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.

A cluster of E. coli O111 illnesses in MN investigated by health officials

Ricky Bobby’s favorite restaurant chain, Applebee’s, is connected to multiple E. coli O111 illnesses but according to health officials, the restaurant is not the sole source of the outbreak. The Minnesota Department of Health sent out a press release detailing an investigation into 13 cases of E. coli O111 which looks like a vendor-linked outbreak. applebbes.ricky_.bobby_

While seven of the people with E. coli O111 infections reported eating at Applebee’s restaurants in Minnesota between June 24 and 27, there are multiple cases with no apparent connection to the restaurant. Applebee’s is cooperating fully with the investigation, and as a precaution volunteered to remove the Oriental Chicken salad from menus at all its Minnesota restaurants while the investigation continues. The restaurant is also removing specific ingredients of its Oriental Chicken salad from other items on its menu out of an abundance of caution. Health officials are still working with Applebee’s, the Minnesota Department of Agriculture, and other regulatory partners to determine the cause of the outbreak.

Health officials say anyone who visited a Minnesota Applebee’s since June 20 and has symptoms of E. coli O111 infection (particularly bloody diarrhea) should contact their health care provider immediately and inform them of their possible involvement in this outbreak. MDH also asks that they contact the department’s foodborne illness hotline at 1-877-FOOD-ILL (1-877-366-3455) to report the potential connection.

Four of the 13 people who became ill were hospitalized, and all have recovered or are recovering.

Till receipts – a new approach for investigating outbreaks?

Selecting suitable controls for outbreak investigations is often difficult and if done inappropriately will lead to biased inferences. Till receipts and other sales records are frequently available on food premises, but their applicability has not been fully explored.

Pre printed till rollsUsing data from an investigation into a Salmonella outbreak affecting 66 individuals exposed in a London takeaway restaurant, this study aimed to evaluate the use of till receipts to assess associations between sales and illness. Cases identified through local case-finding were subjected to a standardised exposure questionnaire. Till receipts over the time period when cases arose were analysed. Estimated food exposures from sales were compared to case reported exposures and till receipts analysis showed strong association between illness and consumption of rotisserie chicken (odds ratio (OR): 2.75; confidence interval (CI): 1.7–4.5). Chicken sales immediately prior to food consumption for cases were compared to two control periods in an ecological case-crossover design. On average there was an estimated increase of 3.7 (CI: 2.2–5.2) extra chickens sold in the hour immediately prior to the consumption in the cases (p<0.0001) and the risk of becoming ill at busy times increased by 5% with each additional chicken quarter sold per hour (OR: 1.05; CI: 1.03–1.08). Microbiological and environmental investigations revealed Salmonella Enteritidis phage type (PT)14b in all available cases’ stool samples, two environmental samples and leftover chicken from the takeaway. The feasibility of this novel approach to obtain exposure information in the population at risk has been demonstrated, and its limitations are discussed. Further validation is required, comparing results with those in a concurrent classic case–control study.

Till receipts – a new approach for investigating outbreaks? Evaluation during a large Salmonella Enteritidis phage type 14b outbreak in a north west London takeaway restaurant, September 2009

Eurosurveillance

D Zenner, J Zoellner3, A Charlett1, W Marmairis4, C Lane1, J Y Chow

Euro Surveill. 2014;19(27):pii=20848. Available online: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=20848

50 sick: Delta Halifax hit by gastrointestinal illness outbreak

Sloan, Dutch Mason, April Wine: all great musicians from Halifax (except the April Wine part).

And now an outbreak of gastrointestinal illness causing vomiting and diarrhea at a downtown Halifax hotel is under investigation by officials at the Capital District Health Authority.

The health authority said at least 50 staff and guests at the Delta Halifax have fallen ill this week.

It said the hotel has increased cleaning, removed “suspected” food and is asking staff who fall ill not to return to work until 48 hours after symptoms end.

19 illnesses in Alabama linked to church meal

Community dinners, the fellowship-fostering events often organized by churches are a nostalgic link to the past when a congregation would financially support members’ activities through chili, pancakes or barbecue. They also, according to CDC’s Rob Tauxe, have created some of the easily traced foodborne illness outbreaks. Like this 2013 outbreak in North Carolina.

And it looks like something really bad happened recently at a Morgan County, Alabama church dinner. According to WAFF, at least 19 illnesses including a death are being investigated. The affected folks ate a catered chicken meal at an unnamed church. Screen-Shot-2013-10-02-at-10.36.50-AM-232x300

The State Health Department is investigating a potential foodborne outbreak in Morgan County. One person is confirmed dead. There are currently two confirmed cases.

There has been 19 reports of gastro-intestinal illnesses at three local hospitals. So far, two of those have tested positive for E. coli, Salmonella, or both, and the person who died had E. coli poisoning.

An epidemiologist with the Alabama Department of Public Health, Doctor Mary McIntyre, said they are looking for a common source, and they need to test more specimens. There is one common thread with several of the patients who had gastro-intestinal illnesses, and that’s that several of them ate a catered chicken meal at a church in Morgan County on May 30.

The health department wants us to tell anyone who has been asked by them to provide a specimen to please consider it, because they are having a tough time getting the number they need for testing.

There is one common thread with several of the patients who had gastro-intestinal illnesses, and that’s that several of them ate a catered chicken meal at a church in Morgan County on May 30.

Sorta odd that two pathogens are involved in the same event. A list of outbreaks linked to community dinners and temporary events can be found here.

