A former professor of food safety and the publisher of barfblog.com, Powell is passionate about food, has five daughters, and is an OK goaltender in pickup hockey. Download Doug’s CV here.
Dr. Douglas Powell
editor, barfblog.com
retired professor, food safety
3/289 Annerley Rd
Annerley, Queensland
4103
dpowell29@gmail.com
61478222221
I am based in Brisbane, Australia, 15 hours ahead of Eastern Standard Time
Emergency units on the island received several patients reporting food poisoning symptoms after eating at the restaurant, which as then identified as the source of the illness.
The Balearic Islands’ public health department says the number of cases could rise even higher because some are not reported immediately when initial symptoms are less severe.
Proceedings against the restaurant have been opened by local government bodies.
Thousands of British holidaymakers visit Majorca each year with many heading to resorts like Magaluf and Palma Nova that are just a short bus or taxi ride from the capital.
I love my shellfish – mussels and scallops (oysters are sorta gross) – but the kid was diagnosed with a shellfish allergy so they’re an occasional lunch while she’s at school.
Health types in the UK report on six cases of diarrhetic shellfish poisoning (DSP) following consumption of mussels in the United Kingdom (UK). The mussels contained high levels of heat-stable okadaic acid (OA)-group toxins. Here we describe the environmental and epidemiological investigation carried out in response to the outbreak.
In June 2019 (day 0), Public Health England South West was notified by the local authority of three diners who were unwell following consumption of mussels in a restaurant 5 days earlier. The local authority had determined that the restaurant had had received a batch recall notice, also 5 days earlier, from the shellfish producer for the mussels because of elevated toxin levels but this was not seen before the mussels were served that day. On day 1, PHE South West received a report from the county neighbouring the first of gastrointestinal illness linked to mussels from the same producer. A multi-agency outbreak control team was therefore convened on day 2 and led by the PHE South West health protection team.
An alert was sent to all health protection teams across England on day 2 asking about any reported cases of gastrointestinal illness following consumption of mussels. Local authorities in areas of product distribution were informed of the identified risk by email. Persons reporting illness who were identified by local authorities as having consumed the affected mussels were asked by PHE to complete a bespoke questionnaire on exposure and clinical data.
A probable case of DSP was defined as an individual with diarrhoea, three or more loose stools in 24 h, or vomiting or abdominal cramps or nausea, with date of onset from 7 days before to 1 day after notification of the outbreak, and time of onset 30 min to 24 h following consumption of mussels harvested from the affected site. Confirmed cases were as probable, but with an absence of pathogens in a stool sample that would otherwise explain illness.
Thirteen individuals reported to have been unwell after consumption of mussels were contacted. Completed questionnaires were received from seven individuals, of which three were confirmed, and three probable cases. The cases ate at four separate venues. One respondent did not meet the case definition as symptom onset was more than 24 h following consumption.
The mean age of cases was 59 years (range: 37–76 years); three were male and three were female. All cases reported eating steamed mussels. Five cases ate mussels as a main course and one as a starter. Reported portion sizes ranged from 11 to 50 mussels.
The mussels were produced in an offshore marine area. A routine shellfish monitoring programme is in place throughout England and Wales, including at the affected site. As a part of this programme, the water column is sampled every 2 weeks from April to September and cell counts of potentially harmful algal species are measured. Shellfish flesh samples are also tested for the presence of selected European Union (EU)-regulated biotoxins every 4 weeks during April to September each year unless phytoplankton counts and/or shellfish toxins are quantified above specified warning limits that require further precautions, including re-testing and closure.
Lipophilic toxin determination, including that for OA-group toxins, is routinely carried out using the method specified in in the EU-Harmonised Standard Operating Procedure for determination of lipophilic marine biotoxins in molluscs by LC-MS/MS [1]. Additional flesh and water samples were taken in advance of the planned sampling date following a report to the local authority from a local fisherman of a red-coloured algal bloom six miles offshore from the production site.
