Maybe something is lost in translation: 4-year-old’s death a misadventure

Kids dying from foodborne illness hits me like a punch in the gut. After following illnesses and outbreaks for 15 years I still take pause to think about my kids when I see a tragic story involving children.

Outbreaks rarely end with the classic smoking gun resolution (a genetically matched strain in the food/environment and stool). Epidemiology, in the absence of pathogen matches, is king and uncertainty is reduced with reliable data and statistics. Once a possible food/site match is made, investigators go out to the field and check the food handling out.broken-telephone

A conscientious investigator can talk about possible risk factors in a report – but the subsequent reporting and broken telephone game of sharing the information can bleed potential factors into must-have-happened fact.

A few years ago an environmental health officer shared her concerns about how the story gets changed between the field and the report interpretation. She had investigated a outbreak blamed on poor handwashing shared with me that her notes showed no soap at the time she was in the kitchen a week after the illnesses were reported – that was translated into poor handwashing by the staff at the time of the outbreak.

She felt that was an extrapolation wrought with assumptions.

Folks who used the example didn’t care.

Getting the risk factor story right really matters.

According to the Straits Times a four-year-old boy in Singapore tragically died from salmonellosis and court proceedings point to food handling practices a shopping center food court stall. Based on the coverage, I’m not sure it’s that simple. And I wouldn’t call it a misadventure.

Shayne Sujith Balasubraamaniam, together with his mother and two-year-old sister, came down with food poisoning on Jan 19 this year, a day after his mother had bought food, including tahu goreng and curry chicken, from a nasi padang stall at Kopitiam food court at Northpoint Shopping Centre.

All three were taken brought to Bukit Batok Polyclinic the next day. Shayne was assessed to be severely dehydrated and was prescribed medication.

He showed apparent signs of recovery, but deteriorated on Jan 22 when his mother found him unconscious at home. He died in hospital about two hours later from salmonella septicaemia.

On Thursday, State Coroner Marvin Bay said in his findings that the boy’s death underscores that careless food handling and inattention to proper hygienic practices can result in catastrophic consequences on young and vulnerable persons. He found the boy’s death to be one of misadventure.

The most significant lapse, the inquiry heard, was the practice of partial cooking and refreezing of chicken parts. The kitchen would receive 80 parts of chicken as a batch. After washing the batch, 60 chicken parts were refrozen for use the next day. They would be stored with plastic bags with other raw food at the freezer, a practice which would encourage cross-infection between the raw and partially cooked food. Swabs from the tongs used to handle food, and the blender found a high concentration of bacteria that exceeded safety limits.

While the post-outbreak investigation demonstrates serious issues with food handling at the business, I’m not sure what was presented is enough to link the salmonellosis. If the stored chicken was partially cooked it implies that it would be further cooked – which if temperatures exceeded 165F would result in a 5-log reduction of Salmonella. Maybe cross contamination between raw and sorta raw chicken is really a factor – especially if there weren’t other illnesses. Or maybe the washing step spread pathogens around the kitchen.

People barfing everywhere: Dozens sick at NAACP annual gala

Public health officials are investigating a possible case of food poisoning that left more than 50 attendees at an NAACP gala with terrible vomiting and diarrhea.

donald-sterling-naacp-honor-withdrawn__oPtTwelve people were taken by ambulance to hospitals and treated for dehydration, officials said. And several more drove themselves to hospitals Saturday night and early Sunday morning after getting sick during a banquet dinner commemorating the closing of the 27th Annual NAACP State Convention.

Among those hospitalized was former Oakland Mayor and Assemblyman Elihu Harris, said George Holland, an attorney who heads the civil rights organization’s Oakland chapter.

More than 300 people, including former San Francisco Mayor and keynote speaker Willie Brown, attended the banquet at the grand ballroom of the Sofitel San Francisco Bay Hotel in Redwood City, Holland said. He didn’t know if Brown had fallen ill.

Several people became sick after eating a dinner that included salmon and salad, Holland said. By 10:30 p.m. attendees were throwing up in the hotel lobby, while more than 20 firefighters and paramedics tended to them.

“It was a terrible scene,” Holland said. “Other hotel guests were very upset.”

Quite a few of the sick were teenagers attending the banquet, Holland said. A 5-year-old also fell ill.

Holland said his wife started vomiting early Sunday, and the illness hit him Monday morning. “I was shivering all day long,” he said.

Sofitel, which is part of a French luxury hotel chain, did not return a call seeking comment. Health officials were unable to produce records Tuesday showing whether the hotel has had similar issues in the past, said Robyn Thaw, spokeswoman for the San Mateo Medical Center.

