Salted clams from China and Korea appear to be the common factor in a spate of hepatitis A cases in various countries.
According to the Korea Biomedical Review, the Korea Centers for Disease Control and Prevention (KCDC) said that it has confirmed that contaminated fermented shellfish was the main culprit behind the hepatitis A outbreak this summer.
The KCDC came to the conclusions after conducting an in-depth epidemiological investigation.
The agency randomly sampled 270 of the 2,178 hepatitis A patients, diagnosed between July 28 and August 24, and surveyed whether they consumed fermented shellfish this summer. It found that 42 percent of the patients had eaten fermented shellfish during the incubation period.
KCDC also found that 80.7 percent of the 26 patients diagnosed with hepatitis A in August also ate fermented shellfish, while discovering Hepatitis A virus genes in 11 batches out of the 18 batches collected after the outbreak.
Notably, five of these genes found in the research showed close relations with the virus detected in hepatitis A patients.
As of now, the disease control agency has confirmed 10 products that have tested positive to the hepatitis A virus. Nine of them were imported from China, and one was made in Korea.
“Out of the total 10 products, weighing 37,094kg, 31,764kg has already been sold to the markets, while the remaining 5,330 kg were recovered and disposed of,” the agency said.
Yesterday, the Australian NSW Food Authority advised that Byul Mi Kim Chi is conducting a recall of Salted clams, due to a possible microbial (Hepatitis A virus) contamination. Further, Koryo Food Co. is conducting a recall of Pickled clams, due to a possible microbial (Hepatitis A virus) contamination.
NSW Food Authority CEO, Lisa Szabo said testing was underway on a number of products but full results may take a number of weeks.
“Although a contamination has not yet been confirmed, we have advised the companies of a potential link to 8 cases of hepatitis A in NSW, and they have both undertaken a recall of the product,” Dr Szabo said.
Nolan Moittie was 23-months-old when he became one of 15 children in the Hauts-de-France region to fall ill having eaten beef contaminated with E. coli.
The boy was left paralysed for life, unable to walk, talk or eat.
Yesterday he was rushed to intensive care when his heart stopped beating.
He died shortly afterwards, despite medics’ efforts to revive him, Le Parisien reported.
The other children suffer from conditions that will affect their kidneys for the rest of their lives.
The lawyer of Nolan’s family, Florence Rault, said the boy had suffered a ‘real ordeal since the accident’.
Bosses at Seb-Cerf, who marketed frozen steaks under the Steak Country brand, were tried at Douai Criminal Court in northern France in 2017.
Former boss Guy Lamorlette, 78, was sentenced to three years in prison for failing to carry out checks on the meat.
He was also banned from any industrial or commercial activity and ordered to pay damages to the victims.
At a February hearing Lamorlette tried to blame Laurent Appere, the company’s former quality manager who died just before the trial began.
Lamorlette is said to be considering an appeal.
Nolan’s family lawyer, Florence Rault, told Le Parisien: “I hope that the person responsible for this tragedy will have the decency to withdraw his appeal on points of law.
“At the first trial, he did not even want to watch Nolan, now he must serve his sentence and Nolan’s parents must be able to be compensated and mourn.”
The UK Food Standards Agency reports the top nine retailers across the UK have published their latest testing results on campylobacter contamination in UK-produced fresh whole chickens (covering samples tested from April to June 2019).
The latest figures show that on average, across the major retailers, 3.6% of chickens tested positive for the highest level of contamination. These are the chickens carrying more than 1,000 colony forming units per gram (cfu/g) of campylobacter.
Results
The sampling and analyses are carried out in accordance with protocols laid down by the FSA and agreed by Industry.
We have been testing chickens for campylobacter since February 2014 and publishing the results as part of a campaign to bring together the whole food chain to tackle the problem. Campylobacter is the most common cause of food poisoning in the UK.
In September 2017 we announced changes to the survey, with major retailers carrying out their own sampling and publishing their results under robust protocols laid down by the FSA. We are continuing to sample fresh whole chickens sold at retail, however, the focus is now on the smaller retailers and the independent market.
