214 sickened at teen hockey tournament in Finland

Chapman and I get sorta excited when food safety intersects with hockey.

ben.family.feb.15So after watching Anaheim take a 2-1 lead after two periods over Chicago, and several OMG e-mails, I can note that in Finland last month, about 30 teens got sick with Salmonella at the Riga Cup.

And then the numbers went to over 200.

But the authors, writing in Eurosurveillance, do a much better job describing the outbreak, so I’ll go back to figuring out my practice plan for this weekend.

On 14 April 2015, a general practitioner in a municipal public health authority in Finland notified the National Registry for Food and Waterborne Outbreaks (RYMY) [1] about a cluster of 30 cases of gastrointestinal disease. All had attended the Riga Cup on the 3 to 6 April weekend 2015 and six had laboratory-confirmed Salmonella serogroup D infection.

The Riga Cup is an annual international youth ice-hockey competition where mainly male teams, with occasional female players, participate. Players in the event are officially categorised in five age groups comprising individuals between 10 and 18 years-old. In 2015, the competition consisted of five tournaments lasting three to four days each, which took place over five consecutive weekends from 27 March to 26 April. The competition attracted 197 teams from Europe, including Belarus, Russia and Ukraine as well as 16 European Union and European Free Trade Association (EU/EFTA) countries. Finland contributed 50 teams. The total number of international and national participants was around 5,000. Tournaments were played according to age groups in four hockey arenas, which were used in parallel, with arena A being the main arena. A fifth arena was added on the last weekend of the tournament. Lunches and dinners for the teams were included in the competition package. The teams, including their male and female coaches and officials, were scheduled to have their meals at the arenas where they were playing. Breakfasts were taken at the hotels where the teams stayed.

Following the notification of the first cluster of cases in mid-April, the Finnish National Institute for Health and Welfare (THL) monitored notifications reported to the National Infectious Disease Registry (NIDR) in order to capture Salmonella infections with a travel history to Latvia. Names were cross-checked against a list of the Finnish players in the Riga Cup obtained from the tournament website. Other cases of Salmonella sp. in NIDR with travel history to Latvia were contacted to determine whether they had participated in the tournament as an accompanying family member or official. Cases were identified according to the outbreak case definition.

doug.sorenne.hockey.apr.14Since this led to the finding of other possible clusters in different parts of Finland, THL invited on 21 April, the Finnish clubs participating in the Riga Cup 2015 to an online survey in order to describe and determine the magnitude of the outbreak. This survey asked about demographics, dates of participation in the competition and place of accommodation. Further, the respondents were requested to specify the tournament venues where they had eaten and on which dates, along with a description of what had been consumed. It was also enquired whether any foods and beverages had been taken outside the venues. Date of onset of diarrhea with three or more loose stools a day, fever (≥38°C), headache, nausea, vomiting, or stomach ache were questioned as were any possible hospitalisations.

As of 8 May, 65 persons with Salmonella sp. infection, who had participated as players or officials in the Riga Cup 2015 between 27 March and 26 April 2015 and had onset of symptoms on or after 27 March were identified by the NIDR in Finland. By the same date, 315 persons had also responded to the online survey. Of these, 31 respondents were classified as confirmed, and were among the 65 confirmed cases identified by the NIDR. The survey additionally identified 57 suspected cases.

Of the 88 cases identified in the survey (Figure), 78 (87%) were male, the median age was 13 years (range: 8–66 years), 7 (8%) had been hospitalised, 86/87 (99%) had been playing at arena A and 39/88 (44%) participated during the tournament taking place over the second weekend of the competition.