Arizona school’s noro outbreak linked to over 100 ill

I was chatting with a couple of guys at a birthday party of one of Sam’s friends this past weekend and relayed that I do food safety stuff. One dude said “I hate this time of year: between the colds, pink eye and norovirus our kids pick up at school we’ll all be sick until Thanksgiving.”

‘Tis the season for school-related infections.norovirus-2-1

According to AZ Central, the so-called winter vomiting virus is making an appearance in the desert. Over 10%, at least 100 students, of Kyrene de la Colina, a Phoenix (AZ) elementary school called in sick last Thursday – definitely an outbreak.

Kyrene Elementary School District spokeswoman Nancy Dudenhoefer said the absences were reported to the Maricopa County Health Department after more than 10 percent of students who attend the Ahwatukee Foothills school called in sick on Thursday.

The district also sent notices to parents about norovirus symptoms and advised them to keep ill children home from school.

In the Tempe Union High School District, Bruce Kipper, principal of nearby Mountain Pointe High, also notified parents about norovirus symptoms.

Kyrene hired a company that specializes in removing norovirus to clean Colina and its school buses before the Friday morning bell. Colina and all other Kyrene schools were open on Friday.

Maricopa County Health Department spokeswoman Jeanene Fowler said norovirus outbreaks are common in schools. “Norovirus is very common,” Fowler said. The solution is “cleaning and getting kids to stay home if they are sick.” (cleaning and sanitizing, with chlorine-based compounds -ben)

Commonwealth Games athletes’ village outbreak report released

In July over 80 staff and volunteers were hit with a touch of the norovirus prior to the Commonwealth Games (the Olympics, sort of, except the only nations invited are part of the British, uh, commonwealth). According to Herald Scotland, HS Greater Glasgow and Clyde released a report (unfortunately we can’t locate it to mine it for other gems) that states that the lack of (and inappropriate) cleaning and sanitation of a specific washroom was to blame – and so was using ineffective alcohol-based hand sanitizer instead of handwashing.2014_Commonwealth_Games_Logo.svg

Now identified as the very common but debilitating norovirus, the bug was first reported on July 15. The Games opened on July 23.

The report said: “This outbreak did not have serious public health consequences. However, due to the timing of the outbreak, there was a risk to the success of the Games if the virus spread beyond the security staff and cases were reported among athletes and team officials.

“Because of the association with the Commonwealth Games there was immense media and political interest.”

The report reveals “deficiencies of cleaning” at the Athletes’ Village. It said: “Some areas of the Village were not covered by any cleaning arrangements. These included the pedestrian screening area, general security areas and one block of toilets being used by security staff.”

It found staff were using the “wrong type of alcohol hand gel, which would not have been effective against norovirus” rather than washing with soap and water.

It also discovered three different cleaning firms contracted at the site were using different products, including quaternary ammonium compounds, which do not kill norovirus. Staff, the report found, did not know how to report something that needed cleaned up.

Eighty of the 83 cases were security staff. No athlete was affected. 

Environmental health officers, meanwhile, checked temporary toilet blocks and found they were substandard. The report said: “In many cases, there were no hand washing facilities with only non-gold standard hand gels being provided.”

Games organisers said their catering, cleaning and waste planning regime was “fully compliant with all relevant industry standards” and insisted they quickly teamed up with health officials to overcome the bug.

Missing a restroom on a list of sanitation stops, using incorrect sanitizers (like quats) in the middle of an outbreak and having only alcohol-based hand sanitizers (that apparently weren’t VF481) isn’t industry best practice.

Salmonellosis outbreak linked to North Carolina church conference

Earlier this year, the Food Safety Summit, an annual gathering of food safety nerds dealt with an outbreak of foodborne illness amongst attendees. Over 100 became ill with C. perfringens  after eating a buffet meal. Conferences provide a nice environment for an outbreak – everyone eats sorta the same stuff and when things go bad, a lot of people get sick. salmonella

WSOCTV reports that Gaston County (NC) health officials are investigating an outbreak of salmonellosis that has been linked to a conference held Oct 1-5 at Living Word Tabernacle Church in Bessemer City.

According to the Department of Health and Human Services, at least 50 attendees are reporting symptoms including diarrhea, abdominal pain and fever.

As of 2 p.m. Tuesday, seven cases of Salmonella were confirmed with a significant number of lab results pending and more samples being collected.