Chicken is safe if consumers follow good kitchen practice:
Cover and chill raw chicken – cover raw chicken and store at the bottom of the fridge so juices cannot drip onto other foods and contaminate them with food poisoning bacteria such as campylobacter
Don’t wash raw chicken – thorough cooking will kill any bacteria present, including campylobacter, while washing chicken can spread germs by splashing
Wash used utensils – thoroughly wash and clean all utensils, chopping boards and surfaces used to prepare raw chicken
Wash hands thoroughly with soap and warm water, after handling raw chicken – this helps stop the spread of campylobacter by avoiding cross-contamination
Cook chicken thoroughly – make sure chicken is steaming hot all the way through before serving. Cut into the thickest part of the meat and check that it is steaming hot with no pink meat and that the juices run clear.
One morning when today’s school lunch was to be cooked at the Torskolan in Torsås, the staff discovered that the falu sausage that would have been cooked was covered with musbajs.
The school called me and told me that something similar to rodent spilling was found on the fallow basket. We then contacted the company from which we buy the sausage, which immediately withdrew it, says Gustaf Nilsson, environmental inspector at Torsås Municipality.
The planned sausage lunch was quickly replaced with soup and a detective work has been underway to find out where the mice have come in.
“I don’t know where they managed to get in, but before it came to school, the sausage was both at a factory and at a transhipment center. However, it is unlikely that it happened at school. The staff has detailed their routines there.
Gustaf Nilsson says he has not been to anything like it before.
“After all, the routines have failed and it is very unfortunate that this has happened. However, the staff at Torskolan did everything right to discover the pellet before starting to cook.”
Samples taken on the sausage show high levels of E. coli, ie some form of stool. The suspicion is that it comes from forest mice.
The U.S. Centers for Disease Control reports that waterborne hepatitis A outbreaks have been reported to CDC. Person-to-person transmission of hepatitis A has increased in recent years.
Reported drinking water–associated hepatitis A outbreaks have declined since introduction of universal childhood vaccination recommendations and public drinking water regulations. However, unvaccinated persons who use water from untreated private wells remain at risk.
Public health officials should raise awareness of risks associated with untreated ground water among users of private wells and of options for private well testing and treatment. Water testing and treatment are important considerations to protect persons who use these unregulated systems from HAV infection.
Hepatitis A virus (HAV) is an RNA virus primarily transmitted via the fecal-oral route and, in rare cases, causes liver failure and death in infected persons. Although drinking water–associated hepatitis A outbreaks in the United States are rarely reported (1), HAV was the most commonly reported etiology for outbreaks associated with untreated ground water during 1971–2008 (2), and HAV can remain infectious in water for months (3). This report analyzes drinking water–associated hepatitis A outbreaks reported to the Waterborne Disease and Outbreak Surveillance System (WBDOSS) during 1971–2017. During that period, 32 outbreaks resulting in 857 cases were reported, all before 2010. Untreated ground water was associated with 23 (72%) outbreaks, resulting in 585 (68.3%) reported cases. Reported outbreaks significantly decreased after introduction of Advisory Committee on Immunization Practices (ACIP) hepatitis A vaccination recommendations* and U.S. Environmental Protection Agency’s (USEPA) public ground water system regulations.† Individual water systems, which are not required to meet national drinking water standards,§ were the only contaminated drinking water systems to cause the last four reported hepatitis A outbreaks during 1995–2009. No waterborne outbreaks were reported during 2009–2017. Water testing and treatment are important considerations to protect persons who use these unregulated systems from HAV infection.
