Vaccines work, especially on that fecal-oral route: Increase in hepatitis A virus infections – U.S. 2013-2018

The U.S. Centers for Disease Control reports that Hepatitis A is a vaccine-preventable viral infection of the liver that is primarily transmitted through consumption of microscopic amounts of feces.

During 2016–2018, reports of hepatitis A infections in the United States increased by 294% compared with 2013–2015, related to outbreaks associated with contaminated food items, among men who have sex with men, and primarily, among persons who report drug use or homelessness.

What are the implications for public health practice?

Increasing vaccination among groups at risk for hepatitis A infection might halt ongoing outbreaks and prevent future outbreaks.

Hepatitis A virus (HAV) is primarily transmitted fecal-orally after close contact with an infected person (1); it is the most common cause of viral hepatitis worldwide, typically causing acute and self-limited symptoms, although rarely liver failure and death can occur (1). Rates of hepatitis A had declined by approximately 95% during 1996–2011; however, during 2016–2018, CDC received approximately 15,000 reports of HAV infections from U.S. states and territories, indicating a recent increase in transmission (2,3). Since 2017, the vast majority of these reports were related to multiple outbreaks of infections among persons reporting drug use or homelessness (4). In addition, increases of HAV infections have also occurred among men who have sex with men (MSM) and, to a much lesser degree, in association with consumption of imported HAV-contaminated food (5,6). Overall, reports of hepatitis A cases increased 294% during 2016–2018 compared with 2013–2015. During 2016–2018, CDC tested 4,282 specimens, of which 3,877 (91%) had detectable HAV RNA; 565 (15%), 3,255 (84%), and 57 (<1%) of these specimens were genotype IA, IB, or IIIA, respectively. Adherence to the Advisory Committee on Immunization Practices (ACIP) recommendations to vaccinate populations at risk can help control the current increases and prevent future outbreaks of hepatitis A in the United States (7).

Hepatitis A infections among persons who meet the Council of State and Territorial Epidemiologists (CSTE) hepatitis A case definition (https://wwwn.cdc.gov/nndss/conditions/hepatitis-a-acute/) are notified to CDC through the National Notifiable Diseases Surveillance System (NNDSS). Cases reported to CDC through NNDSS during 2013–2018 were used to calculate percent change (2013–2015 versus 2016–2018) by state and mapped using RStudio software (version 1.2.1335; RStudio, Inc.). Serum specimens from CSTE confirmed cases submitted to the CDC laboratory were tested for HAV RNA by polymerase chain reaction, and isolated virus was amplified to characterize a 315–base-pair fragment of the VP1/P2B region, which defines the genotype of the virus.

Overall, reports of hepatitis A cases increased 294% during 2016–2018 compared with 2013–2015 (Figure). Eighteen states had lower case counts during 2016–2018 compared with 2013–2015. Nine states and Washington, DC had an increase of approximately 500%. During 2013–2018, 4,508 HAV anti-immunoglobulin M–positive specimens underwent additional testing at CDC. During 2013–2015, 226 specimens underwent additional testing, of which 197 (87%) had detectable HAV RNA; of the RNA-positive specimens, 76 (39%), 121 (61%), and 0 (0%) tested positive for a genotype IA, IB, or IIIA viral strain, respectively. In comparison, 4,282 specimens were tested by CDC during 2016–2018, of which 3,877 (91%) had detectable HAV RNA; 565 (15%), 3,255 (84%), and 57 (<1%) of these specimens were genotype IA, IB, or IIIA, respectively.

The number of hepatitis A infections reported to CDC increased during 2016–2018, along with the number of specimens from infected persons submitted to CDC for additional testing. In the past, outbreaks of hepatitis A virus infections occurred every 10–15 years and were associated with asymptomatic children (8). With the widespread adoption of universal childhood vaccination recommendations (https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5507a1.htm), asymptomatic children are no longer the main drivers of hepatitis A outbreaks (3,9). Although the overall incidence rate of HAV infections has decreased within all age groups, a large population of susceptible, unvaccinated adults who were not infected by being exposed to the virus during childhood remain vulnerable to infection by contaminated foods (typically imported from countries with endemic HAV transmission) and recently, on a much larger scale, through behaviors that increase risk for infection in certain vulnerable populations, such as drug use (3).

