Ice fingered but epi can be ‘squishy’ 61 sickened by Norovirus at journalists’ conference

Two months after a norovirus outbreak at Bali Hai restaurant, county health officials have fingered ice as the foodborne source that sickened at least 61 people — including three in a wedding party.

norovirus-2“We’re certain it had something to do with the ice” served at the annual awards banquet of the local Society of Professional Journalists, said county spokesman Michael Workman. “We’re not certain how it got in the ice.”

In its final report to the San Diego SPJ, the county said 84 of the 172 people at the July 29 banquet returned surveys on what they ate and other issues. Fifty were sickened by norovirus type GI.1. (Eight others also reported getting ill.)

Three diners elsewhere in Bali Hai also got GI.1 — part of a wedding party of 140.

“We have to [classify it as] food poisoning,” Workman said, rather than a sick person spreading the gastrointestinal disease.

A Sept. 4 report said, “We did not link any food service workers with the illness,” but Workman on Tuesday told Times of San Diego that “we can’t say yes or no” to whether an employee caused the outbreak.

Workman stressed that Bali Hai remains “rated for high” for hygiene. “Everyone involved — from the people who attended [the banquet] and from the restaurant … did the right thing.”

County spokesman Workman saluted Bali Hai management.

“The restaurant had a great hygiene procedure, really good,” he said. “They are on the up-and-up on what they do and what they teach their employees. The employees have been there a long time. So they get it.”

But Workman acknowleged the county’s findings can be “squishy” and “it’s not an exact science.”

But: “We’re confident it’s been taken care of.”

Minimize risk: Tracking shellfish contamination

Some shellfish, especially raw oysters, may contain dangerous levels of the pathogen Vibrio parahaemolyticus (Vp), a cousin of the bug that causes cholera.

Raw oystersWhen ingested, Vp can cause the food poisoning called vibriosis, which usually entails an unpleasant three days of nausea, diarrhea, fever and chills. In rare cases and among vulnerable populations—the very young, very old or those with weakened immune systems—the bacterium can cause a more serious blood infection. Vp, which can also cause skin infections, leads to about 30 hospitalizations and kills one to two people each year, according to the Centers for Disease Control and Prevention.

In Massachusetts, 58 cases of Vp-related illnesses were reported to the Department of Public Health in 2013, up from 13 cases in 2011. The state banned oyster harvesting in waters off Cape Cod, Martha’s Vineyard and Nantucket as well as off the towns of Plymouth, Kingston, Duxbury and Marshfield that year. The last two years waters in New York, Oregon and Washington State have been closed to oystering.

Vp occurs naturally in most marine ecosystems, but it typically has only been linked to disease in warm coastal areas, such as the Gulf of Mexico. The recent emergence of Vp-associated illness linked to seafood from waters off Alaska, Long Island and Massachusetts has made public health officials and others sit up and take notice, says Meghan Hartwick, who received a master’s degree in conservation medicine from Cummings School in 2012 and now works to predict and control future outbreaks.

oysters.grillWhy has Vp-related illness spread to more northern latitudes? Some scientists speculate it might have to do with climate change and rising ocean temperatures. “When we see these kinds of outbreaks in historically cold-water areas, it’s really unusual,” says Hartwick, who is studying the Vibrio species as a Ph.D. student in biology at the University of New Hampshire.

Hartwick hopes to develop a predictive mathematical model that can warn public health officials and shellfish growers when Vp outbreaks might occur. She helped implement such an environmental surveillance tool for cholera in Vellore, India, as part of her conservation medicine program at Tufts.

Nationwide, Vibrio parahaemolyticus cases are also on the rise. The Centers for Disease Control reports a 115 percent increase since 1996, when the agency started tracking Vp-associated illnesses. Of the 431 cases the CDC confirmed in 2012, six were fatal. Officials also suspect that Vp is vastly underreported, by as much as tenfold.

Hartwick is studying the Vibrio population in the Great Bay tidal estuary on the New Hampshire coast that empties into the Gulf of Maine. Collaborating with UNH colleagues with expertise in microbial ecology, genetics, molecular evolution and remote sensing, Hartwick is trying to understand the role the bacteria plays within Great Bay’s ecosystem.

