Yearly Archives: 2015

There’s a lot of norovirus in Nevada schools

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The famed winter vomiting virus appears to be making life miserable for Nevada school kids. According to the Reno Gazette Journal over 1700 students in 20 schools have had the virus over the past 5 weeks and the outbreak appears to be spreading.

The case count might be real or it might be inflated due to self reporting (kids who want to stay home) or protective parents who don’t want noro in their house (keeping their kids home).

An outbreak of norovirus has reached such heights in local public schools that health officials stopped counting the number of people infected by the highly contagious illness, which causes days of diarrhea and vomiting.200187143-001

But the Washoe County Health District estimates – based on schools’ absenteeism and reported illnesses – that 1,760 students and staff have been afflicted at 20 schools and a few daycare centers, quadrupling the number of infections since the outbreak started at half as many schools on Oct. 1.

“We were hopeful it wouldn’t get to this point,” said county Director of Epidemiology Randall Todd, noting the virus’ rapid spread to a new school every few days.

The health district has advised the Washoe County School District and families to do three things at outbreak schools, which are concentrated in northern Reno, Spanish Springs and Sparks. The health district isn’t identifying the affected daycare centers.

Disinfect high-traffic areas of the school where surfaces are repeatedly touched, such as railings, desks, chairs and doors. Thoroughly clean and disinfect the area around a vomiting incident up to a 25-foot radius.

Wash hands frequently with soap and water — antibacterial hand-sanitizer does not kill the virus.

Sick students and staff must stay out of school for 72 hours after their last symptoms.

Such a “substantial outbreak” wouldn’t be possible if parents and staff were following all three protocols advised for outbreak schools, said Todd, positing that at least one recommendation isn’t being followed.

The health district hasn’t recommended closing any schools, and school officials said they don’t want to go there either for the sake of academics.

But they’re in luck. The week-long fall break starts Monday.

“We’re keeping our fingers crossed that fall break will give us the boost we need to put this behind us,” said Todd.

Bacteriophage treatment decontaminates infant formula

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A phage showed strong antimicrobial activity against a type of foodborne bacterium that often kills infants after infecting them via infant formula. The research was published Oct. 23 online in Applied and Environmental Microbiology, a journal of the American Society for Microbiology.

750px-PhageExterior.svgIn the study, the phage, called “CR5,” showed high antimicrobial activity against the bacterium, Cronobacter sakazakii, as well as against several other species of Cronobacter, which can also cause dangerous illness, says coauthor Sangryeol Ryu, professor in the Department of Agricultural Biotechnology at the Research Institute of Agriculture and Life Sciences based at Seoul National University in Korea.

The research was conducted using infant formula that had been contaminated with C. sakazakii. “Interestingly, CR5 killed C. sakazakii quickly, and no C. sakazakii was detected in the infant formula after 10 hours had passed,” said Ryu.

Ryu said that the phage is safe for humans, noting that his analysis of its genome revealed neither toxin gene nor virulence factor. In 2006, the US Food and Drug Administration approved the use of bacteriophages as biocontrol agents in foods. But the agency does not allow the use of antibiotics in infant formula.

Bacteriophages are abundant in the environment, which means they are ecologically friendly, said Ryu. “They infect and kill only bacteria, which means they could be used as novel biocontrol agents and even as natural food preservatives,” he added, noting that other food-borne pathogens could also be controlled, by other types of phages.

Cronobacter, the target bacterial genus of the phage, CR5, is a family of closely related species that cause illness in people of all ages. While infection is rare in the US, these bacteria kill up to 40 percent of infected infants. Additionally, those that survive can face long-term neurological problems, according to the Centers for Disease Control and Prevention.

“Heretofore, C. sakazakii-contaminated infant formula has been considered an unsolved problem because antibiotics cannot be used,” said Ryu, adding that C. sakazakii has been known to have multiple antibiotic resistance genes. “In this study, we proved that C. sakazakii-phage CR5 is an efficient biocontrol agent in infant formula. Therefore, this bacteriophage treatment is a promising approach to solve this problem.”