Increasingly, molecular epidemiology is employed by public health laboratories to better characterize hepatitis A transmission patterns. When combined with reliable epidemiologic data, these laboratory data can be used to identify transmission networks and confirm the source of exposure during common-source outbreaks, facilitating prompt and effective public health response. Historically, genotype IA has been the most common genotype circulating in North and South America. During 2013–2018, HAV genotype IB predominated in the United States. Increasing numbers of genotype IIIA were seen, a genotype that is considered rare in the United States.

Decreasing new infections from hepatitis A virus can be achieved and sustained by maintaining a high level of population immunity through vaccination. There is no universal vaccination recommendation for adults in the United States; however, ACIP does recommend vaccination for adults who plan travel to HAV-endemic countries, MSM, persons who use drugs, persons with chronic liver disease, and recently, persons experiencing homelessness (7). Continued efforts to increase hepatitis A vaccination coverage among the ACIP-recommended risk groups is vital to halting the current hepatitis A outbreaks and reducing overall hepatitis A incidence in the United States.

Members of the Division of Viral Hepatitis Laboratory, Division of Viral Hepatitis HAV Incident Management Team, Food and Drug Administration CORE Signals Teams; state and local health departments; medical and mental health partners; corrections partners; syringe service providers.

Brain cloud: UK former Royal Marine tells of holiday Salmonella nightmare that left him a shell of a man

When ex-Royal Marine Commando Steve O’Connell caught salmonella on holiday, he never foresaw it ruining his life.

Trapped in a world of constantly being tired, he turned to medics for help.

Lisa Hutchinson of Chronicle Live writes following the initial trauma from the salmonella, he was diagnosed with ME or chronic fatigue syndrome.

And while Steve struggled with keeping up with the running of his successful business, he would have done virtually anything to get his old life back.

Now, after teaming up with specialist body-worker Adam Foster who put Steve through his paces with his own created recovery model, Steve is now fighting fit again and is back to gruelling circuit training and five mile runs after years of pain and fatigue.

Steve, 47, who owns Advantex Network Solutions Ltd in Gateshead with brother Dave, said: “In 2008 I contracted salmonella on holiday in Turkey and shortly after my recovery I started experiencing excruciating pains all over my body that were not associated with any sort of injury. 

“I would get arthritic pains, my eye balls felt like they were been squeezed, my muscles felt like I had just finished a 10-mile run and I even had pains in my teeth, not tooth ache but pains in my actual teeth.

“I also became very lethargic and tired – I thought I’d become lazy as I couldn’t motivate myself to do anything beyond basic tasks and if I did it would knock me on my back for days.

 “The worst thing though was the brain fog, imagine not been able to hold a sensible or coherent conversation for more than a couple of minutes. 

“I would sit in meetings disengaged and dazed trying so hard to not appear disinterested, giving all my energy to meetings with clients leaving little or no ability to hold meetings with colleagues or talk with my wife and three children when I got home.

“I think it’s safe to say for 10 years they didn’t have the husband or dad I wanted them to have.

Australia wants to kill my cats

I never had warm-blooded pets as a child. I had turtles that would escape and be found behind a sofa.

In 1985, my soon-to-be veterinarian first wife brought home two kittens from the vet clinic: I named them Clark and Kent.

I’ve gone through a lot of cats over the years.

During our 16-year marriage which created four skilled and tough daughters, my ex would castrate the males on the kitchen counter and remind me that I slept with her.

I didn’t fuck around.

Now that I’m in Brisbane, I went away for a weekend talk and came home to find two fur-expelling kittens that were indoor felines because we were in a townhouse. Now that we own our own property, they roam the grounds, chase away magpies, and occasionally bring a dead (or live) possum into the house.

Why doesn’t Australia focus on the rodent-evolved possums like the Kiwis do?

Jessica Camille Aguirre of The New York Times Magazine writes that present national Australian policy is, feral felines are driving the country’s native species to extinction. Now a massive culling is underway to preserve what’s left of the wild.

In the deep winter weeks of last July, Shane Morse and Kevin Figliomeni nearly always got up before the sun rose. They awoke next to the remains of a campfire or, occasionally, in a roadside motel, and in the darkness before dawn they began unloading poisoned sausage from their refrigerated truck. The sausage was for killing cats. One morning near the end of the season, Morse and Figliomeni left the Kalbarri Motor Hotel on the remote western coast of Australia, where they dined on steak and shellfish the night before, and drove along the squally coastline. They kept their eyes fixed to the sky. If it rained, there would be no baiting that day.

