Not just Australia: Poland has an egg problem

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According to the European Centre for Disease Prevention and Control,  1,412 cases have been found associated with this outbreak: 532 confirmed and 166 probable cases since 1 February 2017 and 343 historical-confirmed and 367 historical-probable cases between 2012 and 31 January 2017. In addition, no dates have been reported for four outbreak-confirmed cases, so they are unclassifiable as current or historical cases (Table 1).

Table 1. Distribution of cases by case classification and country, EU/EEA, February 2012 to November 2018 (n=1 420; 4 cases missing date of onset or sampling or receipt at reference laboratory), as of 12 November 2018

 Reporting country  Confirmed cases       Probable cases          Historical-confirmed cases Probable-confirmed cases   Total number of cases

Belgium          0          46        14        127      187

Croatia           0          0          4          0          4

Czech Republic         0          6          0          3          9

Denmark       16        0          6          2          24

Finland           0          0          0          1          1

France 21        0          8          0          29

Greece            0          0          0          2          2

Hungary        0          29        0          5          34

Ireland           12        0          4          4          20

Ireland           1          0          0          0          1

Italy    0          12        1          19        32

Luxembourg 4          0          5          0          9

Netherlands  8          25        90        164      287

Norway         22        18        11        32        83

Poland            25        0          0          0          25

Slovenia         0          7          3          0          10

Sweden          11        20        12        2          45

United Kingdom      412      3          185      6          606

Total   532      166      343      367      1408

                          698                    710 

Most outbreak cases were reported during the summer months. Due to reporting delays, additional cases are expected to be reported with onset in recent months.

A total of 112 confirmed or historical-confirmed cases were reported with travel history in an EU country during the incubation period and therefore were likely infected there. Countries where infections likely took place were Poland (25 cases identified from 2016 to 2018), Bulgaria (22 cases from 2015 to 2018), Cyprus (14 cases in 2016 and 2018), Portugal (11 cases from 2015 to 2017) and Hungary (10 cases from 2016 to 2018). Additional travel-associated cases were also reported (<10 cases per country) with travel history to Austria, Belgium, Greece, Italy, the Netherlands, Romania, Slovenia and Spain.

The 2016 and 2017 European outbreak investigations identified eggs originating from Poland as the vehicle of infection in this outbreak (ECDC/EFSA rapid outbreak assessments published in March and December 2017). Outbreak-confirmed cases belong to four different WGS clusters.

And Scotland: Study could explain higher rates of E. coli O157 infection

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A subtype of E. coli O157 found in cattle may be responsible for higher rates of severe human infection in Scotland, report suggests.

E. coli O157 is a bacterium carried by cattle, which can cause life-threatening human infections when it enters the food chain. Scientists found that cattle in Scotland have a higher level of a subtype of E. coli O157 – PT21/28, which is known to cause more severe human infection.

It may be that local exposure to this particular subtype is a potential factor for the rates of people infected by E. coli O157 in Scotland being around three times higher than in England and Wales.

Researchers used Whole Genome Sequencing (WGS) to define which specific subtypes of E. coli caused an outbreak. For example, data obtained from WGS helped to understand whether a human infection is likely to have arisen from local farm animals or by a strain present in imported food or as a consequence of travel abroad.

The team have also combined WGS data with machine learning to predict which subtypes of E. coli O157 pose the greatest threat to human health.

The research also trialed a vaccine, developed to limit E. coli O157 excretion from and transmission between cattle. Results indicated that the vaccine may be effective in reducing human exposure and infection from E. coli O157.

However, before a vaccine can be made available, further work is needed to assess if it is practical and works in field situations.  Modelling by collaborators at Glasgow University indicates the vaccine would be an effective public health intervention.

The research, undertaken by a consortium of scientists led by The Roslin Institute, University of Edinburgh, the Moredun Research Institute, Scotland’s Rural College, University of Glasgow, Public Health England, NHS Lothian & United States Department of Agriculture (USDA) shows that the overall prevalence of E. coli O157 in cattle is similar across Great Britain, and has remained relatively consistent in Scotland over the last decade.

Food Standards Scotland and the Food Standards Agency published the results of this four-year project in a new report.

The study was a successful collaboration bringing together scientists in multiple disciplines to understand how common E. coli O157 is across farms in Great Britain and then sequencing approaches are used to determine how these bacteria relate to the ones causing human infections.

Strains present in Scottish cattle are more likely to be associated with serious illness in humans, possibly explaining the higher incidence of E. coli O157 infections in Scotland compared to England & Wales.

