Norovirus-contaminated raspberries likely caused deaths, sickened hundreds, in Quebec last summer

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Frozen raspberries imported from China made hundreds of people sick in Quebec last summer and probably resulted in multiple deaths, according to a recent public health report. 

The infected fruits led to a wave of recalls in August 2017 by the Canadian Food Inspection Agency because they had been used by a variety of food processors such as brewers, pastry chefs and ice cream makers and had been cooked in hospital cafeterias and residences for seniors.

The raspberries were contaminated by Norovirus. At least 724 Quebecers fell ill, a number that may represent just “the tip of the iceberg” 

According to Dr. Yves Jalbert, director of public health protection at the Quebec health ministry, it is clear that there were deaths over this period. No specific number has been given. Public health officials in Quebec do not track the progress of each infected patient. 

107 dead, 852 sick from Listeria in South Africa: Suspects unknown

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The National Institute for Communicable Diseases (NICD), in Johannesburg, South Africa, reported 107 case patients have died from Listeria monocytogenes.

The agency, which is a division of the National Health Dept., said 852 listeriosis cases were confirmed between Jan. 1, 2017 and Feb. 5,2018, but so far, the source of the outbreak is not known. “Presently no food sources that are contaminated with the outbreak strain have been found, including amongst poultry and poultry products,” the agency said in a statement.

1 sick from Listeria linked to raw sheep milk cheeses from Spain

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On February 5 the Spanish Agency for Consumer Affairs, Food Safety and Nutrition has learned through the Coordinated System of Rapid Information Exchange (SCIRI) of the existence of an affected by meningitis in the Community of Madrid, as a result of intoxication food by Listeria monocytogenes presumably associated with the consumption of soft milk sheep cheese made by the company Ohian Txiki Koop located in the Basque Country. The affected one evolves favorably.

The cheeses allegedly involved are the following:

Gutizia, raw sheep milk cheese. 

Txuria , soft cheese from raw sheep’s milk. 

Beltza,  lactic cheese-curl of raw sheep’s milk.

These products have been distributed from the manufacturer to the Autonomous Communities of Madrid, Catalonia and the Basque Country. On February 7 there is evidence that from Madrid, there has been a small redistribution to Andalusia, Castilla-La Mancha, Castilla y León, Extremadura, Galicia, Valencia and Portugal, few units.

The removal of all batches of raw soft-ewe sheep milk cheese is being carried out. 

This information has been communicated through the system of the national alert network to the competent Authorities of the Autonomous Communities that are carrying out the appropriate actions, as well as to the competent Portuguese Authorities through the Rapid Alert Network System for Food and Feed. European.

As a precautionary measure, people who have some packaging of these products at home are advised, refrain from consuming them and if they have consumed them and if they present any unusual symptoms, it is recommended to go to a health center.

Australian student who sold monkey skull to ‘people from Pirates of the Caribbean’ fined

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A few years ago, one of those Johnny-Depp-pirate movies — it may have been 5 — was filming down the highway at the Gold Coast.

The set was plagued by drama when it was discovered Depp and then wife Amber Heard had illegally brought two dogs into the country.

This prompted deputy premier Banaby-the-bloody-carp Joyce (right, not exactly as shown) to question Depp’s acting ability after the couple apologized, which shows how small Australia is because now Joyce is embroiled in his own scandalous activities, involving humans, not pets.

Behind the sideshow of movie making, divorce and apologies, a Canberra university student was on Thursday fined for illegally possessing and importing exotic animal remains into Australia, in a case that has shed some light on the shadowy world of wildlife trade.

Alexandra Back of the Canberra Times reports that for years, avid collector Brent Philip Counsell, 28, dealt in what a magistrate described as a “macabre” trade of skulls and animal specimens, once selling a primate skull to the people making the Pirates of the Caribbean movie in Brisbane.