Illinois 4-H camp hit with norovirus; makes a good risk management decision

Camping wasn’t a big part of my youth. My mom’s idea of camping (or roughing it as she calls it) was a hotel that didn’t have a working air conditioner.  When I was a teenager we went camping a couple of times and rented a trailer in a campground beside Darien Lake (a Western New York amusement park). Most of my camping time was spent chasing girls around the park and riding roller coasters. I camped a few more times in high school – which really just meant underage drinking in the woods.

And it always rained. XUprZ

Since my teenage years I’ve met many people that had great experiences at the organized extension of my definition of camping – summer camp.

Looking back, I think I missed out.

We plan on sending our boys to overnight camp, likely through 4-H. Through my extension position I’ve had a chance to interact with lots of the camp organizers and I’ve been impressed with what they do for food safety and infection control: It’s not that they never have problems; it’s that they seem to know how to handle things when people get sick.

This management thing and good risk decision making was exemplified by Curt Sinclair, director of a 4-H camp in Illinois. According to The News-Gazette, Sinclair was faced with a difficult decision when a norovirus outbreak hit his camp. With 10 staff and 30 campers ill, he shut down the camp for a week, canceling a session so the site could be cleaned and sanitized and letting the virus run it’s course in the staff.

“I can’t run the camp on Sunday if they’re still contagious,” said Sinclair. “We all need to stay separate. They need to be resting back at home. To run camp would be irresponsible.”

Campers and counselors alike began showing symptoms of the virus — diarrhea, vomiting and general body achiness — early Thursday.

“From about 2 a.m. till 11 a.m. is when we were having most people ill. It ended up being about 10 staff members and then a little over 30 children,” he said.

“The CDC recommends that 48 to 72 hours after you feel better, you should refrain from working in close quarters and in food service,” he said.

“It can spread very rapidly in a group setting with a lot of people. They’re very close, playing with the same hockey sticks,” he said.

“This response to this unfortunate outbreak of a virus is going to reinforce the trust of the public in what we stand for and how we run our operation. It was the right thing to do. (It) will benefit the camp long-term more than if we had tried to wing it somehow,” Sinclair said.

Between the hockey sticks and Sinclair’s response, this sounds like a pretty good camp.

170 workers hospitalized for food poisoning in northern Vietnam

At least 170 employees at a clothing factory in the northern province of Thai Binh were hospitalized for food poisoning after eating a lunch at the company on June 1 supplied by a caterer.

OLYMPUS DIGITAL CAMERAdThe workers at Nienshing factory in Phuc Khanh Industrial Zone are being treated at three hospitals, Thai Binh, Lam Hoa and Hoang An, Dan Viet newspaper reported Monday.

The surge of patients overloaded the hospitals, leaving three to a bed. Many more patients were laid out on the hospital floors.

Dan Viet reported that the workers had come to believe the mass poisoning was caused by a company lunch served on Sunday.

The company hired the Dung Hop Company in Thai Binh Town to provide the meal at VND10,000 (US$0.47) per person.

Dung Hop served an omelet, minced pork and cabbage.

CDC: Norovirus outbreaks most often linked to infected food handlers

In 1929 Dr. John Zahorsky wrote about children developing sporadic cases of vomiting, supplemented by watery diarrhea each year between November and May – and over 30 years of clinical practice, he coined the term winter vomiting sickness. According to a 1950 Time Magazine article, Dr. Zahorsky was a pediatrician working extolling the virtues of good sanitation during birth and infant care – one of the fathers of disease prevention.m63e0603a1f1
In 1968, one of these winter vomiting sickness outbreaks occurred in an elementary school in Norwalk, OH. Teachers and students were both affected, with 32% of the primary cases spreading illness to others in their families and homes. After a collaborative investigation with researchers from NIH and Walter-Reed Army medical center a causative agent was found in the feces of the ill — a 27nm sized virus particle. Zahorsky’s illnesses then took on the name Norwalk. Since then, the name has morphed to Norwalk and Norwalk-like viruses, which begat noroviruses.
Often linked to cruise ships in popular culture, noro really is linked much more often to food handlers in food service. According to fellow NoroCORE collaborator Aron Hall and colleagues in this week’s MMWR, noroviruses are the leading cause of reported foodborne disease outbreaks nationally and most often linked to restaurants – with contamination occurring from infected food workers.
 
During 2009–2012, a total of 4,318 norovirus outbreaks were reported to NORS (the national outbreak reporting system -ben) , resulting in 161,253 illnesses, 2,512 hospitalizations, and 304 deaths. Foodborne transmission was the primary mode reported in 1,008 (23%) norovirus outbreaks, representing 48% of the 2,098 foodborne outbreaks reported with a single suspected or confirmed cause during the 4-year study period. Other primary transmission modes reported among the 4,318 norovirus outbreaks included person-to-person (2,976 [69%]), environmental (15 [0.35%]), waterborne (11 [0.26%]), and unknown transmission mode (308 [7%]). In 158 (16%) of foodborne norovirus outbreaks, secondary transmission through one of these other modes was reported. Norovirus outbreaks were most common in winter, with 2,394 (55%) occurring during December–February (Figure 1). Among foodborne norovirus outbreaks, 398 (39%) occurred during December–February, compared with 1,996 (60%) of nonfoodborne norovirus outbreaks.
 
Outbreak data (above, exactly as shown) demonstrates that winter vomiting virus is a fitting moniker.