Cyclones, rain, and temperature-verified steak

During a morning of unrelenting and ongoing cyclone-related rain (yes, Brisbane gets weather too, not just Mass.) hockey skating and Chapman embarrassingly wearing a Leafs jersey (although my kid had one on this a.m., but Chapman should know better), I decided, why not barbeque for lunch.

145 F, rested for 10 minutes.

steak.rain.feb.15

19 sickened: ‘Dodgy salad’ behind Celtic Salmonella outbreak

I always worry about the homemade pesto.

The culprit in the Celtic Park salmonella outbreak was probably a dodgy ham and mozzarella salad, a report has revealed.

pesto.basil.cyclosporaNineteen guests at the Glasgow ground were struck down with vomiting and diarrhea last September.

Despite initial suggestions that a lamb dish was the chief suspect, months of sophisticated testing have pointed towards an Italian delicacy.

The investigation by the public health protection unit of NHS Greater Glasgow and Clyde (NHSGGC) found that all those struck down had the starter of “prosciutto ham, mozzarella, and home-made pesto dressing”.

Two people were admitted to hospital following the outbreak but all the victims made a full recovery.

It is believed they were all at the ground for either the Celtic v Motherwell game on Sunday 21st September, or the Celtic v Hearts game three days later.

Investigators carried out an assessment of the food-making process for each component of the starter, even down to the draining of the mozzarella balls.

But it was impossible to test the actual ingredients used in the starters because they had all either been eaten or thrown away.

32 sickened with Campy: Wisconsin raw milk farm penalized in Durand High School case

This is why I pay attention when food is served at the kid’s school.

And I’ve already pissed off a bunch of parents because of my food-safety based draconian and silly requirements for canning and cooking.

doug.braun.sorenne.capitalsThe owners of a Wisconsin dairy farm, who supplied unpasteurized milk to the Durand High School football team this fall causing dozens of students and faculty to become violently ill from Campylobacter bacteria, have agreed to a set of penalties for their role in the outbreak.

The Wisconsin Department of Agriculture announced on Thursday that Roland and Diana Reed of Arkansaw have agreed to a plan that includes suspending the farm’s Grade A permit for 30 days.
The agency says if the farm violates any of the conditions of the agreement within three years, the Grade A permit will be suspended again for 150 days for the current violation and their Grade A permit will be revoked for no less than six months for the additional violation.

“After reviewing the circumstances described in the final DHS epidemiological and laboratory report, we have determined that the farm violated current statutes and rules by distributing unpasteurized milk in an unauthorized manner, so we are taking appropriate action,” said Dr. Steve Ingham, administrator of the Division of Food Safety for DATCP.

Hepatitis A vaccines work: Michigan, 2013

Hepatitis A virus (HAV) infections among persons with developmental disabilities living in institutions were common in the past, but with improvements in care and fewer persons institutionalized, the number of HAV infections has declined in these institutions. However, residents in institutions are still vulnerable if they have not been vaccinated.

hepatitis.AOn April 24, 2013, a resident of a group home (GH) for adults with disabilities in southeast Michigan (GH-A) was diagnosed with hepatitis A and died 2 days later of fulminant liver failure. Four weeks later, a second GH-A resident was diagnosed with hepatitis A. None of the GH-A residents or staff had been vaccinated against hepatitis A. Over the next 3 months, six more cases of hepatitis A were diagnosed in residents in four other Michigan GHs. Three local health departments were involved in case investigation and management, including administration of postexposure prophylaxis (PEP). Serum specimens from seven cases were found to have an identical strain of HAV genotype 1A.

This report describes the outbreak investigation, the challenges of timely delivery of PEP for hepatitis A, and the need for preexposure vaccination against hepatitis A for adults living or working in GHs for the disabled.