In 2016 authorities from the department of environment raided Counsell’s home in Deakin where they found and seized about 100 animal specimens from the living room and bedroom.

Australian environment law makes it illegal to either possess or import protected exotic animal specimens without a permit.

Over several years, Counsell either illegally imported or possessed a small primate skull threaded on a necklace, the skulls of a brown bear and a gibbon, a taxidermy buzzard, water monitor lizard, and teeth from a bear and a hippopotamus tooth.

When he spoke to investigators, Counsell admitted possessing and selling species from his website wulfe.com.au, which he had since shut down.

One of the charges stemmed from an admission Counsell made to authorities after they had searched his home, that he had sold a primate skull to the “people” behind the Pirates of the Caribbean movie that was filming in Brisbane.

He tried to avoid detection, and prosecutors found on his phone articles that offered tips about how to send skulls overseas without being noticed by customs.

Everyone has a camera, especially for selfies: UK couple who claimed holiday was ruined by food poisoning caught out by posting snaps on Facebook

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Martin Naylor of the Mirror reports a brazen couple claimed they fell in with food poisoning while on holiday – only to put up pictures of themselves having fun and eating luxury meals on social media.

Leon Roberts and Jade Muzoka pleaded guilty to fraud and have been warned by a judge that they can face jail.

The couple falsely claimed their holiday in Turkey was ruined in a scam that could have cost travel firm TUI £50,000 had they not been caught out, the Derby Telegraph reports.

But despite the pair discontinuing their story before a penny was paid out, the company chose to prosecute.

District Judge Jonathan Taaffe said: “It would fly in the face of common sense to regard this as an isolated incident.

“It is a real problem in Great Britain and has a real impact on the genuine persons who suffer that make genuine claims and put those who do suffer illness on holiday under suspicion.

“This (the offences) is outside the (sentencing) guidelines because it encourages a tsunami of false claims.

“All (sentencing) options are open at this stage and this is a serious case and it may be that a custodial sentence will follow to show the importance of your wrongdoing.”

Southern Derbyshire Magistrates’ Court was told how Roberts, 37, of Alvaston, and Muzoka, 27, from Sinfin, spent a week at the luxury Cornelia Golf Resort and Spa, in Turkey, in July 2015.

The following April, the pair submitted claims through their solicitor saying they both fell ill during their time away.

But investigators discovered photographs of the couple, who are no longer together, lounging by the pool, drinking and eating dinner.

Rabies (maybe) from bats living in a sorority house, Indiana, 2017

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In February 2017, the Indiana State Department of Health (ISDH) was notified of bat exposures at a university sorority house. The initial complaint was made to ISDH because of concerns for food sanitation. Bats had been routinely sighted in shared living areas and hallways. ISDH, in consultation with the U.S. Centers for Disease Control, collaborated with the university and sorority to assess residents and staff members for potential rabies risk. In 2016, 4.3% of all bats tested in Indiana were positive for rabies. The longest incubation period recorded for indigenously acquired bat rabies is 270 days (1); therefore, out of an abundance of caution, ISDH conducted interviews with 140 students and eight employees who resided or worked in the sorority house during the preceding 12 months, all of whom were considered to have possibly been exposed. A web-based survey was administered in February to collect information about bat exposures, which was used to categorize all respondents into having a low, medium, or high risk for rabies exposure per CDC guidance (2).

Persons who reported a bite, scratch, or direct skin contact with a bat were categorized as having a high risk. Persons were categorized as having moderate risk if they reported waking and finding a bat in the same room where they were sleeping. Persons who reported no bat exposure were categorized as having a low risk. Respondents categorized as having a high or moderate risk had follow-up interviews in person or by telephone.