The “sole goal [of Vp] in life is not to be a human pathogen,” she says. “Vp is an intrinsic part of the flora and fauna of most marine and estuarine ecosystems.”

In the spring and summer, Hartwick collects water and sediment samples and gathers data about water temperature, salinity, pH levels and anything else that might affect the bacteria’s numbers. Over time, she hopes to map how much and which species of Vibrio bacteria are present in Great Bay during the summer, as well as what factors might promote an outbreak.

In addition to developing a Vibrio early-warning tool, Hartwick and the UNH team, including her advisor, bacteriologist Stephen Jones, are working with shellfish growers to figure out how to prevent future outbreaks. After all, no one wants to sell food that makes people sick, she says.

“We’re not blindly throwing a dart and hoping it solves the problem,” Hartwick says. “We’re asking, ‘What is the problem, and what’s the best way to address it,’ so there are no unnecessary burdens placed on the shellfish industry, and there’s also no unnecessary illness. It’s sustainable science contributing to sustainable policy.”

Now into a second summer of collecting samples in Great Bay, Hartwick says she eventually would like to do work in sustainable development on a global scale. Disrupting ecosystems is one of the surest ways to trigger epidemics, such as cholera, she says, and disease is one of the heaviest economic burdens developing nations have to bear.

“If a developing nation can navigate that, it can jump ahead economically,” she says. “It’s hard for me not to think, ‘How can we conserve the environment and improve human health and the economy and education—everything at once?’ My approach is to minimize disease.”

3 sick: Crypto outbreak in Tenn.

Some Scott County parents are on edge after two local children have been hospitalized with a gastrointestinal illness caused by a common microscopic parasite.

crypto.Public-Pool-Dangers-800Cryptosporidiosis is being blamed for at least three illnesses in Scott County children this week, creating a sense of alarm on social media as news of their sickness has spread.

The first local child to be admitted to the hospital was a young girl from Oneida. Initially fearing an appendicitis attack, her mother, Tracy Shoopman, drove her to East Tennessee Children’s Hospital in Knoxville on Tuesday. There, doctors admitted her for testing, and on Wednesday confirmed a diagnosis of cryptosporidiosis.

The same day, another child from Scott County — a student at Huntsville Elementary School — was also diagnosed with cryptosporidiosis by doctors after being hospitalized at Children’s Hospital. Her mother, Mindy Wagaman, told the Independent Herald that her daughter was hospitalized late Tuesday night after she started vomiting blood.

Both children remained hospitalized Thursday.

Also on Wednesday, a third child, also a student at Huntsville Elementary, was diagnosed with the illness by Children’s Hospital doctors. However, she was treated in the hospital’s emergency room and released.

A fourth child, a student at Huntsville, was being tested for the illness.

At first glance, there was no apparent connection between the four cases of the illness — which health officials say is most commonly caught from contaminated water sources. According to the CDC, the illness can be caught by swimming in contaminated bodies of water, which can include streams or lakes but can also include treated water sources, such as pools or splash pads. Because the parasite is resistant to common water treatment methods, it can survive in pools after being unknowingly introduced to the water by someone who is sick.

Knoxville’s WBIR reported last week that East Tennessee health officials are seeing a major spike in crypto cases this year. The story quoted Darci Hodge, Children’s Hospital’s director of quality and infection control, as saying the hospital has confirmed 29 cases of crypto this year — far higher than the next highest single-year number of five cases.

Crypto compensation: United Utilities faces £15m bill

United Utilities accepts it is facing a colossal compensation bill for the first cryptosporidium contamination of drinking water in the North West UK this century.

poop-in-poolBut the company has reassured consumers the payouts – estimated already at £15m and mounting – will not be offset by a rise in water bills.

“Bills will not increase to cover the cost of compensation,” insisted a spokesman.

“This cost will be borne by the company.”

With more than 300,000 households and businesses hit by the scare, now into its third week, United Utilities has declined to put a figure on how much the crypto invasion will amount to.

But in a recent case in Bolton, where consumers had to boil their drinking water for five days after supply problems, the company paid out £15 per house to cover the cost.

With the inconvenience to customers in Preston, South Ribble, Chorley, the Fylde Coast and villages like Samlesbury, Mellor and Mellor Brook at least three times that already, claims could amount to at least £45 a household, or £13.5m in total.

