Norovirus outbreak, including a death, linked to Kansas Meals on Wheels; handwashing issues cited

Posted on January 14, 2015 by Ben Chapman

When I was a kid I used to visit my grandparents in Campbellford,Ontario (that’s in Canada) a bunch. My grandparents lived most of their lives in Toronto (that’s also in Canada) but had retired to this town about 2hrs outside of the city.

My grandparents were into community stuff: volunteering for the hospital auxiliary, organizing charity curling bonspiels and golf tournaments and driving some of their more elderly neighbors to doctor’s appointments.

And my grandfather drove around some food for Meals on Wheels.

I remember being about 8 and going on his route one spring break morning. He grabbed some already-food-filled covered trays and then took a bunch of apples and oranges in bulk. This was before I knew anything about food safety; I didn’t really notice anything about bare hand contact or handwashing.

According to chanute.com, a norovirus outbreak, tragically including a death, has been linked to a Meals on Wheels service in Kansas.

It has been confirmed by the Kansas Department of Health and Environment that the source of the norovirus outbreak in the Neosho County area last week was Meals on Wheels in southeast Kansas.

KDHE Health Programs Public Information Officer Aimee Rosenow said the numbers of confirmed ill have not changed since Friday when there were 29 confirmed ill.

Rosenow said epidemiology staff are still working on the case to narrow down the source of infection.

A Jan. 8 food safety inspection of the Chanute Senior Services of SEK facility found problems with hand washing and properly arranging food in coolers to avoid cross-contamination. Samples were also taken of all food from the batch delivered Jan. 6.

KDHE Public Health Public Information Officer Aimee Rosenow said KDHE does not have an autopsy report confirming the cause of death as Norovirus infection and cannot release the name of the deceased.

“We do know that the patient was ill and has been served by this program,” she said.

Over the past year UNC-Chapel Hill food policy student (and frequent barfblog contributor) Ashley Chaifetz has been researching food handling practices and infrastructure at food pantries in North Carolina (as part of a USDA CAP grant on STECs). Volunteers provide a particular challenge for food safety as they may be transient and have varying food safety values.

Nine people choke to death eating rice cakes in Japan

Posted on January 5, 2015 by Douglas Powell

Japan’s habitual New Year killer has struck again, after nine people were reported to have died in recent days from choking on rice cakes.

Mochi – glutinous cakes of pounded rice – are traditionally eaten in vast quantities over the holidays, usually in soup, or toasted and served with sweet soy sauce and wrapped in dried seaweed.

Several people die eating the starchy delicacy every January, but this year the number is particularly high.

Local media reported that nine people had died over the holidays, while 13 others were in a serious condition in hospital.

‘In my field, likely is not the same as layman term of likely’ Singapore court questions source of 4-year-old’s death from Salmonella

Posted on January 3, 2015 by Douglas Powell

A boy of four who died after contracting Salmonella did not necessarily get it from a nasi padang stall where his mother bought food, a court heard.

At a further inquest into the death of Shayne Sujith Balasubraamaniam on Jan 22 last year, State Coroner Marvin Bay found that it was only a “likelihood” that he contracted the infection from food consumed at the stall.

He, his mother and two- year-old sister suffered fever, diarrhoea and vomiting on Jan 19, a day after eating food bought from Kopitiam food court in Northpoint shopping centre.

His mother had bought home tahu goreng for him, and rice, chicken curry and bergedil (potato cutlets) for the three of them on Jan 18.

All three were taken to a polyclinic where Shayne was assessed to be severely dehydrated and prescribed medication.

He showed signs of recovery on Jan 21 but his condition worsened the next day. The cause of death was primarily consistent with salmonella septicaemia.

Two days later, the implicated food stall was inspected and found to have hygiene lapses.

The stallholder, Madam Siti Abibah Guno, was fined a total of $1,400 last month for failing to register a food handler, and protect food in a covered receptacle.

She has since cancelled her foodstall licence after Kopitiam terminated her tenancy agreement in November.