Among the 148 possibly exposed persons, 100 (68%) responded to the questionnaire, including 92 (66%) students and all eight employees; 94 respondents reported ever having seen a bat in the sorority house. Among those 94 persons, 70 (74%) reported having seen a bat within the previous 12 months, and 34 (36%) reported seeing a bat ≤1 month ago. Among respondents who reported ever having seen a bat in the sorority house, 13 (14%) were identified as having a moderate or high risk for rabies exposure, including 11 sorority members, one university employee, and one nonsorority member student. After follow-up interviews, nine of these 13 persons were reclassified as having a low risk for rabies exposure. The remaining four persons were considered to have a high (three persons) or a moderate (one) risk. All four persons received a recommendation for postexposure prophylaxis (PEP), which consists of human rabies immune globulin and a series of 4 doses of rabies vaccine. Two persons completed the PEP series during March 20–April 18, and two declined PEP because of a perceived lack of risk. No respondent had developed clinical rabies as of February 2018.

ISDH learned that bats had been roosting in the building for approximately 30 years. Commercial wildlife operators conducted an environmental investigation in March and identified multiple small openings between the house’s exterior wall and doorframe, which can serve as points of ingress or egress for bats. In addition, certain students reported hearing scratching behind a wall inside the house’s common space. This wall was scheduled to be removed as part of a house remodel during summer 2017. A commercial wildlife control operator repaired the openings and completed building remediation during this time. Students returned to the house in August 2017. No bat sightings have been reported since students returned.

This is the first reported instance of a mass bat exposure in a fraternity or sorority house. Multiple high-risk rabies exposures occurred in this sorority house, attributable to bat colonization of the building. The initial complaint to ISDH related to concerns for food sanitation, rather than rabies, is consistent with previous reports indicating an underappreciation of the health risks associated with indoor bat exposures (3). ISDH communicated the risk for rabies exposure at meetings with students and university housing directors. All bat exposure events should be reported immediately to public health officials, who can provide advice about rabies risk assessments and determination of the need for PEP.

Notes from the Field: Assessment of Rabies Exposure Risk Among Residents of a University Sorority House — Indiana, February 2017

Morbidity and Mortality Weekly Report; February 9, 2018; 67(5);166

Betsy Schroeder, DVM; Alex Boland, MPH; Emily G. Pieracci, DVM; Jesse D. Blanton, PhD; Brett Peterson, MD; Jennifer Brown, DVM

https://www.cdc.gov/mmwr/volumes/67/wr/mm6705a4.htm?s_cid=mm6705a4_e

Corresponding author: Betsy Schroeder, BSchroeder@cdc.gov, 814-248-5774.

1Epidemic Intelligence Service, CDC; 2Indiana State Department of Health; 3Division of High Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, CDC.

References

De Serres G, Dallaire F, Côte M, Skowronski DM. Bat rabies in the United States and Canada from 1950 through 2007: human cases with and without bat contact. Clin Infect Dis 2008;46:1329–37. CrossRef PubMed

CDC. Assessment of risk for exposure to bats in sleeping quarters before and during remediation—Kentucky, 2012. MMWR Morb Mortal Wkly Rep 2013;62:382–4. PubMed

DeMent J, Trevino-Garrison I. Investigation of potential rabies exposure while attending a camp, Barton County, June 2010. Topeka, KS: Kansas Department of Health and Environment; 2010. http://www.kdheks.gov/epi/download/Bats_at_Camp_Final_Report.pdf

Going public (not): One dead 33 sick from Salmonella at Colorado restaurant in November

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The Tri-County Health Department said one person has died from salmonella poisoning related to eating at a restaurant in Aurora (not the Aurora, Ill. of Wayne’s World). The outbreak put three other people in the hospital.

The health department said 33 people were sickened by eating at La California restaurant on Peoria Street in November.

The health department said lab tests show the family combination meal might have led to the poisoning. The meal includes ingredients such as meat, beans and cilantro.

But investigators could not pinpoint what started the outbreak.

The health department said the outbreak affected people who ate at La California from Nov. 4-26. Almost all of the people infected experienced diarrhea and abdominal cramping.

La California is at 1685 Peoria St.