Don’t poop in pools: when it happens, take action

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The incidence of recreational water-associated outbreaks in the United States has significantly increased, driven, at least in part, by outbreaks both caused by Cryptosporidium and associated with treated recreational water venues.

diaper.poolBecause of the parasite’s extreme chlorine tolerance, transmission can occur even in well-maintained treated recreational water venues (e.g. pools) and a focal cryptosporidiosis outbreak can evolve into a community-wide outbreak associated with multiple recreational water venues and settings (e.g. childcare facilities).

In August 2004 in Auglaize County, Ohio, multiple cryptosporidiosis cases were identified and anecdotally linked to pool A. Within 5 days of the first case being reported, pool A was hyperchlorinated to achieve 99·9% Cryptosporidium inactivition. A case-control study was launched to epidemiologically ascertain the outbreak source 11 days later. A total of 150 confirmed and probable cases were identified; the temporal distribution of illness onset was peaked, indicating a point-source exposure. Cryptosporidiosis was significantly associated with swimming in pool A (matched odds ratio 121·7, 95% confidence interval 27·4–∞) but not with another venue or setting.

The findings of this investigation suggest that proactive implementation of control measures, when increased Cryptosporidium transmission is detected but before an outbreak source is epidemiologically ascertained, might prevent a focal cryptosporidiosis outbreak from evolving into a community-wide outbreak.

Preventing community-wide transmission of Cryptosporidium: a proactive public health response to a swimming pool-associated outbreak – Auglaize County, Ohio, USA

Epidemiology and Infection / Volume 143 / Issue 16 / December 2015, pp 3459-3467

http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=10012375&utm_source=Issue_Alert&utm_medium=RSS&utm_campaign=HYG

 

New Mexico restaurant types on board with new food safety regulations

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There are proposed changes coming down the line for New Mexico restaurants, regulations that impact how food is heated and training requirements for restaurant employees.

In a post on its website, the New Mexico Restaurant Association outlined some of the proposed changes by the New Mexico Environment Department.

For example, each restaurant must have a Certified Food Protection Manager (CFPM), a food safety certification achieved through taking courses and passing an exam.

Also new is that restaurant employees working directly with food, such as those that deal with unpackaged foods and food equipment, must take a basic food safety course. The course will cover such topics as preventing cross-contamination in food and how to property clean and sanitize.

After the course is completed, the person will get his or her Food Handlers Card, which would be required after 30 days of working in a restaurant. The cost to the employee will be between $15 and $35.

Malaysian health types launch crackdown on dirty eateries

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The Federal Territories health department has launched a crackdown on eateries, stalls and restaurants to curb the spread of typhoid in the city.

malaysia.hawkerDepartment director Datuk Dr Narimah Nor Yahya said Ops Premis Makanan was launched as part of efforts to address the disease.

“To date, our task force has inspected 160 premises in Kuala Lumpur and 10 were shut down for failing inspection guidelines as outlined by the Food Act 1983 and Food Act 2009,” she said.

Speaking during a surprise inspection of a popular hawker centre in Kampung Baru, Dr Narimah appealed to the public to be mindful of where they eat.

Workers at the hawker centre were seen scrambling to clear mounds of dirty dishes and hurriedly washing the floor of their kitchen areas.

Two stalls were served with closure notices for failing to meet spection standards.

Blood samples and contact details of all foreign workers employed at the centre were also collected.

She said it was unacceptable for ice cubes to be stored in dirty open containers and for workers to use their bare hands to handle ice.

“Look at the flies buzzing around the raw meat. This place is definitely getting closed,” she said of one eatery, adding that if any workers were not vaccinated for typhoid, charges would be brought against the employer.

“It is mandatory for restaurant or hawker centre operators to have all their workers vaccinated,” she said.

 

Cow poop: Use fencing, buffer zones wisely

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 Fencing or buffer strips to keep cattle out of streams shouldn’t be a first move, University of California-Davis rangeland watershed specialist Kenneth Tate said during a livestock water quality seminar Oct. 22 in Fairfield, Wash.

cow.poop2Best management practices include maintaining healthy cattle or placing salt away from streams to avoid contamination, he said.

