Probably staph: 55 people treated for possible food poisoning at Florida office

The Maitland Fire Rescue treated about 40 people Wednesday in a possible case of food poisoning at an office building, officials said.

vomit.diarrheaDeputy Fire Chief Will Watts said the office was having a “large catered event” when the employees started getting sick around 3:30 p.m. More than 15 people were hospitalized and were listed in stable condition.

“There’s a significant number of patients that have symptoms that are consistent with a stomach illness,” Watts said.

Dain Weister, a spokesman for the Florida Department of Health, said people were vomiting and had diarrhea.

“It’s a pretty big outbreak to have so many people become sick in one location,” he said. “It’s not too often that we have so many people sick.”

Outbreak of foodborne illness strikes Atlanta high school football banquet

Over 15 years ago Rob Tauxe described the traditional foodborne illness outbreak as a scenario that ‘often follows a church supper, family picnic, wedding reception, or other social event.’
 
This scenario involves an acute and highly local outbreak, with a high inoculum dose and a high attack rate. The outbreak is typically immediately apparent to those in the local group, who promptly involve medical and public health authorities. The investigation identifies a food-handling error in a small kitchen that occurs shortly before consumption. The solution is also local.football-banquet-2013
 
According to the Atlanta Journal Contsitution, it could also be a high school football banquet.
Dozens of Centennial High School football players and their parents were sickened after eating at a banquet Monday night, according to the school’s principal. But the exact cause of the gastrointestinal illnesses has not been determined.
 
Symptoms of the illness have included nausea, vomiting, diarrhea and abdominal cramps, Principal Kibbey Crumbley wrote in a letter to a parents of students at the Roswell school.
 
“Unfortunately, these symptoms can be associated with many different viruses and bacteria that could possibly be related to food-borne pathogens,” Crumbley said. “The best means of controlling these types of illnesses is to stay home when sick, wash hands frequently and clean surfaces thoroughly after contact with an infected or ill individual.”
 
Students with symptoms were urged to stay home and to see a healthcare provider, Crumbley said.

I child dead, 4 sick in Australia from raw milk; US says outbreaks quadrupled

Amidst reports that the number of U.S. outbreaks caused by non-pasteurized milk increased from 30 during 2007–2009 to 51 during 2010–2012, a child in Victoria (that’s in Australia) has died and four have become ill from raw milk.

868179-068aae70-8035-11e4-9659-e3748623bf5fUnpasteurised milk is illegal to sell for human consumption in Australia, but the product consumed by the child was classed as cosmetic so was allowed on the shelves.

The child recently died on the Mornington Peninsula after drinking what was marketed as a cosmetic product and labeled “bath milk”, the Victorian Health Department said.

The U.S. Centers for Disease Control and Prevention said Wednesday that the average number of outbreaks from contaminated unpasteurized milk more than quadrupled from three a year between 1993 to 2006 to about 13 between 2007 and 2012.

Overall, there were 81 outbreaks in that last period, sickening nearly 1,000 people, including 73 who were hospitalized. The CDC said that more than 80 percent of the illnesses happened in states where retail sales of raw milk are legal.

Most outbreaks were caused by Campylobacter spp. (77%) and by nonpasteurized milk purchased from states in which nonpasteurized milk sale was legal (81%). Regulations to prevent distribution of nonpasteurized milk should be enforced.

Pasteurization is an effective way to improve milk safety; however, in the United States, illness related to consumption of nonpasteurized milk continues to be a public health problem. The first statewide requirements that dairy products be pasteurized were enacted in Michigan in 1948 (1). In 1987, the US Food and Drug Administration banned the interstate sale or distribution of nonpasteurized milk. However, the laws regulating intrastate sales are set by each state (2). Regulations for intrastate sales of nonpasteurized milk vary from complete bans to permitting sales from farms or retail outlets (2). Even in states in which sale of nonpasteurized milk is illegal, milk can often be obtained through other means. For example, some states allow cow-share or herd-share agreements, in which buyers pay farmers a fee for the care of a cow in exchange for a percentage of the milk produced (3,4).

Consumption of nonpasteurized milk has been associated with serious illnesses caused by several pathogens, including Campylobacter spp., Shiga toxin–producing Escherichia coli, and Salmonella enterica serotype Typhimurium (3,4). Despite the health risks associated with consuming nonpasteurized milk, the demand for nonpasteurized milk has increased (3,5,6). Recently, many state legislatures have considered relaxing restrictions on the sale of nonpasteurized milk (2,6). We report that the number of outbreaks associated with nonpasteurized milk increased from 2007 through 2012.

