The U.S. Centers for Disease Control and Prevention and state health officials are investigating potential exposures to Brucella strain RB51 (RB51) in 19 states, connected to consuming raw (unpasteurized) milk from Miller’s Biodiversity Farm in Quarryville, Pennsylvania. One case of RB51 infection (brucellosis) has been confirmed in New York, and an unknown number of people may have been exposed to RB51 from drinking the milk from this farm. This type of Brucella is resistant to first-line drugs and can be difficult to diagnose because of limited testing options and the fact that early brucellosis symptoms are similar to those of more common illnesses like flu.
The New York case is the third known instance of an infection with RB51 associated with consuming raw milk or raw milk products produced in the United States. The other two human cases occurred in October 2017 in New Jersey and in August 2017 in Texas. Those cases reported drinking raw milk from an online retailer and a Texas farm, respectively. In addition to these three confirmed cases, hundreds of others were potentially exposed to RB51 during these three incidents.
RB51 is a live, weakened strain used in a vaccine to protect cows against a more severe form of Brucella infection that can cause abortions in cows and severe illness in people. On rare occasions, cows vaccinated with RB51 vaccine can shed the bacteria in their milk. People who drink raw milk from cows that are shedding RB51 can develop brucellosis.
People who consumed raw milk or raw milk products from this dairy farm since January 2016 may have been exposed and should talk to their doctor.
People who are still within six months of the date they last consumed the raw milk are at an increased risk for brucellosis and should receive antibiotics to prevent an infection and symptoms, and should monitor their health for possible symptoms for six months. If symptoms develop, they should see their doctor immediately for testing.
Milk samples from Miller’s Biodiversity tested positive for RB51. A cow that tested positive for RB51 has been removed from the milking herd.
On December 1, 2017, PulseNet, the U.S. Centers for Disease Control’s molecular subtyping network for foodborne disease surveillance, identified a cluster of three Listeria monocytogenes clinical isolates with indistinguishable pulsed-field gel electrophoresis (PFGE) pattern combinations. These isolates were closely related to one another by whole-genome multilocus sequence typing within three allele differences (range = 0–3 alleles), indicating that the infections were likely from the same source.
CDC, the Food and Drug Administration (FDA), and state and local health departments initiated a multistate investigation. An outbreak case of listeriosis was defined as an infection with L. monocytogenes, with an isolate that was indistinguishable by PFGE and closely related by whole-genome multilocus sequence typing to the outbreak strain isolated during October–December 2017.
The cases corresponding to the three isolates were identified in Illinois, Iowa, and Michigan. Isolation dates ranged from October 15, 2017, to October 29, 2017. Patients ranged in age from 55 to 71 years (median = 69 years), and all three patients were male. All patients were hospitalized for listeriosis; no deaths were reported. PulseNet was queried routinely for new isolate matches during the investigation, and no additional cases were identified.
Interviews were conducted with all three patients or their surrogates using the standard Listeria Initiative questionnaire (1), which asks about a variety of foods consumed in the month preceding illness onset. Grocery store receipts were collected for the patient in Michigan. Review of reported exposures indicated that all three patients had consumed prepackaged caramel apples purchased from retail establishments in the month preceding illness onset. A case-case analysis was performed comparing exposure frequencies for all food items included in the Listeria Initiative questionnaire for the three outbreak-associated cases with exposure frequencies for 186 sporadic cases of listeriosis from the same states reported to CDC since 2006. Caramel apple consumption was significantly higher among patients included in the outbreak, compared with that among patients with sporadic illnesses (odds ratio = 21.7; 95% confidence interval = 2.3–infinity). None of the interviewed patients had leftover caramel apples in their home for testing.
State and local officials collected records at two of the three retail locations where caramel apples had been purchased. All three retailers sold the same brand of caramel apples (brand A). The product was packaged in a plastic clamshell containing three caramel apples, each on a stick. Caramel apples were seasonal products that were only available for a short period in the fall at two of the retail locations. However, the retail location where the Illinois patient purchased caramel apples had the product in stock at the time of the investigation. Eight packages of caramel apples were collected for testing by the Illinois Department of Public Health, but L. monocytogenes was not detected in any samples. It was not known whether the tested caramel apples were from the same lots as those consumed by the ill persons in this outbreak.
