Last year it was sprouts that sickened some 4,400 and killed 53 in an outbreak centered in Germany; now the number of children that have fallen ill with vomiting and diarrhea after eating food from school cafeterias and daycare centers has risen from about 4,500 to 8,400.
Authorities in Berlin and the surrounding eastern German states reported the new gastroenteritis cases Saturday, while laboratory investigations to determine the exact cause of the outbreak were still under way.
Berlin’s health department says the sicknesses are moderate and most children recover within two days without requiring to be hospitalized.
That’s nice.
In Saxony state, at least 16 cases of norovirus, a mostly food- or water-borne illness, were proven, according to German news agency dapd.
The government-affiliated Robert Koch Institute said Friday that all facilities where the illness occurred likely received food from a single supplier.
German health authorities say at least 6,500 German children and teenagers have fallen ill with diarrhea and vomiting that health authorities say has likely been caused by a foodborne virus in meals delivered to schools and daycare centers.
The Robert Koch-Institut says it was alerted to a sudden surge in gastroenteritis cases that began late Tuesday in Berlin and surrounding regions.
The institute said in a statement late Thursday that laboratory investigations are under way to determine the exact cause of the outbreak.
Raw sprouts are the poster child for failures in what academics call, risk communication.
I’ve been thinking about this for a long time.
About 1999, graduate student Sylvanus Thompson started working with me on risk analysis associated with sprouts. He got his degree and went on to rock-star status in the food safety world with the implementation of the red-yellow-green restaurant inspection disclosure program with Toronto Public Health, but we never published anything.
I remember frantically flying to Kansas City to hang out with this girl in Manhattan (Kansas) I’d met a couple of weeks before, in the midst of the 2005 Ontario raw sprout outbreak that sickened over 700; Jen Tryon, now with Global News, interviewed me at the airport, with me wearing a K-State hockey shirt (that’s the joke; there is no hockey at K-State, and I was still employed by Guelph; and I was going to hang out with this girl).
After the German E. coli O104 outbreak that killed 53 people last year and sickened over 4,000, along with the ridiculous public statements and blatant disregard for public safety taken by sandwich artist Jimmy John’s in the U.S., I figured we really needed to publish something.
The basic conclusions:
• raw sprouts are a well-documented source of foodborne illness;
• risk communication about raw sprouts has been inconsistent; and,
• continued outbreaks question effectiveness of risk management strategies and producer compliance.
We document at least 55 sprout-associated outbreaks occurring worldwide affecting a total of 15,233 people since 1988. A comprehensive table of sprout-related outbreaks can be found at http://bites.ksu.edu/sprouts-associated-outbreaks.
Sprouts present a unique food safety challenge compared to other fresh produce, as the sprouting process provides optimal conditions for the growth and proliferation of pathogenic bacteria. The sprout industry, regulatory agencies, and the academic community have been collaborating to improve the microbiological safety of raw sprouts, including the implementation of Good Manufacturing Practices (GMP), establishing guidelines for safe sprout production, and chemical disinfection of seed prior to sprouting. However, guidelines and best practices are only as good as their implementation. The consumption of raw sprouts is considered high-risk, especially for young, elderly and immuno-compromised persons (FDA, 2009).
Sol Erdozain, now a graduate student in psychology at Kansas State University, took the lead on this one. Kevin Allen, now a prof-type and hockey goon at the University of British Columbia (that’s blue-eyes, right) who used to take great pleasure firing pucks off my head – even though he is also a goalie – weighed in with his microbiology expertise, Katija Morley (nee Blaine) made our arguments more coherent, and I pestered everyone. Because I should have published something like this 12 years ago.
Writing is hard.
