86,000 sickened: Waterborne outbreaks in Nordic Countries, 1998 To 2012

Water.

We love it, take it for granted, and yet water can be the source of horrific outbreaks, like E. coli O157 in Walkerton, Ontario, Canada.

walkertonA total of 175 waterborne outbreaks affecting 85,995 individuals were notified to the national outbreak surveillance systems in Denmark, Finland and Norway from 1998 to 2012, and in Sweden from 1998 to 2011. Between 4 and 18 outbreaks were reported each year during this period.

Outbreaks occurred throughout the countries in all seasons, but were most common (n = 75/169, 44%) between June and August. Viruses belonging to the Caliciviridae family and Campylobacter were the pathogens most frequently involved, comprising n = 51 (41%) and n = 36 (29%) of all 123 outbreaks with known aetiology respectively.

Although only a few outbreaks were caused by parasites (Giardia and/or Cryptosporidium), they accounted for the largest outbreaks reported during the study period, affecting up to 53,000 persons. Most outbreaks, 124 (76%) of those with a known water source (n = 163) were linked to groundwater. A large proportion of the outbreaks (n = 130/170, 76%) affected a small number of people (less than 100 per outbreak) and were linked to single-household water supplies. However, in 11 (6%) of the outbreaks, more than 1,000 people became ill.

Although outbreaks of this size are rare, they highlight the need for increased awareness, particularly of parasites, correct water treatment regimens, and vigilant management and maintenance of the water supply and distribution systems.

Waterborne Outbreaks in the Nordic Countries, 1998 To 2012

Eurosurveillance, Volume 20, Issue 24, 18 June 2015

B Guzman-Herrador, A Carlander, S Ethelberg, B Freiesleben de Blasio, M Kuusi, V Lund6, M Löfdahl, E MacDonald, G Nichols, C Schönning, B Sudre, L Trönnberg, L Vold, J C Semenza, K Nygård

http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=21160

Finland marketing: Please don’t go to the toilet in the water

And you thought Canadians were polite (we’re not, we swear a lot, fornicate and play hockey, what else to do in cold weather; sorta like Finland).

la-et-mn-russell-crowe-career-in-pictures-2015-045Finland’s health authorities have been issuing advice in an attempt to prevent the spread of Norovirus among swimmers this summer, following last year’s outbreak when hundreds of beachgoers caught the contagious vomiting bug.

Authorities are now keen to avoid a repeat of last year’s numerous beach closures.

Senior inspector Jaana Kilponen, from the health and safety executive Valvira, said that changing rooms and toilet facilities at bathing spots were also responsible for the spread.

“When you’ve got ideal swimming conditions, such as warm water and lots of people, then it’s important that authorities make sure the facilities are cleaned more frequently, and kept well stocked with soap and hand towels,” she told Yle.

Kilponen also implored swimmers to avoid being sick or going to the toilet in the water – and not to drink it. Anyone with Norovirus should wait two weeks before going swimming. Kilponen admits that in theory it’s possible that a single infected swimmer could contaminate the water.

Irrigation water and produce safety

Back before there was youtube, we started videoing my friend, Jeff Wilson, about farming stuff.

boog.powell.mesquite.cookingWe knew irrigation water was an issue, but it was one most didn’t want to talk about.

Researchers at Cornell have reported that environmental (i.e., meteorological and landscape) factors and management practices can affect the prevalence of foodborne pathogens in produce production environments.

This study was conducted to determine the prevalence of Listeria monocytogenes, Listeria species (including L. monocytogenes), Salmonella, and Shiga toxin–producing Escherichia coli (STEC) in produce production environments and to identify environmental factors and management practices associated with their isolation.

Ten produce farms in New York State were sampled during a 6-week period in 2010, and 124 georeferenced samples (80 terrestrial, 33 water, and 11 fecal) were collected. L. monocytogenes, Listeria spp., Salmonella, and STEC were detected in 16, 44, 4, and 5% of terrestrial samples, 30, 58, 12, and 3% of water samples, and 45, 45, 27, and 9% of fecal samples, respectively. Environmental factors and management practices were evaluated for their association with terrestrial samples positive for L. monocytogenes or other Listeria species by univariate logistic regression; analysis was not conducted for Salmonella or STEC because the number of samples positive for these pathogens was low. Although univariate analysis identified associations between isolation of L. monocytogenes or Listeria spp. from terrestrial samples and various water-related factors (e.g., proximity to wetlands and precipitation), multivariate analysis revealed that only irrigation within 3 days of sample collection was significantly associated with isolation of L. monocytogenes (odds ratio = 39) and Listeria spp. (odds ratio = 5) from terrestrial samples.

