Monthly Archives: October 2013

Handwashing is never enough: a parent’s story about sickness at state fairs

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Arinn Dixon Widmayer of Raleigh, North Carolina, writes in the Charlotte Observer:

As I sat in a darkened room in the middle of the night watching a nurse hook up a dialysis machine to my pale and shivering 7-year-old son, I wondered how in the world we ended up here.

It was October 2011, and my husband and I had been watching our son’s health all week. He stood motionless on the soccer field on Tuesday night, white handwash.UK.petting.zoo.09as a sheet, as the ball rolled by. By Thursday, he was nauseated and feverish. Our pediatrician told us to keep him hydrated, reduce the fever, that it was a bug and he’d get past it. By the weekend, he was eating little, sleeping most of the day.

This is a tale any parent can tell. We see it all the time – children with a virus, a cold, the flu. Parents worry, give them medicine, juice and too much TV, and in a few days they perk up and get back to their normal selves.

Except when they don’t.

During that weekend, the pediatrician thought maybe our son had eaten something that made him sick. She treated his symptoms and started running some tests for infection. It was at that visit I first heard a suggestion of salmonella, of listeria, of E. coli.

By Monday, he was in bad shape. I helped him to the bathroom that morning and hugged him while he sat there crying that his tummy hurt. Once I got him standing back up, I turned to flush the toilet and froze. It was full of blood. Only blood. Within three hours, an ER doctor was explaining test results. It was E. coli.

I closed my eyes, just relieved to have a name for this suffering, so I wasn’t looking at the doctor’s face when she uttered the words “double kidney failure.” handwashing.ekka.jpgAnd then I was in that dark room with the doctors and nurses and the dialysis machine. How did we get here?

Our son was infected with E. coli at the N.C. State Fair. Public health officials narrowed the site of his infection to the Kelley Building, one of the animal exhibit areas. It was a no-contact exhibit where the animals were fenced in. My family walked up and down the rows of pigs, sheep and goats. Our kids pointed and giggled at the jumping goats and fuzzy sheep. When we left the building, we stopped at the hand-washing station at the door and cleaned up. We did everything right. We avoided the petting zoo. We didn’t eat near the animals. We used the hand-washing stations when we left the exhibit and before we ate. None of us ever touched an animal. And our son still ended up enduring six dialysis treatments, four blood transfusions, 15 days in the hospital and a brush with death because of our decision to walk into that building.

Our son was just one of 27 people infected with E. coli at the State Fair in 2011. Add that to 108 people infected at the fair in 2004 and another three in 2006, and we end up with a serious public health issue. State health officials have recently made changes to the fair to reduce the risk of infection. They changed traffic patterns in the animal exhibits, increased the number of hand-washing stations, added signage warning fairgoers against touching animals and other measures.

Those are great steps toward protecting the public, but are they enough to protect fairgoers this year? I’m not advocating keeping animals and fairgoers separated by a glass wall, and I don’t pretend to know what else the fair can do to eliminate the risk of infection. But I do have to wonder whether large crowds and animals that carry deadly bacteria can coexist without the risk of E. coli? And at what point do those risks outweigh the benefits?

Handwashing is never enough. While some studies suggest inadequate handwashing facilities may have contributed to enteric disease outbreaks or washing hands was protective against illness, others suggest relevant infectious royal.petting.zooagents may be aerosolized and inhaled. Handwashing tool selection may also contribute to the success of hand hygiene as a preventive measure, as some outbreak investigations have reported alcohol-based hand sanitizer was not protective against illness, especially when hands are soiled.

All the refs can be found in our 2012 paper, a sorta secret petting zoo shopper, Observation of public health risk behaviors, risk communication and hand hygiene at Kansas and Missouri petting zoos – 2010-2011.

I’m fine with animal interactions; but people, and organizers, should be a lot more careful than they thought. That’s what I told my 3-year-old’s daycare as they prepared for a chicken coop. I’m not sure people like that message.

Further, sanitizers have limited effectiveness, and in a petting zoo situation, so does handwashing; it’s only one component of an overall strategy to reduce risk. But it’s easy to say handwashing because that blames the patrons, not something else.

A table of petting zoo outbreaks is available at http://bites.ksu.edu/petting-zoos-outbreaks.