With businesses set to lodge much higher demands for compensation after providing bottled water to all employees during the scare – BAE Systems is thought to have spent more than £100,000 already on keeping its 10,000-strong workforce in Lancashire hydrated – the bill is estimated to be rising by £1m a day.

‘It’s something in the pool. But I’m not a doctor’ Hundreds of Dutch tourists fall ill in Macedonia

Dozens of Dutch tourists are spending their holiday in Macedonia in the bathroom rather than at the pool or the beach. A mysterious virus from the nearby Skopje has two-thirds of the Dutch tourists in the Izgrev Spa & Aqua Park in Ohrid stuck in their hotel rooms.

the Izgrev Spa & Aqua Park in OhridThe hotel has room for about 700 guests, 332 of them are Dutch tourists who traveled through travel agency Corendon. So far only about 20 people reported to the company that they were sick. All of them were treated for diarrhea. CEO Atilay Uslu told the Telegraaf that the virus has to do with “something in the pool. But I’m not a doctor.”

Irrigation water, produce and pathogens

The microbiological sanitary quality and safety of leafy greens and strawberries were assessed in the primary production in Belgium, Brazil, Egypt, Norway and Spain by enumeration of Escherichia coli and detection of Salmonella, Shiga toxin-producing E. coli (STEC) and Campylobacter.

strawberryWater samples were more prone to containing pathogens (54 positives out of 950 analyses) than soil (16/1186) and produce on the field (18/977 for leafy greens and 5/402 for strawberries). The prevalence of pathogens also varied markedly according to the sampling region. Flooding of fields increased the risk considerably, with odds ratio (OR) 10.9 for Salmonella and 7.0 for STEC.

A significant association between elevated numbers of generic E. coli and detection of pathogens (OR of 2.3 for STEC and 2.7 for Salmonella) was established. Generic E. coli was found to be a suitable index organism for Salmonella and STEC, but to a lesser extent for Campylobacter. Guidelines on frequency of sampling and threshold values for E. coli in irrigation water may differ from region to region. 

Risk Factors for Salmonella, shiga toxin-producing Escherichia coli and Campylobacter occurrence in primary production of leafy greens and strawberries

International Journal of Environmental Research and Public Health

Siele Ceuppens, Gro S. Johannessen, Ana Allende, Eduardo César Tondo,  Fouad El-Tahan, Imca Sampers, Liesbeth Jacxsens, and  Mieke Uyttendaele

Biosensor platform for rapid detection of E. coli in drinking water

The need for rapid, specific and sensitive assays that provide a detection of bacterial indicators are important for monitoring water quality. Rapid detection using biosensor is a novel approach for microbiological testing applications. Besides, validation of rapid methods is an obstacle in adoption of such new bio-sensing technologies.

drinking.water.e.coliIn this study, the strategy developed is based on using the compound 4-methylumbelliferyl glucuronide (MUG), which is hydrolyzed rapidly by the action of E. coli β-D-glucuronidase (GUD) enzyme to yield a fluorogenic product that can be quantified and directly related to the number of E. coli cells present in water samples. The detection time required for the biosensor response ranged from 30 to 120 minutes, depending on the number of bacteria. The specificity of the MUG based biosensor platform assay for the detection of E. coli was examined by pure cultures of non-target bacterial genera and also non-target substrates. GUD activity was found to be specific for E. coli and no such enzymatic activity was detected in other species. Moreover, the sensitivity of rapid enzymatic assays was investigated and repeatedly determined to be less than 10 E. coli cells per reaction vial concentrated from 100 mL of water samples.

The applicability of the method was tested by performing fluorescence assays under pure and mixed bacterial flora in environmental samples. In addition, the procedural QA/QC for routine monitoring of drinking water samples have been validated by comparing the performance of the biosensor platform for the detection of E. coli and culture-based standard techniques such as Membrane Filtration (MF). The results of this study indicated that the fluorescence signals generated in samples using specific substrate molecules can be utilized to develop a bio-sensing platform for the detection of E. coli in drinking water. The procedural QA/QC of the biosensor will provide both industry and regulatory authorities a useful tool for near real-time monitoring of E. coli in drinking water samples. Furthermore, this system can be applied independently or in conjunction with other methods as a part of an array of biochemical assays in order to reliably detect E. coli in water.