The local authority determined the source of the mussels by questioning venues linked to reports of illness. Subsequently, the shellfish producer provided the outbreak control team with a complete list of all businesses who had received the affected mussels. Mussels from the site were harvested daily from 9 to 5 days before notification of the outbreak for commercial sale. The mussels were not tested by the producer for the presence of toxins. A large volume of mussels was distributed to seafood wholesalers, restaurants and pubs, and subject to the recall notice distributed by the producer 5 days before reports of illness to PHE. A limited number of businesses not linked to any known cases, including wholesalers, retailers, restaurants and pubs, responded to the recall stating they had sold some of the affected produce. No produce was found to still be in circulation at the time of the outbreak response.
Water column and shellfish flesh sampling results are summarised in Table 2. Measured densities of Dinophysis spp. in the water column increased rapidly from being undetectable 16 days before outbreak notification to 1,600 cells per litre 7 days before, coinciding with the time of harvesting of the affected batch and exceeding the England, Wales and Northern Ireland Food Standards Agency trigger level of 100 cells per litre. The level of total OA-group lipophilic toxins in mussel flesh was 338 µg OA equivalents (eq) per kg, following application of measurement uncertainty, 7 days before outbreak notification. This exceeded the maximum permitted limit (MPL) of 160 µg OA eq per kg defined by European Commission (EC) regulation 853/2004 [2]. Toxin concentrations quantified showed that an average of 94% of the OA-group toxins present in the mussels consisted of OA itself, with the remainder being dinophysistoxin 2 (DTX2).
Water column sampling 7 days before outbreak notification did not detect other harmful algal species apart from Pseudo-nitzschia spp., the causative diatom for domoic acid responsible for amnesic shellfish poisoning, at 1,320 cells per litre. This is below the trigger level of 150,000 cells per litre for this species.
Routine shellfish sampling at the same site during the same time period did not detect paralytic shellfish poisoning toxins. Trace levels of yessotoxins were detected, but along with traces of azaspiracids, they were well below regulatory levels. Amnesic shellfish poisoning toxins were below the limit of quantitation (LOQ).
In response to the elevated toxin levels quantified and reported 5 days before outbreak notification, the shellfish bed was immediately closed for harvesting as per standard practice in England. The Food Standards Agency urgently contacted local authorities of places where the affected product had been distributed to ensure that wholesalers and venues had acted upon the recall. Venues were asked whether any product had been frozen, for example in the form of stock, as this would not deactivate the toxin, but there was no evidence this had been done.
Discussion
We report on six cases of DSP associated with consumption of mussels harvested in the South West of England. Without an available validated test for relevant toxins in human samples, the diagnosis was made based on characteristic clinical symptoms, including diarrhoea, abdominal pain, nausea and fever/chills, elevated levels of OA-group toxins in the flesh of mussels from the same batch as those consumed, the absence of faecal pathogens in stool of cases and epidemiological evidence of exposure to the produce.
DSP occurs following consumption of seafood containing high levels of the heat-stable OA-group toxins produced by dinoflagellates including Dinophysis spp., and is characterised by a rapid-onset of self-limiting gastrointestinal illness [3,4]. Recognised outbreaks of DSP are rare. Seventy cases were identified in 2013 following consumption of mussels harvested around the Shetland Islands [5] and 49 cases were identified in 1998 following consumption of UK-harvested mussels in London [6]. Outbreaks have been recorded in recent years in China, the United States, France and Canada [4,7–9].
The lowest-observed-adverse-effect level of OA is 45 to 50 µg OA eq per person [4,10]. In our study, an average main course portion of mussels (500 g in shell) would provide 41 µg OA eq., using a flesh weight yield of 24% [11]. This level of exposure is consistent with DSP as the cause of illness considering variability in portion sizes, flesh yield, body weight and toxin levels at the production site. Individual mussel sizes served were unavailable but would likely vary. Therefore, overall estimated portion weight was used to calculate the exposure dose. A limitation is that body weight (bw) was not recorded for cases and because of this, OA eq per kg bw could not be calculated.