Phages be sexing up E. coli O157 in England and Wales

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We used whole-genome sequencing to investigate the evolutionary context of an emerging highly pathogenic strain of Shiga toxin–producing Escherichia coli (STEC) O157:H7 in England and Wales. A timed phylogeny of sublineage IIb revealed that the emerging clone evolved from a STEC O157:H7 stx-negative ancestor ≈10 years ago after acquisition of a bacteriophage encoding Shiga toxin (stx) 2a, which in turn had evolved from a stx2c progenitor ≈20 years ago. Infection with the stx2a clone was a significant risk factor for bloody diarrhea (OR 4.61, 95% CI 2.24–9.48; p<0.001), compared with infection with other strains within sublineage IIb. Clinical symptoms of cases infected with sublineage IIb stx2c and stx-negative clones were comparable, despite the loss of stx2c. Our analysis highlighted the highly dynamic nature of STEC O157:H7 Stx-encoding bacteriophages and revealed the evolutionary history of a highly pathogenic clone emerging within sublineage IIb, a sublineage not previously associated with severe clinical symptoms.

Highly pathogenic clone of shiga toxin-producing Escherichia coli O157:H7, England and Wales, December 2018

Emerging Infectious Diseases vol. 24 no. 12

Lisa Byrne, Timothy Dallman, Natalie Adams, Amy Mikhail, Noel McCarthy, and Claire Jenkins

https://wwwnc.cdc.gov/eid/article/24/12/18-0409_article

4 sick: Outbreak of listeria infections linked to pork products

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The U.S. Centers for Disease Control (CDC) and public health and regulatory officials in several states, and the U.S. Department of Agriculture’s Food Safety and Inspection Service (USDA-FSIS) are investigating a multistate outbreak of Listeria monocytogenes infections linked to pork products produced by 165368 C. Corporation, doing business as Long Phung Food Products.

On November 20, 2018, 165368 C. Corporation, doing business as Long Phung Food Products in Houston, TX recalled ready-to-eat pork products because they might be contaminated with Listeria.

Do not eat, sell, or serve recalled products from Long Phung Food Products.

The full list of recalled ready-to-eat pork patty rolls is on the USDA-FSIS website.

Recalled products are labeled with establishment number “EST. 13561” inside the USDA mark of inspection.

Recalled pork patty rolls were produced on various dates from May 21, 2018, through Nov. 16, 2018. These items were shipped to distributors and retail locations nationwide.

Return any recalled pork products to the store for a refund or throw them away. Even if some of the product was eaten and no one got sick, do not eat it. If you do not know if the pork product you purchased was recalled, ask the place where you purchased it or throw it away.

Wash and sanitize drawers or shelves in refrigerators and freezers where recalled pork products were stored. Follow these five steps to clean your refrigerator.

Retailers should clean and sanitize deli slicers and other areas where recalled pork products were prepared, stored, or served. Follow the manufacturer’s recommendations for sanitizer strength and application to ensure it is effective.

If you develop symptoms of a Listeria infection  after eating recalled pork products, contact a healthcare provider and tell them you ate recalled pork products. This is especially important if you are pregnant, age 65 or older, or have a weakened immune system.

Four people infected with the outbreak strain of Listeria monocytogenes have been reported from four states.

Listeria specimens from ill people were collected from July 1, 2017, to October 24, 2018.

Four people have been hospitalized. No deaths have been reported.

Epidemiologic and laboratory evidence indicates that pork products from 165368 C. Corporation, doing business as Long Phung Food Products are a likely source of the outbreak.

On November 20, 2018, 165368 C. Corporation, doing business as Long Phung Food Products recalled ready-to-eat pork products because they might be contaminated with Listeria.

This investigation is ongoing, and CDC will provide updates when more information is available.

 

Golden Ponds: Lawsuits proceed 2 years after 306 sickened in Rochester’s worst food poisoning outbreak

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On Thanksgiving Day in 2016, as many as 1,100 people ate their holiday dinner at Golden Ponds Restaurant and Party House, which was located just up Long Pond Road from the Greece Town Hall in Rochester, N.Y.

Within 24 hours, patrons began to experience stomach pain, cramping and diarrhea. Some were hospitalized and at least one underwent emergency surgery.

Eventually, 306 people who dined at Golden Ponds that day reported they had been sickened by the food, officials at the Monroe County Department of Public Health now say.

A public-health investigation later determined that the pernicious Clostridium perfringens bacteria that made people ill was in gravy that had been stored and served at an unacceptably low temperature.