U.S. states and territories have voluntarily reported waterborne disease outbreaks to WBDOSS since 1971.¶ Waterborne hepatitis A outbreaks (1971–2017) reported as of March 13, 2018, were reviewed. An outbreak of hepatitis A was defined as two or more cases of HAV infection epidemiologically linked by time and location of water exposure. To compare occurrence with other waterborne exposure pathways, outbreaks reviewed included those caused by drinking, recreational, environmental (i.e., nondrinking, nonrecreational water), or undetermined water exposures.** As described previously (1), data reviewed included location; date of first illness; estimated number of primary cases, hospitalizations, and deaths; water system type according to USEPA Safe Drinking Water Act definitions (i.e., community, noncommunity, and individual); setting of exposure; drinking water sources (i.e., ground water, surface water, and unknown); and water system characteristics.†† Community and noncommunity water systems are public water systems that have 15 or more service connections or serve an average of 25 or more residents for ≥60 days per year.§§ A community water system serves year-round residents of a community, subdivision, or mobile home park. A noncommunity water system serves an institution, industry, camp, park, hotel, or business. Individual water systems are small systems (e.g., private wells and springs) not owned or operated by a water utility that have fewer than 15 connections or serve fewer than 25 persons. The number of outbreaks before and after public health interventions were compared; chi-squared tests were used to identify significant (p-value<0.05) differences. Data were analyzed using SAS software (version 9.4; SAS Institute) and visualized in ArcGIS (version 10.6.1; Environmental Systems Research Institute).
Thirty-two drinking water–associated hepatitis A outbreaks were reported to CDC during 1971–2017; the last one occurred in 2009 (Table). These drinking water–associated outbreaks accounted for 857 cases (range = 2–50), with no reported deaths. Data on number of deaths were unavailable for three outbreaks. Data on hospitalizations were unavailable for all outbreaks. Outbreaks occurred in 18 states, all in the lower continental United States (Figure 1). One environmental outbreak (1975) and one recreational water outbreak (1989) were reported during this period, but were excluded from this analysis.
The most commonly reported water system type associated with an outbreak was individual, accounting for 13 of 32 (41%) outbreaks and 257 of 857 (30.0%) cases, followed by community (10 [31%] outbreaks; 241 [28.1%] cases) and noncommunity (9 [28%] outbreaks; 359 [41.9%] cases). All individual water systems with outbreaks were supplied by private wells or springs. The majority of all drinking water outbreaks and cases were associated with systems supplied by ground water (30 [94%] outbreaks; 804 [93.8%] cases) and with an absence of water treatment (23 [72%] outbreaks; 585 [68.3%] cases).
The incidence of reported drinking water–associated hepatitis A outbreaks significantly decreased after introduction of the 1989 USEPA Total Coliform and Surface Water Treatment Rules (77% decline from 1971–1989 [24 outbreaks] to 1990–2017 [eight]; p = 0.003), the 1996 ACIP hepatitis A vaccination recommendations (87% decline from 1971–1996 [29] to 1997–2017 [three]; p<0.001), and the 2006 Ground Water Rule and expanded ACIP vaccine recommendations (78% decline from 1971–2006 [30] to 2007–2017 [two]; p = 0.038) (Figure 2). From 1995 through 2009, all four hepatitis A drinking water–associated outbreaks, resulting in 35 cases, were attributed to individual water systems using untreated ground water sources. No water-associated hepatitis A outbreaks have been reported since July 2009.
Reported drinking water–associated hepatitis A outbreaks have declined since reporting began in 1971, and none have been reported since 2009, mirroring the overall decline in U.S. cases (4,5). Vaccination for hepatitis A, combined with USEPA regulations that require testing and, where necessary, corrective actions or treatment for drinking water supplies, likely played a role in reducing reported hepatitis A drinking water–associated outbreaks.