The health department’s report said 13 of the 33 cases are confirmed, and 20 of the cases are probable for salmonella.

The illnesses involved 32 restaurant patrons and one employee.

Twenty-five cases had exposures at the restaurant with their meals within a five-day period from Nov. 10-14.

“It was significantly associated with the illness. But we couldn’t ID a single item in the family combo that was associated with the illness. … Everybody ate everything in the family combo,” Tri County Health spokeswoman Jen Chase told CBS Denver.

Raw is risky: 17 sick with Campylobacter from raw milk in Colorado, 2016

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In August 2016, a local public health agency (LPHA) notified the Colorado Department of Public Health and Environment (CDPHE) of two culture-confirmed cases of Campylobacter infection among persons who consumed raw (unpasteurized) milk from the same herdshare dairy.

In Colorado, the sale of raw milk is illegal; however, herdshare programs, in which a member can purchase a share of a herd of cows or goats, are legal and are not regulated by state or local authorities. In coordination with LPHAs, CDPHE conducted an outbreak investigation that identified 12 confirmed and five probable cases of Campylobacter jejuni infection. Pulsed-field gel electrophoresis (PFGE) patterns for the 10 cases with available isolates were identical using the enzyme Sma. In addition, two milk samples (one from the dairy and one obtained from an ill shareholder) also tested positive for the outbreak strain. Five C. jejuni isolates sent to CDC for antimicrobial susceptibility testing were resistant to ciprofloxacin, tetracycline, and nalidixic acid (1).

Although shareholders were notified of the outbreak and cautioned against drinking the milk on multiple occasions, milk distribution was not discontinued. Although its distribution is legal through herdshare programs, drinking raw milk is inherently risky (2). The role of public health in implementing control measures associated with a product that is known to be unsafe remains undefined.

Investigation and Results

On August 23, 2016, El Paso County Public Health notified CDPHE of two culture-confirmed cases of C. jejuni infection; campylobacteriosis is a reportable disease in Colorado. Both patients reported drinking unpasteurized milk from the same herdshare dairy in Pueblo County. Since 2005, obtaining raw milk by joining a herdshare program has been legal for Colorado residents, but selling raw milk is illegal. By purchasing a share of a herd (cows or goats), shareholders are entitled to a portion of the raw milk.

Because the prevalence of consuming unpasteurized milk is low (2.4% in Colorado, 2006–2007 FoodNet Population Survey; 3.1%, 2009 Colorado Behavioral Risk Factor Surveillance System), two cases of enteric illness with a common exposure to raw milk are unlikely to occur by chance (3,4). In this outbreak, a confirmed case was defined as diarrheal illness with onset on or after August 1, 2016, in a person with known consumption of unpasteurized milk from the same herdshare dairy and culture-confirmed C. jejuni infection. A probable case was defined as diarrhea onset on or after August 1, lasting 1 or more days, in a person with either known consumption of milk from the same herdshare dairy or with an epidemiologic link to a confirmed case.

Cases were identified through routine passive reporting with follow-up interviews, a Health Alert Network broadcast to area providers, and attempts to contact all shareholders. A public health order was issued to obtain a list of shareholders with their contact information after it was not provided by the dairy within 5 days of the initial request. CDPHE attempted to contact shareholders to inform them about the outbreak and assess possible illness. Up to three calls were made to each shareholder household. Epidemiologists contacted laboratories to request that isolates from potential outbreak-associated cases be forwarded to the state public health laboratory.

Among 91 (53%) of 171 shareholder households that responded to requests for follow-up interviews, representing 207 persons in five or more Colorado counties, 12 confirmed and five probable cases were identified (Figure). Among confirmed cases, patients ranged in age from 12 to 68 years (median = 58 years); nine were male. Duration of illness ranged from 3 to >10 days. One hospitalization occurred; there were no deaths. In addition to diarrhea, among the 12 confirmed cases, the majority of patients also experienced fever (10), abdominal pain or cramps (eight), headache (eight), and myalgia (seven); vomiting and bloody diarrhea were reported less frequently (in five and four persons, respectively).