During an inspection at the caramel apple production facility, FDA reviewed records and practices and collected environmental samples for testing. No significant food safety concerns were observed. None of the environmental swabs yielded L. monocytogenes. Environmental swabs collected at a single whole apple supplier yielded L. monocytogenes, but it was not the outbreak strain. Traceback activities did not implicate a specific lot or supplier of whole apples used in brand A caramel apple production during the period of interest.
No additional outbreak-associated illnesses were identified during the investigation. In light of the limited shelf life of the product (reported by the production facility to be 15 days), it was unlikely that caramel apples consumed by ill persons in this outbreak would have still been available for purchase or in persons’ homes at the time of the investigation. Because there was no evidence to suggest an ongoing risk to the public, no public warning was issued by federal or state agencies.
Although the outbreak strain of L. monocytogenes was not isolated from caramel apples or their production environment, the epidemiologic evidence indicated that caramel apples were the suspected vehicle in this outbreak. All outbreak-associated ill persons consumed a specific brand of a relatively uncommon food product in the month before their illness onset, and all were infected with indistinguishable L. monocytogenes strains. Caramel apples were previously implicated in a large multistate outbreak of listeriosis during 2014–2015, caused by contamination of whole apples (2). Ready-to-eat food processors, including those that make caramel apples, could consider the introduction and persistence of L. monocytogenes in food production environments as a potential hazard and mitigate that risk through appropriate environmental monitoring and preventive controls (3). Further research into the control of L. monocytogenes in fresh produce, including fresh apples, might help identify prevention strategies to reduce or eliminate the pathogen in some ready-to-eat foods.
Notes from the field: Outbreak of listeriosis likely associated with prepackaged caramel apples
25.jan.19
CDC
Jessica R. Marus, MPH1; Sally Bidol, MPH2; Shana M. Altman3; Oluwakemi Oni, MPH4; Nicole Parker-Strobe, MPH2; Mark Otto, MSPH5; Evelyn Pereira, MPH5; Annemarie Buchholz, PhD5; Jasmine Huffman1,6; Amanda R. Conrad, MPH1; Matthew E. Wise, PhD1
1Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC; 2Michigan Department of Health and Human Services; 3Illinois Department of Public Health; 4Iowa Department of Public Health; 5Food and Drug Administration, Silver Spring, Maryland; 6Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee.
All authors have completed and submitted the ICMJE form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.
Not only does Canada continue to have a problem with fish mislabelling, but that problem persists throughout the supply chain, according to a first-ever study by University of Guelph researchers.
U of G researchers found 32 per cent of fish were mislabelled and the number of incorrectly identified samples became compounded as the samples moved through the food system.
“We’ve been doing seafood fraud studies for a decade,” said Prof. Robert Hanner, lead author and associate director for the Canadian Barcode of Life Network. “We know there are problems. But this is the first study to move beyond that and look at where the problems are happening throughout the food supply chain.”
The findings reveal that mislabelling happens before fish are imported into Canada, as well as throughout the supply chain, Hanner added.
“It seems it’s not isolated to foreign markets, but it’s also happening at home. The Canadian Food Inspection Agency (CFIA) has partnered with us to actively find solutions to this persistent problem,” said Hanner.
Published recently in the journal Food Research International, the study was conducted in collaboration with the Canadian Food Inspection Agency (CFIA).
Hanner is the associate Director for the Canadian Barcode of Life Network, headquartered at the Biodiversity Institute of Ontario, University of Guelph.
U of G researchers examined 203 samples from 12 key targeted species collected from various importers, processing plants and retailers in Ontario. Of the samples, 141 (69.5 per cent) were from retailers, 51 (25 per cent) from importers and 11 (5.5 per cent) from processing plants.
Researchers identified the samples using DNA barcoding. Developed at U of G, DNA barcoding allows scientists to determine species of organisms using a short, standardized region of genetic material.
The findings revealed 32 per cent of the samples overall were mislabelled. The mislabelling rate was 17.6 per cent at the import stage, 27.3 per cent at processing plants and 38.1 per cent at retailers.
Jackie Botts of Reuters writes that a Colombian veterinarian who surgically implanted liquid heroin inside live puppies to smuggle the drug into the United States was sentenced to six years in prison on Thursday.
Andres Lopez Elorez, 39, admitted conspiring to import heroin and will be deported to Colombia after his sentence, according to federal prosecutors in Brooklyn, New York.
