In an ongoing effort to understand sources of foodborne illness in the United States, the Interagency Food Safety Analytics Collaboration (IFSAC) collects and analyzes outbreak data to produce an annual report with estimates of foods responsible for foodborne illnesses caused by pathogens. The report estimates the degree to which four pathogens – Salmonella, E. coli O157, Listeria monocytogenes, and Campylobacter – and specific foods and food categories are responsible for foodborne illnesses.
The Centers for Disease Control and Prevention (CDC) estimates that, together, these four pathogens cause 1.9 million foodborne illnesses in the United States each year. The newest report (PDF), entitled “Foodborne illness source attribution estimates for 2017 for Salmonella, Escherichia coli O157, Listeria monocytogenes, and Campylobacter using multi-year outbreak surveillance data, United States,” can be found on the IFSAC website.
The updated estimates, combined with other data, may help shape agency priorities and inform the creation of targeted interventions that can help to reduce foodborne illnesses caused by these pathogens. As more data become available and methods evolve, attribution estimates may improve. These estimates are intended to inform and engage stakeholders and to improve federal agencies’ abilities to assess whether prevention measures are working.
Foodborne illness source attribution estimates for 2017 for salmonella, Escherichia coli O157, listeria monocytogenes, and campylobacter using multi-year outbreak surveillance data, United States, Sept.2019
Emma Broadhurst was six months pregnant when she flew out to Turkey with friends for a 7-night stay at the Crystal Sunset Luxury Resort and Spa, east of the city of Antayla, at the start of September.
But, according to Andy Rudd of The Mirror, within days of arriving she fell unwell suffering from chronic diarrhea and became dehydrated and lost weight.
Just over 24 hours later her best friend’s seven-year-old son, Kailan, also fell ill with diarrhea and on their return to the UK his mum, Emma McComb, fell ill and Kailan was left ‘screaming in agony’ and projectile vomiting.
All three, who shared a room while on holiday, were then diagnosed with salmonella poisoning after stool samples were sent for testing by their local GP, claims Emma.
The friends stayed in the same hotel where two-year-old Allie Birchall and her family holidayed before little Allie was taken ill before passing away having contracted E. coli.
All members of her family, from Wigan, Greater Manchester, suffered from gastric symptoms including stomach cramps and diarrhoea during their 10-day stay with Jet 2.
Allie’s condition became so severe she was rushed to hospital after the family returned to the UK.
Her parents had to make the heartbreaking decision to switch off her life support on August 3.
A four-year-old girl was left fighting for her life after contracting the deadly E.coli infection after a trip to the Isle of Wight.
Isla Grainger had to be put in an induced coma in intensive care after the harmful bug caused her kidneys to fail.
Pippa Allen-Kinross of the Mirror reports Isla spent 17 days in hospital and is now recovering at home, but is still not well enough to go to school.
She began to have diarrhoea and sickness after a weekend trip to the Isle of Wight with her mum Lauren Aspery, 21, and mum’s partner Lewis Keith.
The family visited a petting zoo, arcades and a beach in Sandown on the island before Isla became unwell.
But, as yet, they do not know where the infection came from.
Mum Lauren, who lives in Whiteley near Fareham, also had painful stomach aches and nausea.
After Isla stopped eating and struggled to go to the toilet for three days, Lauren took her daughter to the emergency department at Southampton General Hospital.
The little girl was rushed into emergency surgery to insert a catheter and begin urgent dialysis after tests revealed she had E.coli O157.
Medics realised the E.coli had developed into hemolytic uremic syndrome, affecting Isla’s blood cells and vessels and resulting in kidney failure.
She had to undergo surgery to remove a twisted catheter and was later moved to intensive care and placed in an induced coma.
Devastated Lauren was left terrified she would lose her daughter, as Isla’s condition quickly became a “matter of life or death”.
She said: “It was terrifying. I thought the worst and that we were going to lose our little girl.
“I really believed this was just a bad case of sickness.
“The doctor took a breath and told us that ‘Isla is very, very poorly, much more sick than we thought’.
To date, disease doctors have identified 11 cases of E. coli 0157 among Minnesotans who were at the State Fair between Aug. 25 and Sept. 2. All of them fell ill between Aug. 29 and Sept. 6.
Ages of those sickened range from 2 to 43 years old. Six of the cases required the patient to be hospitalized, including one person developing hemolytic uremic syndrome, which the MDH says is a potentially fatal complication.
One person is still in a hospital being treated.
Investigators are working to determine the source of the outbreak, with evidence so far indicating that it most likely began with contact with livestock.
Most of the 11 patients visited the Miracle of Birth exhibit and made physical contact with calves, goats, sheep or piglets, but others suffering from the E. coli strain did not make direct contact with animals, leading the MDH to consider the possibility that those people made contact with contaminated surfaces.
“This serves as a strong reminder to always wash your hands after being around livestock and their enclosures,” the MDH says.
Fortunately, there is “little chance” of ongoing exposure to the strain since the fair has ended.