The Study

A foodborne disease outbreak is defined as the occurrence of >2 cases of a similar illness resulting from ingestion of a common food. State and local health departments voluntarily report outbreaks to the Foodborne Disease Outbreak Surveillance System of the Centers for Disease Control and Prevention through a standard web-based form (www.cdc.gov/nors). We reviewed outbreaks reported during 2007–2012 in which the food vehicle was nonpasteurized milk. Outbreaks attributed to consumption of other dairy products made with nonpasteurized milk, such as cheese, were excluded. We analyzed outbreak frequency, number of illnesses, outcomes (hospitalization, death), pathogens, and age groups of patients. Data on the legal status of nonpasteurized milk sales in each state were obtained from the National Association of State Departments of Agriculture (79) and an online search of state regulations. The sources from which nonpasteurized milk was obtained or purchased were categorized according to the description from the state outbreak reports, when available.

colbert.raw.milkDuring 2007–2012, a total of 81 outbreaks associated with nonpasteurized milk were reported from 26 states. These outbreaks resulted in 979 illnesses and 73 hospitalizations. No deaths were reported. The causative agent was reported for all outbreaks. Of the 78 outbreaks with a single etiologic agent, Campylobacter spp. was the most common pathogen, causing 62 (81%) outbreaks, followed by Shiga toxin–producing E. coli (13 [17%]), Salmonella enterica serotype Typhimurium (2 [3%]), and Coxiella burnetii (1[1%]) (Figure 1). Three outbreaks were caused by multiple pathogens (Figure 1). The number of outbreaks increased from 30 during 2007–2009 to 51 during 2010–2012. During 2007–2009, outbreaks associated with nonpasteurized milk accounted for ≈2% of outbreaks with an implicated food; during 2010–2012, this percentage increased to 5%. The number of outbreaks of Campylobacter spp. infection also increased, from 22 during 2007–2009 to 40 during 2010–2012.

How milk was obtained was reported for 68 (84%) outbreaks. Nonpasteurized milk was obtained from dairy farms (48 [71%] outbreaks), licensed or commercial milk sellers (9 [13%]), cow- or herd-share arrangements (8 [12%]), and other sources (3 [4%]). Of the 81 outbreaks, 66 (81%) were reported from states where the sale of nonpasteurized milk was legal in some form: Pennsylvania (17 outbreaks), New York, Minnesota (6 outbreaks each), South Carolina, Washington, and Utah (5 outbreaks each). A total of 15 (19%) outbreaks were reported in 8 states in which sales were prohibited. Among these outbreaks, the sources of nonpasteurized milk were reported as a dairy farm (6 outbreaks), cow or herd share (4 outbreaks), and unknown (5 outbreaks).

Conclusions

Within this 6-year period, the number of outbreaks associated with nonpasteurized milk increased. The number of outbreaks caused by Campylobacter spp. nearly doubled. The average number of outbreaks associated with nonpasteurized milk was 4-fold higher during this 6-year period (average 13.5 outbreaks/year) than that reported in a review of outbreaks during 1993–2006 (3.3 outbreaks/year) (4). This increase was concurrent with a decline in the number of states in which the sale of nonpasteurized milk was illegal, from 28 in 2004 to 20 in 2011 (79) and with an increase in the number of states allowing cow-share programs (from 5 in 2004 to 10 in 2008) (8,9). The decision to legalize the sale of nonpasteurized milk or allow limited access through cow-share programs may facilitate consumer access to nonpasteurized milk (5). The higher number of outbreaks in states in which the sale of nonpasteurized milk is legal has been reported elsewhere (4).

The legal status of nonpasteurized milk sales in 1 state can also lead to outbreaks in neighboring states. In a 2011 outbreak of Campylobacter spp. infections associated with nonpasteurized milk in North Carolina, where sales of this product were prohibited, milk was purchased from a buying club in South Carolina, where sales were legal. Another outbreak of Campylobacter spp. infection in 2012 implicated nonpasteurized milk from a farm in Pennsylvania, where sales are legal; cases from this outbreak were reported from Maryland, West Virginia, and New Jersey, all of which prohibit sale of raw milk (10). All patients residing outside Pennsylvania had traveled to Pennsylvania to purchase the milk (10).