Recalled to the stand yesterday, Dr Hishamuddin Badaruddin, assistant director at the Health Ministry’s Communicable Diseases Division, could not conclude 100 per cent that the source of infection was the nasi padang stall.

The further hearing was held as the State wanted the court to clarify the coroner’s phrasing last October that it was “highly likely” the family had contracted the infection from the stall.

At the last hearing, Dr Hishamuddin had said lapses such as the way food was prepared could have contributed to bacterial growth, particularly the practice of partial cooking and refreezing of chicken parts.

He testified yesterday that the results of environmental swabs showed no salmonella in the stall nor in the food samples taken.

While there was salmonella bacteria found in the three family members, there was nothing else to link it to the stall.

He agreed with State Counsel Zhou Yihong, who assisted in the inquiry, that although he used the word “likely”, this likelihood of bacteria found in the cases was actually quite low.

“In my field, the word likely is not the same as the layman term of likely,” he said.

‘Cosmetic’ milk in Australia: Raw milk remains untested

Posted on December 14, 2014 by Douglas Powell

Raw milk producers are not being subjected to the same rigorous testing as dairy farmers who produce milk for human consumption.

United Dairy Farmers of Victoria president Tyran Jones said milk from dairy farms was subjected to stringent tests to ensure its safe consumption, but no such tests existed for “raw” milk or “bath” milk.

Mr Jones said milk from his Gruyere farm, 50km northeast of Melbourne, went straight into a refrigerated vat to be chilled to 4C. “It is tested daily for bacteria. The milk factory takes a sample and sends if off for independent testing every day,” he said.

His comments come after a three-year-old child died and several others fell ill after drinking “bath” milk from Victoria’s Mountain View Organic Dairy, which is sold as a cosmetic product but has been stored next to consumables in many Victorian stores.

Craig Dalton of The Conversation writes that the Australian Competition and Consumer Commission (ACCC) has been investigating the role of microbiological contamination in cosmetic injuries, which has resulted in recalls in some instances. ACCC Deputy Chair Delia Rickard recently noted that cosmetic surveys revealing microbiological contamination were a timely reminder as the trend to produce all natural and all organic products may increase pressure on manufacturers to produce cosmetics with less preservatives or less effective natural preservatives.

Complicating this issue is that bath milk is often sold in containers that look just like drinking milk containers and may be stored in refrigerators alongside drinking milk. This may provide a false sense of security leading people to believe it is a food or as safe as a food.

Nevertheless, raw milk apologist are out in force, with David Gumpert writing, the vultures are circling in force with news that an Australian three-year-old may have died from drinking raw milk.

This is news raw milk opponents have lusted after for many years, and now they mean to use it for full effect, tying it to a new study from the U.S. Centers for Disease Control that suggests illnesses from raw milk are rising. Even though raw milk is already highly restricted in Australia, there are calls for a complete ban now that raw milk has been “proven” by this death to be unacceptably risky.

Most intriguing, the farmer accused of producing the milk that led to the three-year-old boy’s death says he has been told the child was seriously ill before drinking raw milk. The child’s parents may have been providing raw milk in hopes of improving the child’s health.

Um, what about the other three kids under five-years-old who developed hemolytic uremic syndrome but have (sorta) recovered?

I child dead, 4 sick in Australia from raw milk; US says outbreaks quadrupled

Posted on December 11, 2014 by Douglas Powell

Amidst reports that the number of U.S. outbreaks caused by non-pasteurized milk increased from 30 during 2007–2009 to 51 during 2010–2012, a child in Victoria (that’s in Australia) has died and four have become ill from raw milk.

Unpasteurised milk is illegal to sell for human consumption in Australia, but the product consumed by the child was classed as cosmetic so was allowed on the shelves.

The child recently died on the Mornington Peninsula after drinking what was marketed as a cosmetic product and labeled “bath milk”, the Victorian Health Department said.