Nine patient isolates were microbiologically characterised [2-4] at THL. The isolates were selected so that they represented clusters identified in different participating teams from different parts of Finland (Figure). All nine cases had been infected by S. Enteritidis phage type 1 (PT1) with multilocus variable-number tandem repeat analysis (MLVA) profile 3–10–6-4–1 (SENTR7-SENTR5-SENTR6-SENTR4-SE3). The isolates were susceptible to the standard panel of antibiotics tested (ampicillin, cefotaxime, chloramphenicol, gentamicin, mecillinam, meropenem, nalidixic acid, perfloxacin, streptomycin, sulfonamide, tetracycline, and trimethoprim). S. Enteritidis PT1 is rare in Finland as well as in Norway and Sweden (Lin Thorstensen Brandahl and Cecilia Jernberg, personal communications, May 2015), but common in Baltic countries, Russia and Korea [5,6].

On 16 April, THL launched an urgent inquiry through the Epidemic Intelligence Information System for Food and Waterborne Diseases (EPIS-FWD) [7] to identify cases in other countries. Potentially affected non-EU countries were informed of the outbreak via the World Health Organization and were given access to EPIS-FWD.

On 24 April, a Rapid Risk Assessment of the outbreak by the European Centre for Disease Control and Prevention (ECDC) [8] was distributed through the Early Warning and Response System (EWRS). On the request from Latvia, ECDC deployed a fellow from the European Programme for Intervention Epidemiology Training (EPIET) from Finland to support the investigation in Riga on 26 April 2015.

On 29 April, the Latvian Centre for Disease Prevention and Control (LCDC) contacted the leaders of all teams participating in the Riga Cup, except the Finnish and Norwegian teams, which had already been contacted by their national public health authorities, by email and asked if they were aware of cases of gastroenteritis with onset during or after the tournament.

2004HockeyTournanment 051An ECDC expert on food and waterborne disease outbreaks joined the investigating team in Riga on 4 May 2015. As of 8 May, seven countries (Estonia, Finland, Hungary, Lithuania, Norway, Sweden, and the United Kingdom (UK)) have reported a total of 214 cases with gastrointestinal symptoms. Identical MLVA profiles to the Finnish cases were confirmed in one Norwegian and three Swedish patient isolates. The MLVAs were performed at the Department of Food-borne Infections at the Norwegian Institute of Public Health, and Public Health Agency of Sweden, respectively. The results were communicated through EPIS and at telephone conferences concerning the outbreak (Lin Thorstensen Brandahl and Cecilia Jernberg, personal communications, May 2015).

Food and environmental investigations in Latvia

Based on the information gained from the first detected cluster in Finland, the cafeteria at arena A was suspected as the source of outbreak [8]. On 16 April, the THL and the Finnish Food Safety Authority, Evira, alerted their respective counterparts in Latvia through the EWRS [9] and the Rapid Alert System for Food and Feed [10]. On the same day, the LCDC in collaboration with the Latvian Food and Veterinary services inspected the kitchen at arena A, interviewed all kitchen staff and their family doctors, and collected fecal samples and environmental and food samples. None of the kitchen staff reported gastrointestinal symptoms during the Riga Cup and all the samples were negative for S. Enteritidis. No cases of S. Enteritidis related to Riga Cup were registered in Latvia and the number of S. Enteritidis cases did not exceed the average level in March and April 2015.

Follow-up controls took place at arena A on 24 and 27 April. Members of one team playing at the tournament on the second weekend of the competition, with five suspected cases, had only eaten their meals in arena B, so arena B was inspected on 29 April. Menus were retrieved from all arenas and wholesale suppliers were identified via the purchase receipts. The arena restaurants had been contracted by the organiser and advised to serve the same lunch and dinner menus to the participating teams. The meals were mainly prepared at the tournament arenas. The caterers at the venues served the team members a separate menu than the public during the weeks in between the tournament weekends. Leftovers of the food served to the teams were discarded at the end of each day. Latvian teams did not take lunch and dinner at the venues.

Control measures

Physicians in Finland were alerted about the outbreak by news bulletins (on 15, 20 and 30 April) [11]. The Finnish ice-hockey teams scheduled to play on the last tournament weekend were prior advised to take standard hand hygiene and food safety precautions, such as eating only cooked foods and drinking bottled beverages.