“Rest assured there are a significant number of people who will never think of Thanksgiving the same way,” said Paul Vincent Nunes, a Rochester lawyer who has brought lawsuits against the defunct Greece restaurant. 

According to Steve Orr of the Democrat and Chronicle, here’s what’s happened since:

Golden Ponds is closed. The establishment at 500 Long Pond Road, which had been operated by Ralph Rinaudo for 33 years, was closed by the health department after the food poisoning episode. Improvements were made and the restaurant was allowed to open in late December. But business was predictably slow, and it closed for good in February 2017.

Rinaudo sold the property in January of this year to a corporation that shares the address of a Henrietta construction firm, Team FSI General Contractors. The building appears to be empty at present and future use of the property isn’t clear. Officials at FSI did not respond to a request for comment.

The health department has continued its practice of inspecting every restaurant once a year. It has not stepped up inspections of buffet-style eateries like Golden Ponds, spokesman Ryan Horey said. Inability to maintain food at the proper temperatures during buffet serving was key  factor in the Golden Ponds incident. The Democrat and Chronicle checked inspection records available on nydatabases.com for six Rochester-area buffet restaurants. Five of them have been cited by the health departments for serious violations involving foods being kept at the wrong temperature since the Golden Ponds episode.

Four lawsuits filed on behalf of 31 plaintiffs are pending against Golden Ponds. The four were consolidated into one case in July. Court-ordered mediation to seek a resolution before trial is set to begin soon. The cases are not suited for class-action status, as the damages incurred differed from one patron to the next, Nunes said.

Nunes said, “These were not just tummy aches. People were quite sick, some in the hospital. These are life-threatening events.”

Clemson researchers target vomit cleanup methods in new norovirus research

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Ever since that time in 2008 when one of Amy’s French students barfed in class, we’ve sorta been obsessed with, what is the proper way to clean up barf?

Especially if norovirus is involved.

The previous story gives an idea of just how infectious this stuff is.

Two Clemson researchers who are working with the federal government to combat stomach bug outbreaks among the elderly are convinced that advancements in this field could be lifesaving. 

Clemson University professors Angela Fraser and Xiuping Jiang catered their new norovirus research project to the needs of residents in long-term care facilities.

“I just think that those of us who are fortunate need to look out for those who are vulnerable,” Fraser said. “And this is a vulnerable population.”

One of the main goals of their new project, which recently received more than $1 million in funding from the federal Agency for Healthcare Research and Quality, is to come up with easy-to-implement, cost-efficient and effective vomit cleanup procedures for soft surfaces. The hope is that this will directly combat the high percentage of norovirus outbreaks in long-term care facilities and places with similar environments. 

The study, which has funding for three years, will be done in partnership with the Centers for Disease Control and Prevention, Emory University and the University of Illinois-Chicago.

In past studies on proper vomit cleanup, Fraser and Jiang learned that there were gaps in the research, particularly when it came to the proper disinfectant to use on soft services to prevent the spread of diseases.

Chlorine bleach, the most commonly used disinfectant, mainly worked on hard surfaces and could rarely be used on soft surfaces like carpets and couches. One of the areas they realized could benefit the most from this information was long-term care facilities. 

“Long-term facilities want to create a very homelike environment, so they have lots of carpet around in comparison to hospitals and other environments,” Jiang said.

They also, of course, tend to have a high number of older adults.

“That’s people’s living environment,” Fraser said. “Do you really want people to be living where everything is just cinder block or smooth walls?”

She said because older patients are more likely to have chronic diseases, their immune systems are typically weakened as well. This means that when these older adults get infected with diseases like the norovirus, there can be a more severe expression of the disease compared to someone younger. Because of all of these factors, some view the study as even more imperative.

 

Multiple modes of transmission during a Thanksgiving Day Norovirus outbreak, 2017

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The U.S. Centers for Disease Control reports on November 28, 2017, the manager of restaurant A in Tennessee reported receiving 18 complaints from patrons with gastrointestinal illness who had dined there on Thanksgiving Day, November 23, 2017. Tennessee Department of Health officials conducted an investigation to confirm the outbreak, assess exposures, and recommend measures to prevent continued spread.