The U.S. Centers for Disease Control and Prevention said Wednesday that the average number of outbreaks from contaminated unpasteurized milk more than quadrupled from three a year between 1993 to 2006 to about 13 between 2007 and 2012.

Overall, there were 81 outbreaks in that last period, sickening nearly 1,000 people, including 73 who were hospitalized. The CDC said that more than 80 percent of the illnesses happened in states where retail sales of raw milk are legal.

Most outbreaks were caused by Campylobacter spp. (77%) and by nonpasteurized milk purchased from states in which nonpasteurized milk sale was legal (81%). Regulations to prevent distribution of nonpasteurized milk should be enforced.

Pasteurization is an effective way to improve milk safety; however, in the United States, illness related to consumption of nonpasteurized milk continues to be a public health problem. The first statewide requirements that dairy products be pasteurized were enacted in Michigan in 1948 (1). In 1987, the US Food and Drug Administration banned the interstate sale or distribution of nonpasteurized milk. However, the laws regulating intrastate sales are set by each state (2). Regulations for intrastate sales of nonpasteurized milk vary from complete bans to permitting sales from farms or retail outlets (2). Even in states in which sale of nonpasteurized milk is illegal, milk can often be obtained through other means. For example, some states allow cow-share or herd-share agreements, in which buyers pay farmers a fee for the care of a cow in exchange for a percentage of the milk produced (3,4).

Consumption of nonpasteurized milk has been associated with serious illnesses caused by several pathogens, including Campylobacter spp., Shiga toxin–producing Escherichia coli, and Salmonella enterica serotype Typhimurium (3,4). Despite the health risks associated with consuming nonpasteurized milk, the demand for nonpasteurized milk has increased (3,5,6). Recently, many state legislatures have considered relaxing restrictions on the sale of nonpasteurized milk (2,6). We report that the number of outbreaks associated with nonpasteurized milk increased from 2007 through 2012.

The Study

A foodborne disease outbreak is defined as the occurrence of >2 cases of a similar illness resulting from ingestion of a common food. State and local health departments voluntarily report outbreaks to the Foodborne Disease Outbreak Surveillance System of the Centers for Disease Control and Prevention through a standard web-based form (www.cdc.gov/nors). We reviewed outbreaks reported during 2007–2012 in which the food vehicle was nonpasteurized milk. Outbreaks attributed to consumption of other dairy products made with nonpasteurized milk, such as cheese, were excluded. We analyzed outbreak frequency, number of illnesses, outcomes (hospitalization, death), pathogens, and age groups of patients. Data on the legal status of nonpasteurized milk sales in each state were obtained from the National Association of State Departments of Agriculture (7–9) and an online search of state regulations. The sources from which nonpasteurized milk was obtained or purchased were categorized according to the description from the state outbreak reports, when available.

During 2007–2012, a total of 81 outbreaks associated with nonpasteurized milk were reported from 26 states. These outbreaks resulted in 979 illnesses and 73 hospitalizations. No deaths were reported. The causative agent was reported for all outbreaks. Of the 78 outbreaks with a single etiologic agent, Campylobacter spp. was the most common pathogen, causing 62 (81%) outbreaks, followed by Shiga toxin–producing E. coli (13 [17%]), Salmonella enterica serotype Typhimurium (2 [3%]), and Coxiella burnetii (1[1%]) (Figure 1). Three outbreaks were caused by multiple pathogens (Figure 1). The number of outbreaks increased from 30 during 2007–2009 to 51 during 2010–2012. During 2007–2009, outbreaks associated with nonpasteurized milk accounted for ≈2% of outbreaks with an implicated food; during 2010–2012, this percentage increased to 5%. The number of outbreaks of Campylobacter spp. infection also increased, from 22 during 2007–2009 to 40 during 2010–2012.