From November 2010 into 2011, an outbreak linked to raw sprouts in the U.S. and involving sandwich franchise Jimmy John’s sickened 140 people. This was the third sprout related outbreak involving this franchise, yet the owner of the Montana Jimmy John’s outlet, Dan Stevens, expressed confidence in his sprouts claiming that because the sprouts were locally grown they would not be contaminated. By the end of December 2010 a sprout supplier, Tiny Greens Farm, was implicated in the outbreak. Jimmy John’s owner, John Liautaud, responded by stating the sandwich chain would replace alfalfa sprouts with clover sprouts since they were allegedly easier to clean. However, a week earlier a separate outbreak had been identified in Washington and Oregon in which eight people were infected with Salmonella after eating sandwiches containing clover sprouts from a Jimmy John’s restaurant. This retailer was apparently not aware of the risks associated with sprouts, or even outbreaks associated with his franchisees.
In late December 2011, less than one year after making the switch to clover sprouts, Jimmy John’s was linked to another sprout related outbreak, this time it was E.coli O26 in clover sprouts. In February 2012, sandwich franchise Jimmy John’s announced they were permanently removing raw clover sprouts from their menus. As of April 2012, the outbreak had affected 29 people across 11 states. Founder and chief executive, John Liautaud, attempted to appease upset customers through Facebook stating, “a lot of folks dig my sprouts, but I will only serve the best of the best. Sprouts were inconsistent and inconsistency does not equal the best.” He also informed them the franchise was testing snow pea shoots in a Campaign, Illinois store, although there is no mention regarding the “consistency” or safety of this choice.
Despite the frequent need for sprout-based risk communication, messaging with industry and public stakeholders has been limited in effectiveness. In spite of widespread media coverage of sprout-related outbreaks, improved production guidelines, and public health enforcement actions, awareness of risk remains low. Producers, food service and government agencies need to provide consistent, evidence-based messages and, more importantly, actions. Information regarding sprout-related risks and food safety concerns should be available and accurately presented to producers, retailers and consumers in a manner that relies on scientific data and clear communications.
Erdozain, M.S., Allen, K.J., Morley, K.A. and Powell, D.A. 2012. Failures in sprouts-related risk communication. Food Control. 10.1016/j.foodcont.2012.08.022
Nutritional and perceived health benefits have contributed to the increasing popularity of raw sprouted seed products. In the past two decades, sprouted seeds have been a recurring food safety concern, with at least 55 documented foodborne outbreaks affecting more than 15,000 people. A compilation of selected publications was used to yield an analysis of the evolving safety and risk communication related to raw sprouts, including microbiological safety, efforts to improve production practices, and effectiveness of communication prior to, during, and after sprout-related outbreaks. Scientific investigation and media coverage of sprout-related outbreaks has led to improved production guidelines and public health enforcement actions, yet continued outbreaks call into question the effectiveness of risk management strategies and producer compliance. Raw sprouts remain a high-risk product and avoidance or thorough cooking are the only ways that consumers can reduce risk; even thorough cooking messages fail to acknowledge the risk of cross-contamination. Risk communication messages have been inconsistent over time with Canadian and U.S. governments finally aligning their messages in the past five years, telling consumers to avoid sprouts. Yet consumer and industry awareness of risk remains low. To minimize health risks linked to the consumption of sprout products, local and national public health agencies, restaurants, retailers and producers need validated, consistent and repeated risk messaging through a variety of sources.
There was this one time, Chapman came to Manhattan (Kansas) and lasted one quarter of a Kansas State football game before rushing home with explosive diarrhea.
My whiny kid didn’t help either.
He spent the rest of the visit holed up downstairs, sucking back Gatorade and sitting on the toilet.
When he got back to North Carolina he had the wherewithal to donate a stool sample, and eventually found out he was part of a state-wide antibiotic-resistant campylobacter outbreak.
In light of the German-based E. coli O104 outbreak in raw sprouts last year, researchers in Germany and Sweden are now calling for all stool samples from patients with diarrhea to be tested for enteropathic E. coli.