CDC MMWR 64(06);148-152

Susan R. Bohm, Keira Wickliffe Berger, Pamela B. Hackert, Richard Renas, Suzanne Brunette, Nicole Parker, Carolyn Padro, Anne Hocking, Mary Hedemark, Renai Edwards, Russell L. Bush, Yury Khudyakov, Noele P. Nelson, Eyasu H. Teshale

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6406a4.htm?s_cid=mm6406a4_x

Vaccines work: So says Kristen Bell (and Israel)

Data on long-term impact of universal national vaccination programmes against hepatitis A are lacking. We aimed at evaluating the impact on hepatitis A incidence of the Israeli toddlers-only universal routine two-dose vaccination programme against hepatitis A initiated in 1999.

kristen-bell1All hepatitis A episodes reported to the national surveillance system from 1993 to 2012 were analysed in relation to the vaccination programme and coverage. Mean vaccine coverage in Israel between 2003 and 2010 was 92% for the first dose, given at 18 months of age, and 88% for the second dose, given at 24 months.

The annual hepatitis A incidence declined from a mean of 50.4 per 100,000 in the period between 1993 and 1998 to a mean of <1.0, during the period from 2008 to 2012, representing a reduction of >98%. The decline was evident in all ages and ethnicity groups, including unvaccinated populations.

Of the 1,247 cases reported nationwide between 2002 and 2012, the vaccination status could be ascertained in 1,108 (89%). Among them, only 20 (2%) were reported be vaccinated with one dose and three (<1%) received two doses.

The sustained results of this long-term impact study suggest that a toddlers-only universal routine two-dose vaccination programme is highly effective and practical. These findings underscore the importance of sustainability in both the surveillance systems and vaccination programmes and will aid to determine vaccination policies.

The impact of a national routine immunisation programme initiated in 1999 on Hepatitis A incidence in Israel, 1993 to 2012

Euro Surveill. 2015;20(7)

Levine H, Kopel E, Anis E, Givon-Lavi N, Dagan R.

http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=21040

http://www.today.com/parents/kristen-bell-get-vaccinated-whooping-cough-if-you-want-hold-2D80499716

And Penn and Teller (NSFV).

We’re all hosts on a viral planet: E. coli O157 edition

A novel phage, Φ241, specific for Escherichia coli O157:H7 was isolated from an industrial cucumber fermentation where both acidity (pH ≤ 3.7) and salinity (≥5% NaCl) were high.

phageThe phage belongs to the Myoviridae family. Its latent period was 15 min and average burst size was 53 phage particles per infected cell. The phage was able to lyse 48 E. coli O157:H7 strains, but none of the 18 non-O157 strains (including E. coli O104:H7) or the 2 O antigen-negative mutants of O157:H7 strain, 43895Δper (also lacking H7 antigen) and F12 (still expressing H7 antigen). However, the phage was able to lyse a per-complemented strain (43895ΔperComp) which expresses O157 antigen.

These results indicated that phage Φ241 is specific for O157 antigen, and E. coli strains lacking O157 antigen were resistant to the phage infection, regardless of the presence or absence of H7 antigen. SDS-PAGE profile revealed at least 13 structural proteins of the phage.

The phage DNA was resistant to many commonly used restriction endonucleases, suggesting the presence of modified nucleotides in the phage genome. At the multiplicity of infection of 10, 3, or 0.3, the phage caused a rapid cell lysis within 1 or 2 h, resulting in 3.5- or 4.5-log-unit reduction in cell concentration. The high lytic activity, specificity and tolerance to low pH and high salinity make phage Φ241 a potentially ideal biocontrol agent of E. coli O157:H7 in various foods. To our knowledge, this is the first report on E. coli O157:H7 phage isolated from high acidity and salinity environment.

 Escherichia coli O157:H7 bacteriophage Φ241 isolated from an industrial cucumber fermentation at high acidity and salinity

Frontiers in Microbiology, 17 February 2015 [ahead of print]

Zhongjing Lu and Fred Breidt

http://journal.frontiersin.org/article/10.3389/fmicb.2015.00067/abstract

Oliver Sacks on learning he has terminal cancer: How We Die and A Gentle Death

Oliver Sacks, a professor of neurology at the New York University School of Medicine, the author of many books, including “Awakenings” and “The Man Who Mistook His Wife for a Hat,” has revealed he is dying, via the N.Y. Times.

oliver.sacks“My luck has run out,” is how Sacks, 81, announced to the world Thursday that he has terminal cancer.

