STEC O91 may help with the others

Shiga toxin-producing Escherichia coli (STEC) strains are important zoonotic foodborne pathogens, causing diarrhea, hemorrhagic colitis, and life-threatening hemolytic uremic syndrome (HUS) in humans. However, antibiotic treatment of STEC infection is associated with an increased risk of HUS. Therefore, there is an urgent need for early and effective therapeutic strategies.

Here, we isolated lytic T7-like STEC phage PHB19 and identified a novel O91-specific polysaccharide depolymerase (Dep6) in the C terminus of the PHB19 tailspike protein. Dep6 exhibited strong hydrolase activity across wide ranges of pH (pH 4 to 8) and temperature (20 to 60°C) and degraded polysaccharides on the surface of STEC strain HB10. In addition, both Dep6 and PHB19 degraded biofilms formed by STEC strain HB10.

In a mouse STEC infection model, delayed Dep6 treatment (3 h postinfection) resulted in only 33% survival, compared with 83% survival when mice were treated simultaneously with infection. In comparison, pretreatment with Dep6 led to 100% survival compared with that of the control group. Surprisingly, a single PHB19 treatment resulted in 100% survival in all three treatment protocols. Moreover, a significant reduction in the levels of  proinflammatory cytokines was observed at 24 h postinfection in Dep6- or PHB19-treated mice. These results demonstrated that Dep6 or PHB19 might be used as a potential therapeutic agent to prevent STEC infection.

IMPORTANCE Shiga toxin-producing Escherichia coli (STEC) is an important foodborne pathogen worldwide. The Shiga-like toxin causes diarrhea, hemorrhagic colitis, and life-threatening hemolytic uremic syndrome (HUS) in humans. Although antibiotic therapy is still used for STEC infections, this approach may increase the risk of HUS. Phages or phage-derived depolymerases have been used to treat bacterial infections in animals and humans, as in the case of the “San Diego patient” treated with a phage cocktail. Here, we showed that phage PHB19 and its O91-specific polysaccharide depolymerase Dep6 degraded STEC biofilms and stripped the lipopolysaccharide (LPS) from STEC strain HB10, which was subsequently killed by serum complement in vitro. In a mouse model, PHB19 and Dep6 protected against STEC infection and caused a significant reduction in the levels of proinflammatory cytokines. This study reports the use of an O91-specific polysaccharide depolymerase for the treatment of STEC infection in mice.

 A novel tail-associated O91-specific polysaccharide depolymerase from a podophage reveals lytic efficacy of shiga toxin-producing Escherichia coli, 28 February 2020

Applied and Environmental Microbiology

Yibao Chen, Xiangmin Li, Shuang Wang, Lingyu Guan, Xinxin Li, Dayue Hu, Dongyang Gao, Jiaoyang Song, Huanchun Chen, Ping Qian

DOI: 10.1128/AEM.00145-20

https://aem.asm.org/content/86/9/e00145-20 

Me and Chapman, we love the covert studies (for science)

Hand hygiene is one of the most effective method for preventing cross-contamination. Food handlers have a major role in the prevention of foodborne illness during food production1 , consequently food handler hand hygiene failures are frequently reported to be implicated in foodborne illness2 . Although informative, food safety cognitions are not indicative of actual practices and may be subject to biases3 , therefore food handlers may demonstrate awareness of food safety, however may fail to translate knowledge into safe practices4 .

For this reason observational data are superior to survey data5 . However, during direct observations, researcher presence can increase subject reactivity6 , whereas covert video observation provide a more comprehensive analysis over a sustained period, where familiarity reduces reactivity bias7 . Previous video observation research have assessed food handler behaviours at retail/catering settings8-10 , however, this method has been under-utilised in food manufacturing business environments. Covert observation may allow the comparison of practices in different areas of manufacturing over the same period of time.

A comparison of hand hygiene compliance in high-care and high-risk areas in a Welsh food manufacturing business using covert observation

Cardiff Metropolitan University

Ellen Evans, Catherine Bunston and Elizabeth Redmond

https://www.metcaerdydd.ac.uk/health/zero2five/research/Documents/Hand%20hygiene%20two%20areas%20EE_04_04_2019%20Final.pdf

Crypto in raw milk

This review analysed outbreaks of human cryptosporidiosis due to raw milk. The objective of our study was to highlight and identify underestimated and underreported aspects of transmission of the parasite as well as the added value of genotyping Cryptosporidium isolates.