Morse and Figliomeni unpacked their boxes, filled with thousands of frozen sausages they produced at a factory south of Perth, according to a recipe developed by a man they jokingly called Dr. Death. It called for kangaroo meat, chicken fat and a mix of herbs and spices, along with a poison — called 1080 — derived from gastrolobium plants and highly lethal to animals, like cats, whose evolutionary paths did not require them to develop a tolerance to it. (The baits would also be lethal to other nonnative species, like foxes.) As the sun brightened the brume, the baits began to defrost. By midmorning, when Morse helped load them into a wooden crate inside a light twin-engine propeller Beechcraft Baron, they were burnished with a sheen of oil and emitted a stomach-turning fetor. The airplane shot down the runway and lifted over the gently undulating hills of the sand plains that abut the Indian Ocean.

Rising over the mantle of ghostlike smoke bushes that carpeted the ground to the treeless horizon, the plane traced a route over the landscape, its bombardier dropping 50 poisoned sausages every square kilometer. It banked over the deep cinnamon sandstone gorges carved by the Murchison River, which extends to the coastal delta, surveying the edge of one of earth’s driest, hottest continents, where two to six million feral cats roam. As it flew, it charted the kind of path it had done dozens of times before, carpeting thousands of hectares of land with soft fingers of meat, laying down nearly half a million baits in the course of one month. Dr. Death, whose real name is Dr. Dave Algar and who is the principal research scientist in the Department of Biodiversity Conservation and Attractions for the state of Western Australia, told me that he began developing the recipe for the poisoned sausages by examining cat food in supermarkets and observing which flavors most thrilled his own two cats. As Morse said: “They’ve got to taste good. They are the cat’s last meal.”

These fatal airdrops owed their existence to Australia’s national government, which decided in 2015 to try to kill two million feral cats by 2020, out of grave concern for the nation’s indigenous wildlife — in particular, groups of small, threatened rodent and marsupial species for which cats have become a deadly predator. The Royal Melbourne Institute of Technology estimated that 211,560 cats were killed during the first 12 months after the plan was announced. Dropping lethal sausages from the sky is only part of the country’s efforts to eradicate feral cats, which also include trapping, shooting and devising all manner of poison-delivery vessels.

When the policy was announced, it was met in some quarters with apoplexy. More than 160,000 signatures appeared on half a dozen online petitions entreating Australia to spare the cats. Brigitte Bardot wrote a letter — in English, but with an unmistakably French cadence — beseeching the environment minister to stop what she called animal genocide. The singer Morrissey, formerly of the Smiths, lamented that “idiots rule the earth” and said the plan was akin to killing two million miniature Cecil the Lions. Despite anger from some animal rights groups and worries about the potential effects on pet cats, Australia went ahead with its plan, and the threatened-species commissioner replied by mail to both Bardot and Morrissey, politely describing the “delightful creatures” already lost to the world.

After that, Morse and Figliomeni spent much of each baiting season behind the wheel of their rig, hauling boxes to the most remote corners of one of the least populated places in the world, to beat back what Australia has deemed an invasive pest. As is the case on islands around the world, the direction of life in Australia took a distinctly different route than that on the larger continents, and unlike places like North America, the country has no native cat species. Over millions of years of isolation, Australia’s native beasts became accustomed to a different predatory order, so while cats aren’t necessarily more prevalent there than anywhere else, their presence is more ruinous. They have also become nearly ubiquitous: According to the estimates of local conservationists, feral cats have established a permanent foothold across 99.8 percent of the country, with their density reaching up to 100 per square kilometer in some areas. Even places nearly devoid of human settlement, like the remote and craggy Kimberley region, have been found to harbor cats that hunt native animals. The control effort, to which Western Australia’s baiting program belongs, was meant to ease the predation pressure that cats exerted in every corner of the country where they had settled. Faced with a choice between a species regarded as a precious pet and the many small creatures of their unique land, Australians seemed to have decided that guarding the remaining wild might mean they would have to spill some blood.

BTW, Ted Nugent sucks.

3 dead, 3 sick in UK hospital sandwich outbreak

I’ve told these Australian hospitals to stop serving raw sprouts and cold cuts to immunocompromised people.

They just call me crazy.

Three hospital patients in the UK have died in an outbreak of listeria linked to pre-packed sandwiches.

Public Health England (PHE) said the victims were among six patients affected in England and the deaths occurred in Manchester and Liverpool.

Two of the victims were at Manchester Royal Infirmary, with the other a patient at Aintree Hospital.