A shellfish biotoxin programme monitoring the occurrence of harmful algal blooms and toxins in classified shellfish production areas in the UK, alongside food business operator checks, remains a robust system to protect population health. Nonetheless, a rapid increase in concentrations of Dinophysis spp. cells within the waters of the production site may have contributed to the outbreak, in tandem with shellfish harvesting occurring before official control results were reported and site closure. Whyte et al. (2014) demonstrated that a similar rapid increase in Dinophysis levels, resulting from a change in prevailing wind direction, occurred in the 2013 Shetland Islands origin outbreak [5]. Transdisciplinary research is required to predict future risk and inform monitoring, particularly given likely changes in the distribution of potentially-toxic species particularly if temperature of ocean water increases [12]. Our investigation suggested that affected produce may have been sold by restaurants and pubs with no known linked cases. Given that DSP is a self-limiting illness that may be under-reported by cases and has low awareness among clinicians, the actual number of persons affected in this outbreak is likely to be higher [13].
This outbreak highlights that clinicians and public health professionals should be aware of algal-derived toxins as a potential cause of illness following seafood consumption, and that the need for effective end-product testing of shellfish to ensure food safety remains.
Outbreak of diarrhetic shellfish poisoning associated with consumption of mussels, United Kingdom, May to June 2019
How do that many people get exposed to a single raccoon?
Step 1: Take a wild raccoon and try to make it into a pet
Bad idea and illegal most places (including Ontario).
Step 2: Take it to a “Raccoon or kitten event” (whatever that is) where the public gets to play with it.
That’s it. But should be followed up by…
Step 3: Talk to your insurance company because tens (or hundreds) of thousands of dollars of treatment may be required.
Thirty-seven (37) people who visited the event had been contacted at last report, and 33 were considered potentially exposed to rabies through contact with this raccoon. Twenty-one (21) are undergoing post-exposure prophylaxisso far, and presumably (hopefully) the rest will be treated soon. That’s why standard guidelines say that rabies reservoir species like raccoons should never be used for public contact events. Wildlife should be left in the wild.
Mohamad Fadli Mohd Saleh, 38, an auxiliary police officer, died of sepsis and multi-organ failure a week after eating from a bento box prepared by Spize.
This was about five hours after the food had been prepared at Spize’s River Valley outlet between 9.30am and 10.30am.
A post-mortem initially stated the cause of Fadli’s death as cardiorespiratory failure.
A subsequent report found that Fadli had died of sepsis and multi-organ failure following acute gastroenteritis.
Seven separate suspected food-borne incidents were linked to Spize between Nov. 6 and 9.
Numbers
211 people consumed food from Spize.
73 people fell sick
47 people of them were hospitalised, including Fadli
36 tested positive for salmonella
The other 35 have recovered from salmonella.
The salmonella outbreak was described as “unusually severe”.
Salmonella is a “self-limiting disease”, with an incubation period of between 12 and 36 hours.
This Spize incident had an immediate incubation period that was much shorter, within just eight hours, and there was a high hospitalisation rate.
The possibility of there being a virulent strain of pathogens was ruled out after an investigation.
The severity of those affected was perhaps due to the increased bacteria loads of the contaminated food item.
Details of packed bento:
There were three types of rice placed in the bento boxes:
Indonesian rice, which included egg fried rice, prawn omelette mung beans and tofu;
Malaysian rice, which included kampung fried rice, chicken sambal and stir-fried morning glory; and
Chinese rice, which was egg fried rice with Chinese sausage, omelette, crispy fish and other ingredients.
State coroner Kamala Ponnampalam said in her case findings Aug 23/19, “The joint investigations by the agencies uncovered several alarming lapses in the food handling and food preparation methods which directly contributed to the outbreak of acute gastroenteritis,” said the coroner.
Strains of salmonella were found on the ready-to-eat bento sets at Spize’s River Valley Road outlet, where the food was prepared.
The bacteria was also found on raw food items and commonly touched surfaces such as a door handle leading to a cold room and the cold room rack at the restaurant.
“This was suggestive of cross-contamination with raw meat, borne by the food handlers,” said the coroner.
“There was also faecal matter detected in the ready-to-eat food (belacan egg fried rice) and on the kitchen tools like the chopping board and knife used in the chicken rice preparation which points to poor hygiene practices, either in the handling of unclean raw meat, or in poor personal hygiene.”