Outbreaks associated with nonpasteurized milk continue to pose a public health challenge. Legalization of the sale of nonpasteurized milk in additional states would probably lead to more outbreaks and illnesses. This possibility is especially concerning for vulnerable populations, who are most susceptible to the pathogens commonly found in nonpasteurized milk (e.g., children, senior citizens, and persons with immune-compromising conditions). Public health officials should continue to educate legislators and consumers about the dangers associated with consuming nonpasteurized milk; additional information can be obtained at http://www.cdc.gov/foodsafety/rawmilk/raw-milk-index.html. In addition, federal and state regulators should enforce existing regulations to prevent distribution of nonpasteurized milk.

Ms Mungai is a surveillance epidemiologist at the Atlanta Research and Education Foundation and at the Centers for Disease Control and Prevention. Her interests include infectious disease epidemiology and food safety.

References

Steele JH. History, trends and extent of pasteurization. J Am Vet Med Assoc. 2000;217:175–8 . DOIPubMed

Weisbecker A. A legal history of raw milk in the United States. J Environ Health. 2007;69:62–3 .PubMed

Oliver SP, Boor KJ, Murphy SC, Murinda SE. Food safety hazards associated with consumption of raw milk. Foodborne Pathog Dis. 2009;6:793–806. DOIPubMed

Langer AJ, Ayers T, Grass J, Lynch M, Angulo FJ, Mahon BE. Nonpasteurized dairy products, disease outbreaks, and state laws—United States, 1993–2006. Emerg Infect Dis. 2012;18:385–91. DOIPubMed

Buzby JC, Gould LH, Kendall ME, Timothy FJ, Robinson T, Blayney DP. Characteristics of consumers of unpasteurized milk in the United States. J Consum Aff. 2013;47:153–66.

David SD. Raw milk in court: implications for public health policy and practice. Public Health Rep. 2012;127:598–601 .PubMed

National Association of State Departments of Agriculture. NASDA releases raw milk survey 2011 [cited 2012 Nov 2]. http://www.nasda.org/file.aspx?id=3916

National Association of State Departments of Agriculture. Dairy division of national association of state departments of agriculture raw milk survey, November, 2004 [cited 2012 Nov 2]. http://www.nasda.org/File.aspx?id=1582

National Association of State Departments of Agriculture. NASDA releases raw milk survey 2008. [cited 2012 Nov 2]. www.nasda.org/File.aspx?id=2149

Longenberger AH, Palumbo AJ, Chu AK, Moll ME, Weltman A, Ostroff SM. Campylobacter jejuni infections associated with unpasteurized milk—multiple states, 2012. Clin Infect Dis. 2013;57:263–6. DOIPubMed

Suggested citation for this article: Mungai EA, Behravesh CB, Gould LH. Increased outbreaks associated with nonpasteurized milk, United States, 2007–2012. Emerg Infect Dis [Internet]. 2015 Jan [date cited]. http://dx.doi.org/10.3201/eid2101.140447

Vomit cruise hits New Zealand; infection control steps shared

I’ve never been on a cruise vacation. The closest I’ve been is a river boat dinner voyage in New Orleans. Not quite the same thing. I can’t think of too many better places to conduct some reality research though. With the increased media scrutiny of infection control measures the cruise folks have had to step up their game and respond when an incident happens – and share what they are doing to keep an outbreak from spreading. That helps build trust (if they can verify that steps are correctly being followed).pr_dawn

According to the Otago Daily Times (NZ), when the Princess Cruise Lines’ Dawn Princess docked in Port Chalmers any affected passengers were not able to come in contact with others (on and off the ship – which was a concern for the kiwi media).

About 200 passengers have been confined to their cabins after the norovirus bug spread through the cruise ship while on a trip around New Zealand.

Canterbury Medical Officer of Health Dr Alistair Humphrey said Dawn Princess had its own doctor on board and the ship’s crew were confident they could control the situation.

The cruise line spokesman said most passengers were unaffected by the outbreak and it took relatively few cases for stringent sanitation levels to be implemented to contain any spread of the illness.

The proactive onboard response included disinfecting high-touch surfaces such as railings, door handles and lift buttons; isolating ill passengers in their cabins; closing all self-service food areas; and encouraging passengers to use their own cabin bathroom facilities, he said.

Although he would not confirm if any passengers visiting Dunedin had norovirus, if they did it was standard protocol for the relevant public health authorities to be notified and those passengers would remain isolated in their cabins.

30 sick after Thanksgiving at hotel in New Jersey

The Princeton Health Department received 30 reports between Thanksgiving and Tuesday of individuals experiencing gastrointestinal illnesses.