Vaccination efforts have led to significant changes in hepatitis A epidemiology (4,6,7). HAV infection rates in the United States have decreased since the introduction of hepatitis A vaccine in 1995 (4,5). Vaccine recommendations were originally targeted to children in communities with high rates of hepatitis A infections west of the Mississippi and other groups at risk (e.g., international travelers, men who have sex with men, illicit drug users, persons with clotting factor disorders, and persons with occupational risk). By 2006, routine hepatitis A vaccination was recommended for all children aged ≥l year regardless of geographic area of residence (5). Although vaccination was never recommended for users of individual ground water systems, this group likely benefited from the recommendations targeting children and other groups at risk. Incidence of HAV infection is now lowest among persons aged 0–19 years (4). However, the proportion of HAV-associated hospitalizations steadily increased during 1999–2011, likely because of more severe disease in older adults, with persons aged ≥80 years experiencing the highest rates of infection (6). The number of hepatitis A cases in the United States reported to CDC increased by 294% during 2016–2018, compared with the period 2013–2015 (8), primarily because of community-wide outbreaks in persons reporting homelessness or drug use (7). ACIP recommends vaccination to persons who use drugs and recently expanded recommendations to persons experiencing homelessness.¶¶
Reported drinking water–associated hepatitis A outbreaks were most commonly linked to individual water systems that used wells with untreated ground water. Recreational and environmental outbreaks were only reported twice, suggesting that drinking water is a more common waterborne exposure pathway for hepatitis A. Nearly 43 million U.S. residents, or 13% of the population, are served by individual water systems, primarily from ground water sources (https://pubs.er.usgs.gov/publication/cir1441external icon). Untreated ground water sources were associated with 30% of all drinking water–associated outbreaks reported to CDC during 1971–2008 (1). The USEPA Total Coliform and Surface Water Treatment Rules of 1989 and Ground Water Rule of 2006 provide enhanced safety measures for public water systems using ground water sources and might have contributed to the absence of reported hepatitis A outbreaks linked to community water sources since 1990. However, federal regulations do not apply to individual water systems, which often have inadequate or no water treatment (9). Private wells or springs were the only contaminated drinking water systems to cause the last four reported hepatitis A outbreaks during 1995–2009. CDC recommends that owners of private wells test their water annually for indicators of fecal contamination (https://www.cdc.gov/healthywater/drinking/private/wells/testing.html). Factors contributing to fecal contamination of ground water include nearby septic systems or sewage, weather patterns (e.g., heavy rainfall), improper well construction and maintenance, surface water seepage, and hydrogeologic formations (e.g., karst limestone) that allow for rapid pathogen transport (2,9).
The findings in this report are subject to at least three limitations. First, waterborne hepatitis A outbreak reporting is through a passive, voluntary surveillance system; health departments have varying capacity to detect, investigate, and report outbreaks, which might result in incomplete data on outbreak occurrence and characteristics within and across jurisdictions. Thus, outbreak surveillance data might underestimate the actual number of drinking water–associated hepatitis A outbreaks and might underreport information regarding health outcomes such as cases of illness. Second, attributing the source of an outbreak to individual water systems can be particularly difficult because hepatitis A can also be spread through person-to-person transmission within a household. Finally, outbreak data before 2009 did not include case-specific information; thus, demographic factors, including age, could not be assessed.
Drinking water–associated hepatitis A outbreaks have declined and essentially stopped, likely in large part because of the introduction of an efficacious vaccine as part of the routine childhood immunization program and microbial drinking water regulations for public water systems. The degree to which these interventions have contributed to the decline in outbreaks is uncertain. However, waterborne outbreak surveillance data is not yet finalized for 2018, and the recent increase in person-to-person transmission of hepatitis A (7,8) has the potential to cause a resurgence in waterborne outbreaks through increased fecal HAV contamination of private ground water supplies. Outbreak data suggest that individual water systems, primarily those systems drawing untreated ground water from wells, pose the highest risk for causing drinking water–associated hepatitis A outbreaks. These systems are not regulated by USEPA; CDC recommends that owners evaluate their well water quality at least yearly. If indicators of fecal contamination are detected, remediation and treatment of private well water is recommended. Guidance on private well testing and treatment solutions for microbial contamination is provided by USEPA (https://www.epa.gov/privatewells/protect-your-homes-waterexternal icon) and CDC (https://www.cdc.gov/healthywater/drinking/private/wells/index.html). Although the current nationwide outbreak of hepatitis A is not water-associated, considering ground water as a possible transmission route is warranted during community-wide outbreaks of hepatitis A. Ground water can be contaminated with HAV during community transmission of hepatitis A, increasing the risk for persons using untreated water. Public health education about the risks associated with drinking untreated ground water from individual systems, as well as relevant safety measures (i.e., water testing, water treatment, and vaccination), is needed to prevent future drinking water–associated hepatitis A outbreaks.