In Latvia, two other junior ice hockey events took place in Riga, from 28 April to 2 May 2015 and from 14 to 16 May 2015 respectively. As some Finnish teams were to take part in these two events, the Finnish public health authorities informed these teams and the Finnish Ice Hockey Association on 27 April about the Riga Cup outbreak and ongoing investigation. Standard hand hygiene and food safety precautions were recommended and participants were also advised to notify THL in case gastrointestinal symptoms appeared during or after the competition.

On 30 April and 8 May the Latvian public health authorities contacted the organisers of both events and recommended to consume only well-cooked foods and maintain proper hand hygiene. In addition, a phone number to a specialist from the Latvian public health authority was provided in case any of the event participants would develop gastroenteritis symptoms.

Conclusions

This outbreak was first detected by municipal public health authorities in Finland. Due to budget cuts at THL since 2015 Salmonella isolates of foreign origin are no longer typed nor are the cases monitored in real time and outbreaks of foreign origin can only be identified at a local level. This will delay detection of Salmonella outbreaks among travellers. Cross-border outbreaks and outbreaks related to mass gatherings pose special problems [12-15] and cooperation between national authorities and ECDC is needed. The investigation to determine the source of the outbreak is ongoing and a retrospective cohort study among event participants from several EU/EFTA countries is underway in order to identify the source.

Acknowledgements

We would like to thank experts from THL, The Centre for Disease Prevention and Control of Latvia, Latvian Food and Veterinary Services, national focal points of affected countries and ECDC which are continuously contributing to the outbreak investigation.

Conflict of interest

None declared.

Authors’ contributions

Anne-Katrine Pesola, Triin Pärn, Sari Huusko, Jurijs Perevoščikovs, Jukka Ollgren, Saara Salmenlinna, Taru Lienemann, Celine M. Gossner, Niklas Danielsson and Ruska Rimhanen-Finne reviewed and approved the manuscript. Anne-Katrine Pesola acted as outbreak coordinator, Anne-Katrine Pesola, Triin Pärn, Sari Huusko, Jurijs Perevoščikovs, Jukka Ollgren, Celine M. Gossner, Niklas Danielsson and Ruska Rimhanen-Finne carried out the epidemiological investigation. Saara Salmenlinna and Taru Lienemann, carried out the microbiological investigation, Anne-Katrine Pesola, Triin Pärn and Ruska Rimhanen-Finne drafted the manuscript and data analysis. All co-authors critically reviewed the draft of the paper and approved the final version.

 References

Finnish food Safety Authority Evira. Elintarvike- ja vesivälitteisten ruokamyrkytysepidemioiden ilmoittaminen ja raportointi. [Food and waterborne outbreaks, notification and reporting]. Finland; 2014. Finnish. Available from: http://www.evira.fi/portal/fi/tietoa+evirasta/asiointi/sahkoinen+asiointi/elintarvikkeet/ruokamyrkytysepidemioiden+raportointi+rymy/

Issenhuth-Jeanjean S, Roggentin P, Mikoleit M, Guibourdenche M, de Pinna E, Nair S, et al. Supplement 2008-2010 (no. 48) to the White-Kauffmann-Le Minor scheme. Res Microbiol. 2014;165(7):526-30. http://dx.doi.org/10.1016/j.resmic.2014.07.004 PMID:25049166

Ward LR, de Sa JD, Rowe B. A phage-typing scheme for Salmonella enteritidis. Epidemiol Infect. 1987;99(2):291-4. http://dx.doi.org/10.1017/S0950268800067765 PMID:3315705

Hopkins KL, Peters TM, de Pinna E, Wain J. Standardisation of multilocus variable-number tandem-repeat analysis (MLVA) for subtyping of Salmonella enterica serovar Enteritidis. Euro Surveill. 2011;16(32):19942. PMID:21871223