Sandwiches and salads from The Good Food Chain linked to the outbreak have been withdrawn and production ceased.

PHE said the products were withdrawn from hospitals when the links to the infections were first identified.

PHE said The Good Food Chain had been supplied with meat produced by North Country Cooked Meats which subsequently produced a positive test result for the outbreak strain of listeria.

This business and North Country Quality Foods, who it distributes through, have also voluntarily ceased production.

A spokesman for The Good Food Chain Ltd said the company’s production facility in Stone, Staffordshire, was “cross contaminated by an ingredient from one of its approved meat suppliers”.

Empathy, barfblog and rock and roll

I used to have Mick Taylor hair.

And then it turned grey, and went straight up, like Lyle Lovett.

I used to have a brain, but I feel it ever so slowly fading away, so I’ll get as much writing in while I’m somewhat together.

Personality, worse than ever, because I alternate between frightened, fearless and forlorn, and have no control over it.

This won’t end well.

Chapman asked me if doing all this end of life stuff like making sure my families were taken care of was a downer, and I say no, I’ve been fighting so long, it’s sort of cathartic.

My wife rolls her eyes and turns away when I tell people, I couldn’t remember my own phone number yesterday because I started taking pucks to the head in 1967.

She just thinks I’m a drunk.

Empathy may not be her strong suit.

Yet new research shows that just one concussion can mess the brain up.

I’ve had dozens, if not hundreds.

I’ve shared this with my physicians, but why not use this megaphone. When I die, someone please call this number and they’ll have a look at my brain. They’re hooked up with the CTE clinic in Boston (that’s a Sydney number, so needs a 61 first).

Research published by the American Psychological Association finds that even when feeling empathy for others isn’t financially costly or emotionally draining, people will still avoid it because they think empathy requires too much mental effort.

Amy’s had a lot to deal with and I blame her for nothing.

If I’ve learned anything on this journey, it’s the value of empathy (but like a good scientist, I want to know what works and what doesn’t, not just a bunch of catch-phrases).

I’ll stick with it as long as I can, because the reason I started the Food Safety Network in 1993 is still valid today: no parent, no individual, should say, they didn’t know the risk (followed by tragedy).

And where else would I get to play the music I love.

Freedom of the press belongs to those who own one.

Bacteria flip an electric switch to worsen food poisoning

Salmonella bacteria flip an electric switch as they hitch a ride inside immune cells, causing the cells to migrate out of the gut toward other parts of the body, according to a new study publishing on April 9 in the open-access journal PLOS Biology by Yaohui Sun and Alex Mogilner of New York University and colleagues. The discovery reveals a new mechanism underlying the toxicity of this common food-borne pathogen.

Salmonella are among the commonest, and deadliest, causes of food poisoning, causing over 400,000 deaths every year. Many of those deaths result when the bacteria escape the gut inside immune cells called macrophages. Macrophages are drawn to bacteria in the gut by a variety of signals, most prominently chemicals released from the site of infection. Once there, they engulf the bacteria as a regular part of their infection-fighting job. However, rather than remaining there, bacteria-laden macrophages often leave the site and enter the bloodstream, disseminating the bacteria and greatly increasing the gravity of the infection.

Tissues such as the gut often generate small electrical fields across their outer surfaces, and these electrical fields have been known to drive migration of cells, including macrophages. In the new study, the authors first showed that the lining of the mouse cecum (the equivalent of the human appendix) maintains a cross-membrane electrical field, and that Salmonella infection altered this field and contributed to the attraction of macrophages. Measurements of the polarity of the local charge indicated that the macrophages were attracted to the anode, or positively charged pole within the field. Once they engulfed bacteria, however, they became attracted to the cathode and reversed their migratory direction, moving away from the gut lining, toward vessels of the circulatory system. This switch was driven by a in the composition of certain charged surface proteins on the macrophages; the mechanism by which bacterial engulfment triggers this change is still under investigation.

“Dissemination, rather than localized infection, is the greatest cause of mortality from Salmonella (and other food-borne bacteria), and so understanding more about this polarity switch is likely to help develop new treatments to reduce deaths from food-borne bacterial infections,” said Mogilner.