Erdozain G, Kukanich K, Chapman B, Powell D. 2012. Observation of public health risk behaviours, risk communication and hand hygiene at Kansas and Missouri petting zoos – 2010-2011. Zoonoses Public Health. 2012 Jul 30. doi: 10.1111/j.1863-2378.2012.01531.x.
Observation of public health risk behaviors, risk communication and hand hygiene at Kansas and Missouri petting zoos – 2010-2011Outbreaks of human illness have been linked to visiting settings with animal contact throughout developed countries. This paper details an observational study of hand hygiene tool availability and recommendations; frequency of risky behavior; and, handwashing attempts by visitors in Kansas (9) and Missouri (4), U.S., petting zoos.
Handwashing signs and hand hygiene stations were available at the exit of animal-contact areas in 10/13 and 8/13 petting zoos respectively. Risky behaviors were observed being performed at all petting zoos by at least one visitor. Frequently observed behaviors were: children (10/13 petting zoos) and adults (9/13 petting zoos) touching hands to face within animal-contact areas; animals licking children’s and adults’ hands (7/13 and 4/13 petting zoos, respectively); and children and adults drinking within animal-contact areas (5/13 petting zoos each). Of 574 visitors observed for hand hygiene when exiting animal-contact areas, 37% (n=214) of individuals attempted some type of hand hygiene, with male adults, female adults, and children attempting at similar rates (32%, 40%, and 37% respectively). Visitors were 4.8x more likely to wash their hands when a staff member was present within or at the exit to the animal-contact area (136/231, 59%) than when no staff member was present (78/343, 23%; p<0.001, OR=4.863, 95% C.I.=3.380-6.998). Visitors at zoos with a fence as a partial barrier to human-animal contact were 2.3x more likely to wash their hands (188/460, 40.9%) than visitors allowed to enter the animals’ yard for contact (26/114, 22.8%; p<0.001, OR= 2.339, 95% CI= 1.454-3.763).
Inconsistencies existed in tool availability, signage, and supervision of animal-contact. Risk communication was poor, with few petting zoos outlining risks associated with animal-contact, or providing recommendations for precautions to be taken to reduce these risks.
In the spring of 2018, an E. coli O157 outbreak linked to romaine lettuce grown in the Yuma, Arizona area resulted in 210 reported illnesses from 36 states, 96 hospitalizations, 27 cases of hemolytic uremic syndrome (HUS) and five deaths.
The U.S. Food and Drug Administration has launched a new initiative with support from the Arizona Department of Agriculture, and in conjunction with the University of Arizona Cooperative Extension, the Wellton-Mohawk Irrigation and Drainage District (WMIDD), and members of the Yuma area leafy greens industry to better understand the ecology of human pathogens in the environment in the Yuma agricultural region. This initiative will be a multi-year study which will focus on how these pathogens survive, move and possibly contaminate produce prior to harvest.
While the FDA, the Arizona Department of Agriculture and other state partners conducted an environmental assessment from June through August 2018 that narrowed the scope of the outbreak, the specific origin, the environmental distribution and the potential reservoirs of the outbreak strain remain unknown.
Between 2009 and 2017, FDA and partners at CDC identified 28 foodborne STEC outbreaks with known or suspected links to leafy greens. Like a lot of fresh produce, leafy greens are often eaten raw without a kill-step, such as cooking, that could eliminate pathogens that may be present.
Sounds like Yuma growers could use a Box of Rain. Or maybe more knowledge of the microbial ripple effect. May death be groovy for you, long-time Grateful Dead collaborator and lyricist Robert Hunter, who passed on Tuesday, aged 78.
Julie Gilmartin, 39, said her son Matthew Bennett, 10, started to develop symptoms including diarrhea on the plane home from a week-long stay at the Bone Club Sunset Hotel & Spa, Antalya, at the start of July.
Stacey Mullen of the Herald Scotland writes the youngster, from Penilee, Glasgow, was then seen by a GP, who requested a stool sample after the boy experienced further symptoms, including severe abdominal pains and passing blood.
His health deteriorated and he was taken to A&E, where he was admitted to the Royal Hospital for Children in Glasgow for more than three days.
Following several tests, his mother was advised Matthew had been diagnosed with E.coli O157, a serious bacterial infection that can cause serious long-term complications and sometimes even death.
Ms Gilmartin, a customer assistant at Sainsbury’s, said: “Matthew went to the toilet a few times on the plane journey home, which seemed odd for him.
“Then, as the days passed, there was clearly something wrong. He didn’t eat well and started to suffer from further issues, like stomach cramps.
“I ended up calling the NHS 24-hour helpline and was told straight away to take him to hospital. It was awful to see how the illness affected him and they [doctors] felt they had no choice to admit him. It was horrendous.”
Ms Gilmartin and Matthew, along with his father Henry and younger brother Ollie, arrived at the Turkish resort on July 6, after booking the break through Jet2. She added: “I was stunned to get the news that Matthew’s illness was E.coli.
“I’m just so frustrated we went away for what should have been a nice, family break, only for this to happen.
“It is awful and we deserve some answers as to how Matthew’s illness emerged and whether it could have been prevented.