Hasenson LB, Kaftyreva L, László VG, Woitenkova E, Nesterova M. Epidemiological and microbiological data on Salmonella enteritidis. Acta Microbiol Hung. 1992;39(1):31-9. PMID:1632197

Kang ZW, Jung JH, Kim SH, Lee BK, Lee DY, Kim YJ, et al. Genotypic and phenotypic diversity of Salmonella enteritidis isolated from chickens and humans in Korea. J Vet Med Sci. 2009;71(11):1433-8. http://dx.doi.org/10.1292/jvms.001433 PMID:19959892

Gossner CM, de Jong B, Hoebe CJPA, Coulombier D, and European Food and

Multinational Outbreak Of Salmonella Enteritidis Infection During An International Youth Ice Hockey Competition In Riga, Latvia, Preliminary Report, March And April 2015

Eurosurveillance, Volume 20, Issue 20, 21 May 2015

A K Pesola, T Pärn, S Huusko, J Perevoščikovs, J Ollgren, S Salmenlinna, T Lienemann, C Gossner, N Danielsson, R Rimhanen-Finne

http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=21133

Swedish pupil ‘slept in poo and sick’ at school

Amy and I both went to public schools and got PhDs.

In Australia, parents plan which school to send their kids to beginning in kindergarten (prep here) in hopes of getting into a better high school.

sorenne.hockeyaug.14There is also a lot of private schools that charge upwards of $30,000 per year in high school.

That’s just crazy.

A teenage student in Sweden attending Liljaskolen high school near Umeå is reported to have been sleeping on a mattress in school basement covered in feces, urine and vomit, despite clean dormitories being available elsewhere in the building.

Social services in Vännas are understood to have been alerted to the pupil’s living conditions at Liljaskolen high school near Umeå in northern Sweden last month, although the story has only just emerged in the Swedish media.

Liljaskolen is attended by 800 students and specializes in teaching snow sports such as skiing and ice hockey alongside vocational subjects including tourism, design and watch-making. Its pupils come from more than 50 municipalities across Sweden, Finland and Denmark.

The school provides several dormitories for students who do not come from the area, funded by Vännas council.

It is understood that the pupil is now living with family members.

You don’t need to go to school to learn hockey. Just come to the rink.

Hockey and food safety? Sure they’re the same, keep elbows up when you go in the corners

This isn’t about food safety. It’s about coaching, mentoring, whatever words you like that are often thrown around in the food safety world but often not practiced (follow the money).

No money involved here, just me and fellow coach Kyle spending four Sundays trying to teach a bunch of surfer kids in 90 F heat how to play hockey.

And it was a family affair. Sorenne and Amy both helped out with the various tasks to get people on the ice, as did Kyle’s kids.

The regular season begins next weekend, and I’m anxious to get back on the ice as a goalie (if my body can handle it) and coaching.

But this was fun. Thanks to all who volunteered their time. And especially my family who tolerate my Canadian indulgences in Australia.

come.and.try.15

‘Total lack of knowledge’ In poor taste in Phoenix

Parenting and preparing food are about the only two activities that do not require some kind of certification in Western countries. To coach little girls playing ice hockey in Canada requires 16 hours of training. To coach kids on a travel team requires an additional 24 hours of training. Anyone who serves, prepares or handles food, in a restaurant, nursing home, day care center, supermarket or local market should have some basic food safety training.

court.hockeyNot the case in Phoenix, where Judy Hedding of About.com Travel writes, I don’t recall ever seeing such extensive comments by an inspector about the total lack of knowledge of food operations as I read in the report of our worst offender for last week. Eat sushi there? I don’t think so. Eat anything there? I think not. I have to wonder why there is not such score as F.

The following list represents those restaurants (not schools, caterers, corporate cafeterias, bakeries or other food processing businesses) that had three or more Priority Violations — those that are considered a serious risk for foodborne illness — during their last inspection. Three or more Priority Violations means that the grade for that inspection is a D (there are no F grades). The worst are at the top of the list. A restaurant that had that many Priority Violations noted would be one that I’d avoid, at least until they had subsequent inspections showing more understanding of safe food preparation standards and concern for their patrons. I also include establishments where their license was immediately suspended by the inspector.