Seven of the 34 food handlers were not registered with NEA and had not attended the basic food hygiene course.
There was no soap provided at the restaurant’s basin, so it was likely that the food handlers did not wash their hands with soap before handling cooked ingredients, preparing meals, after handling raw ingredients, or after touching other parts of the kitchen.
This could have led to cross-contamination of salmonella bacteria between the raw ingredients and cooked food, the court heard.
Vibrio parahaemolyticus is a leading cause of seafood-borne gastroenteritis. Given its natural presence in brackish waters, there is a need to develop operational forecast models that can sufficiently predict the bacterium’s spatial and temporal variation.
This work attempted to develop V. parahaemolyticus prediction models using frequently measured time-indexed and -lagged water quality measures. Models were built using a large data set (n = 1,043) of surface water samples from 2007 to 2010 previously analyzed for V. parahaemolyticus in the Chesapeake Bay. Water quality variables were classified as time indexed, 1-month lag, and 2-month lag. Tobit regression models were used to account for V. parahaemolyticus measures below the limit of quantification and to simultaneously estimate the presence and abundance of the bacterium. Models were evaluated using cross-validation and metrics that quantify prediction bias and uncertainty.
Presence classification models containing only one type of water quality parameter (e.g., temperature) performed poorly, while models with additional water quality parameters (i.e., salinity, clarity, and dissolved oxygen) performed well. Lagged variable models performed similarly to time-indexed models, and lagged variables occasionally contained a predictive power that was independent of or superior to that of time-indexed variables. Abundance estimation models were less effective, primarily due to a restricted number of samples with abundances above the limit of quantification. These findings indicate that an operational in situ prediction model is attainable but will require a variety of water quality measurements and that lagged measurements will be particularly useful for forecasting.
Future work will expand variable selection for prediction models and extend the spatial-temporal extent of predictions by using geostatistical interpolation techniques.
IMPORTANCE Vibrio parahaemolyticus is one of the leading causes of seafood-borne illness in the United States and across the globe. Exposure often occurs from the consumption of raw shellfish. Despite public health concerns, there have been only sporadic efforts to develop environmental prediction and forecast models for the bacterium preharvest.
This analysis used commonly sampled water quality measurements of temperature, salinity, dissolved oxygen, and clarity to develop models for V. parahaemolyticus in surface water. Predictors also included measurements taken months before water was tested for the bacterium. Results revealed that the use of multiple water quality measurements is necessary for satisfactory prediction performance, challenging current efforts to manage the risk of infection based upon water temperature alone.
The results also highlight the potential advantage of including historical water quality measurements. This analysis shows promise and lays the groundwork for future operational prediction and forecast models.
Vibrio parahaemolyticus in the Chesapeake Bay: Operational in situ predition and forecast models can benefit from inclusion of lagged water quality measurements
Public and Environmental Health Microbiology
Benjamin J. K. Davis, John M. Jacobs, Benjamin Zaitchik, Angelo DePaola, Frank C. Curriero
A Chinese restaurant in Old Hickory was closed temporarily Tuesday by the Metro health Department after a video showed employees washing kitchen utensils in a nearby lake.
A video taken on Tuesday morning and posted to social media showed restaurant employees washing cooking utensils in Old Hickory Lake. The man who took the video, Lance Glover, said he recorded the incident around 7 a.m. Tuesday.
The video showed people cleaning what appears to be a fire grate in Old Hickory Lake. Glover’s video then shows the employees returning with the equipment to the restaurant.
The Metro Health Department shut down No. 1 Chinese Restaurant, located 1435 Robinson Rd., after inspectors visited the restaurant.
According to Victor Oguntimehin, the health inspector, the restaurant operators initially denied they washed items in the lake. The restaurant admitted to washing the utensils in the lake after Oguntimehin showed them Glover’s video.
Mary Capps, who fishes on Old Hickory Lake, told News 4 she has seen the employees cleaning “greasy grates” almost every morning.
Gastroenteritis caused from infections with Salmonella enterica (salmonellosis) causes significant morbidity in Australia. In addition to acute gastroenteritis, approximately 8.8% of people develop irritable bowel syndrome (IBS) and 8.5% of people develop reactive arthritis (ReA). We estimated the economic cost of salmonellosis and associated sequel illnesses in Australia in a typical year circa 2015.