“The absolute last place I would recommend a start is to consider fencing off creeks, because first and foremost, we don’t know that it’s required,” he said. “Start with the cheap stuff, the easy stuff, and build your way into it, just as you would with any business going into a new venture.”

Best management practices need to make economic sense to ranchers, Tate said.

“There’s a lot of things to think about before you start erecting hundreds of miles of fence,” he said.

More than 90 percent of microbes in a pile of manure, or range cow fecal pat, never leave, Tate said. Depending on temperature or environmental conditions, they die very quickly. It removes a lot of the potential microbial pollutants, he said.

Most microbes are trapped roughly a yard around the pat. Microbes reduce by 70 to 90 percent for every additional yard they travel, such as in runoff during a storm.

The first step is deciding whether a buffer zone is needed, and how efficiently a location traps pollutants, Tate said.

“It really comes down to site-specific conditions and the magnitude of the risk,” he said. “It’s not a one-size-all answer. Anybody who tells you (it) is is oversimplifying our extremely complex world.”

 

The kids are not alright: STEC in England

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Between 1 January 2009 and 31 December 2012 in England, a total of 3717 cases were reported with evidence of Shiga toxin-producing E. coli (STEC) infection, and the crude incidence of STEC infection was 1·80/100 000 person-years.

kids.are.alrightIncidence was highest in children aged 1–4 years (7·63/100 000 person-years). Females had a higher incidence of STEC than males [rate ratio (RR) 1·24, P < 0·001], and white ethnic groups had a higher incidence than non-white ethnic groups (RR 1·43, P < 0·001). Progression to haemolytic uraemic syndrome (HUS) was more frequent in females and children. Non-O157 STEC strains were associated with higher hospitalization and HUS rates than O157 STEC strains.

In STEC O157 cases, phage type (PT) 21/28, predominantly indigenously acquired, was also associated with more severe disease than other PTs, as were strains encoding stx2 genes.

Incidence of STEC was over four times higher in people residing in rural areas than urban areas (RR 4·39, P < 0·001). Exposure to livestock and/or their faeces was reported twice as often in cases living in rural areas than urban areas (P < 0·001). Environmental/animal contact remains an important risk factor for STEC transmission and is a significant driver in the burden of sporadic STEC infection.

The most commonly detected STEC serogroup in England was O157. However, a bias in testing methods results in an unquantifiable under-ascertainment of non-O157 STEC infections. Implementation of PCR-based diagnostic methods designed to detect all STEC, to address this diagnostic deficit, is therefore important.

 The epidemiology, microbiology and clinical impact of Shiga toxin-producing Escherichia coli in England, 2009–2012

Epidemiology and Infection / Volume 143 / Issue 16 / December 2015, pp 3475-3487

http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=10012382&utm_source=Issue_Alert&utm_medium=RSS&utm_campaign=HYG

Spit season: South Australians warned of Salmonella risk linked to meats cooked on spits

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South Australians are being warned to take care when using home rotisseries or spits after they were linked to more than 20 people falling ill last financial year.

lamb-on-spitHealth Minister Jack Snelling said SA Health investigations identified home cooked pig and lamb on the spit as the main causes of salmonella outbreaks at two separate home gatherings in 2014-15.

“The use of home rotisseries and spits is becoming increasingly common across the state as a fun way to feed large groups, especially with the weather warming up and people wanting to cook outside,” Mr Snelling said.

“Proper storage, including hygiene and refrigeration are vital so that dangerous bacteria do not get the chance to multiply before the cooking process takes place.

“If you don’t have an appropriate place to safely store a whole animal we advise that you pick the raw meat up from the butcher or supermarket as close to preparation time as possible.”

SA Health director Dr Fay Jenkins said ensuring the meat had been fully cooked through was essential in preventing salmonella.