The neurologist and author — his autobiography comes out this spring, and he has “several other books nearly finished — revealed his condition in an op-ed in Thursday’s New York Times that was soon being widely shared, and admired, online.

Here are five of the most frequently quoted words of wisdom from the column:

  1. Self-assessment: “I cannot say (nor would anyone who knows me say) that I am a man of mild dispositions. I am a man of vehement disposition, with violent enthusiasms, and extreme immoderation in all my passions.”
  2. Detachment: “I still care deeply about the Middle East, about global warming, about growing inequality, but these are no longer my business; they belong to the future.”
  3. Gratitude: “I have loved and been loved; I have been given much and I have given something in return.”
  4. Focus: “There is no time for anything inessential.”
  5. Inimitability: “When people die, they cannot be replaced. They leave holes that cannot be filled, for it is the fate — the genetic and neural fate — of every human being to be a unique individual, to find his own path, to live his own life, to die his own death.”

This is what I wrote in Toronto’s Globe and Mail book review section in 1994, about my grandmother, who ended her own life in 1983.

After five years of painstaking care for her husband, who was slowly deteriorating from the cerebral ravages of Alzheimer’s disease, she decided that a sixth was not worth facing.

Her death was quick and without warning. One moment we were saying goodbye before a routine trip to the store, the next I was transferring her from car to wheelchair at the hospital emergency ward. Within 30 minutes she was officially deceased, the result of a major pharmaceutical overdose.

Looking back, I’ve often wondered what I would say to her, given the chance. Don’t do it, life is really okay. You are not alone. Things will get better.

But in reality, life is often harsh, she was often alone, and the prospects of yet another winter, trekking to the hospital each day to watch the person she had spent the vast majority of her life with become even more unfamiliar, meant that things certainly were not about to get better; at least not in any foreseeable future.

Humans have created powerful myths and rituals to accompany death, writes Sherwin Nuland in How We Die, but perhaps none more bizarre than the modern hospital, “where it can be hidden, cleansed of its organic blight, and finally packaged for modern burial. We can now deny the power not only of death but of nature itself. We hide our faces from its face, but still we spread our fingers just a bit, because there is something in us that cannot resist a peek.”

Dr. Nuland, a physician who has authored several books about the medical profession and continues to teach surgery and the history of medicine at Yale University, says this book was written to demythologize the process of dying, to present it in its biological and clinical realities. The changes at a cellular and organ-level that accompany heart attacks, stroke and cancer are presented in detail that may be intimidating to the uninitiated. Then again, any person who is faced with life-threatening disease can quite rapidly assimilate the medical jargon — they have to. Physicians capable of talking in clear, simple language are rare.

Marilynne Seguin’s A Gentle Death is an attempt to help ease that journey for patients and their families. Sequin, a registered nurse for over 30 years as well as a founding member and executive director of the Toronto-based Dying With Dignity tells how she, like Nuland, was trained to prolong life at all costs. Experience has taught her to question prevailing attitudes of the medical establishment and she stresses that patients must become informed and responsible for the medical decisions that affects their lives.

In presenting the many examples of people approaching death who Sequin has cared for, a common theme emerges. Rather than a passive silence, many approaching death wish to be at home, surrounded by the noise of children — the noise of life — rather than the sobering silence of loneliness.

Both books try to dispel the hero myth, the one where the nurse or physician is never to allow the patient to lose hope. Yet hope and wishing for miracles get in the way of true discussion; it robs people of their death.

Nuland writes we are currently in the vitamin era, following previous attempts to prolong life through the pseudoscience of monkey glands, mother’s milk, and, as King David tried, sleeping between two virgins. Coming soon will be expanded attempts to prolong life through the mass availability of human growth hormone, derived by genetic engineering, and gene therapy. Only “accurate knowledge of how a disease kills,” writes Nuland, “serves to free us from unnecessary terrors of what we might be fated to endure when we die. We may thus be better prepared to recognize the stations at which it is appropriate to ask for relief, or perhaps to begin contemplating whether to end the journey altogether.”

Which leads to the hotly debated topic of physician-assisted suicide and the right of rational individuals to decide how and when to end their lives. At this point the two books differ strongly. Nuland approves of Living Wills and other advanced care directives, instructing physicians what treatments to withhold in the face of terminal illness, but he strongly disapproves of physician-assisted suicide. Seguin, whoever, sees no distinction. Much of her book is devoted to a frank discussion of the practical advantages and limitations of such approaches.

Nuland, however, fails to come clean on the topic, when he mentions in passing that, “Like so many of my colleagues, I have more than once broken the law to ease a patient’s going, because my promise, spoken or implied, could not be kept unless I did so.” Seguin states quite clearly that many physicians have engaged in such activity, so why not create clear, legally-binding rules, as has been done in the Netherlands.

One Dutch physician who supports the new law says society needs a counterweight for the enormous technology of modern medicine. But more importantly he says, it gives the patient a chance to take leave openly of his children, his grandchildren, and others.

That openness seems crucial to further public discussion of death and dying. I still wonder what I would say to someone who is about to leave this earth on their own accord. Both books provide unique and moving insight into such conversations. Perhaps I now know what I might have said to my grandmother.

Norovirus confirmed in PA university outbreak

There’s a lot of norovirus on campuses this time of year. A bunch of Virginia colleges dealt with the pathogen a couple of weeks ago, and it looks like N.C. State did too. According to mcall.com, the virus caused over 150 illnesses at East Stroudsburg University in Pennsylvania.

The vomiting, diarrhea and stomach pain that affected 154 students at East Stroudsburg University last week was the result of a highly contagious virus, the state Health Department said Thursday.

The Department of Health has determined that there is now enough accumulated evidence to say the recent ESU outbreak is due to norovirus,” department spokesman Wes Culp said.

The illnesses swept through the campus so fast that doctors and medical staffs could not identify its cause with certainty, though doctors did suspect norovirus. The outbreak affected 2.5 percent of ESU students.

Here are some campus-specific food safety infosheets. Click on the pics to download.

Lots of support for restaurant that had food handler with hepatitis A

n a truly Canadian move, more than 70 owners, management and staff from Sudbury bars and restaurants ate and drank at a Sudbury, Ontario (that’s in Canada) Casey’s in a show of solidarity. In early February over a thousand patrons might have been exposed to hepatitis A after a food handler was diagnosed with the virus. According to The Sudbury Star, even the local health unit, the folks who ran the hep A shot clinics, hosted a retirement party for over 40 folks at the restaurant.default-1

Last week, Peddler’s Pub invited fellow establishments to join them in a show of support for the Kingsway bar and grill, which suffered a publicity setback last month when an employee was diagnosed with hepatitis A and patrons were urged to get vaccines through the Sudbury and District Health Unit.

“It’s one of those unfortunate things that can happen to any restaurant,” said Peddler’s marketing manager Cliff Skelliter. “Casey’s is such an important part of our community. A lot of people have jobs there and the owners are amazing, just absolute sweethearts.”

Dave Temmerman, co-owner of Hard Rock, brought a contingent of 14 people affiliated with his Elm Street pub.

“In times like this it’s nice to know who your friends are and stick together,” said Temmerman.

The public should have no fear of dining at Casey’s, he said, as standards of hygiene at this restaurant are as strict as any he’s encountered.

“I’ve worked in a lot of places, and it’s one of the cleanest I’ve worked in,” he said. “What happened to them is just a bad deal. People in the industry know it can happen to anybody, and it’s not because their place is dirty.”

Casey’s owner Marty Wills said the endorsement of counterparts means a lot.

“It’s wonderful what all the other restaurants have done,” he said. “They’ve been getting together and showing a little love, a little support for us, because they understand we didn’t do anything wrong.”

The hepatitis A that was detected in a Casey’s employee “was never created here,” said Wills. “She just happened to work here.”

Having a clean restaurant (whatever that means) doesn’t really matter; in this situation, risk is influenced by the food handler’s handwashing behavior. US FDA risk factor studies have shown that handwashing compliance in food service isn’t great. Requiring your staff to have hep A vaccinations would avoid stuff like this.