We estimated incidence, hospitalizations, other health care usage, absenteeism, and premature mortality for four age groups using a variety of complementary data sets. We calculated direct costs (health care) and indirect costs (lost productivity and premature mortality) by using Monte Carlo simulation to estimate 90% credible intervals (CrI) around our point estimates.
We estimated that 90,833 cases, 4,312 hospitalizations, and 19 deaths occurred from salmonellosis in Australia circa 2015 at a direct cost of AUD 23.8 million (90% CrI, 19.3 to 28.9 million) and a total cost of AUD 124.4 million (90% CrI, 107.4 to 143.1 million). When IBS and ReA were included, the estimated direct cost was 35.7 million (90% CrI, 29.9 to 42.7 million) and the total cost was AUD 146.8 million (90% CrI, 127.8 to 167.9 million).
Foodborne infections were responsible for AUD 88.9 million (90% CrI, 63.9 to 112.4 million) from acute salmonellosis and AUD 104.8 million (90% CrI, 75.5 to 132.3 million) when IBS and ReA were included. Targeted interventions to prevent illness could considerably reduce costs and societal impact from Salmonella infections and sequel illnesses in Australia.
Cost of salmonella infections in Australia, 2015
September 2019
Journal of Food Protection vol. 82 no. 9
LAURA FORD,1 PHILIP HAYWOOD,2 MARTYN D. KIRK,1 EMILY LANCSAR,3 DEBORAH A. WILLIAMSON,4 and KATHRYN GLASS1*
Norman Sharpless and Frank Yiannas of the U.S. Food and Drug Administration write that fresh papayas are most often eaten raw, without cooking or processing to eliminate microbial hazards; and therefore, the way they are grown, harvested, packed, held, processed and distributed is crucial to minimizing the risk of contamination with human pathogens.
Since 2011, American consumers have been exposed to eight outbreaks caused by Salmonella serotypes linked to imported, fresh papaya. And, just this June we started an investigation into an outbreak of Salmonella Uganda illnesses tied to the consumption of whole, fresh papaya imported from Mexico. While the 2019 outbreak is ongoing, the first seven outbreaks accounted for almost 500 reported cases of illness, more than 100 hospitalizations, and two deaths.
This trend has to stop. The pattern of recurrent outbreaks we have observed since 2011, including the 2019 illnesses, have involved Salmonella infections traced back to, or are suspected of being associated with, papaya grown in Mexico. The recurring nature of these outbreaks is a clear indication that more must be done within all sectors of the papaya industry to protect its customers and to meet its legal obligations. This includes growers, importers and even retailers that can and must do more.
This is why today we have issued a letter calling on all sectors of the papaya industry to take actions to prevent these outbreaks in the future. We are urging growers, packers, shippers and retailers in the papaya industry to review their operations and make all necessary changes to strengthen public health safeguards.
Our letter calls on the papaya industry to assess the factors that make their crops vulnerable to contamination. If a foodborne pathogen is identified in the crop or growing environment, a root cause analysis should be performed to determine the likely source of contamination. Procedures and practices that minimize that contamination must be implemented.
We are strongly encouraging the papaya industry to examine the use and monitoring of water used to grow, spray (pesticides, fungicides), move, rinse or wax crops to identify and minimize risks from potential hazards. All sectors of the industry should adopt tools and practices needed to enhance traceability since papayas are a perishable commodity, to more rapidly facilitate the tracking of involved product to expedite its removal from commerce, prevent additional consumer exposures, and properly focus any recall actions.
And finally, they should fund and actively engage in food safety research to identify the potential sources and routes of contamination by microbial pathogens and develop data-driven and risk-based preventive controls.
In response to this most recent Salmonella Uganda outbreak, the FDA deployed an inspection team to the packing house and farm that was linked to the contaminated papayas via traceback and epidemiological evidence. The findings of those visits will be made public when their investigation is complete. We have also increased sampling and screening of papayas at the border. In addition, the FDA is actively collaborating with our counterparts in the Mexican government regarding this current outbreak through the agency’s Latin America Office to determine ways to further our collaborative prevention efforts.