Methods

We conducted a descriptive literature review using the digital archives Pubmed and Embase. All original papers and case reports referring to outbreaks of Cryptosporidium due to unpasteurized milk were reviewed. The cross-references from these publications were also included.

Results

Outbreaks have been described in the USA, Australia, and the UK. Laboratory evidence of Cryptosporidium from milk specimens was lacking in the majority of the investigations. However, in most recent reports molecular tests on stool specimens along with epidemiological data supported that the infection was acquired through the consumption of unpasteurized milk. As the incubation period for Cryptosporidium is relatively long (days to weeks) compared with many other foodborne pathogens (hours to days), these reports often lack microbiological confirmation because, by the time the outbreak was identified, the possibly contaminated milk was not available anymore.

Conclusion

Cryptosporidiosis is generally considered a waterborne intestinal infection, but several reports on foodborne transmission (including through raw milk) have been reported in the literature. Calves are frequently infected with Cryptosporidium spp., which does not multiply in milk. However, Cryptosporidium oocysts can survive if pasteurization fails. Thus, pasteurization is essential to inactivate oocysts. Although cryptosporidiosis cases acquired from raw milk are seldom reported, the risk should not be underestimated and Cryptosporidium should be considered as a potential agent of contamination. Genotyping Cryptosporidium isolates might be a supportive tool to strengthen epidemiologic evidence as well as to estimate the burden of the disease.

A review of outbreaks of cryptosporidiosis due to unpasteurized milk, 15 April 2020

Infection

Tamara Ursini, Lucia MoroAna Requena-MéndezGiulia Bertoli & Dora Buonfrate 

https://link.springer.com/article/10.1007/s15010-020-01426-3

Brucellosis linked with raw milk

In December 2018, the Pennsylvania Department of Agriculture (PDA) and Pennsylvania Department of Health (PADOH) were notified of a New York patient with brucellosis caused by infection with Brucella abortus RB51, the live attenuated vaccine strain of B. abortus used to prevent brucellosis in cattle (1). Brucellosis is a serious zoonotic infection caused by the bacteria Brucella spp. The most common sign is fever, followed by osteoarticular symptoms, sweating, and constitutional symptoms (2). Without proper treatment, infection can become chronic and potentially life-threatening (2). The patient had consumed raw (unpasteurized) milk from dairy A in Pennsylvania.*

In July 2017, Texas health officials documented the first human case of domestically acquired RB51 infection associated with raw milk consumption from a Texas dairy (3). In October 2017, a second RB51 case associated with raw milk consumption was documented in New Jersey; the milk source was not identified at the time.

To determine the RB51 source for the New York case, PDA conducted an environmental investigation at dairy A in December 2018. PDA collected individual milk samples from all cows, excluding those known not to have been vaccinated against B. abortus, and from the bulk milk tank, which included milk pooled from all cows. All milk samples underwent polymerase chain reaction (PCR) testing and culture; whole-genome sequencing (WGS) was performed on patient and milk sample isolates. PDA conducted a traceback investigation of any cow with a milk sample that tested positive for RB51. PADOH worked with the raw milk cooperative that distributed dairy A’s milk to notify potentially exposed consumers and distributed notifications through Epi-X§ to identify cases.

Dairy A sold only raw milk and did not provide RB51 vaccination to cows born there (16 of the 30-cow herd). The remaining 14 cows were born outside the dairy and had inadequate vaccination records to determine whether they had received RB51. Because these cows might have been vaccinated, milk samples were collected from them. RB51 was detected by PCR and isolated in milk samples collected from the bulk tank and a single cow (cow 122). WGS identified two distinct RB51 strains shed by cow 122: one matched the 2018 New York patient’s isolate (3 single nucleotide polymorphisms [SNPs] different) and one, unexpectedly, matched the 2017 New Jersey patient’s isolate (1 SNP different). The two different RB51 strains were also shed from different quarters of cow 122’s udder. (It’s an old disease that won’t go away, like hockey players. This pic, left, is from about 2001 that my hockey pal Norm unearthed — he’s the coach in the middle, Bill and I were assistant coaches, daughter 2-of-4 beside me.)