“Although I had seen some concerning issues in relation to the cleanliness and hygiene in the restaurant, such as roaming cats and food sometimes being served lukewarm, I never thought I was at serious risk of illness. I dread to think that other children might be running the risk of also being affected.”
Due to the potential of enterohemorrhagic Escherichia coli (EHEC) serogroup O157 to cause large food borne outbreaks, national and international surveillance is necessary.
For developing an effective method of molecular surveillance, a conventional method, multilocus variable-number tandem-repeat analysis (MLVA), and whole-genome sequencing (WGS) analysis were compared. WGS of 369 isolates of EHEC O157 belonging to 7 major MLVA types and their relatives were subjected to comprehensive in silico typing, core genome single nucleotide polymorphism (cgSNP), and core genome multilocus sequence typing (cgMLST) analyses. The typing resolution was the highest in cgSNP analysis. However, determination of the sequence of the mismatch repair protein gene mutS is necessary because spontaneous deletion of the gene could lead to a hypermutator phenotype. MLVA had sufficient typing resolution for a short-term outbreak investigation and had advantages in rapidity and high throughput. cgMLST showed less typing resolution than cgSNP, but it is less time-consuming and does not require as much computer power. Therefore, cgMLST is suitable for comparisons using large data sets (e.g., international comparison using public databases). In conclusion, screening using MLVA followed by cgMLST and cgSNP analyses would provide the highest typing resolution and improve the accuracy and cost-effectiveness of EHEC O157 surveillance.
IMPORTANCE Intensive surveillance for enterohemorrhagic Escherichia coli (EHEC) serogroup O157 is important to detect outbreaks and to prevent the spread of the bacterium. Recent advances in sequencing technology made molecular surveillance using whole-genome sequence (WGS) realistic. To develop rapid, high-throughput, and cost-effective typing methods for real-time surveillance, typing resolution of WGS and a conventional typing method, multilocus variable-number tandem-repeat analysis (MLVA), was evaluated. Nation-level systematic comparison of MLVA, core genome single nucleotide polymorphism (cgSNP), and core genome multilocus sequence typing (cgMLST) indicated that a combination of WGS and MLVA is a realistic approach to improve EHEC O157 surveillance.
Effective surveillance using multilocus variable-number tandem-repeat analysis and whole-genome sequencing for enterohemorrhagic Escherichia coli O157
Applied and Environmental Microbiology
Kenichi Lee, Hidemasa Izumiya, Sunao Iyoda, Makoto Ohnishi and EHEC Working Group
I am fascinated with viruses, and we’re all hosts on a viral planet.
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
The agribusiness program Goldberg developed in 1955 continues to bring business leaders and policy makers from around the world together each year. Throughout his tenure, Ray has written over 100 articles and 24 books on the business of agriculture, including his very latest, Food Citizenship: Food System Advocates in an Era of Distrust.
He was interviewed by podcast host, Brian Kenny: Did you coin the term agribusiness?
Ray Goldberg: I did, together with John Davis. He was the Assistant Secretary of Agriculture under Eisenhower, and he became the first head of the (HBS) Agribusiness Program.
Brian Kenny: The case cites examples of foodborne illness outbreaks in the US. We’re coming on the heels of the recent romaine lettuce issue in the US, which has now occurred, I think, twice in the last few months.
Ray Goldberg: I can describe the romaine lettuce [event], because I talked to the produce manager this morning, and he tells me the cost to the industry was $100 million dollars.
The problem is that romaine lettuce itself, when cold temperatures occur, begins to blister, which make it more susceptible to listeria. When they tried to find the location of that listeria, it came from a dairy herd about 2,000 feet away from where that lettuce was grown. We have a rule that 1,200 feet is far enough, but they actually found listeria a mile away from where that lettuce was concerned, so he feels very strongly that they have to change the rules.
(They seem to be confusing Listeria with E.coli O157 in Romaine, but that’s Haaaaaaaaarvard.)
Brian Kenny: Which gets to another issue that the case raises, which is has the industry done well enough trying to regulate itself? What are some of the things the industry has tried to do?
Ray Goldberg: Under Danny Wegman’s leadership—he was the person in charge of food safety of the Food Marketing Institute that really looked at the whole industry—he got several members of the industry to sit down and create new rules with the FDA, the EPA, the USDA, and CDC, all of them saying we have to have better rules. Produce, as you know in the case, is the most valuable part of a supermarket but also the most susceptible to problems.
Brian Kenny: This gets a little bit to the topic of your book, Food System Advocates in an Era of Distrust. [What[ are the big ideas coming out of your book?
Ray Goldberg: The big ideas are two-fold, that the kind of men and women in the industry have changed from commodity handlers and bargaining as to how cheap they can buy something, or how expensive they can make something, to finally realizing that they have to be trusted. And because they have to be trusted, they have to start working together to create that trust. In addition to that, they realize that the private, public and not-for-profit sectors really need to work together. That’s why I tried to write a book to give people an inkling of the kind of men and women in this industry who really are the change-makers, who are changing it to a consumer-oriented, health-oriented, environmentally-oriented, economic development-oriented industry.
We would appreciate any reports of upswings in the number of cases of this process in the upper Midwest USA or elsewhere.