How milk was obtained was reported for 68 (84%) outbreaks. Nonpasteurized milk was obtained from dairy farms (48 [71%] outbreaks), licensed or commercial milk sellers (9 [13%]), cow- or herd-share arrangements (8 [12%]), and other sources (3 [4%]). Of the 81 outbreaks, 66 (81%) were reported from states where the sale of nonpasteurized milk was legal in some form: Pennsylvania (17 outbreaks), New York, Minnesota (6 outbreaks each), South Carolina, Washington, and Utah (5 outbreaks each). A total of 15 (19%) outbreaks were reported in 8 states in which sales were prohibited. Among these outbreaks, the sources of nonpasteurized milk were reported as a dairy farm (6 outbreaks), cow or herd share (4 outbreaks), and unknown (5 outbreaks).

Conclusions

Within this 6-year period, the number of outbreaks associated with nonpasteurized milk increased. The number of outbreaks caused by Campylobacter spp. nearly doubled. The average number of outbreaks associated with nonpasteurized milk was 4-fold higher during this 6-year period (average 13.5 outbreaks/year) than that reported in a review of outbreaks during 1993–2006 (3.3 outbreaks/year) (4). This increase was concurrent with a decline in the number of states in which the sale of nonpasteurized milk was illegal, from 28 in 2004 to 20 in 2011 (7–9) and with an increase in the number of states allowing cow-share programs (from 5 in 2004 to 10 in 2008) (8,9). The decision to legalize the sale of nonpasteurized milk or allow limited access through cow-share programs may facilitate consumer access to nonpasteurized milk (5). The higher number of outbreaks in states in which the sale of nonpasteurized milk is legal has been reported elsewhere (4).

The legal status of nonpasteurized milk sales in 1 state can also lead to outbreaks in neighboring states. In a 2011 outbreak of Campylobacter spp. infections associated with nonpasteurized milk in North Carolina, where sales of this product were prohibited, milk was purchased from a buying club in South Carolina, where sales were legal. Another outbreak of Campylobacter spp. infection in 2012 implicated nonpasteurized milk from a farm in Pennsylvania, where sales are legal; cases from this outbreak were reported from Maryland, West Virginia, and New Jersey, all of which prohibit sale of raw milk (10). All patients residing outside Pennsylvania had traveled to Pennsylvania to purchase the milk (10).

Outbreaks associated with nonpasteurized milk continue to pose a public health challenge. Legalization of the sale of nonpasteurized milk in additional states would probably lead to more outbreaks and illnesses. This possibility is especially concerning for vulnerable populations, who are most susceptible to the pathogens commonly found in nonpasteurized milk (e.g., children, senior citizens, and persons with immune-compromising conditions). Public health officials should continue to educate legislators and consumers about the dangers associated with consuming nonpasteurized milk; additional information can be obtained at http://www.cdc.gov/foodsafety/rawmilk/raw-milk-index.html. In addition, federal and state regulators should enforce existing regulations to prevent distribution of nonpasteurized milk.

Ms Mungai is a surveillance epidemiologist at the Atlanta Research and Education Foundation and at the Centers for Disease Control and Prevention. Her interests include infectious disease epidemiology and food safety.

References

Steele JH. History, trends and extent of pasteurization. J Am Vet Med Assoc. 2000;217:175–8 . DOI PubMed

Weisbecker A. A legal history of raw milk in the United States. J Environ Health. 2007;69:62–3 .PubMed

Oliver SP, Boor KJ, Murphy SC, Murinda SE. Food safety hazards associated with consumption of raw milk. Foodborne Pathog Dis. 2009;6:793–806. DOI 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. DOI PubMed

Buzby JC, Gould LH, Kendall ME, Timothy FJ, Robinson T, Blayney DP. Characteristics of consumers of unpasteurized milk in the United States. J Consum Aff. 2013;47:153–66.