Nassau Inn.thanksgiving.dec.14All 30 people ate at the restaurant at the Nassau Inn on Thanksgiving or the day after the holiday, Princeton Health Officer Jeffrey Grosser said. Many of the people also ate at other restaurants during the time period.

The health department has increased its surveillance of retail food establishments because of the incidents, and the Nassau Inn was inspected yesterday.

Laboratory testing has not yet confirmed the cause of the illnesses yet, but Grosser said the Norovirus is suspected in most or all of reported cases because of the symptoms and the time frame for the onset of symptoms and the recovery. The Norovirus is the most common cause of gastrointestinal illness and is especially common during the winter months.

“All the phone calls we received were similar in terms of where people ate, when people became ill (Thursday and Friday) and when they started feeling better (Sunday and Monday),” Grosser said.

An inspection of the restaurant at the hotel only revealed minor issues that can easily be rectified. Grosser said the issues did not cause the illnesses. About 70 percent of all Norovirus outbreaks are spread by food workers.

’Tis the season for holiday illnesses (apparently)

There’s a perception that there are more outbreaks around the holidays because folks don’t know how to cook turkey. The epidemiology isn’t all that strong around amateur bird preparation and illnesses –  but there are a lot of parties and potluck/covered dish dinners this time of year.

And it’s also noro season. img_1787

According to Planet Princeton, over 30 people reported illnesses to health authorities after eating at the Nassau Inn over Thanksgiving – and it looks like norovirus.

The Princeton Health Department received 30 reports between Thanksgiving and Tuesday of individuals experiencing gastrointestinal illnesses.

All 30 people ate at the restaurant at the Nassau Inn on Thanksgiving or the day after the holiday, Princeton Health Officer Jeffrey Grosser said. Many of the people also ate at other restaurants during the time period.

Laboratory testing has not yet confirmed the cause of the illnesses yet, but Grosser said the Norovirus is suspected in most or all of reported cases because of the symptoms and the time frame for the onset of symptoms and the recovery. 

“All the phone calls we received were similar in terms of where people ate, when people became ill (Thursday and Friday) and when they started feeling better (Sunday and Monday),” Grosser said.

An inspection of the restaurant at the hotel only revealed minor issues that can easily be rectified. Grosser said the issues did not cause the illnesses. 

 

Over 100 exposed to hepatitis A after virus-shedding kids go to school

Getting my kids to wash their hands is a constant struggle. I’m likely not alone. There’s not a whole lot of great information on this outbreak but Heart is reporting that an outbreak of hepatitis A in Wessex (U.K.) has led to over 100 IgG shots.

According to health authorities, seven school-aged kids at a couple of schools in the U.K. have picked up hepatitis A – and the common link appears to be household-contact related.dirty-hands-medium-new

The Wessex PHE Centre has recommended that close contacts of the cases, including household, some children and staff attending the same class groups in school as some cases should receive Hepatitis A vaccination to prevent further spread of this infection.

Officials say the likelihood of spread of this infection in the school environment is very low, however as a precaution, all parents have been advised of the signs and symptoms of Hepatitis A and asked to contact their General Practitioner if they have concerns:

Dr Anand Fernandes, Consultant in Health Protection at PHE Wessex, said:

“We are working closely with colleagues in the local NHS and Portsmouth City Council Environmental Health and Public Health Departments to manage the very low risk of further spread of this illness. “No other children, staff or visitors to the schools will be offered the vaccine as the risk of exposure to them is very low.”

The News reports that Around 150 vaccinations are now being carried out at the Devonshire Infant School and Fernhurst Junior School in Southsea.

 

U.K. health authority’s lack of public information questioned in E. coli O55 outbreak

Doug chronicled one of the issues that public health folks deal with regularly – what to tell the public about investigations into outbreaks, and when – for his most recent column for Texas A&M’s Center for Food Safety,

Go public too early, and make a mistake, and a corporation or industry’s reputation could unduly suffer. Go public too late, and individuals and businesses may be denied critical information they could use to protect public health.

An E. coli O55 outbreak that has led to at least 11 illnesses has family members challenging the unwritten dogma of when health officials go public, according to the Bournemouth Daily Echo.Screen Shot 2014-11-28 at 5.14.57 PM

Victims of the E coli outbreak have criticised Public Health England for not doing more to publicise the risks of the bug.  PHE stressed it had thoroughly investigated each and every case but had not been able to find any common source between the cases in July and August. It said it had not told any of the victims their cases were closed but that activity would have slowed because of the lack of any common factor between cases.

