.
Following an outbreak of enterohaemorrhagic Escherichia coli (EHEC) in Germany 2011, we observed increases in EHEC and non-EHEC E. coli cases in Bavaria. We compared the demographic, clinical and laboratory features of the cases reported during the outbreak period, but not related to the outbreak, to the cases reported before and after. The number of EHEC and non-EHEC E. coli cases notified per week during the outbreak was fivefold and twofold higher respectively, compared to previous years. EHEC cases notified during the outbreak were more often reported with bloody diarrhoea, and less often with unspecified diarrhoea, compared to the other periods. They were more often hospitalised during the outbreak and the following period compared to the period before. Their median age (26.5 years, range: 0–90) was higher compared to before (14.5 years, range: 0–94) and after (5 years, range: 0–81). The median age of non-EHEC E. coli cases notified during the outbreak period (18 years, range 0–88) was also higher than before and after (2 years, p<0.001). The surveillance system likely underestimates the incidence of both EHEC and non-EHEC E. coli cases, especially among adults, and overestimates the proportion of severe EHEC cases. Testing all stool samples from patients with diarrhoea for enteropathic E. coli should be considered.
“In view of the major EHEC outbreak in early summer 2011, the BfR once again draws attention to hygiene measures which must be observed in the cultivation and preparation of sprouts, since contaminated sprouts were in all likelihood the cause of the numerous infections at the time. Independently of the past EHEC outbreak, the BfR had already earlier drawn attention to the risk of contracting disease resulting from the consumption of raw sprouts.
“When handling seeds and raw sprouts, consumers should be particularly meticulous in taking hygiene measures in order to minimise the risk of an infection. If possible, sprouts should also be sufficiently heated by boiling or frying or at least thoroughly washed before they are eaten. Pathogens cannot be removed completely by light heating or washing of the sprouts. For this reason, persons with a weak immune system, i.e. infants, pregnant women, the elderly and persons suffering from illness should, to be on the safe side, only eat sprouts after they have been adequately heated.”
With 53 dead and some 4,400 sickened, mostly in Germany, it was a, uh, major outbreak. And it was most likely contaminated fenugreek seed imported from Egypt that was the underlying cause. Washing isn’t going to do much and cross-contamination is always a risk. Also not much help for those who buy sandwiches or salads in Europe (and Australia) where sprouts are ubiquitous.
Take a brochure for lunch next time and be better educated.
Ukraine team doctor Leonid Mironov believes the weakened players suffered from “the bad effects of eating a salad,” the Interfax news agency reported Thursday.
Team spokesman Oleksandr Glyvynskiy told The Associated Press there will be no further investigation into the cause of the food poisoning, despite head coach Oleg Blochin suggesting on Ukrainian TV that “it may have been sabotage.”
The researchers conducted exploratory interviews via telephone with the hostess, three barbecue guests and one person who had prepared a salad but did not attend the barbecue himself.
The barbecue lasted from about 15:00 hours until well after midnight. According to the hostess, 14 persons attended the barbecue and all of them became ill with gastroenteric symptoms that night or the day after the party.
A person who was supposed to attend the barbecue party had fallen ill the day before (30 April). He had prepared a vegetable pasta salad in the morning and
developed gastroenteric symptoms within 3 h after salad preparation. He was hospitalized the next morning (1 May) and therefore did not attend the barbecue.
Nevertheless, his salad was served at the party. It was stored unrefrigerated for 23 h at approximately 20C before being served. The stored salad contained only pasta, tomatoes, peppers and cucumbers and was dressed with basic vinaigrette from oil and vinegar just shortly before consumption.
Storing the salad at room temperature for 23 h allowed a substantial increase of bacterial load, which can explain the severe infections of all barbecue guests, none of whom belonged to a risk group for severe infections. Proliferation is inhibited or can be reduced by acidic pH values but vinegar was only
added to the salad shortly before serving.
This outbreak underscores the importance of proper kitchen hygiene and food storage in private settings. Food hygiene recommendations should be reiterated to the public at the beginning of the barbecue season by public health actors. Additionally, it should be emphasized that if a person develops gastroenteric symptoms shortly after preparing a meal, the food should be considered as potentially infectious and discarded.
Severe infections caused by Salmonella Enteritidis PT8/7 linked to a private barbecue
Epidemiology and Infection, FirstView Article : pp 1-7
E. Mertens, H. Kreher, W. Rabsch, B. Bornhofen, K. Alpers and F. Burckhardt http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=8542116 A cohort study on a barbecue-associated Salmonella outbreak was conducted to describe the burden of disease and to identify the outbreak vehicle. Dose–response relationships were tested with Fisher’s exact and Wilcoxon rank sum tests (alpha=0·05). S. Enteritidis isolates were cultured and phage-typed. Information was available for 11 out of 14 individuals attending the barbecue; all were healthy young adults (median age 27 years). The attack rate was 100%. Three cases were hospitalized and two developed acute pancreatitis. The exposure common to all cases was a vegetable pasta salad that had been stored unrefrigerated for 23 h. Consuming higher doses was associated with longer median symptom duration (7 days vs. 4 days, P=0·11). S. Enteritidis was found in the stools of nine barbecue guests. Phage type 8/7 was identified in the stools of the salad preparer and one barbecue guest. This outbreak shows that S. Enteritidis can cause serious infection in young healthy individuals without well-known risk factors.