The U.S. Federal Food, Drug, and Cosmetic Act prohibits food producers from introducing, or delivering for introduction, into interstate commerce adulterated foods (meaning foods that are potentially harmful to consumers). Additionally, there are new requirements under the FDA Food Safety Modernization Act (FSMA). The Produce Safety Rule under FSMA sets science- and risk-based minimum standards for domestic and foreign farms for the safe growing, harvesting, packing and holding of covered produce, which includes papayas. Another FSMA rule, the Foreign Supplier Verification Program (FSVP) makes importers responsible for verifying that the foods they bring into the U.S., including papayas, have been produced in a manner that meets applicable U.S. safety standards.
Tommy Tobin of Forbes reports Franklin County, Missouri, joins a handful of jurisdictions across the country with mandatory Hepatitis A vaccine programs aimed at preventing further cases. This development is part of a larger trend aimed at expanding vaccinations for Hepatitis A and addressing future outbreaks of the disease.
The CDC is investigating outbreaks of Hepatitis A across 29 states. According to the CDC, 233 individuals have died from Hepatitis A between 2016 and 2019 out of over 24,000 reported cases. Several states, including Kentucky, Florida, Ohio, and West Virginia, have seen thousands of cases.
In an effort to curb the increase in reported cases of Hepatitis A, many local jurisdictions are considering mandatory Hepatitis A vaccines for food service workers. For example, Missouri has reported 387 cases of Hepatitis A in the past two years. Over 50 of these cases are from Franklin County, which has a population of about 100,000 residents. Franklin County officials have imposed mandatory vaccinations for individuals who handle food. Food establishments, including restaurants, have 90 days to ensure their employees are vaccinated. Nearby St. Louis County, Missouri enacted a mandatory vaccine requirement nearly 20 years ago. Similar ordinances requiring vaccines for food service workers were enacted in Kentucky’s Ashland and Boyd Counties last year.
With the numerous cases across the country of Hepatitis A, the National Restaurant Association recently issued guidance to its member restaurants in an effort to reduce future cases. In this guidance, the Association recommended that restaurant managers and operators encourage employees to get vaccinated, educate restaurant staff about the virus, and monitor for any signs of the disease. (Note: The National Restaurant Association did not respond to requests for comment on this story). Separately, a CDC advisory panel recently recommended expanding the use of the Hepatitis A vaccine to all youth aged 2 to 18.
As of August 23 2019, there have been seven confirmed cases of Listeria monocytogenes illness in three Canadian provinces: British Columbia (1), Manitoba (1) and Ontario (5) linked to cooked Rosemount brand cooked diced chicken.
The Public Health Agency of Canada notes Rosemount cooked diced chicken was supplied to institutions (including cafeterias, hospitals and nursing homes) where many of the individuals who became sick resided, or visited, before becoming ill.
Individuals became sick between November 2017 and June 2019. Six individuals have been hospitalized. Individuals who became ill are between 51 and 97 years of age. The majority of cases (86%) are female.
The collaborative outbreak investigation was initiated because of an increase of Listeria illnesses that were reported in June 2019. Through the use of a laboratory method called whole genome sequencing, two Listeria illnesses from November 2017 were identified to have the same genetic strain as the illnesses that occurred between April and June 2019. It is possible that more recent illnesses may be reported in the outbreak because of the period of time it takes between when a person becomes ill and when the illness is reported to public health officials. In national Listeria monocytogenes outbreak investigations, the reporting time period is usually between four and six weeks.
The U.S. CDC is also investigating an outbreak of Listeria illnesses occurring in several states. The type of Listeria identified in the U.S. is closely related genetically (by whole genome sequencing) to the Listeria making people sick in Canada. Canada and U.S. public health and food safety partners are collaborating on these ongoing Listeria investigations.
CDC is not recommending that consumers avoid any particular food at this time. Restaurants and retailers are not advised to avoid serving or selling any particular food. We will update our advice if a source is identified.
Holidaymakers are among those affected by the outbreak of the deadly food poisoning on the holiday island.