“Every dog has its day, and with today’s sentence, Elorez has been held responsible for the reprehensible use of his veterinary skills to conceal heroin inside puppies as part of a scheme to import dangerous narcotics into the United States,” Richard Donoghue, U.S. Attorney for the Eastern District of New York, said in a statement.
According to prosecutors, between 2004 and 2005 Elorez leased a farm in Medellin, Colombia, where he reared dogs and sewed bags of liquid heroin into nine puppies for importation to the United States.
During a search of the farm in 2005, foreign law enforcement agents seized 17 bags of liquid heroin weighing nearly three kilograms (6.6 lb), including 10 bags extracted from the puppies. Three puppies died after contracting a virus following the surgeries, U.S. prosecutors said.
Joshua Mansour, M.D., a board-certified hematologist and oncologist in Stanford, California doing work in the field of hematopoietic stem cell transplantation and cellular immunotherapy (left, exactly as shown), writes in this contributed piece, from the beginning of medical school, one of the first things instructional videos that we had to watch during orientation was about social media and what not to do. There began this stigma and it was frowned upon to use social media if you were a healthcare provider.
There are the obvious things that physicians should not do, such as post private information about patients, show a patient’s face without their permission, or exploit medically sensitive information. But no one tells you what you can do and possibly what you actually should do.
There is a new wave that has now taken over that we as a healthcare community and a community as a whole should support, especially if it is meant to help others. Most recently I have approached social media in a different way and gone out to explore what is available as a tool to help others. What I’m finding has been mind-blowing and I am very excited to see where it continues to progress in the future.
People are sharing their journeys, inspiring others, raising awareness. There is a whole community of individuals working as a team to help others. It is incredibly inspiring.
Before recently I had thought of social media as being full of people only posting pictures of fun trips or nights out, throwing out their opinions out into the open for people to see. We now have social impact movements, live videos with question and answers for students, people showing their tough times and how they are overcoming them. People are reaching out to others for encouragement, collaborations, and progress. Using it to spread the message. With the busy days of many healthcare professionals, it is difficult for them to find the time to engage with social media and with others. There are many healthcare providers that are making an impact and finding the time to do it.
What we need to start teaching in medical school and in other schools in not only what not to do on social media, but how to use social media in a positive light. This is something that is happening and only continuing to grow. It is time to get on board but shine the light in a positive manner. Teach students from early what to do instead of only what not to do. You never know they may be able to influence people in a way like never before.
Recently I have recently been able to connect with others across the world and learn new things about medicine and how it is practiced in those locations. This will help me evolve as a physician as well and has helped my patients.
The roles of environmental reservoirs, including wild birds, in the molecular epidemiology of Campylobacter jejuni have not been assessed in depth.
Our results showed that game birds may pose a risk for acquiring campylobacteriosis, because they had C. jejuni genomotypes highly similar to human isolates detected previously. Therefore, hygienic measures during slaughter and meat handling warrant special attention. On the contrary, a unique phylogeny was revealed for the western jackdaw (right) isolates, and certain genomic characteristics identified among these isolates are hypothesized to affect their host specificity and virulence.
Comparative genomics within sequence types (STs), using whole-genome multilocus sequence typing (wgMLST), and phylogenomics are efficient methods to analyze the genomic relationships of C. jejuni isolates.
Population Genetics and Characterization of Campylobacter jejuni Isolates from Western Jackdaws and Game Birds in Finland Sara Kovanen, Mirko Rossi, Mari Pohja-Mykrä, Timo Nieminen, Mirja Raunio-Saarnisto, Mikaela Sauvala, Maria Fredriksson-Ahomaa, Marja-Liisa Hänninen and Rauni Kivistö
Appl. Environ. Microbiol. February 2019 85:e02365-18; Accepted manuscript posted online 14 December 2018, doi:10.1128/AEM.02365-18
Increasingly, routine surveillance and monitoring of foodborne pathogens using whole-genome sequencing is creating opportunities to study foodborne illness epidemiology beyond routine outbreak investigations and case–control studies.
Using a global phylogeny of Salmonella entericaserotype Typhimurium, we found that major livestock sources of the pathogen in the United States can be predicted through whole-genome sequencing data. Relatively steady rates of sequence divergence in livestock lineages enabled the inference of their recent origins. Elevated accumulation of lineage-specific pseudogenes after divergence from generalist populations and possible metabolic acclimation in a representative swine isolate indicates possible emergence of host adaptation.