Biosensor platform for rapid detection of E. coli in drinking water

Arizona State University Digital Repository

Hesari, Nikou / Abbaszadegan, Morteza / Alum, Absar / Fox, Peter  / Stout, Valerie

UV equipment brought in to kill off crypto

Water bosses are bringing in ultra violet ray equipment to help kill off cryptosporidium in the water supply which has affected over 300,000 Lancashire residents.

United Utilities is to use the portable UV rigs at three sites on the Fylde which it says should make a difference and help kill off cryptosporidium. The equipment, which consists of powerful fluorescent UV lights shining in a tank through which water passes, will be used on water leaving the Warbreck, Weeton and Westby service reservoir outlets.

The UV C rays attack the DNA of the parasite killing it rapidly. It also works on other potentially harmful microbes such as e-coli. John Butcher, UU’s regional supplies manager, said: “Cryoptosporidium is very vulnerable to this UV C light. The normal treatment process at Franklaw deals with it and the water coming out of there is clear, but we have brought this in to deal with the water now going through the system.”

Gary Dixon UU’s customer services director said they had identified a possible source for the contamination but had to wait for the Drinking Water Inspectorate’s official report.

Surveillance for waterborne disease outbreaks associated with drinking water – United States, 2011-2012

The U.S. Centers for Disease Control reports in Morbidity and Mortality Weekly that advances in water management and sanitation have substantially reduced waterborne disease in the United States, although outbreaks continue to occur (1). Public health agencies in the U.S. states and territories* report information on waterborne disease outbreaks to the CDC Waterborne Disease and Outbreak Surveillance System (

water.wellFor 2011–2012, 32 drinking water–associated outbreaks were reported, accounting for at least 431 cases of illness, 102 hospitalizations, and 14 deaths. Legionella was responsible for 66% of outbreaks and 26% of illnesses, and viruses and non-Legionella bacteria together accounted for 16% of outbreaks and 53% of illnesses. The two most commonly identified deficiencies† leading to drinking water–associated outbreaks were Legionella in building plumbing§ systems (66%) and untreated groundwater (13%). Continued vigilance by public health, regulatory, and industry professionals to identify and correct deficiencies associated with building plumbing systems and groundwater systems could prevent most reported outbreaks and illnesses associated with drinking water systems.

This report provides information on drinking water–associated¶ waterborne disease outbreaks in which the first illness occurred in 2011 or 2012** (, and summarizes outbreaks reported to the Waterborne Disease and Outbreak Surveillance System through the electronic National Outbreak Reporting System ( as of October 30, 2014. For an event to be defined as a waterborne disease outbreak, two or more persons must be linked epidemiologically by time, location of water exposure, and case illness characteristics; and the epidemiologic evidence must implicate water as the probable source of illness. Data submitted for each outbreak include 1) the number of cases, hospitalizations, and deaths; 2) the etiologic agent (confirmed or suspected); 3) the implicated water system; 4) contributing factors in the outbreak; and 5) the setting of exposure.

Karlyn D. Beer, PhD1,2; Julia W. Gargano, PhD2; Virginia A. Roberts, MSPH2; Vincent R. Hill, PhD2; Laurel E. Garrison, MPH3; Preeta K. Kutty, MD3; Elizabeth D. Hilborn, DVM4; Timothy J. Wade, PhD4; Kathleen E. Fullerton, MPH2; Jonathan S. Yoder, MPH, MSW2

Crypto in UK water supply, 300K homes affected

More than 300,000 homes in Lancashire have been told that they may have to boil their drinking water after a microbial parasite was discovered in their supply.

Lancashire.waterUnited Utilities, which provides water and sewage services to around seven million people in North West England, found traces of the parasite cryptosporidium at Franklaw water treatment works near Preston, during routine tests.

Cryptosporidium can cause gastrointestinal illness with diarrhoea in humans. The parasite can cause acute, short-term infections, but symptoms can become severe in children and people with low immune systems.

The alert was initially issued by United Utilities last Thursday but the company have advised customers in Blackpool, Chorley, Fylde, Preston, South Ribble and Wyre to continue carrying out precautions till at least Wednesday as “low” levels of the parasite still remain in the supply.