On November 23, one patron vomited in a private dining room, and an employee immediately used disinfectant spray labeled as effective against norovirus* to clean the vomitus. After handwashing, the employee served family-style platters of food and cut pecan pie. For the November 23 Thanksgiving Day, restaurant A served 676 patrons a limited menu from 11 a.m. to 8 p.m. The manager provided contact information, seating times, and seating locations for 114 patrons with reservations. All patrons with contact information were telephoned, and a questionnaire was used to assess illness and exposures for anyone living in the household who ate at restaurant A on November 23. Stool specimens were requested from ill patrons. Among the 676 patrons, 137 (20%) were enrolled in a case-control study.

A probable case was defined as diarrhea (three or more loose stools in 24 hours) or vomiting within 72 hours of eating at restaurant A on November 23; probable cases with norovirus RNA detected in a stool specimen by real-time reverse transcription–polymerase-chain reaction (RT-PCR) were considered confirmed. On November 30, environmental swabs for norovirus testing were collected in the restaurant. Patient and environmental samples were tested by real-time RT-PCR and sequenced at the Tennessee State Public Health Laboratory.

Thirty-six (26%) case-patients (two confirmed and 34 probable) and 101 (74%) controls were enrolled in the case-control study. Illness onsets occurred during November 23–25, with 17 of 35 (49%) cases occurring on November 24. The mean incubation period was 31 hours (range = 2.5–54.5 hours), and the mean illness duration was 3 days (range = 0–6 days). Only one case-patient sought medical care. Diarrhea was reported by 33 (94%) case-patients, fatigue by 29 (83%), nausea and abdominal cramps by 28 (80%), vomiting by 24 (69%), and fever by six (17%).

Among menu items, only pecan pie was significantly associated with illness (odds ratio [OR] = 2.6; 95% confidence interval [CI] = 1.1–5.8); however, it was eaten by only 16 (47%) of 34 case-patients. The vomiting event occurred around noon; patrons seated during 11 a.m.–1 p.m. were significantly more likely to become ill than were patrons seated during other times (OR = 6.0; 95% CI = 2.6–15.3). No significant differences between dining locations (i.e., private dining room versus general seating) were identified (OR = 1.4; 95% CI = 0.4–4.3). Logistic regression was used to evaluate the effects of eating pecan pie, seating time, and seating location; only seating time during 11 a.m.–1 p.m. remained statistically significant (OR = 6.0; 95% CI = 2.2–16.5).

Stool specimens from two case-patients identified Norovirus GII.P16-GII.4 Sydney. Norovirus GII was identified in one environmental swab collected from the underside of a table leg adjacent to the vomitus.

A point-source norovirus outbreak occurred after an infected patron vomited in a restaurant. Transmission near the vomiting event likely occurred by aerosol or fomite. Norovirus spread throughout the restaurant could have occurred by aerosol, person-to-person, fomite, or foodborne routes. Inadequate employee handwashing likely facilitated foodborne transmission through servings of pecan pie.

In hospital settings, CDC and the Tennessee Department of Health recommend contact precautions (e.g., gloves and gowns) when personnel have contact with vomitus (1). Similarly, the Food and Drug Administration’s 2017 Food Code recommends restaurants have a written plan detailing when and how employees should use personal protective equipment for cleaning vomitus (2). Reinforcing the need for proper handwashing and performing thorough environmental cleaning with appropriate personal protective equipment in food service establishments can prevent or mitigate future outbreaks.

Acknowledgments

Teresa Vantrease, Jana Tolleson, Tiffany Rugless, Lee Wood, Anita Bryant-Winton, Heather Mendez, Jeannette Dill, Alan Pugh, Jason Pepper, Katie Nixon, Marcy McMillian, Jane Yackley; FoodCORE Interview Team; staff members from restaurant A.

Corresponding author: Julia Brennan, JBrennan@cdc.gov, 615-253-9971.

1Epidemic Intelligence Service, CDC; 2Division of Scientific Education and Professional Development, CDC; 3Communicable and Environmental Diseases and Emergency Preparedness, Tennessee Department of Health; 4Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee.

All authors have completed and submitted the ICMJE form for disclosure of potential conflicts of interest. William Schaffner reports personal fees from Pfizer, Merck, Dynavax, Seqirus, SutroVax, and Shionogi, outside the submitted work. No other potential conflicts of interest were disclosed.

* Active ingredients = n-Alkyl dimethyl benzyl ammonium chlorides and n-Alkyl dimethyl ethylbenzyl ammonium chlorides.

FDA’s update on Romaine-linked outbreak investigation – it is California stuff

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The normal folks who I hang out with at the hockey arena have already started asking when they can start eating Romaine again (who knew there were so many Caesar fans).

FDA’s answer to when is soon

Some places never stopped serving it. 