We developed and retrospectively applied a machine learning Random Forest classifier for genomic source prediction of Salmonella Typhimurium that correctly attributed 7 of 8 major zoonotic outbreaks in the United States during 1998–2013. We further identified 50 key genetic features that were sufficient for robust livestock source prediction.
Zoonotic source attribution of Salmonella Enterica serotype typhimurium using genomic surveillance data, United States
January 2019
Emerging Infectious Diseases vol. 25 no. 1
Shaokang Zhang, Shaoting Li, Weidong Gu, Henk den Bakker, Dave Boxrud, Angie Taylor, Chandler Roe, Elizabeth Driebe, David M. Engelthaler, Marc Allard, Eric Brown, Patrick McDermott, Shaohua Zhao, Beau B. Bruce, Eija Trees, Patricia I. Fields, and Xiangyu Deng
Deborah Blum, one of my favorite writers, writes in National Geographic that ketchup—that cheerful red sauce sold in handy glass bottles—first came on the American market in the 19th century. But its ingredients were shockingly different than they are today.
Food advocates complained that the sauce was frequently made from tomato scraps thickened with ground pumpkin rinds, apple pomace (the skin, pulp, seeds, and stems left after the fruit was pressed for juice), or cornstarch, and dyed a deceptive red. One French cookbook author described the ketchup sold in markets as “filthy, decomposed and putrid.”
By the late 19th century, it would become less putrid, as manufacturers added chemical preservatives to slow decomposition in the bottle. But the real change—the invention of modern ketchup—occurred in the 20th century, and it’s a story of both politics and personality. It begins with an unlikely alliance between one of the country’s richest food manufacturers, Henry J. Heinz, and an underpaid federal chemist. The two men bonded over a mutual belief that unsafe and untrustworthy food was a growing national problem.
Harvey Washington Wiley’s position on the matter surprised no one. As chief of the U.S. Department of Agriculture’s chemistry bureau, Wiley had been pushing for food safety standards since the 1880s. At that time, his tiny department was the only federal division responsible for the country’s food quality. His chemists had exposed both widespread fraud—from gypsum in flour to brick dust in cinnamon—and a dismayingly reckless use of untested preservatives, ranging from formaldehyde to borax.
Heinz’s stance was a shock, especially to his fellow industrialists. He refused to fall in line with other US corporations, which were mostly moving to block any effort to establish food and drink standards. And to understand that, we need to take a look at the man himself as well as the successful businessman.
He was born in 1844 in Pittsburgh, the son of German immigrant parents. His parents, John and Anna Margaretha, were devout Lutherans; their children—Henry was the oldest of eight—were educated at a Lutheran school. Their mother insisted they live by Christian principles: “Do all the good you can. Do not live for yourself,” was one of her favourite sayings. It was also expected that the children would work hard and make a good living. That went without saying.
As a child Henry sold extra vegetables from the family’s kitchen garden to neighbours; by age ten he had his own garden and carried produce by wagon to local grocers. By the time he was a teen, he was delivering produce to the grocers by horse cart and also selling prepared horseradish in small glass jars. Many commercial varieties were sold then in coloured glass—sometimes for decorative purposes, sometimes because it obscured the contents. Young Heinz deliberately used clear glass so that customers could see the horseradish inside. By 1888, at age 44, he had his own food manufacturing business, the H.J. Heinz Company, and from there he never looked back.
Heinz’s company made some 60 products in 1896—and that would rise to 200 by the turn of the century. The company still offered horseradish but also pickles, ketchup, vinegars, chilli sauces, tomato sauce, mincemeat, fruit butters, baked beans, preserved cherries, mustard dressings, currant jelly, pineapple preserves, an assortment of mustards, canned pastas. Heinz was a master promoter—the company used everything from lighted billboards to painted wagons to displays at World Fairs to advertise its products.
But Heinz also believed that for promotion to succeed, the product itself had to be good, the manufacturer trustworthy. He allowed public tours of his Pittsburgh factory so that people could admire its cleanliness and well-treated workers. He built greenhouses to experiment with the best varieties of fruits and vegetables. He continued to use clear glass, rather than coloured, for his products. For his ketchup, he created one with an eight-sided base so customers could study the sauce from many angles.
And it was ketchup itself that would inspire him to go even further. …
In June 1906 the first two pieces of major consumer protection legislation in the United States—the Meat Inspection Act and the Pure Food and Drug Act—became law, laying the foundation for federal safety regulations.
And H.J. Heinz’s new, preservative-free ketchup was ready to go. As the company’s advertising campaign proclaimed, it was “recognised as the standard by Government pure food authorities.” It was also the new model for American ketchup—a thick mixture of politics, personality, a 20th-century acceptance that food safety matters, and of course, tomatoes.
Pulitzer Prize-winning journalist Deborah Blum is director of the Knight Science Journalism Program at MIT. Her books include The Monkey Wars and her latest, The Poison Squad.
However, one mum – who is tired of buying new toilet brushes every few months – has come up with a controversial idea to keep her toilet brush clean – and it’s certainly divided certain circles on the Internet.
Taking to UK site Mumsnet, the woman asks: “Would it be absolutely disgusting to… put loo brushes in the dishwasher on their own, on hot setting, followed by a hot wash on empty??!!!”
Um… yes, yes it would be absolutely disgusting. But maybe that’s just us because the most mind-blowing revelation to come out of the thread was that this woman was not alone.
“Of course it’s fine! Dishwashers temperature is set to kill all bugs. I wouldn’t and don’t even do a hot wash afterwards,” one replied.
“I do my four loo brushes, pots they go in, pots they stand on (it’s a whole contraption) every month in the dishwasher. It’s a full load, wouldn’t put anything else in with them,” another added.
There’s a yuck factor involved, so I reached out to my microbiological friends who agreed, yes there is a yuck factor, but it’s a fine procedure.
The bigger risk may be the drip drip carrying the brush to the dishwasher, so carry it in the holder, and put it in the dishwasher as well.
I’m all for legalization of marijuana and may have to move back to Canada because it’s legal for recreational use in the entire country.
Just kidding, I’m spoiled and couldn’t stand the snow; I like going to the ice hockey arena in flip-flops and shorts, like they do in Tampa.
But there are downsides to legalization.
Parents wouldn’t pack their kids’ lunches with whiskey and smokes, so why would a mom send pot-laced gummies in her’ kid’s lunch?
Probably forgot. I hear weed does that.
Jeff Truesdell of People reports an Ohio mom was arrested on child endangerment charges after her 9-year-old son brought marijuana-laced gummy bears from home to his elementary school, prompting alarm after 14 students who ate them became sick.
Cleveland police confirmed the arrest of the 27-year-old woman, whose name is being withheld by PEOPLE due to the nature of the charge against her.
The report of ill children brought officers and EMS workers to Anton Grdina School about 1:45 p.m. Monday. “Some of the students were complaining of upset stomachs but had no other signs of impairment,” a police report states.
“As a precaution today, we called EMS to examine several students to determine whether gummy bears shared with them by other students during lunch may have been marijuana-laced,” the school’s principal, Latosha Glass, said in a statement, reports News 5 Cleveland. “This precaution was taken because the packaging of the candy was not recognizable to us and appeared suspicious.”
The 9-year-old said his mom and aunt had thrown a party at their apartment on Sunday, where he said the gummies were given to him and other children by his aunt, who “had gotten drunk” and “was not in her right mind,” according to the police report.
After the boy was told to go to bed, his mother allegedly put the gummies on a table and told him not to touch them. But another child urged the boy to follow his mother into the kitchen and say he loved her, so the second child could take them, according to the report.
The children carried the gummies in their book bags to school on Monday. A school staff member cleaning up a room later found a zip-lock bag printed with wording that indicated the contents contained drugs. An EMS worker reported recovering the bag still containing three gummy bears and a plastic bottle containing several gummy worms and gummy bears.
Staff members at the school reviewed video footage to identify kids who were present when the gummies allegedly were handed out.
Those taken by EMS workers to a hospital for evaluation included four 5-year-olds, three 6-year-olds, one 8-year-old and the 9-year-old. The parents of five other students declined the EMS transport.
The New York case is the third known instance of an infection with RB51 associated with consuming raw milk or raw milk products produced in the United States. The other two human cases occurred in October 2017 in New Jersey and in August 2017 in Texas. Those cases reported drinking raw milk from an online retailer and a Texas farm, respectively. In addition to these three confirmed cases, hundreds of others were potentially exposed to RB51 during these three incidents.