Erdozain G, Kukanich K, Chapman B, Powell D. 2012. Observation of public health risk behaviours, risk communication and hand hygiene at Kansas and Missouri petting zoos – 2010-2011. Zoonoses Public Health. 2012 Jul 30. doi: 10.1111/j.1863-2378.2012.01531.x. [Epub ahead of print]

Abstract below:

Observation of public health risk behaviors, risk communication and hand hygiene at Kansas and Missouri petting zoos – 2010-2011Outbreaks of human illness have been linked to visiting settings with animal contact throughout developed countries. This paper details an observational study of hand hygiene tool availability and recommendations; frequency of risky behavior; and, handwashing attempts by visitors in Kansas (9) and Missouri (4), U.S., petting zoos. Handwashing signs and hand hygiene stations were available at the exit of animal-contact areas in 10/13 and 8/13 petting zoos respectively. Risky behaviors were observed being performed at all petting zoos by at least one visitor. Frequently observed behaviors were: children (10/13 petting zoos) and adults (9/13 petting zoos) touching hands to face within animal-contact areas; animals licking children’s and adults’ hands (7/13 and 4/13 petting zoos, respectively); and children and adults drinking within animal-contact areas (5/13 petting zoos each). Of 574 visitors observed for hand hygiene when exiting animal-contact areas, 37% (n=214) of individuals attempted some type of hand hygiene, with male adults, female adults, and children attempting at similar rates (32%, 40%, and 37% respectively). Visitors were 4.8x more likely to wash their hands when a staff member was present within or at the exit to the animal-contact area (136/231, 59%) than when no staff member was present (78/343, 23%; p<0.001, OR=4.863, 95% C.I.=3.380-6.998). Visitors at zoos with a fence as a partial barrier to human-animal contact were 2.3x more likely to wash their hands (188/460, 40.9%) than visitors allowed to enter the animals’ yard for contact (26/114, 22.8%; p<0.001, OR= 2.339, 95% CI= 1.454-3.763). Inconsistencies existed in tool availability, signage, and supervision of animal-contact. Risk communication was poor, with few petting zoos outlining risks associated with animal-contact, or providing recommendations for precautions to be taken to reduce these risks.

Slipped my mind: 2,000 bottles of potentially tainted water found in Toronto food venues long after closure order

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More than 2,000 bottles of water from a Caledon producer shut down in July because of its bacteria-tainted product have been found in Toronto restaurants, hotels and a health food store in recent weeks, according to Rob Cribb of the Toronto Star.

While Blue Glass Water Co. Ltd. was under a provincial health order to stop producing and shipping its product as of July 18, Toronto health officials say blue_glass_water.jpg.size.xxlarge.promopotentially tainted water was still entering food establishments here as recently as Sept. 27.

In an exclusive interview with the Star, Toronto’s medical officer of health, Dr. David McKeown, said Friday it is impossible to know whether there could be more of the banned product still out there. “We don’t have a complete and accurate distribution list (because) it has not been provided by the operator,” he said. “So, in terms of the challenges of responding, it’s more complex than other such cases.”

Marshall Kazman, the only listed director of Blue Glass Water Co. Ltd. in Ontario corporate filings, has dismissed the allegations in interviews with the Star, calling his water safe and naturally infused with cancer-fighting properties. The disbarred lawyer, who is currently facing criminal fraud charges, called the ordered shutdown of his facility “a witch hunt” and “much ado about nothing.” He said he has not shipped his product since being ordered closed in July. “If there was a real danger would you not think a recall would have been ordered months ago?” he said in a statement Saturday.

The Canadian Food Inspection Agency, which originally tested the water along with Peel Region in late July, found “elevated levels of aerobic colony counts” in some samples, it said in a statement to the Star. The tests did not show pathogens such as E. coli or parasites, it says. “Based on the absence of an identified hazard and the contained exposure . . . the CFIA determined that a risk assessment was not needed and as such, no recall action was requested.” The level of concern about the water is much higher among provincial and local health officials. Officials at both levels have told the Star that testing of the Caledon Clear Watercompany’s water revealed it was “heavily contaminated” and “unfit to drink.” The “overgrowth of bacteria” in the water “masked” identification of specific pathogens such as E. coli and coliform, said the province’s chief medical officer of health, Dr. Arlene King.