Typically, this involves an equipment failure that can’t be corrected immediately. Examples might be refrigeration units that don’t cool enough, plumbing problems, or availability of clean water. Their license might be reinstated, even later that same day, if they correct the problems noted. Restaurants reported here are located in communities all over Maricopa County. That means not only Phoenix, but also Scottsdale; the cities and towns in the West Valley like Glendale, Peoria, Surprise; the cities and towns in the East Valley like Tempe, Chandler and Mesa; as well as other county locations. County inspectors may or may not inspect restaurants in every part of the county every week.

After you peruse the worst, please take a look at the many Phoenix area restaurants that achieved the best inspections during the week ending January 18, 2015. Those are arranged by zip code, for your convenience. They deserve our support and our business. Restaurants With the Worst Health Department Inspection Results For Week Ending January 18, 2015

Business Name Address City Zip Code Priority Violation
Schlotzsky’s 4445 E Thomas Rd Phoenix 85018 Immediate Suspension
Eastwind Restaurant 13637 N Tatum Blvd Phoenix 85032 9
La 15 Y Salsas Restaurant 1507 W Hatcher Rd Phoenix 85021 6
Dobson Ranch Bar & Grill 1644 S Dobson Rd Mesa 85202 6
Nanay’s 2390 N Alma School Rd Chandler 85224 6
Abuelo’s Mexican Food Embassy 16092 Arrowhead Ftns Ctr Dr Peoria 85381 4
Rosa’s Mexican Grill 328 E University Dr Mesa 85201 4
Cristal Bakery & Mexican Food 6402 W Glendale Ave Glendale 85303 4
Thai Spices 66 S Dobson Rd Mesa 85202 4
Sonic Drive In Mesa 618 W Southern Ave Mesa 85210 3
Flancer’s Cafe 610 N Gilbert Rd Gilbert 85223 3
Tropical Smoothie Cafe 13375 W Mcdowell Rd Goodyear 85338 3
Waffle House 1801 W Baseline Rd Guadalupe 85283 3
Culver’s 630 E Southern Ave Tempe 85282 3

braun.hockeyYou can see the inspection history of any place that serves or handles food at the Maricopa County website. If you are interested in Apache Junction, Gold Canyon, Superior, Florence, Maricopa or Casa Grande, you can find restaurant reports for Pinal County, too. Restaurant information provided by the Maricopa County Environmental Health Services Division, used with permission. The image on this page is generic, and not associated with any of the restaurants mentioned here.    

Would you play hockey in Brisbane? Steal sticks?

With daytime highs of 100F and nighttime lows of 79F, what better time to head back to the rink next week in Brisbane.

2004HockeyTournanment 053For years, Amy and I have talked about building our own rink, with a restaurant where we could do food safety studies – because Manhattan, Kansas had nothing. Brisbane has a couple of rinks, but they favor public skating and figure skating; gotta pay the bills (that’s me and Chapman, 11 years ago).

So a bunch of us are seriously looking into the prospects of building our own arena and restaurant, where hockey (that’s ice hockey) would rule. Anyone with advice – or more importantly money – please e-mail directly. This will take awhile, but we are serious.

braunwynn.hockeyAnd we care about stories like this: The Ottawa Sun reports that Gatineau cops are chasing a pair of bandits currently on a breakaway with a slew of hockey sticks. Around 10 p.m. on Jan. 12, two men broke into Marc Sport Source for Sports at 455 Maloney Blvd. East and stole $28,000 worth of adult hockey sticks. Police believe the thieves will likely try to resell the sticks, so if someone on your beer league hockey team has suddenly found his scoring touch, it could be that his stick really is hot.

But girls can’t play (ice) hockey: Saudi Arabia municipality refuses to compromise on food safety

A number of restaurant owners whose businesses have been shut down recently by Jeddah’s municipality, have defied the decision by opening their doors again. Several owners also tried to attack inspectors, requiring the intervention of police to help close down their businesses.

sorenne.hockey.dec.14Muhammed Al-Buqami, Jeddah municipality’s spokesman, confirmed the events, noting that the decision to shut down the restaurants is only temporary. He said some of the establishments that opened without approval from the municipality, have been shut down again, and received a fine for violating the municipality’s ruling.

Al-Buqami also addressed the recent complaints made by these restaurant owners to the Makkah governorate, calling the municipality’s decree, an injustice.

It must be serious: Flu outbreak cancels Minn State-Princeton hockey game

As mumps makes its way through the dressing rooms of the National Hockey League, Minnesota State was forced to cancel its game Saturday against Princeton because of a flu-like outbreak.

minn.state.hockey.mavericksMike Hastings said the first news he received about a member of the Minnesota State men’s hockey team being sick came about 5:30 a.m. Saturday.

It snowballed from there.

“I’ve never seen anything go like that — that fast,” the Mavericks’ coach said. “At this point (around 2 p.m.) we’re sick and getting sicker. We couldn’t have put a team on the ice.”

A flu-like outbreak that affected about half of Minnesota State’s roster, caused the cancellation of Saturday’s game between the third-ranked Mavericks and nonconference opponent Princeton.

No players were hospitalized, Hastings said.

Flu-like illnesses have increased across the region, according to Kevin Burns, director of public affairs for Mayo Clinic Health System in Mankato.

Pat Quinn, ‘one of hockey’s most respected individuals,’ has died

Whenever I travel, people ask me what I do, and it inevitably evolves into discussions about food safety and hockey.

patquinnThe topics aren’t necessarily connected, other than commitment.

I’m thankful for my parents who spent endless hours at the ice rink so I could play, and I’m thankful for all the food safety types who let me play as well.

Pat Quinn, a Hamilton (that’s in Canada) boy, passed away yesterday and was widely praised as a respected hockey dude.

That’s about the best most of us can hope for, whatever our profession.

Quinn, a two-time Jack Adams winner for coach of the year, led both Philadelphia (1980) and Vancouver (1994) to the Stanley Cup Finals as a bench boss and was highly decorated internationally, winning gold medals at the U-18, World Junior, World Cup and — most famously — the Olympic level, guiding Canada to victory in 2002 at Salt Lake.

Quinn also served as the chairman of the Hockey Hall of Fame.

Here’s the statement from Canucks president of hockey operations Trevor Linden, who played for Quinn in Vancouver:

“We have lost a great man. It’s a sad day for hockey and for everyone who loves our game. On this difficult day I am thinking about Pat, his family and his friends, and how much he will be missed.

sorenne.hockey“I wouldn’t be the person I am today if it weren’t for Pat. He was a great leader and always a teacher. He taught me how to be a professional on and off the ice. He taught me how to play hockey the right way, how to win, and about the importance of respect and loyalty.

“Pat’s impact on our city has been immeasurable. He was responsible for bringing hockey to the forefront in Vancouver. He brought the pride back to the Canucks and today his finger prints and impact are still felt within this organization.”

It’s what I’ve tried to instill in my five daughters. and food safety types around the world.

Scary? Barfing pumpkins, hockey goalie masks and Aust tax deadlines

For whatever reason,  the Australian fiscal year goes from July 1 — June 30, with taxes required to be filed by Oct. 31.

goalie.maskSo while North Americans were contemplating costumes, I spent the day finishing my taxes.

That’s scary.

So is this drunk pumpkin, and this 1959 goalie mask, the first one ever used in a professional (ice) hockey game by Jacques Plante of the Montreal Canadians. I got one from Canadian Tire in 1968 and it hurt like hell every time I got hit in the head.

pumpkin.pukeI relate these tales to the young goalies I now coach. They think I’m old, weird and scary.

Boo.