These findings suggest that intervention at the irrigation level may reduce the risk of produce contamination.

Irrigation is significantly associated with an increased prevalence of Listeria monocytogenes in produce production environments in New York State

Journal of Food Protection®, Number 6, June 2015, pp. 1064-1243, pp. 1132-1141(10), DOI: http://dx.doi.org/10.4315/0362-028X.JFP-14-584

Weller, Daniel; Wiedmann, Martin; Strawn, Laura K.

http://www.ingentaconnect.com/content/iafp/jfp/2015/00000078/00000006/art00010

8 sick: Suspected outbreak of cryptosporidium hits thousands of homes in Ireland

Almost 6,500 homes in Westport have been placed on a boil water notice after a suspected outbreak of cryptosporidium.

crypto_enlargedThe precautionary notice was issued by Irish Water to a large number of customers in the town and to those on nearby group water schemes this evening.

It will affect thousands of homes and businesses in the busy tourist town.

Irish Water says the HSE has issued the precautionary boil notice, after eight people in the Westport area reported symptoms of crytosporidium.

They say no crytosporidium had been detected in ongoing water samples, however, as a precaution they are urging customers to boil water before using it for drinking, preparing food and baby food or brushing teeth.

Beaver fever: Giardiasis surveillance, US 2011–2012

Problem/Condition: Giardiasis is a nationally notifiable gastrointestinal illness caused by the protozoan parasite Giardia intestinalis.

Reporting Period: 2011–2012.

beaver.feverDescription of System: Forty-four states, the District of Columbia, New York City, the Commonwealth of Puerto Rico, and Guam voluntarily reported cases of giardiasis to CDC through the National Notifiable Diseases Surveillance System (NNDSS).

Results: For 2011, a total of 16,868 giardiasis cases (98.8% confirmed and 1.2% nonconfirmed) were reported; for 2012, a total of 15,223 cases (98.8% confirmed and 1.3% nonconfirmed) were reported. In 2011 and 2012, 1.5% and 1.3% of cases, respectively, were associated with a detected outbreak. The incidence rates of all reported cases were 6.4 per 100,000 population in 2011 and 5.8 per 100,000 population in 2012. This represents a slight decline from the relatively steady rates observed during 2005–2010 (range: 7.1–7.9 cases per 100,000 population). In both 2011 and 2012, cases were most frequently reported in children aged 1–4 years, followed by those aged 5–9 years and adults aged 45–49 years. Incidence of giardiasis was highest in Northwest states. Peak onset of illness occurred annually during early summer through early fall.

Interpretation: For the first time since 2002, giardiasis rates appear to be decreasing. Possible reasons for the decrease in rates during 2011–2012 could include changes in transmission patterns, a recent change in surveillance case definition, increased uptake of strategies to reduce waterborne transmission, or a combination of these factors. Transmission of giardiasis occurs throughout the United States, with more frequent diagnosis or reporting occurring in northern states. Geographical differences might suggest actual regional differences in giardiasis transmission or variation in surveillance capacity across states. Six states did not report giardiasis cases in 2011–2012, representing the largest number of nonreporting states since giardiasis became nationally notifiable in 2002. Giardiasis is reported more frequently in young children, which might reflect increased contact with contaminated water or ill persons, or a lack of immunity.

Public Health Action: Educational efforts to decrease exposure to unsafe drinking and recreational water and prevent person-to-person transmission have the potential to reduce giardiasis transmission. The continual decrease in jurisdictions opting to report giardiasis cases could negatively impact the ability to interpret national surveillance data; thus, further investigation is needed to identify barriers to and facilitators of giardiasis case reporting. Existing state and local public health infrastructure supported through CDC (e.g., Epidemiology and Laboratory Capacity grants and CDC-sponsored Council of State and Territorial Epidemiologists Applied Epidemiology Fellows) could provide resources to enhance understanding of giardiasis epidemiology.