Traceback revealed that cow 122 had received RB51 in 2011 and was purchased by dairy A in 2016. During 2016–2018, dairy A distributed raw milk potentially contaminated with RB51 to 19 states; PADOH notified those states’ public health veterinarians. PADOH provided a letter with RB51 information and brucellosis prophylaxis recommendations to the cooperative, which they distributed to dairy A customers. No additional cases were identified. Cow 122 was excluded from milk production, and serial PCR testing of bulk milk samples were subsequently negative for RB51.

Isolation of two different RB51 strains from different quarters of a cow’s udder has not previously been reported. These infections highlight the need to prevent RB51 infections. Raw milk consumption is also associated with serious illnesses caused by other pathogens, including Campylobacter spp., Shiga toxin–producing Escherichia coli, and Salmonella spp. (4). During 2007–2012, the number of raw milk outbreaks in the United States increased; 66 (81%) of 81 reported outbreaks occurred in states where raw milk sale is legal (5). Pregnant women, children, older adults, and persons with immunocompromising conditions are at greatest risk for infection.

To eliminate infection risk from milkborne pathogens, including RB51, all milk should be pasteurized. Because limited information is available about intermittent or continuous RB51 shedding among dairy cows, more research is needed to more fully understand this emerging public health threat for milk consumers. States can also consider the United States Animal Health Associations’ recommendations regarding the need for RB51 vaccination in areas where B. abortus is not endemic in wildlife.**

Notes from the field: Brucella abortus RB51 infections associated with consumption of raw milk from Pennsylvania—2017 and 2018, 17 April 2020

Morbidity and Mortality Weekly Report pp.482-483

Joann F. Gruber, PhD1,2; Alexandra Newman, DVM3; Christina Egan, PhD3; Colin Campbell, DVM4; Kristin Garafalo, MPH4; David R. Wolfgang, VMD5; Andre Weltman, MD2; Kelly E. Kline, MPH2; Sharon M. Watkins, PhD2; Suelee Robbe-Austerman, DVM, PhD6; Christine Quance6; Tyler Thacker, PhD6; Grishma Kharod, MPH1; Maria E. Negron, DVM, PhD1; Betsy Schroeder, DVM2

https://www.cdc.gov/mmwr/volumes/69/wr/mm6915a4.htm

The burden of norovirus

Up-to-date estimates of the burden of norovirus, a leading cause of acute gastroenteritis (AGE) in the United States, are needed to assess the potential value of norovirus vaccines in development. We aimed to estimate the rates, annual counts, and healthcare charges of norovirus-associated ambulatory clinic encounters, Emergency Department (ED) visits, hospitalizations, and deaths in the United States.

Methods

We analyzed administrative data on AGE outcomes from July 1, 2001 through June 30, 2015. Data were sourced from IBM® MarketScan® Commercial and Medicare Supplemental Databases (ambulatory clinic and ED visits), the Healthcare Utilization Project National Inpatient Sample (NIS; hospitalizations), and the National Center for Health Statistics multiple-cause-of-mortality (MCM) data (deaths). Outcome data (ambulatory clinic and ED visits, hospitalizations, or deaths) were summarized by month, age group, and setting. Healthcare charges were estimated based on insurance claims. Monthly counts of cause-unspecified gastroenteritis-associated outcomes were modeled as functions of cause-specified outcomes, and model residuals were analyzed to estimate norovirus-associated outcomes. Healthcare charges were estimated by applying average charges per cause-unspecified gastroenteritis encounter to the estimated number of norovirus encounters.

Results

We estimate 900 deaths (95% Confidence Interval [CI]: 650 – 1100), 110,000 hospitalizations (95%CI: 80,000 – 145,000), 470,000 ED visits (95% CI: 348,000 – 610,000), and 2.3 million ambulatory clinic encounters (95% CI: 1.7 – 2.9 million) annually due to norovirus, with an associated $430 – 740 million in healthcare charges.

Conclusions

Norovirus causes a substantial health burden in the United States each year, and an effective vaccine could have important public health impact.