Four milk samples were tested for C. jejuni; pathogen identification and PFGE were performed on available isolates from persons epidemiologically linked to the outbreak. C. jejuni with one of two outbreak PFGE patterns (PulseNet DBRS16.0008 using the enzyme Sma and PulseNet DBRK02.1272 or DBRK02.0028 using the enzyme Kpn) was confirmed in 10 isolates that were available at the public health laboratory and two of the four raw milk samples. The National Antimicrobial Resistance Monitoring System performed antimicrobial susceptibility tests on five representative isolates; all were resistant to ciprofloxacin, tetracycline, and nalidixic acid (1).

Public health responses to this outbreak consisted of notifying shareholders about the outbreak on three occasions and requiring the dairy to provide additional written notification about the outbreak at milk distribution points. A press release was issued by two LPHAs in response to detecting at least one infection in a person who was not a shareholder but was given milk by shareholders. In addition, a number of shareholders reported sharing milk with nonshareholders who might have been unaware of the outbreak. Although milk sample results were positive for C. jejuni, CDPHE did not close the dairy or stop distribution of its milk because without pasteurization CDPHE could not create standards for safely reopening the dairy (5). Shareholders were, however, urged to discard raw milk distributed since August 1 and were reminded that Colorado statute prohibits redistribution of raw milk.

Discussion

Raw milk from a herdshare dairy was the source of this outbreak of C. jejuni infections, and the investigation highlighted the difficulties inherent in addressing an outbreak related to unpasteurized milk from a herdshare dairy. During three previous herdshare-associated outbreaks in Colorado, public health authorities temporarily took action to stop milk distribution until a series of negative tests were obtained from the milk (Alicia Cronquist, CDPHE, personal communication, December 2017). However, because CDPHE could not ensure that unpasteurized milk would be safe in the future, the decision was made not to close the dairy during this outbreak. In addition, CDPHE’s Division of Environmental Health and Sustainability chose not to make formal recommendations on the dairy’s processes because no protocol improvements short of pasteurization could ensure the product’s safety, even with improved sanitation (5).

All tested isolates’ resistance to three antibiotics was concerning, particularly as fluoroquinolones are frequently used to treat Campylobacter infections in those cases where treatment is indicated. Treatment of antibiotic-resistant Campylobacter infections might be more difficult, of longer duration, and possibly lead to more severe illness than treatment of nonresistant Campylobacter infections (6–8). In 2015, approximately 25.3% of U.S. C. jejuni isolates were resistant to ciprofloxacin, an increase from 21.6% a decade earlier (1).

In collaboration with LPHAs, CDPHE is creating guidelines to address future outbreaks related to raw milk from herdshares. As more states legalize the sale or other distribution of unpasteurized milk, the number of associated outbreaks will likely increase (9,10). The role of public health in responding to raw milk–related outbreaks should be further defined. State-level guidelines might assist with this process.

 

Corresponding author: Alexis Burakoff, aburakoff@cdc.gov, 303-692-2745.

1Epidemic Intelligence Service, Division of Scientific Education and Professional Development, CDC; 2Colorado Department of Public Health and Environment, Denver, Colorado; 3Pueblo City-County Health Department, Pueblo, Colorado; 4El Paso County Public Health, Colorado Springs, Colorado; 5Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC.

References

CDC. National Antimicrobial Resistance Monitoring System for Enteric Bacteria (NARMS): human isolates surveillance report for 2015 (final report). Atlanta, Georgia: US Department of Health and Human Services, CDC; 2018.