Street food vendors in Hyderabad, India have some food safety issues

I’m a food truck kind of guy, but I prefer to eat from places that have to follow the basic rules of sanitation. In North Carolina mobile food vendors have to be linked up with a physical kitchen (for cooling and prepping food) and even then they are inspected. Keeping food safe in a truck can be done, but it takes vigilance and a sense of hazard identification.

And not using water from a toilet.1680787-poster-1280-water-reuse-graphic

Like what the Times of India reported about some street food vendors in Hyderabad, India.

Every sixth Hyderabadi taking street food is falling sick from food-borne infections (whoa, I’d like to see the data -ben), says a study that directly observed the hygienic practices followed by 500 food vendors and small restaurants in different parts of the city. 

The most common ailments reported by denizens after eating street food or ‘stale’ food served by some established restaurants are diarrhea, abdominal pain, nausea and vomiting, reveals a study released to mark the ‘food safety’ theme on World Health Day. 

And here’s why: The majority of street food vendors (423 out of 500 surveyed) were found drawing untreated water for cooking from nearby apartments, while only seven were using protective head cover. None were using protective gloves and almost all used nearby shops to dump their raw material overnight. 

“Our team, which also communicated with customers, came across around 50 vendors with tobacco addiction, leaving the remnants of the ash on the food being served,” said Dr K Suresh, president of Osmania Medical College Doctors’ Forum, who led the study. 

Worse, 15 out of 500 vendors were found drawing water for cooking from toilets of nearby apartments, while almost all were found to skip hand washing after a visit to the toilet or lavatory. This is what the 30-member team of MBBS undergraduates led by Dr Suresh found after analyzing data gathered from street- vendors from December-2014 to February-2015.

Cryptosporidium: 22 years since Milwaukee outbreak killed 69 sickened 400K

Twenty-two years ago this month, residents of Milwaukee started falling ill with nausea, diarrhea and abdominal cramps. At first, a highly contagious intestinal virus was blamed. But as symptoms struck tens of thousands of people – closing schools and businesses and nearly bringing the city to a standstill – health officials discovered the culprit: a tiny, pink-colored parasite.

crypto cystCryptosporidium, also known as crypto, had made its way through Milwaukee’s water treatment plant and into the city taps. Sickening more than 400,000 people and killing 69, it remains the largest waterborne outbreak in U.S. history. Since then, utilities nationwide have made improvements in water treatment and monitoring.

Public water technology to prevent crypto may have improved, but not the drugs to treat it, said Washington State University researcher Jennifer Zambriski of the Paul G. Allen School for Global Animal Health based in the College of Veterinary Medicine. Once the organism infects the small intestines, its onslaught on the body is just as toxic as it was 22 years ago, she said.

“Crypto is hardy and doesn’t die easily. When someone contracts it, there’s simply no drug to make it go away,” said Zambriski, whose research focuses on finding ways to disrupt the parasite’s pathway through the digestive tract – before it gains a stranglehold on its host.

Which is a big deal, because the parasite still lurks – in ponds, streams, day care centers and swimming pools. In developing countries like Kenya and industrial ones like the United States, it continues to make waves.

Cryptosporidiosis, the disease it causes, is one of the most frequently occurring waterborne diseases among humans in the U.S., according to the U.S. Centers for Disease Control and Prevention. And in Asia and Africa, the parasite is a leading cause of diarrheal disease and death among infants. (See Lancet study, 2013: http://www.sciencedirect.com/science/article/pii/S0140673613608442).

These soft-pink colored pathogenic foes, appearing “almost cute” under a microscope, according to Zambriski, live in the intestines of infected humans and certain animals and are shed in the stool. Once outside the body, a tough outer shell allows them to survive in dirt, water and food for 18 months or longer.

“Bleach, chlorine, freezing backwater streams and water purifying tablets – they can’t kill crypto,” she said.

Whether through contaminated water or an infected person’s unclean hands, the parasites are easily transmitted to humans.