The burden of norovirus in the United States, as estimated based on administrative data: Updates for medically attended illness and mortality, 2001-2015, 14 April 2020

Clinical Infectious Diseases

Rachel M Burke, PhD, MPH, Claire Mattison, MPH, Talia Pindyck, MD, MPH, Rebecca M Dahl, MPH, Jessica Rudd, MPH, Daoling Bi, MS, Aaron T Curns, MPH, Umesh Parashar, MBBS, MPH, Aron J Hall, DVM, MSPH

https://doi.org/10.1093/cid/ciaa438

https://academic.oup.com/cid/article/doi/10.1093/cid/ciaa438/5820114

Vibrio and oysters: A review

Vibrio parahaemolyticus is a Gram‐negative bacterium that is naturally present in the marine environment. Oysters, which are water filter feeders, may accumulate this pathogen in their soft tissues, thus increasing the risk of V. parahaemolyticus infection among people who consume oysters. In this review, factors affecting V. parahaemolyticus accumulation in oysters, the route of the pathogen from primary production to consumption, and the potential effects of climate change were discussed. In addition, intervention strategies for reducing accumulation of V. parahaemolyticus in oysters were presented.

A literature review revealed the following information relevant to the present study: (a) managing the safety of oysters (for human consumption) from primary production to consumption remains a challenge, (b) there are multiple factors that influence the concentration of V. parahaemolyticus in oysters from primary production to consumption, (c) climate change could possibly affect the safety of oysters, both directly and indirectly, placing public health at risk, (d) many intervention strategies have been developed to control and/or reduce the concentration of V. parahaemolyticus in oysters to acceptable levels, but most of them are mainly focused on the downstream steps of the oyster supply chain, and (c) although available regulation and/or guidelines governing the safety of oyster consumption are mostly available in developed countries, limited food safety information is available in developing countries. The information provided in this review may serve as an early warning for managing the future effects of climate change on the safety of oyster consumption.

Managing the risk of vibrio parahaemolyticus infections associated with oyster consumption: A review

Comprehensive Reviews in Food Science and Food Safety

Nodali Ndraha, Hin‐chung Wong, Hsin‐I Hsiao

https://doi.org/10.1111/1541-4337.12557

https://onlinelibrary.wiley.com/doi/full/10.1111/1541-4337.12557

Recall: E.coli O157 found in pepperoni product sold in Ireland

Co-op Sliced Pepperoni, with a pack size of 70g, is subject to the food safety alert after the bacteria was found in one of its batches.

Escherichia coli (STEC), detected in the batch with a use by date of May 19, 2020, produces a powerful toxin which can cause “severe illness”.

The food safety chiefs said: “Co-op is recalling the above batch of its Sliced Pepperoni due to the detection of E.coli O157. 

“Point-of-sale recall notices will be displayed in stores supplied with the implicated batch.”

Food Safety Talk 207: Keeping Food Out of Toilet Rooms

This episode was recorded in February, back before stay-at-home orders, school closures and the recognition of a global pandemic. We ended up recording a couple more episodes after this that we put up because of timeliness. This one is a bit of a mess with interruptions and edits, sorry. In this episode Don and Ben deal with dog sounds, talk about British comedy shows and other things they are watching. The guys then talk about a guest pitch from someone not named Ray Romano. The guys do a deep dive on ghost kitchens and the challenges regulating them. They then talk about issues related to using consumer food purchase data to help with outbreak investigations. No deliberation, just conversation. The guys talk about how they consume news, where they stay up to date on food safety and other things. The episode ends on some listener feedback related to free venison.

Download the show here or on your favorite podcast ap.

Show notes so you can follow along at home:

C. diff rates decline

Efforts to prevent Clostridioides difficile infection continue to expand across the health care spectrum in the United States. Whether these efforts are reducing the national burden of C. difficile infection is unclear.

The Emerging Infections Program identified cases of C. difficile infection (stool specimens positive for C. difficile in a person ≥1 year of age with no positive test in the previous 8 weeks) in 10 U.S. sites. We used case and census sampling weights to estimate the national burden of C. difficile infection, first recurrences, hospitalizations, and in-hospital deaths from 2011 through 2017. Health care–associated infections were defined as those with onset in a health care facility or associated with recent admission to a health care facility; all others were classified as community-associated infections. For trend analyses, we used weighted random-intercept models with negative binomial distribution and logistic-regression models to adjust for the higher sensitivity of nucleic acid amplification tests (NAATs) as compared with other test types.