5 dead, 22 sick: Multi-country outbreak of Listeria monocytogenes clonal complex 8 infections linked to consumption of cold-smoked fish products

The European Centre For Disease Prevention and Control reports a prolonged multi-country outbreak of 22 listeriosis cases caused by Listeria monocytogenes sequence type (ST) 1247, clonal complex (CC) 8 has been identified through whole genome sequencing (WGS) in five EU countries: Denmark (9 cases), Estonia (6), Finland (2), France (1) and Sweden (4). Five patients have died due to, or with, the disease. The first case had symptom onset in July 2014 in Estonia, and the most recent case occurred in Denmark in February 2019. Eight patients, out of twelve for whom a food consumption history was available, confirmed the consumption of cold-smoked fish products.

L. monocytogenes food isolates, matching the human outbreak strain by WGS, were detected at wholesale and retail level in four countries (i.e. France, Denmark, Italy and Sweden) from 13 batches of cold smoked or gravad salmon and from six batches of cold smoked trout products. Traceability information of the contaminated batches pointed to the Estonian processing Company A as the single common manufacturer of these fish products. The raw fish was received from suppliers in Norway and Finland. Environmental investigations and food testing at the Estonian processing plant showed the presence of L. monocytogenes that matched the outbreak strain in two samples on the processing line and in four batches of the final product.

The presence of L. monocytogenes matching the outbreak strain over several years in the fish products suggests the persistence of the microorganism at the Estonian company’s premises. Further investigation is needed to identify points of cross-contamination in the food processing plant. Control measures were implemented in Estonia, Denmark, France and Italy following the RASFF (Rapid Alert System for Food and Feed) notifications, but until the source of infection has been identified and controlled, new invasive listeriosis cases associated with this event may still occur.  

In general, pregnant women, the elderly and immunocompromised individuals are at increased risk of invasive listeriosis, which is associated with severe clinical course and potentially death. 

Looks like I missed this one too: ‘My mom’s death was needless’ Families want answers after Salmonella outbreak at Winnipeg care home

Tessa Vanderhart of CBC reported last month a Winnipeg care home where two residents recently died has confirmed it served frozen food from Thailand that was later linked to the Canada-wide outbreak of salmonella. 

Golden West Centennial Lodge executive director Joyce Kristjansson told staff and families in an email on Tuesday morning it had given residents cream puffs that are now on the recall list. 

Two residents at the 116-bed personal care facility in the Sturgeon Creek neighbourhood died in March, and a third was sickened. All three tested positive for salmonella.

The Public Health Agency of Canada confirmed the three cases at Golden West are linked to the outbreak which has struck 73 people nationwide. 

Investigators have linked the bacteria-caused gastrointestinal illnessto Celebrate-brand frozen profiteroles and mini chocolate eclairs.

Science behind the human urge to tell stories

Whenever I speak with a psychiatrist or psychologist who is trying to rearrange my brain until I’m sane, they all say the same thing: stop with the stories and get to the point.

They think I’m using stories as a distraction tactic, whereas I’m using stories to enhance the meaning of what is or isn’t going on upstairs.

If you’ve seen the film, Lincoln, you may know what I’m storying about.

And the eggheads don’t get it.

Leo Robson of New Statesman America writes that although it has been more than 60 years since Ernst Gombrich delivered his Mellon lectures on art and illusion – the title of his subsequent bestselling book – the application of empirical thinking to works of culture or creativity is still considered a minority interest, even a kind of novelty. There are academic courses in critical approaches such as “evolutionary literary theory” and “cognitive poetics”, but they are taught by academics with devoted professorships in other fields of study.

With notable exceptions, most of the movement has been from the humanities towards the sciences, as was the case with Gombrich, who used cognitive psychology to illuminate the processes of visual representation; with the film scholar David Bordwell, who has cited Gombrich’s example; and with the Nabokov biographer Brian Boyd, who in his book On the Origin of Stories (2010) mentioned the “revelatory” experience of discovering Bordwell’s work. Now Will Storr, a journalist and writing teacher, has written an account of our story-telling instincts that doubles as a guide to telling better stories.

It would be hard to imagine a case of more wholehearted advocacy. The book is heavy with categories, dichotomies and tags (“identity claims”, “feeling regulators”). Storr begins with the idea that stories emerged to address the fact that life is “meaningless”. This does not explain why a child oblivious to the planet’s looming “heat death”, the “infinite, dead, freezing void”, may still enjoy an episode of Paw Patrol, but it’s true that a desire for order has always prevailed among human beings. Or, in Storr’s rather Tarzan-ish phrasing, “Story is what brain does.” He goes further, arguing with clarity and conviction that it is due to our brains’ desire for control that we are excited by stories of change. Boy meets girl. Stranger dismounts from horse. Complacent youth is humbled. Ancient order shows signs of frailty.