US: Impact of public health interventions on drinking water-associated outbreaks of hepatitis A-United States, 1971-2017
Rita Giordano of The Philadelphia Inquirer writes the Philadelphia Department of Public Health on Thursday announced an outbreak of E. coli infections that has sickened 14 people so far.
In a statement, city health officials said their investigation “has identified a few shared restaurant exposures.” It did not name the restaurants.
All 14 affected people, ranging in age from 7 to 90, “presented with signs of acute gastroenteritis with bloody and non-bloody diarrhea,” according to the statement.
The cases have been reported since Aug. 30.
The health department said the illnesses were due to Shiga-toxin E. coli, one of five E. coli strains. Symptoms usually start with non-bloody diarrhea, which can progress to bloody diarrhea after two to three days. Severe abdominal pain and fever may also occur.
Exposure to the bacteria often occurs through contact with food or water contaminated by human or animal stool, or through contact with an infected person. Outbreaks have been associated with consuming undercooked beef, unpasteurized milk, or raw leafy vegetables, as well as exposure at petting zoos.
Nicole Sikora, 31, a performing arts administrator who lives in Northern Liberties, said a severe stomach ache and bloody diarrhea caused her to go to the emergency room of Thomas Jefferson University Hospital about a week ago, where she was told she was infected by E. coli. She said her fiancé, who had similar symptoms, was admitted to Jefferson last weekend and is still at the hospital, being monitored for dehydration.
They sought care when their symptoms didn’t seem to be easing at home.
“I didn’t know if I was going to get better,” Sikora said. “It was really pretty painful.”
The Local reports that Danish Patient Safety Authority (Styrelsen for Patientsikkerhed, DPSA) has confirmed that two children have died as a result of complications related to E. coli poisoning. The two cases are not connected.
Two children – one on the island of Funen and another in the Copenhagen area – died due to a rare complication related to VTEC, a strain of the E. Coli bacteria.
Both children died of kidney failure, but the two tragic cases are not connected. A third child also contracted kidney failure but survived, DPSA said.
A consultant doctor and head of department at Copenhagen infectious disease research institute SSI stressed that the cases were not evidence of an outbreak and that the number of cases was not improbable.
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.”
Why do government-types never learn to write in clear and coherent sentences?
CFIA has been evolving the way we manage risk, to further support industry’s ability to compete globally, and embracing technology to provide more efficient and responsive services.
The Establishment-based Risk Assessment (ERA) model for food establishments is a tool developed by the CFIA to evaluate food establishments based on the level of risk they represent to Canadian consumers. The ERA model uses data and a mathematical algorithm to assess the food safety risks of food establishments under CFIA jurisdiction. It takes into consideration risks associated with a specific food commodity, operation or manufacturing process, mitigation strategies implemented by the industry to control their food safety risks, as well as establishment compliance information. The ERA model will be used, along with other factors, to inform where inspectors should spend more or less time and inform program planning, in order to focus efforts on areas of highest risk.
How does the ERA model for food establishments work?
The current human brucellosis epidemic in Ath Mansour has again claimed new victims. These are 2 citizens of Ath Vouali, hospitalized Wednesday [28 Aug 2019] at the EPH Kaci Yahia M’Chedallah. The affected subjects are a 40-year-old father and his 15-month-old son. Met in the halls of the hospital, the father indicated that he and his family have consumed raw milk from the farmer whose goats were infected almost 2 months ago.
After these 2 new victims, 6 cases of human brucellosis have been detected since last week [18-24 Aug 2019] in this commune and hospitalized at M’Chedallah hospital. In this context, we learned that a Daira commission, composed of a member of the APC executive of Ath Mansour, the subdivisionary of agriculture of Ahnif, a member of the prevention of the Ahnif EPSP and the M’Chedallah Civil Protection Unit, was set up on the instructions of the Daira Chief.’
According to the Korea Biomedical Review, the Korea Centers for Disease Control and Prevention (KCDC) said that it has confirmed that contaminated fermented shellfish was the main culprit behind the hepatitis A outbreak this summer.
As of now, the disease control agency has confirmed 10 products that have tested positive to the hepatitis A virus. Nine of them were imported from China, and one was made in Korea.