RESULTS

The number of cases of C. difficile infection in the 10 U.S. sites was 15,461 in 2011 (10,177 health care–associated and 5284 community-associated cases) and 15,512 in 2017 (7973 health care–associated and 7539 community-associated cases). The estimated national burden of C. difficile infection was 476,400 cases (95% confidence interval [CI], 419,900 to 532,900) in 2011 and 462,100 cases (95% CI, 428,600 to 495,600) in 2017. With accounting for NAAT use, the adjusted estimate of the total burden of C. difficile infection decreased by 24% (95% CI, 6 to 36) from 2011 through 2017; the adjusted estimate of the national burden of health care–associated C. difficileinfection decreased by 36% (95% CI, 24 to 54), whereas the adjusted estimate of the national burden of community-associated C. difficile infection was unchanged. The adjusted estimate of the burden of hospitalizations for C. difficile infection decreased by 24% (95% CI, 0 to 48), whereas the adjusted estimates of the burden of first recurrences and in-hospital deaths did not change significantly.

CONCLUSIONS

The estimated national burden of C. difficile infection and associated hospitalizations decreased from 2011 through 2017, owing to a decline in health care–associated infections. (Funded by the Centers for Disease Control and Prevention.)

Trends in US burden of clostridioides difficile infection and outcomes, 02 April 2020

New England Journal of Medicine

Alice Y. Guh, M.D., M.P.H., Yi Mu, Ph.D., Lisa G. Winston, M.D., Helen Johnston, M.P.H., Danyel Olson, M.S., M.P.H., Monica M. Farley, M.D., Lucy E. Wilson, M.D., Stacy M. Holzbauer, D.V.M., M.P.H., Erin C. Phipps, D.V.M., M.P.H., Ghinwa K. Dumyati, M.D., Zintars G. Beldavs, M.S., Marion A. Kainer, M.B., B.S., M.P.H., Maria Karlsson, Ph.D., Dale N. Gerding, M.D., and L. Clifford McDonald, M.D.

DOI: 10.1056/NEJMoa1910215

https://www.nejm.org/doi/10.1056/NEJMoa1910215

Vibrio in seafood goes up

There has been an increase in reported outbreaks and cases of foodborne disease attributed to pathogenic Vibrio species. As a result, there have been several instances where the presence of pathogenic Vibrio spp. in seafood has led to a disruption in international trade.

The number of Vibrio species being recognized as potential human pathogens is increasing. The food safety concerns associated with these microorganisms have led to the need for microbiological risk assessment to support risk management decision making for their control.

Vibrio parahaemolyticus is considered to be part of the autochthonous microflora in the estuarine and coastal environments in tropical to temperate zones. Food safety concerns have been particularly evident with V. parahaemolyticus. There have been a series of pandemic outbreaks of V. parahaemolyticus foodborne illnesses due to the consumption of seafood. In addition, outbreaks of V. parahaemolyticus have occurred in regions of the world where it was previously unreported. The vast majority of strains isolated from patients with clinical illness produce a thermostable direct haemolysin (TDH) encoded by the tdh gene. Clinical strains may also produce a TDH-related haemolysin (TRH) encoded by the trh gene. It has therefore been considered that those strains that possess the tdh and/or trh genes and produce TDH and/or TRH should be considered those most likely to be pathogenic. V. vulnificus can occasionally cause mild gastroenteritis in healthy individuals following consumption of raw bivalve molluscs. It can cause primary septicaemia in individuals with chronic pre-existing conditions, especially liver disease or alcoholism, diabetes, haemochromatosis and HIV/AIDS. This can be a serious, often fatal, disease with one of the highest fatality rates of any known foodborne bacterial pathogen.