David SD. Raw milk in court: implications for public health policy and practice. Public Health Rep. 2012;127:598–601 .PubMed

National Association of State Departments of Agriculture. NASDA releases raw milk survey 2011 [cited 2012 Nov 2]. http://www.nasda.org/file.aspx?id=3916

National Association of State Departments of Agriculture. Dairy division of national association of state departments of agriculture raw milk survey, November, 2004 [cited 2012 Nov 2]. http://www.nasda.org/File.aspx?id=1582

National Association of State Departments of Agriculture. NASDA releases raw milk survey 2008. [cited 2012 Nov 2]. www.nasda.org/File.aspx?id=2149

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. DOI PubMed

Suggested citation for this article: Mungai EA, Behravesh CB, Gould LH. Increased outbreaks associated with nonpasteurized milk, United States, 2007–2012. Emerg Infect Dis [Internet]. 2015 Jan [date cited]. http://dx.doi.org/10.3201/eid2101.140447

1 child dead: Safety of food a mystery – even to Cambodia gov’t

Posted on December 10, 2014 by Douglas Powell

In Tbong Khmum, an otherwise reportedly healthy 6-year-old girl’s death, after eating snacks suspected to be contaminated, has prompted a local food-poisoning scare and raised larger questions about the safety of Cambodia’s food distribution.

On November 15, three girls in Dambe district started seizing and vomiting, according to the district authorities.

One of the girls was particularly badly affected. After 24 hours of severe gastrointestinal symptoms and convulsing, her parents headed to the provincial hospital, but she died before a doctor could see her, the village chief told the Post.

Though no cause of death has been confirmed, local officials blamed two packaged imported snacks the girls shared hours before becoming ill.

The village chief confiscated the remaining packages for sale, and the provincial Health Department sent samples to labs in Phnom Penh. But after two weeks, the samples failed to test positive for a contaminant, which didn’t surprise the health workers.

“Cambodia doesn’t have lab equipment for checking this kind of sample,” said Keo Vannak, director of the provincial Health Department, adding that the treats have been sent abroad for better analysis.

While questions remain about what caused the girls’ sickness, the village is in a panic about its food supply.

“Our villagers are scared to buy packaged foods,” said Phath Sath, the village chief.

Despite confronting an enormous problem of nutrient wastage through diarrheal diseases – which kill millions annually – there is no “coordinated program of food surveillance and little analytical data regarding microbiological or chemical contamination of food” in Cambodia, the government says.

Maybe something is lost in translation: 4-year-old’s death a misadventure

Posted on October 30, 2014 by Ben Chapman

Kids dying from foodborne illness hits me like a punch in the gut. After following illnesses and outbreaks for 15 years I still take pause to think about my kids when I see a tragic story involving children.

Outbreaks rarely end with the classic smoking gun resolution (a genetically matched strain in the food/environment and stool). Epidemiology, in the absence of pathogen matches, is king and uncertainty is reduced with reliable data and statistics. Once a possible food/site match is made, investigators go out to the field and check the food handling out.

A conscientious investigator can talk about possible risk factors in a report – but the subsequent reporting and broken telephone game of sharing the information can bleed potential factors into must-have-happened fact.

A few years ago an environmental health officer shared her concerns about how the story gets changed between the field and the report interpretation. She had investigated a outbreak blamed on poor handwashing shared with me that her notes showed no soap at the time she was in the kitchen a week after the illnesses were reported – that was translated into poor handwashing by the staff at the time of the outbreak.

She felt that was an extrapolation wrought with assumptions.

Folks who used the example didn’t care.

Getting the risk factor story right really matters.

According to the Straits Times a four-year-old boy in Singapore tragically died from salmonellosis and court proceedings point to food handling practices a shopping center food court stall. Based on the coverage, I’m not sure it’s that simple. And I wouldn’t call it a misadventure.

Shayne Sujith Balasubraamaniam, together with his mother and two-year-old sister, came down with food poisoning on Jan 19 this year, a day after his mother had bought food, including tahu goreng and curry chicken, from a nasi padang stall at Kopitiam food court at Northpoint Shopping Centre.

All three were taken brought to Bukit Batok Polyclinic the next day. Shayne was assessed to be severely dehydrated and was prescribed medication.