Earlier today I told Korin Miller at Yahoo the below:

If you happen to visit a restaurant that tries to claim its romaine is safe, it’s really best to avoid the food. “I would send it back,” Benjamin Chapman, an assistant professor and food safety extension specialist at North Carolina State University, tells Yahoo Lifestyle. “When the CDC comes out with a message that says ‘Don’t eat romaine lettuce,’ you should heed that advice,” he says. “Right now, we don’t have any indication that it’s romaine from any certain part of the country or a certain company. It’s a standing blanket statement.”

And now we’ve got more information (that’s how quickly this stuff moves).

FDA announced late today that they have narrowed their investigation to field grown Romaine from Central Coast growing regions of northern and central California.

All other lettuce is as safe as it was last week before the announcement.

FDA is taking things a step further, in a really positive way in concept – asking producers to label where it came from.

Based on discussions with producers and distributors, romaine lettuce entering the market will now be labeled with a harvest location and a harvest date or labeled as being hydroponically- or greenhouse-grown. If it does not have this information, you should not eat or use it.

There is no recommendation for consumers or retailers to avoid using romaine lettuce that is certain to have been harvested from areas outside of the Central Coast growing regions of northern and central California. For example, romaine lettuce harvested from areas that include, but are not limited to the desert growing region near Yuma, the California desert growing region near Imperial County and Riverside County, the state of Florida, and Mexico, does not appear to be related to the current outbreak. Additionally, there is no evidence hydroponically- and greenhouse-grown romaine is related to the current outbreak.

During this new stage of the investigation, it is vital that consumers and retailers have an easy way to identify romaine lettuce by both harvest date and harvest location. Labeling with this information on each bag of romaine or signage in stores where labels are not an option would easily differentiate for consumers romaine from unaffected growing regions.

‘Turds’ flow through NZ bistro-days after $150,000 fit-out

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Hamish McNeilly of Stuff reports a new bistro in Otago that opened less than two weeks ago has been forced to close because of “turds, toilet paper, and p….”.

The word is poop.

Tap & Dough owner Norma Emerson is unsure when, or even if, the fledgling Middlemarch business will open its doors again.

Business had been “going well” until Tuesday night, Emerson said.

Otago bistro Tap & Dough opened on November 10, but was forced to close after floodwater and sewage flowed through the building.

“We expected to see, at the most, a little water in. What we did not expected was the sewage.”

Just metres from the business at the corner of Mold St and Snow Ave, raw sewage overflowed in the rising waters.

Floodwater and raw sewage flowed through The Tap & Dough.

Emerson and her brewer husband, Richard, spent about $150,000 fitting out the leased property, which opened on November 10.

But on Wednesday, decontaminating contractors were removing carpets, wall linings and wood panelling.

“This is a major job. We had turds in here, and all over the carpet.”

When she realised raw sewage was “lapping” at the doors on Tuesday, she called for help.

“I did what any reasonable citizen would do, and rung emergency services”.

Emerson said she was upset by a comment from local Strath Taieri board chairman Barry Williams as volunteers from the fire brigade helped pump water from the bistro.

“He went to the fire brigade and said ‘why are the Emerson’s getting preferential treatment?”‘

“Do I not have a right to protect my property, I’m furious about that.

“It is an emergency when s…., turds, toilet paper, and p…. flow through your door at an eating establishment, at which you have just spent $150,000 on refurbishing.”

The word is shit.

Williams told Stuff he did not recall the incident unfolding that way.

“That’s bloody strange,” he said.

He maintained he asked the volunteer firefighters to pump the excess water into an open ditch, rather than the side of the street.

Williams said he hoped to clear the air with Emerson, “or she could call me”.

It was one of several businesses impacted by sewage in the town, a popular start/finishing point for the Otago Central Rail Trail – about 80km from Dunedin.

On Tuesday a Dunedin City Council spokeswoman said three streets in Middlemarch were closed due to surging from the wastewater network, with a pump used to provide extra capacity.

Food Safety Talk 170: Pants Pants Pants!

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The show opens with a discussion of technology and cyber Monday, before segueing to Ben’s missing tooth. From there the guys do a deep dive into the recent E. coli O157:H7 in romaine lettuce outbreak before turning to listener feedback. They cover heating breastmilk, putting bleach on the food of homeless people, temperature monitoring devices, proper methods for thawing turkey, reconditioning cutting boards, and air quality of dairy processing plant all based on listener feedback. Buckle up, this is a bonus sized episode.

You can download episode 169 here and at iTunes.

Show notes so you can follow along at home: