Danielle Ann of Alvinology reports researchers at the Singapore General Hospital have found definite similarities between the virus strains of Hepatitis E virus or (HEV) in pig liver and human liver.
This means that ingesting raw pork liver could mean you’re ingesting a strain of HEV that’s similar enough to human HEV that it could cause you get infected.
The same report said that people who have contracted HEV has risen steadily over the years. While the researchers could not say if the ingestion of raw pig liver is the main cause of the rise in cases, many local dishes feature this ingredient and do not cook the meat thoroughly.
The same report said that you can acquire the disease from eating contaminated food or substances. Ingesting water that is laced with the disease or accidentally drinking water that has trace amounts of faeces. Eating raw or half-cooked meat that is infected can also transmit the virus to you.
For a country that still proclaims, we “enjoy the safest food supply in the world” in U.S. Department of Agriculture missives, when we’ve been arguing reduced risk is a better message for 25 years and that there are so many countries with the self-proclaimed title of safest food in the world they can’t all be right – it’s alarming that Mycobacterium bovis has been transmitted from deer to a human.
My dad went a few times but I’m not sure if he enjoyed it or not.
Whatever.
The U.S. Centers for Disease Control reports that in May 2017, the Michigan Department of Health and Human Services was notified of a case of pulmonary tuberculosis caused by Mycobacterium bovis in a man aged 77 years. The patient had rheumatoid arthritis and was taking 5 mg prednisone daily; he had no history of travel to countries with endemic tuberculosis, no known exposure to persons with tuberculosis, and no history of consumption of unpasteurized milk. He resided in the northeastern Lower Peninsula of Michigan, which has a low incidence of human tuberculosis but does have an enzootic focus of M. bovis in free-ranging deer (Odocoileus virginianus). The area includes a four-county region where the majority of M. bovis–positive deer in Michigan have been found.
Statewide surveillance for M. bovis via hunter-harvested deer head submission has been ongoing since 1995; in 2017, 1.4% of deer tested from this four-county region were culture-positive for M. bovis, compared with 0.05% of deer tested elsewhere in Michigan. The patient had regularly hunted and field-dressed deer in the area during the past 20 years. Two earlier hunting-related human infections with M. bovis were reported in Michigan in 2002 and 2004. In each case, the patients had signs and symptoms of active disease and required medical treatment.
Whole-genome sequencing of the patient’s respiratory isolate was performed at the National Veterinary Services Laboratories in Ames, Iowa. The isolate was compared against an extensive M. bovis library, including approximately 900 wildlife and cattle isolates obtained since 1993 and human isolates from the state health department. This 2017 isolate had accumulated one single nucleotide polymorphism compared with a 2007 deer isolate, suggesting that the patient was exposed to a circulating strain of M. bovis at some point through his hunting activities and had reactivation of infection as pulmonary disease in 2017.
Whole-genome sequencing also was performed on archived specimens from two hunting-related human M. bovis infections diagnosed in 2002 (pulmonary) and 2004 (cutaneous) that were epidemiologically and genotypically linked to deer (3). The 2002 human isolate had accumulated one single nucleotide polymorphism since sharing an ancestral genotype isolated from several deer in Alpena County, Michigan, as early as 1997; the 2004 human isolate shared an identical genotype with a grossly lesioned deer harvested by the patient in Alcona County, Michigan, confirming that his infection resulted from a finger injury sustained during field-dressing. The 2002 and 2017 cases of pulmonary disease might have occurred following those patients’ inhalation of aerosols during removal of diseased viscera while field-dressing deer carcasses.
In Michigan, deer serve as maintenance and reservoir hosts for M. bovis, and transmission to other species has been documented. Since 1998, 73 infected cattle herds have been identified in Michigan, resulting in increased testing and restricted movement of cattle outside the four-county zone. Transmission to humans also occurs, as demonstrated by the three cases described in this report; however, the risk for transmission is understudied.
Similar to Mycobacterium tuberculosis, exposure to M. bovis can lead to latent or active infection, with risk for eventual reactivation of latent disease, especially in immunocompromised hosts. To prevent exposure to M. bovis and other diseases, hunters are encouraged to use personal protective equipment while field-dressing deer. In addition, hunters in Michigan who submit deer heads that test positive for M. bovis might be at higher risk for infection, and targeted screening for tuberculosis could be performed. Close collaboration between human and animal health sectors is essential for containing this zoonotic infection.
Notes from the Field: Zoonotic mycobacterium bovis disease in deer hunters—Michigan, 2002-2017
James Sunstrum, MD1; Adenike S hoyinka, MD2; Laura E. Power, MD2,3; Daniel Maxwell, DO4; Mary Grace Stobierski, DVM5; Kim Signs, DVM5; Jennifer L. Sidge, DVM, PhD5; Daniel J. O’Brien, DVM, PhD6; Suelee Robbe-Austerman, DVM, PhD7; Peter Davidson, PhD5
In 2018, an outbreak of leptospirosis was identified among raspberry workers from a mixed‐berry farm in New South Wales, Australia. Initial testing had not revealed a cause, but eventually leptospirosis was detected via polymerase chain reaction (PCR). Further serological testing detected Leptospira borgpetersenii serovar Arborea, of which rodents are the predominant reservoir. Leptospirosis is rare in Australia, with outbreaks usually related to flooding. We conducted an investigation to identify risk factors for infection, to inform control measures.
Cases were detected through laboratory notifications, hospital‐based syndromic surveillance, awareness‐raising among farm employees and clinician alerts. Confirmed cases had a four‐fold rise in antibody titre or single titre ≥400 on microscopic agglutination test, and a positive IgM. Probable cases had a positive Leptospira PCR or IgM, and possible cases had a clinically compatible illness. We conducted a case–control study among raspberry workers on the farm and compared reported exposures between cases and seronegative controls. We assessed environmental risks on‐site and tested rodents for leptospirosis.
We identified 84 cases over a 5‐month period (50 confirmed, 19 probable and 15 possible). Compared with controls, cases were less likely to wear gloves and more recently employed. Cases also more commonly reported always having scratched hands, likely from the thorns on raspberry plants. We observed evidence of rodent activity around raspberry plants and three of thirteen trapped mice tested positive for Leptospira Arborea. Control measures included enhanced glove use, doxycycline prophylaxis and rodent control.
This is the largest known outbreak of leptospirosis in Australia. Workers were likely exposed through scratches inflicted during harvesting, which became contaminated with environmental leptospires from mice. Leptospirosis should be considered an occupational risk for raspberry workers, requiring protective measures. Chemoprophylaxis may assist in controlling outbreaks. PCR assists in the early diagnosis and detection of leptospirosis and should be included in surveillance case definitions.
Investigation and response to an outbreak of leptospirosis among raspberry workers in Australia, 2018
The current human brucellosis epidemic in Ath Mansour has again claimed new victims. These are 2 citizens of Ath Vouali, hospitalized Wednesday [28 Aug 2019] at the EPH Kaci Yahia M’Chedallah. The affected subjects are a 40-year-old father and his 15-month-old son. Met in the halls of the hospital, the father indicated that he and his family have consumed raw milk from the farmer whose goats were infected almost 2 months ago.
After these 2 new victims, 6 cases of human brucellosis have been detected since last week [18-24 Aug 2019] in this commune and hospitalized at M’Chedallah hospital. In this context, we learned that a Daira commission, composed of a member of the APC executive of Ath Mansour, the subdivisionary of agriculture of Ahnif, a member of the prevention of the Ahnif EPSP and the M’Chedallah Civil Protection Unit, was set up on the instructions of the Daira Chief.’
As of Monday, about 560 human cases have been reported, much more this time of year than usual and even more than 2015 when 859 people across the country suffered from the illness.
Most cases of illness are reported from central Sweden (the Dalarna region, Gävleborg and Örebro), but an increasing number of reports are also starting to come in from other regions, especially in northern Sweden.
Since the number of illness cases is usually highest in September in Sweden, the outbreak is expected to grow further in the coming weeks.
Infections in Sweden are mainly seen in forest and field hares and rodents, but the disease has been reported in several other species, including other mammals, birds, amphibians, insects, ticks and unicellular animals.
Tularemia, or harpest as it’s known as in Sweden, is one of the most common native zoonoses in people in Sweden. People are infected mainly through mosquitoes, but also through direct contact with sick or dead animals and by inhalation of, for example, infectious dust.
While cyclosporiasis cases are reported year-round in the United States, cyclosporiasis acquired in the United States (i.e., “domestically acquired”, or cases of cyclosporiasis that are not associated with travel to a country that is considered endemic for Cyclospora) is most common during the spring and summer months. The exact timing and duration of U.S. cyclosporiasis seasons can vary, but reports tend to increase starting in May. In previous years the reported number of cases peaked between June and July, although activity can last as late as September. The overall health impact (e.g., number of infections or hospitalizations) and the number of identified clusters of cases (i.e., cases that can be linked to a common exposure) also vary from season-to-season.
The number of reported cases of domestically acquired cyclosporiasishas increased from the previous month and remains elevated in the United States since May 1, 2019.