The Star first reported health concerns about serious contamination in Blue Glass Water on Thursday, a threat nearly three months old that had not been made public. That lack of public notification meant the water continued to be served to unwitting customers across southern Ontario even as health officials were quietly looking for the water in food establishments for confiscation.

Following the Star’s questions to the province, the ministry issued a strongly worded statement warning the public not to consume Blue Glass Water because of the “potential health threat posed by these products.” Since the Star’s story, Toronto Public Health received several complaints from people who say they were made ill after drinking it. Inspectors are now investigating those cases.

So far, Toronto inspectors have found Blue Glass Water in 20 food establishments, ranging from high-end restaurants to a hotel and a health food store. The city is not identifying the establishments since they no longer serve the water and “they did nothing wrong,” said McKeown.

2 sick; oyster farmers back in business

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Katama Bay oyster beds in Massachusetts have been reopened a month after closing because of links to at least two Vibrio illnesses.

Katama oysters should be back in the restaurants by Columbus Day. “I’m really happy for all the farmers and I’m certainly SUN0705N-Oyster7relieved,” said Jack Blake, owner of Sweet Neck Farm, in a telephone call with the Times Friday evening, as his wife Susan cheered in the background.

“We haven’t stopped working; I’ve watched the sun rise every day. We’ve been getting our market size oysters ready to go. We have to empty some cages because we need the room, the seed is growing fast.” Mr. Blake said the Offshore Ale Company and The Lookout Tavern could be serving his oysters as early as tomorrow. “

People sick from Salmonella in salami in Italy

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An increase in abnormal cases of salmonellosis throughout the Italian province of Piacenza has led the Health Services Veterinary Service to conclude the culprit was Val d’Ongina brand salami and advise consumers to return any product.

The owner of the delicatessen Val D’Ongina, Furio Burgazzi sought to reassure consumers: “We have already taken steps to withdraw Val d'Ongina brand salamithe product from all the restaurants and supermarkets with which we work. We agree with the local health authorities to ask, as a precaution, to return the salami they may have suffered contamination. Every week we sell 4,000 salami – he pointed out – and to this day had never happened. Thanks to our control systems and high-level cleaning our products have always been a guarantee of quality.”

Note: some things may have been lost in translation.

Family speaks out after Salmonella death; 15 sick in outbreak linked to Kentucky restaurant

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Steve Davis, 61, of Hanson, Kentucky, died just weeks ago from Salmonella. His aunt tells 14 News that he was just the first of four family members who got infected.

“We’re going to miss Steve,” says Joyce Elieff. Joyce is still learning how to live without her nephew, Steve. “He always ended with, ‘If I can do anything for ya, call me,’ and ‘I love you, Aunt Joyce.’ That’s hard,” Joyce shares. 

Steve and his brother, Gary, ate at Casa Mexicana in Madisonville a few weeks ago. About a week after their meal, Steve got salmonella and died in the hospital.  Gary was also mexican-food-tacoinfected and hospitalized. “It’s just something I never would have thought of,” Joyce says.  Then, shortly after helping clean Steve’s home, a third family member, Joyce’s son, Johnny, also got salmonella. Soon after that, Joyce says the doctors told her that she also had the illness. “I was very careful and I still ended up with it. I just thank God that my son and my nephew are OK. …

“I didn’t even realize that was possible before now. That’s why I want people to realize how contagious it is. You just really can’t be too careful.” 
14 News, WFIE, Evansville, Henderson, Owensboro

6 sick: federal health types publicly absent in Canadian E. coli burger outbreak

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The Canadian Food Inspection Agency announced late Wednesday night that certain Compliments brand Super 8 Beef Burgers were being recalled because they may be contaminated with E. coli O157:H7.

They said people were sick but wouldn’t say how many; that’s up to either the e.coli.O157.belmont.oct.13Public Health Agency of Canada or Health Canada (who knows the difference).

The silence has been deafening.

However, a spokesman for Ontario’s health ministry told the Weyburn Review there have been six confirmed cases of illness in that province associated with the beef in question. Of the six people, four were hospitalized; of the four, one is still in hospital. All are recovering, the ministry said.

From 8 to 1: US shutdown hampers foodborne illness tracking

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The U.S. government shutdown is, according to NPR, pushing the nation’s food safety system to its limits.

There is normally a team of eight people overseeing Pulsenet, the critical foodborne illness tracking database. Centers for Disease Control Director Tom Frieden said pulsenetpost-shutdown, there’s only one. Some research and reference labs have gone from a staff of 80 to 2, and staff at the 20 quarantine stations dotted along the country’s borders and ports has been reduced by 85 percent.

The CDC is currently monitoring about 30 clusters of foodborne illnesses around the country, which is typical at any given time. About half the CDC staffers involved in surveillance and outbreak response have also been furloughed.

Hand sanitizers didn’t protect Iowa kids against crypto after petting cows

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This is why the UK says, handwashing with soap and water only at any petting farm or zoo.

A recent cluster of cryptosporidium cases cropped up after a Iowa preschool class visited a farm, Dr. Patricia Quinlisk, the Iowa Department of Public Health’s medical director, reported this morning. “While on the farm, the children petted cows and cow_hug_cumberlandate snacks,” Quinlisk wrote in a weekly email to public-health officials statewide. “The children did use hand sanitizer before eating; however, hand sanitizers are not particularly effective against crypto. Please continue to encourage handwashing with soap and water whenever possible.”

The Des Moines Register reports the parasite sickened hundreds of Iowans this summer, mainly via tainted swimming-pool water. Many of the patients suffered severe diarrhea. The outbreak has slowed now that most public pools have closed for the season. But infections also can happen in other ways, including contact with infected animals.

Quinlisk did not identify the preschool or say how many children became ill.

On Sept. 12, the state health department reported that there had been 861 confirmed or probable cases in Iowa so far in 2013. In all of 2012, there were 328 such cases.

Go evidence or go home: some online journals will publish fake science, for a fee

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A long time ago in a galaxy far, far away – Canada – we ran the national food safety info line.

You can imagine rotary phones, but it was a tad more sophisticated.

The question we grappled with was, who’s evidence is right?

We came up with specific guidelines for how to answer questions based on the preponderance of scientific evidence, and were completely transparent about the the.sting.publishinglimitations, using a sound risk analysis framework.

When answers in the scientific literature seemed, uh, weird or missing, we’d go do our own original research and fill in the gaps.

We questioned everything and still do. It’s good for science, but can be hard on relationships.

Any time some hack said, here’s the science to prove something, we would question it.

Apparently with good reason.

As reported by NPR, an elaborate sting carried out by Science found that many online journals are ready to publish bad research in exchange for a credit card number.

The business model of these “predatory publishers” is a scientific version of those phishes from Nigerians who want help transferring a few million dollars into your bank account.

To find out just how common predatory publishing is, Science contributor John Bohannon sent a deliberately faked research article 305 times to online journals. More than half the journals that supposedly reviewed the fake paper accepted it.
“This sting operation,” Bohannan , reveals “the contours of an emerging Wild West in academic publishing.”

Online scientific journals are springing up at a great rate. There are thousands out there. Many, such as PLOS, are totally respectable. This “open access” model is making good science more accessible than ever before, without making users pay the hefty subscription fees of traditional print journals.

(It should be noted that Science is among these legacy print journals, charging subscription fees and putting much of its online content behind a pay wall.)

But the Internet has also opened the door to clever imitators who collect fees from scientists eager to get published. “It’s the equivalent of paying someone to publish the.sting.noseyour work on their blog,” Bohannan tells Shots.

Bohannan says his experiment shows many of these online journals didn’t notice fatal flaws in a paper that should be spotted by “anyone with more than high-school knowledge of chemistry.” And in some cases, even when one of their reviewers pointed out mistakes, the journal accepted the paper anyway — and then asked for hundreds or thousands of dollars in publication fees from the author.

A journalist with an Oxford University PhD in molecular biology, Bohannan fabricated a paper purporting to discover a chemical extracted from lichen that kills cancer cells. Its authors were fake too — nonexistent researchers with African-sounding names based at the fictitious Wassee Institute of Medicine in Asmara, a city in Eritrea.

With help from collaborators at Harvard, Bohannan made the paper look as science-y as possible – but larded it with fundamental errors in method, data and conclusions.

The highest density of acceptances was from journals based in India, where academics are under intense pressure to publish in order to get promotions and bonuses.

“Peer review is in a worse state than anyone guessed,” he says.

The Internet and open access are great tools, but like any technology, hucksters will be there to exploit the tool for personal (PhD) gain.

Maybe the peer-review system needs to open up, and the Internet can help with that.