She said the best way to ensure meat was cooked through was to place a thermometer into the thickest part of the meat to measure the temperature.

“Meat, particularly poultry, needs to reach a temperature of 75 degrees Celsius to be completely safe,” she said.

Germans who wrongly fingered Spanish cucumbers ordered to pay

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Many regulators see going public with information related to an outbreak as a no-win situation. As Paul Mead once said – ‘If you’re wrong, you went public too early; if you’re right, you went [public] too late.’

Best to err on the side of public health – and tell folks about the uncertainties in your data and decision-making.spain_ag_minister_cuc_may_11(2)

In 2011, at the height of an E. coli O104 outbreak which led to 4,075 illnesses (including 908 cases of HUS) and 50 deaths in 16 countries, epidemiological information was evolving. During the investigation, German authorities, based on a sample taken out of a trash bin, fingered Spanish cucumbers as the source. It turned out to be fenugreek sprouts.

According to ThinkSpain, a Spanish cucumber firm is being compensated for being wrongfully implicated.

A German court has upheld a Málaga-based vegetable cooperative’s claim for compensation after the E.coli scare was incorrectly linked to Spanish cucumbers.

Sales director for Frunet, Richard Söpenberg, says that although the co-op had sued for €2.3 million, the case was more about clearing its name than earning back the money it had lost through the unfair finger-pointing at its produce.

“The judge in Hamburg has recognised that we did nothing wrong, and we are very proud and happy about that – above and beyond the compensation awarded, what’s most important is the restitution of the company’s good name,” Söpenberg revealed.

The cooperative’s sales manager says he ‘trusts the case will serve as a learning curve’, since it highlights the extent of harm an ‘unfounded accusation’ can cause any firm.

cucumber.spainMEP-300x188“Pointing the finger at a company can destroy it completely in seconds, and this is something that could happen to any firm in the world,” Söpenberg warned.

Missing from the mis-fingered cucumber story is the food safety steps that Spanish growers/shippers/distributors take to ensure microbial food safety. An outbreak like this was an opportunity to brag – if procedures are in place and there’s data to back it up. Too bad it had to come out in court proceedings over four years later.

Norovirus hospitalizes thousands of Canadians annually

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Most people get over a bout of norovirus relatively quickly and without a visit to a health care provider. In extreme cases, a couple of days worth of vomit and painful stomach cramps can send folks to the hospital, especially if they become severely dehydrated.

Our hoser colleagues have estimated that between 4000 and 11,000 people are hospitalized as a result of Norovirus annually in Canada, resulting in a cost burden of over $21 million CAD (or about 5 million Timbits).images

Estimated hospitalizations attributed to norovirus and rotavirus infection in Canada, 2006–2010
V.K. Morton, M.K. Thomas and S. A McEwen
Epidemiology and Infection / Volume 143 / Issue 16 / December 2015, pp 3528-3537

Enteric viruses including norovirus and rotavirus are leading causes of gastroenteritis in Canada. However, only a small number of clinical cases are actually tested for these pathogens leading to systematic underestimation of attributed hospitalizations in administrative databases. The objective of this analysis was to estimate the number of hospitalizations due to norovirus and rotavirus in Canada. Hospitalization records for acute gastroenteritis-associated discharges at all acute-care hospitals in Canada between 2006 and 2011 were analysed. Cause-unspecified gastroenteritis hospitalizations were modelled using age-specific negative binomial models with cause-specified gastroenteritis admissions as predictors. The coefficients from the models were used to estimate the number of norovirus and rotavirus admissions. The total annual hospitalizations for rotavirus were estimated to be between 4500 and 10 000. Total annual hospitalizations for norovirus were estimated to be between 4000 and 11 000. The mean total annual cost associated with these hospitalizations was estimated to be at least $16 million for rotavirus and $21 million for norovirus (all figures in Canadian dollars). This study is the first comprehensive analysis of norovirus and rotavirus hospitalizations in Canada. These estimates provide a more complete assessment of the burden and economic costs of these pathogens to the Canadian healthcare system.