“Ingesting just a small amount can deliver a severe spell of diarrhea to those who are healthy and a grave illness and even death to infants or people with weakened immune systems,” Zambriski said.

Winnipeg water system investigated following January boil water advisory

Pathogens being pumped throughout a city into cups, food and showers make water system outbreaks scary in scope and outcome. In 1993 an estimated 400,000+ people in Milwaukee had cryptosporidiosis after oocysts made it through the city’s water treatment filtration system. In 2000, seven deaths and 2,300 illnesses were linked to a negligently-managed water system in Walkerton, Ontario (that’s in Canada).Price of Water Set To Rise

Winnipeg, Manitoba (that’s also in Canada) had a boil water advisory for a couple of days last month that was blamed on a set of samples that falsely showed the water was positive for E. coli. Canadian food micro guru Rick Holley said a couple of weeks ago questioned the water folk’s explanation saying,

“I still had concerns at that time and still do that the false positives might not be scientifically discredited,” said Holley. “It’s all too easy to continue testing until you get the results you want and any results you don’t want you discard as being false. That’s inappropriate.”

Holley said the only way to be sure Winnipeg water is safe is to understand what caused the positive results earlier this week.

“Why were those six samples positive? There has to be a reason why and that has to be established,” said Holley.

According to Global News, it sounds like the Manitoba Government agrees with Rick.

The Manitoba government has ordered an investigation into the susceptibility of Winnipeg’s drinking water after a false E. coli result prompted a boil-water advisory last month for the capital’s 700,000 residents.

City staff say they are confident the water system was not contaminated with bacteria, but the waste and water director says the province has ordered a further assessment.

“It’s a vulnerability assessment,” Diane Sacher told a city council committee Wednesday. “It’s to look at whether our system is vulnerable to possible contamination.”

The report is due at the end of April, Sacher said. The city is also waiting on an independent audit of how water samples are taken and analyzed so as to be sure last month’s results were due to a lab or sampling error.

The province has also amended the city’s licence so water samples are no longer all collected on the same day, but rather spread over a week, she added. It has also requested the city come up with a better plan to notify potentially vulnerable people rather than relying on the media.

69 sick: Water supply causes mass hepatitis A infection in Russia

Water supply companies in Russia’s republic of Dagestan are facing a criminal investigation after 69 people became infected with Hepatitis A from drinking water.

dangerous_face_waterAn online statement posted Thursday by Russia’s health watchdog Rospotrebnadzor said that cases were recorded in three different places in the North Caucasus republic: the towns of Derbent and Dagestanskiye Ogni and the village of Gedzhukh. Fifty-eight of those infected were children.

The victims all complained of feeling generally ill and noticing a yellow tint to the skin, the RGVK Dagestan television channel reported.

Laboratory testing indicated that the local water supply was to blame for the outbreak, according to the statement, noting that all the victims received their drinking water from the same water main.

Poop-in-water made me sick says CSIRO employee; nope says Tribunal

A CSIRO spin doctor who says she contracted a virus after drinking water contaminated with feces at a conference has lost her bid for compensation.

water.jug.feb.15The Administrative Appeals Tribunal found federal workplace insurer Comcare had no liability for her ill-health as it could not be certain the type of virus, where it had been contracted, or if it could cause chronic fatigue syndrome.

Sasha Hardcastle reported flu-like symptoms on the third day of the 2012 conference and was rushed to hospital a week later with chest pain.

Mrs Hardcastle saw a number of doctors when her health did not improve over the following months, and was diagnosed with post viral fatigue and CFS.

She claimed that she had contracted Coxsackie B virus at the conference after she drank water contaminated with feces due to the jug being filled from the hand basin in the ladies’ toilets.

The communications manager took her case to the tribunal after Comcare rejected her compensation claim.

There is no dispute Ms Hardcastle suffered from chronic fatigue syndrome.

simpsons.aust.toiletsBut Comcare did not accept that the illness had been caused by her employment or that she contracted Coxsackie B virus at the conference.

Medical experts agreed that the chances of catching Coxsackie B virus from a jug filled from the tap in a hand basin located in a toilet facility were so low that they would both be comfortable drinking the water.