The 41st Session of the Codex Committee on Food Hygiene (CCFH) requested FAO/WHO to convene an expert meeting to address a number of issues relating to V. parahaemolyticus and V. vulnificus including:

  • conduct validation of the predictive risk models developed by the United States of America based on FAO/WHO risk assessments, with a view to constructing more applicable models for wider use among member countries, including adjustments for strain virulence variations and ecological factors; xi
  • review the available information on testing methodology and recommend microbiological methods for Vibrio spp. used to monitor the levels of pathogenic Vibrio spp. in seafood and/or water;
  • conduct validation of growth rates and doubling times for V. parahaemolyticus and V. vulnificus in Crassostrea virginica (Eastern or American oyster) using strains isolated from different parts of the world and different bivalve molluscan species.

The requested expert meeting was held on 13-17 September 2010, and this report is the outcome of this meeting. Rather than undertaking a validation exercise, the meeting considered it more appropriate to undertake an evaluation of the existing risk calculators with a view to determining the context to which they are applicable and potential modifications that would need to be made to extend their application beyond that context. A simplified calculator tool could then be developed to answer other specific questions routinely. This would be dependent on the availability of the appropriate data and effort must be directed towards this. The development of microbiological monitoring methods, particularly molecular methods for V. parahaemolyticus and V. vulnificus is evolving rapidly. This means the identification of any single method for the purposes of monitoring these pathogens is challenging and also of limited value as the method is likely to be surpassed within a few years. Therefore, rather than making any single recommendation, the meeting considered it more appropriate to indicate a few of the monitoring options available while the final decision on the method selected will depend to a great extent on the specific purpose of the monitoring activity, the cost, the speed with which results are required and the technical capacity of the laboratory.

The meeting considered that monitoring seawater for V. parahaemolyticus and V. vulnificus in bivalve growth and harvest areas has limited value in terms of predicting the presence of these pathogens in bivalves. A linear relationship between levels of the vibrios in seawater and bivalves was not found and whatever relationship does exist can vary between region, the Vibrio spp. etc. Also, the levels of Vibrio species of concern in seawater tend to be very low. This presents a further challenge as the method used would need to have an appropriate level of sensitivity for their detection. Nevertheless, this does not preclude the testing of seawater for these vibrios; for example, in certain situations testing can provide an understanding of the aquatic microflora in growing areas. Monitoring of seafood for these pathogenic vibrios was considered the most appropriate way to get insight into the xii levels of the pathogens in these commodities at the time of harvest. Monitoring on an ongoing basis could be expensive, so consideration could be given to undertaking a study over the course of a year and using this as a means to establish a relationship between total and pathogenic V. parahaemolyticus and V. vulnificus in the seafood and abiotic factors such as water temperature and salinity. Once such a relationship is established for the harvest area of interest measuring these abiotic factors may be a more cost-effective way of monitoring.

The meeting undertook an evaluation exercise rather than attempting to validate the existing growth models. The experts considered the JEMRA growth model for V. vulnificus and the FDA growth model for V. parahaemolyticus were appropriate for estimating growth in the American oyster (Crassostrea virginica). The JEMRA growth model for V. vulnificus was appropriate for estimating growth in at least one other oyster species, Crassostrea ariakensis. The FDA model for V. parahaemolyticus was also appropriate for estimating growth in at least one other oyster species, Crassostrea gigas, but was not appropriate for predicting growth in the Sydney rock oyster (Saccostrea glomerata). There was some evidence that the V. parahaemolyticus models currently used over predict growth at higher temperatures (e.g. > 25 °C) in live oysters. This phenomenon requires further investigation. Growth model studies were primarily undertaken using natural populations of V. parahaemolyticus as these were considered to be the most representative. Data were limited and inconsistent with respect to the impact of the strain on growth rate although recent studies in live oysters suggest differences exist between populations possessing tdh/trh (pathogenic) versus total or non-pathogenic populations of V. parahaemolyticus.

There was no data to evaluate the performance of the growth models in any other oyster species or other filter feeding shellfish or other seafood and as such its use in these products could not be supported. If the models are used there should be a clear understanding of the associated uncertainty. This indicated a data gap which needs to be addressed before the risk assessments could be expanded in a meaningful manner.

Risk assessment tools for vibrio parahaemolyticus and vibrio vulnificus associated with seafood, 2020

FAO and WHO

https://apps.who.int/iris/bitstream/handle/10665/330867/9789240000186-eng.pdf?sequence=1&isAllowed=y