As of August 28, 2019, 1,696 laboratory-confirmed cases of cyclosporiasis were reported to CDC by 33 states, District of Columbia and New York City in people who became ill since May 1, 2019 and who had no history of international travel during the 14-day period before illness onset.
The median illness onset date was June 29, 2019 (range: May 1–August 13, 2019).
At least 92 people were hospitalized; no deaths were reported.
At this time, multiple clusters of cases associated with different restaurants or events are being investigated by state public health authorities, CDC, and FDA.
Many cases of cyclosporiasis could not be directly linked to an outbreak, in part because of the lack of validated molecular typing tools for C. cayetanensis.
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
With hundreds of new Coast Guard Academy cadets, or swabs (how perfect is that – dp), starting their military training, staff at the medical clinic on campus have had their hands full during the summer months.
Julia Bergman of Military writes that the outbreak was magnified two weeks ago, when a bacterial infection began spreading among swabs.
What started as a few swabs reporting similar symptoms — fever, nausea, vomiting — ultimately grew to about 40 people — both swabs and second-class cadets overseeing their training, who were suspected of having the same infection. Swabs are separated by companies and it became clear that the symptoms were being reporting primarily by swabs assigned to two of the companies.
“When you start putting together your epidemiological hat, really quickly you’re like, ‘Oh, we need to contain this,'” said Capt. Esan O. Simon, medical director at the clinic, who’s only been on the job about two months.
Clinic staff contacted the microbiology team at Lawrence + Memorial Hospital in New London, who were able to quickly analyze the labs and determine that it was a bacterial infection.
At the clinic, which employs about 60 people, it was an all-hands-on-deck effort with staff working around the clock to manage the situation. Within a three-hour period, they screened more than 400 people, including cadets and officer candidates.
Infections can spread quickly on college campuses. Swabs live and train alongside one another. Add to that the stress of their seven-week summer training.
Initially the sick swabs were told to stay in the barracks and wear face masks, and they were instructed on how to clean bacteria from their rooms.
When the number of cases started creeping up, clinic staff separated the sickest of the swabs from their peers and placed them in a separate wing in the barracks to prevent the infection from spreading.
“You didn’t want the folks in the same food line as the whole entire campus and that kind of thing,” Simon said.
A system was devised to deliver meals and administer medication to the isolated swabs, to minimize their exposure to the rest of the campus.
Staff were able to quickly contain the situation, which could have been a lot worse, said Cmdr. Dave Milne, a spokesman for the academy. Only a few cadets are still sick.
The U.S. Centers for Disease Control (CDC), public health and regulatory officials in several states, and the U.S. Food and Drug Administration (FDA) are investigating a multistate outbreak of Cyclospora infections linked to fresh basil from Siga Logistics de RL de CV of Morelos, Mexico.
CDC is advising that consumers do not eat or serve any fresh basil from Siga Logistics de RL de CV of Morelos, Mexico. This investigation is ongoing and the advice will be updated when more information is available.
Consumers who have fresh basil from Siga Logistics de RL de CV of Morelos, Mexico, in their homes should not eat it. Throw the basil away, even if some has been eaten and no one has gotten sick.
Do not eat salads or other dishes that include fresh basil from Siga Logistics de RL de CV of Morelos, Mexico. This includes dishes garnished or prepared with fresh basil from Siga Logistics de RL de CV of Morelos, Mexico, such as salads or fresh pesto.
If you aren’t sure the fresh basil you bought is from Siga Logistics de RL de CV of Morelos, Mexico, you can ask the place of purchase. When in doubt, don’t eat the fresh basil. Throw it out.
Wash and sanitize places where fresh basil was stored: countertops and refrigerator drawers or shelves.
The FDA strongly advises importers, suppliers, and distributors, as well as restaurants, retailers, and other food service providers to not sell, serve or distribute fresh basil imported from Siga Logistics de RL de CV located in Morelos, Mexico. If you are uncertain of the source, do not sell, serve or distribute the fresh imported basil.
Two hundred and five people with laboratory-confirmed Cyclosporainfections and who reported eating fresh basil have been reported from 11 states; exposures occurred at restaurants in 5 states (Florida, Minnesota, New York, Ohio, and Wisconsin).
Illnesses started on dates ranging from June 10, 2019 to July 18, 2019.
Five people have been hospitalized. No deaths attributed to Cyclospora have been reported in this outbreak.
Epidemiologic evidence and early product distribution information indicate that fresh basil from Siga Logistics de RL de CV of Morelos, Mexico is a likely source of this outbreak.
2019 Outbreak of Cyclospora infections linked to fresh basil from Mexico
This means that ingesting raw pork liver could mean you’re ingesting a strain of HEV that’s similar enough to human HEV that it could cause you get infected.