But victims and relatives are still unhappy with the way the PHE has handled the issue. The grandfather of a three-year-old Blandford girl, currently battling E coli in Southampton General Hospital, said: “Why does it need a newspaper to get involved for PHE to do something? “They could have let people know about the symptoms and what to look out for weeks or months ago.”

He said his granddaughter had been in theatre for an operation on Wednesday and was now back on dialysis. “We are just keeping everything crossed at the moment. It’s so heartbreaking to walk in and see her hooked up to all these machines.”

Gabrielle Archer, whose son Isaac Mortlock was among the first victims of the current outbreak, said: “I’m devastated to hear that these other children are now suffering and going through the daily blood tests and dialysis that Isaac had to go through. “I feel that perhaps had Public Health England taken this case a bit more seriously that might not have happened.”

A spokesperson for PHE said they had been proactive but said this did not necessarily mean engaging with the media.

In a related story, the mother of one of the children tragically impacted by the outbreak detailed the devastating effects of E. coli O55

These horrifying images of 21-month old Freddy Osborne seriously ill with E coli show just how serious the bug can be. Mum Charlotte Fudge, 25, allowed the Echo to print the picture of Freddy in intensive care to raise awareness of the illness, which since July has affected 10 people who are either residents in Dorset or visited the county. It’s believed Freddy, of Bournemouth, was the first to contract the disease in July and spent a month in Southampton General Hospital, two weeks of which he spent in paediatric intensive care. He needed four blood transfusions, one platelet transfusion and had four seizures due to swelling on the brain. One of these lasted for four hours and left him blind for 10 days. Following this seizure, he was put into a coma for six days as it was too dangerous for him to try and breathe by himself. He had fluid on his heart causing his heart rate to go up to 202 beats per minute and he ended up suffering from morphine withdrawal.  

U.K. restaurant fines are no joke; caterer fined £20k for outbreak

Wedding season for Dani and I lasted three years. Not our wedding (which was organized somewhat hastily) but the ones we attended and participated in for our friends. At one point we had attended 30 in 24 months.

We didn’t experience an outbreak though. According to Get West London a caterer contributed to what sounds like the worst wedding ever – over 400 guests came down with Bacillus cereus intoxication.

A food inspector in a chip shop

And U.K. health officials slapped a £20,111 fine on Royal Club and it’s owner is banned from running a food business for 5 years.

Ealing Council’s food safety team were first alerted by the father of the bride on September 24, 2013, who contacted them claiming that 90% of the 470 wedding guests were suffering with food poisoning.

However, the prosecution could only be based on the 93 guests who formally reported their symptoms of food poisoning to investigators.

Greenford catering company, the Royal Club, was given a £20,111 penalty by Ealing Magistrates Court on Tuesday November 25. The company’s sole director, Mr Biku Thapa, was ordered to complete 200 hours of unpaid work and is banned from being a director of any company for five years.

Inspections of the Royal Club kitchen revealed serious food hygiene violations. Only one member of staff was trained in food safety. Both the head chef and remaining staff had not received any food safety training at all. Inspectors also discovered that The Royal Club had no refrigerated vehicles in which to safely transport food to events.

U.K. nursery closed following E. coli O55 outbreak

500065432206023-1BBC reports that the Blandford Children’s Centre Nursery in Dorset (U.K.) was closed as health officials investigate a cluster of rare E. coli illnesses.

Vanessa Glenn, head of family support at Dorset County Council, which runs the nursery in Black Lane, said a child there was diagnosed with E. coli infection in mid-October.

She said it was closed for three days while deep-cleaning work was carried out.

Another child from the nursery was infected on Monday and it is currently closed pending the results of staff blood tests and child stool samples, she added.

She said there had also been another E. coli case involving a child from Blandford who had attended Shaftesbury Children’s Centre, although this is not part of the “cluster”.

Ms Glenn said: “While there is no indication of a direct link between the nursery and recent cases, we are working closely with Public Health England and local authority environmental health officers to help tackle the problem.”

She added parents had been “kept fully informed” and were being advised of the nursery closure.

“As some cases have occurred in people associated with a children’s nursery, letters have been sent to parents whose children attend the nursery and staff, informing them about E. coli O55 and the ongoing investigation,” PHE said.

A couple of years ago I collaborated with Clemson’s Angie Fraser on a set of USDA NIFA funded food safety and infection factsheets for childcare facilities including using exclusion of ill staff and children as an outbreak control measure. The sheets can be downloaded here and here.