Storr succeeds in bridging evolutionary psychology and narrative theory, or making one the basis for the other. But unlike Gombrich or Bordwell, his aim isn’t to answer a critical question better. He’s probing his own craft in order to teach it to others. So it’s odd that he approaches the subject mainly as a researcher. He doesn’t bring to bear his experience of working on his novel, The Hunger and the Howling of Killian Lone; or of turning research into books, such as The Heretics; or, in his work as a ghostwriter, shaping reams of interview transcripts into a pleasing or plausible account of a life. It would be rather as if David Hockney had neglected to mention his life as “an artist, a mark-maker”, in Secret Knowledge, his remarkable study of optical devices.

Instead, Storr turns to novels and films for examples of storytelling that appeal to our neural processes, but they do little to help his case. He tells us that Raymond Chandler packs “a tonne of meaning” into the image “Dead men are heavier than broken hearts”; and that the lines “I love the smell of napalm in the morning” and “These go to 11” are “so dense with narrative information it’s as if the entire story is packed into just a few words”. His most frequently cited case studies are Kazuo Ishiguro’s novel The Remains of the Day and Citizen Kane, though neither is very representative, being less stories than meta-stories, respectively a faux-memoir of an unusually ruminative sort and the portrait of a journalist assigned to uncover what made a man tick.

It’s in the writing manual section that the book is at its strongest. In one terrific passage, Storr explains that an audience’s curiosity – resembling the shape of the lower-case “n” – peaks when we know something and fades away when we know everything. Then, in an appendix, Storr elaborates his theory that “more traditional” – ie non-science-based – “attempts at decoding story”, such as Joseph Campbell’s monomyth” or idea of the “hero’s journey”, have emphasised ideas of plot and structure at the expense of what he calls “character work”. Storr’s concept of the “sacred flaw” – an over-compressed phrase referring to the faulty concept that a character holds sacred – is lucid, original, plausibly grounded in the science and proves once again just how much goodwill can be derived from a satisfying ending, even when it depends on a deus ex machina (I don’t speak foreign languages).

Ontario parents speak out after 2-year-old’s E. coli linked death

I seemed to have missed this, which is inexcusable, volunteer or not, medical stuff for me or not, but here it is, a month later (and if I did publish it, shows where my brain is going).

Avis Favaro of CTV News reported in early May that it all started with a romaine salad.

Kristen and Brad Bell felt a little sick after eating the salad last October.

Their two-year-old son soon started to show more severe symptoms. Cooper Bell was vomiting. He developed diarrhea. Then his mother noticed the blood in his diaper.

“I had no idea [what] was happening,” Kristen Bell told CTV News from her home in Stirling, Ont.

“I thought ‘This is not normal.'”

An emergency room doctor thought Cooper might have contracted a bacterial infection. The family’s pediatrician agreed, saying the Bells should keep their son hydrated and bring him back in the morning.

Soon after the Bells returned home, they noticed some worrying changes in Cooper’s behavior.

“He wasn’t responding to me the same as he was earlier. It wasn’t long after that, that he had a seizure in Brad’s arms,” Kristen Bell said.

Seeing their son shaking uncontrollably with his eyes closed, the Bells called an ambulance. He spent a few hours in hospital in nearby Belleville, Ont., and was then airlifted to the Children’s Hospital of Eastern Ontario in Ottawa.

Doctors at CHEO diagnosed Cooper with kidney failure brought on by E. coli. He suffered cardiac arrest and died. The Bells believe it was the romaine lettuce that made Cooper sick, although they were unable to send the lettuce for testing to confirm their belief because it had been thrown out.

There were 29 illnesses and 10 hospitalizations reported across Canada during last fall’s E. coli outbreak, according to the Public Health Agency of Canada. It was one of three outbreaks in North America over the past year all of which were linked to romaine lettuce.

Keith Warriner, a food safety expert and professor at the University of Guelph in Ontario, said in an interview that the food industry has long been slow to improve its testing practices something that could improve overall food safety, but would mean extra costs for their operations.

“The industry itself has known for many years what it needs to do, but it’s just been reluctant to do it,” he said.

The Bells agree. They’re sharing their story of grief with the hope it will help hospital workers and other parents better understand the danger of E. coli, but also because they want to see changes at the food production level.

“E. coli shouldn’t be in our food,” Brad Bell said.

“The way that we’re growing food is dangerous, and something has to change.”