CDC. Food safety: raw milk. Atlanta, GA: US Department of Health and Human Services, CDC; 2016. https://www.cdc.gov/foodsafety/rawmilk/raw-milk-index.html

CDC. Foodborne diseases active surveillance network (FoodNet) population survey atlas of exposures, 2006–2007. Atlanta, GA: US Department of Health and Human Services, CDC; 2011. https://www.cdc.gov/foodnet/PDFs/FNExpAtl03022011.pdf

Colorado Department of Public Health and Environment. Colorado Behavioral Risk Factor Surveillance System, 2009. [Data on raw milk]. Denver, CO: Colorado Department of Public Health and Environment; 2009. http://www.chd.dphe.state.co.us/Resources/brfss/BRFSS2009results_raw%20milk.pdf

Longenberger AH, Palumbo AJ, Chu AK, Moll ME, Weltman A, Ostroff SM. Campylobacter jejuni infections associated with unpasteurized milk—multiple states, 2012. Clin Infect Dis 2013;57:263–6. CrossRef PubMed

Evans MR, Northey G, Sarvotham TS, Rigby CJ, Hopkins AL, Thomas DR. Short-term and medium-term clinical outcomes of quinolone-resistant Campylobacter infection. Clin Infect Dis 2009;48:1500–6. CrossRef PubMed

Helms M, Simonsen J, Olsen KE, Mølbak K. Adverse health events associated with antimicrobial drug resistance in Campylobacter species: a registry-based cohort study. J Infect Dis 2005;191:1050–5. CrossRef PubMed

Nelson JM, Smith KE, Vugia DJ, et al. Prolonged diarrhea due to ciprofloxacin-resistant Campylobacter infection. J Infect Dis 2004;190:1150–7. CrossRef PubMed

Langer AJ, Ayers T, Grass J, Lynch M, Angulo FJ, Mahon BE. Nonpasteurized dairy products, disease outbreaks, and state laws—United States, 1993–2006. Emerg Infect Dis 2012;18:385–91. CrossRef PubMed

Mungai EA, Behravesh CB, Gould LH. Increased outbreaks associated with nonpasteurized milk, United States, 2007–2012. Emerg Infect Dis 2015;21:119–22. CrossRef PubMed

Outbreak of Fluoroquinolone-Resistant Campylobacter jejuni Infections Associated with Raw Milk Consumption from a Herdshare Dairy — Colorado, 2016

Morbidity and Mortality Weekly Report; February 9, 2018; 67(5);146–148

Alexis Burakoff, MD; Kerri Brown, MSPH; Joyce Knutsen; Christina Hopewell; Shannon Rowe, MPH; Christy Bennett; Alicia Cronquist, MPH

https://www.cdc.gov/mmwr/volumes/67/wr/mm6705a2.htm

Can the Internet help make a better person?

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I don’t like myself.

Never have.

I’ve been going to shrinks now for a few years, and while I like the group activity – like the original Bob Newhart show – it’s not really going anywhere, so I thought I’d enlist the help of the collective barfblog.com brain.

I really love Amy, but my level of self-loathing is affecting our relationship.

Any tips and tidbits, please pass along, if it works we can write a book.

UK cops say suspect has refused to poop for 3 weeks

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I poop about three times a day.

Probably not the image you wanted, but it affects my ability to go for a morning run, and dates back to working construction 40 years ago (corn silks can be versatile).

Essex Police in the UK are on #poowatch and tweeting about it. This after a suspected drug dealer believed to have drugs hidden in his body has now for 21 days refused to poop. The BBC reports the 24-year-old was arrested Jan. 17 and has been under supervision since then, with the department’s Operation Raptor team that arrested him providing updates like this one, tweeted Wednesday: “Day 21/3 weeks for our man on #poowatch still no movements/items to report, he will remain with us until Friday when we are back at court where we will be requesting a further 8 days should he not produce anything before that hearing.”

Last Friday they tweeted that the man is being watched by doctors and was in fine health at the time. Per the BBC, police decided to keep the public informed of the man’s bowel movements in an effort to quash any illusions that drug dealing is “glamorous.”