He showed apparent signs of recovery, but deteriorated on Jan 22 when his mother found him unconscious at home. He died in hospital about two hours later from salmonella septicaemia.

On Thursday, State Coroner Marvin Bay said in his findings that the boy’s death underscores that careless food handling and inattention to proper hygienic practices can result in catastrophic consequences on young and vulnerable persons. He found the boy’s death to be one of misadventure.

The most significant lapse, the inquiry heard, was the practice of partial cooking and refreezing of chicken parts. The kitchen would receive 80 parts of chicken as a batch. After washing the batch, 60 chicken parts were refrozen for use the next day. They would be stored with plastic bags with other raw food at the freezer, a practice which would encourage cross-infection between the raw and partially cooked food. Swabs from the tongs used to handle food, and the blender found a high concentration of bacteria that exceeded safety limits.

While the post-outbreak investigation demonstrates serious issues with food handling at the business, I’m not sure what was presented is enough to link the salmonellosis. If the stored chicken was partially cooked it implies that it would be further cooked – which if temperatures exceeded 165F would result in a 5-log reduction of Salmonella. Maybe cross contamination between raw and sorta raw chicken is really a factor – especially if there weren’t other illnesses. Or maybe the washing step spread pathogens around the kitchen.

‘Children come to our schools to get support, not to leave in stretchers’ Third child dies in suspected food poisoning case in South Africa

Posted on September 26, 2014 by Douglas Powell

Cake provided by a community member may have resulted in the deaths of three children in Winterveldt, north of Pretoria.
It was earlier reported that three children died after eating food provided through a state feeding scheme at the Ema Primary School.

But Gauteng Education MEC Panyaza Lesufi says a preliminary report indicates that all three of the children had also eaten food from a non-feeding scheme source.

“From the feeding programme we provided yesterday, dough or bread was not part of the menu. It emerged that they ate cake, and we did not provide cake. Late last night a granny came forward to say she had provided the cake.” Police are now interrogating the woman.

The three girls, aged between 6 and 8, died at a local clinic shortly after falling ill at the primary school yesterday.

Lesufi has ordered an investigation into the incident and says other pupils who ate the government supplied food have been observed overnight and are in good health.

“I’m speechless. Children come to our schools to get support, not to leave our schools in stretchers. I’m saddened and don’t have words to describe this. I will investigate this.”

Not another: Washington 3-year-old girl dies after contracting E. coli

Posted on September 10, 2014 by Douglas Powell

She was a fun-loving girl excited to start preschool. But instead, 3 1/2 year old Brooklyn Hoksbergen ended up in the hospital last week after contracting E. coli. Her family tells KING 5 she passed away Friday.

Her father, Rob Hoksbergen, says they do not know how or where Brooklyn became sick. She was admitted to Children’s Hospital Wednesday, and initially showed signs of improvement. But doctors tell the family she took a sudden turn for the worse and passed away.

Brooklyn was the youngest of four daughters. No one else in the family is ill. Her funeral is Friday.

Four-year-old Serena Profitt died Monday in Oregon from E. coli.

Chef in China killed by decapitated cobra

Posted on August 24, 2014 by Douglas Powell

A chef preparing a dish made from cobra flesh died after the snake bit his hand – 20 minutes after he had severed it from its body.

Peng Fan from Foshan, Guangdong province, southern China, had been preparing a special dish made from Indochinese spitting cobra, a rare delicacy.

It was as he went to chuck the cobra’s head in the bin that it bit him, injecting Mr Peng with its flesh-killing, neurotoxic venom.

The snake was being diced up to be made into snake soup, which is a delicacy in Guangdong and a much sought after dish in the province’s high-end restaurants.

Restaurant guest Lin Sun, 44, who was in the restaurant with his wife Su at the time said: “We were in the restaurant having a meal for my wife’s birthday when suddenly there was a lot of commotion.

Victims of the Indochinese spitting cobra generally asphyxiate after the neurotoxin paralyses their respiratory system.

barfblog

safe food from farm to fork

Tag Archives: Death