“Our public health staff is working closely with the church, the North Carolina Division of Public Health, and the community,” said Chris Dobbins, DHHS director. “Our priority is to identify those who have fallen ill, ensure they have received proper medical attention, and work together to identify a source so we can educate and prevent future outbreaks of this nature.”

South Carolina health officials investigating two outbreaks of salmonelloisis

In 2009 when I had a Campylobacter infection it took me a few days of puking and diarrhea to go to my doctor. Then it took a week for the lab results. And then it took another week for the county folks to follow up with me about a food history.

Our conversation revolved around food that I had consumed a month prior (within the window of exposure).Unknown-14

Outbreak investigations can be messy.

According to the Island Packet (in South Carolina), the S.C. Department of Health and Environmental Control is investigating a couple of clusters of salmonellosis that appear not to be linked.

State health officials have yet to determine if eight Beaufort County salmonella poisoning cases in the past three weeks stem from a common source. Neither have any new cases been reported to the S.C. Department of Health and Environmental Control since the agency first confirmed last week a team is investigating a possible outbreak, DHEC spokeswoman Cassandra Harris said Friday.

However, the longer an investigation takes, the less likely the team will pin down a common source, she added.

“While efforts are made to identify the cause of salmonella clusters, the success of those efforts often depends on the cooperation of those involved and their recollection of what they ate,” Harris said. “As time passes, we are less likely to be able to identify a potential source for the illnesses.”

Harris also dispelled rumors that many more people in the county might be sick.

“At this time, there are no other indications of an unexpected increase in illnesses in the community” apart from the reported cases, Harris said (although CDC estimates that there are 38 related Salmonella illnesses for ever confirmed case due to underreporting -ben).

DHEC is also helping the U.S. Centers for Disease Control and Prevention investigate a separate, single case of salmonella poisoning that matches a national cluster of salmonella, Harris said.

However, DHEC and CDC investigators have not identified a common source of infections within that national cluster, according Laura Burnworth, a spokeswoman for the CDC’s Division of Foodborne, Waterborne and Environmental Diseases.

Chicken sausages linked to four illnesses in Alberta

My Wednesday night hockey team grills brats after games sometimes. Sort of a late night tailgate – after a shower and a quick in-dressing room beer, a portable grill is fired up in the parking lot.

We each bring an item or two to contribute to the meal.photo 2

I bring a meat thermometer (right, exactly as shown).

This week there were some pork brats as well as some spicy chicken sausages. Kinda like the ones that were, according to CBC, linked on Friday to an E. coli O157:H7 outbreak in Alberta (that’s in Canada).

Missing Link Extraordinary Sausage is recalling frozen, raw and ground chicken products over concerns of E. coli O157:H7 contamination.

The Canadian Food Inspection Agency says there have been four reported illnesses associated with the products.

The national food agency says recalled products from the Calgary-based company should be thrown out or returned to the store where they were purchased.

· Garlic, Garlic and More Garlic Chicken Sausage: 454 grams sold between July 14, 2014, and Oct. 3, 2014.
· Missing Link Extraordinary Sausage Garlic, Garlic and More Garlic Chicken Sausage: 227 grams sold between July 14, 2014, and Oct. 3, 2014.
· Missing Link Extraordinary Sausage Garlic, Garlic and More Garlic Chicken Burgers: 340 grams sold between July 14, 2014, and Oct. 3, 2014.
· Missing Link Extraordinary Sausage Garlic, Garlic and More Garlic Chicken Sausage “In the Raw”: 454 grams sold between July 14, 2014, and Oct. 3, 2014.

Michigan Tough Mudder race organizers share info about avoiding illnesses

Over the past 6 months I’ve been running a few times a week as a way to get some decent exercise while I try to get to a more healthy weight.

Not an activity that I liked until I was about 30, I do most of my running on treadmills while I watch sports and listen to podcasts. There are a few guys on my hockey team who have taken up endurance mud running as a way to work off the chicken sandwiches and beer we consume every Monday night. A couple of them ran the Tough Mudder in South Carolina a couple of years ago and are trying to talk me into joining them in the spring. Not sure I’m into it.TMSplash

From the organizer’s website, “Tough Mudder events are hardcore 10-12 mile obstacle courses designed by British Special Forces to test your all around strength, stamina, mental grit, and camaraderie. Triathlons, marathons, and other lame-ass mud runs are more stressful than fun. Not Tough Mudder. As hardcore as our courses are, we meet you at the finish line with a beer, a laugh, and a rockin’ live band.”

The site lists a set of obstacles with names like Arctic Enema, Dirty Ballerina and Kiss of Mud.

The races have a history of testing more than physical and mental toughness – they have been linked to multiple pathogen outbreaks.

A 2012 Tough Mudder in Scotland was linked to at least three cases of E. coli O157.  Last year a Michigan event recent was linked to norovirus.

According to Mlive, the organizers of this weekend’s Michigan event are addressing pathogen concerns.

Tough Mudder officials want to remind anyone planning to compete or attend this year’s event to practice good hygiene before and after attending.

“Illnesses of this nature are extremely rare. More than 1.5 million Mudders have run a Tough Mudder course; this issue is highly isolated,” said Ben Johnson, a spokesperson for Tough Mudder, via email. “However, safety is our No. 1 priority, and we encourage all participants, spectators, and volunteers to take the following preventative measures:

- It is important to not attend the event if you are feeling ill. We can provide a transfer to a future event.

- Practice good hygiene before and after the event:

Stay home for at least 48 hours after symptoms disappear.

Use chlorine-bleach based household cleaners to disinfect contaminated surfaces.

Free transfers to a future event is a good step – maybe that will result in sick folks skipping it until they’re done shedding pathogens.

Finding vomit on an airplane

Illness happens on planes, and when it does it’s miserable.

In 2009 I dealt with campylobacteriosis over a day of travel from Manhattan (Kansas) to Raleigh. In 2013, then four-year-old Jack yacked on a flight which led to a fascinating approach by Delta Airlines involving plastic bags to contain the risk and coffee pods to manage the smell. The flight crew let us off the plane first (although we were in the second-to-last row) as we potentially inoculated the plane and passengers with norovirus.

Maybe the best plane-related outbreak was one reported in Clinical Infectious Diseases a couple of years ago. I’d describe my poop and barf-related imagination as pretty good but I couldn’t have dreamt up the scenario that unfolded on a plane leaving Boston bound for Los Angeles in October 2008.111007015237-sick-throwing-up-airplane-motion-story-top

Members of [the] tour group experienced diarrhea and vomiting throughout an airplane flight from Boston, Massachusetts, to Los Angeles, California, resulting in an emergency diversion 3 h after takeoff.

The problematic flight departed Boston on Oct 8, 2008, heading for Los Angeles and carrying among its passengers 35 members of a leaf-peeping tour group. (Four more members of the group had planned other routes home, while two had been hospitalized in the previous 2 days.)

The outbreak included a passenger with “multiple episodes of diarrhea, with at least 1 occurring in the aisle of the first-class section. The soiled aisle was not cleaned until after completion of the flight.”

As the international discussion of Ebola transmission continues, USA Today writes about bodily fluids on airplanes.

[Linda] Cannon, a teacher from Palatine, Ill., was on a United Airlines flight from Chicago to Las Vegas when she felt something wet on her seat. “I pulled out my hand, which was covered in vomit,” she recalls.

The crewmember cleaned the seat while Cannon changed into some clean clothes. But it didn’t help: Bits of upchuck still coated her seat.

“I sat for 3½ hours with the remnants of vomit on my jeans and underwear,” says Cannon. ” I spent the entire flight with nausea and the woman in the next seat telling me it still smelled.”

The passengers who came into contact with blood, urine and vomit wonder who to blame for the lack of hygiene on a plane, and what they’re doing about it.

The answer is a bit complicated. Of course, airlines are responsible for the cleanliness of their aircraft, and it’s a job they say they take seriously.

At American Airlines, for example, planes are tidied up between flights, which can include cleaning the lavatories, seats and replacing any obviously soiled blankets or pillows.

Overnight, the planes are serviced more thoroughly. The restrooms are serviced, seats and tray tables are wiped down, carpets are vacuumed and blankets and pillows are replaced.

Every month, each aircraft is given a “deep” cleaning, where seat covers are washed and the entire cabin is sanitized using government-approved cleaning agents. 

While there have many been plane-linked outbreaks, a quick overnight servicing with a wipe-down could explain reoccurring noro events.

Ecuador investigating cases of mass food poisoning in Santa Rosa

The Ministry of Health took samples to investigate the causes that led to a weekend a mass poisoning in Santa Rosa, in the province of El Oro. Meanwhile, of the 405 intoxicated, 10 remain hospitalized with abdominal pain, fever and dehydration.

Ecuador-food-streetvendorThe case was then submitted that these people ate chicken and tuna sandwiches during the holidays proclamation of Medina Estero community.

“I could not resist, I came here (hospital) and I put a drip, can not stand, can not resist the pain,” said Elicia Guerrero.