Following an outbreak of enterohaemorrhagic Escherichia coli (EHEC) in Germany 2011, we observed increases in EHEC and non-EHEC E. coli cases in Bavaria. We compared the demographic, clinical and laboratory features of the cases reported during the outbreak period, but not related to the outbreak, to the cases reported before and after. The number of EHEC and non-EHEC E. coli cases notified per week during the outbreak was fivefold and twofold higher respectively, compared to previous years. EHEC cases notified during the outbreak were more often reported with bloody diarrhoea, and less often with unspecified diarrhoea, compared to the other periods. They were more often hospitalised during the outbreak and the following period compared to the period before. Their median age (26.5 years, range: 0–90) was higher compared to before (14.5 years, range: 0–94) and after (5 years, range: 0–81). The median age of non-EHEC E. coli cases notified during the outbreak period (18 years, range 0–88) was also higher than before and after (2 years, p<0.001). The surveillance system likely underestimates the incidence of both EHEC and non-EHEC E. coli cases, especially among adults, and overestimates the proportion of severe EHEC cases. Testing all stool samples from patients with diarrhoea for enteropathic E. coli should be considered.
“In view of the major EHEC outbreak in early summer 2011, the BfR once again draws attention to hygiene measures which must be observed in the cultivation and preparation of sprouts, since contaminated sprouts were in all likelihood the cause of the numerous infections at the time. Independently of the past EHEC outbreak, the BfR had already earlier drawn attention to the risk of contracting disease resulting from the consumption of raw sprouts.
“When handling seeds and raw sprouts, consumers should be particularly meticulous in taking hygiene measures in order to minimise the risk of an infection. If possible, sprouts should also be sufficiently heated by boiling or frying or at least thoroughly washed before they are eaten. Pathogens cannot be removed completely by light heating or washing of the sprouts. For this reason, persons with a weak immune system, i.e. infants, pregnant women, the elderly and persons suffering from illness should, to be on the safe side, only eat sprouts after they have been adequately heated.”
With 53 dead and some 4,400 sickened, mostly in Germany, it was a, uh, major outbreak. And it was most likely contaminated fenugreek seed imported from Egypt that was the underlying cause. Washing isn’t going to do much and cross-contamination is always a risk. Also not much help for those who buy sandwiches or salads in Europe (and Australia) where sprouts are ubiquitous.
Take a brochure for lunch next time and be better educated.
Ukraine team doctor Leonid Mironov believes the weakened players suffered from “the bad effects of eating a salad,” the Interfax news agency reported Thursday.
Team spokesman Oleksandr Glyvynskiy told The Associated Press there will be no further investigation into the cause of the food poisoning, despite head coach Oleg Blochin suggesting on Ukrainian TV that “it may have been sabotage.”
The researchers conducted exploratory interviews via telephone with the hostess, three barbecue guests and one person who had prepared a salad but did not attend the barbecue himself.
The barbecue lasted from about 15:00 hours until well after midnight. According to the hostess, 14 persons attended the barbecue and all of them became ill with gastroenteric symptoms that night or the day after the party.
A person who was supposed to attend the barbecue party had fallen ill the day before (30 April). He had prepared a vegetable pasta salad in the morning and
developed gastroenteric symptoms within 3 h after salad preparation. He was hospitalized the next morning (1 May) and therefore did not attend the barbecue.
Nevertheless, his salad was served at the party. It was stored unrefrigerated for 23 h at approximately 20C before being served. The stored salad contained only pasta, tomatoes, peppers and cucumbers and was dressed with basic vinaigrette from oil and vinegar just shortly before consumption.
Storing the salad at room temperature for 23 h allowed a substantial increase of bacterial load, which can explain the severe infections of all barbecue guests, none of whom belonged to a risk group for severe infections. Proliferation is inhibited or can be reduced by acidic pH values but vinegar was only
added to the salad shortly before serving.
This outbreak underscores the importance of proper kitchen hygiene and food storage in private settings. Food hygiene recommendations should be reiterated to the public at the beginning of the barbecue season by public health actors. Additionally, it should be emphasized that if a person develops gastroenteric symptoms shortly after preparing a meal, the food should be considered as potentially infectious and discarded.
Abstract below.
Severe infections caused by Salmonella Enteritidis PT8/7 linked to a private barbecue
Epidemiology and Infection, FirstView Article : pp 1-7
E. Mertens, H. Kreher, W. Rabsch, B. Bornhofen, K. Alpers and F. Burckhardt http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=8542116 A cohort study on a barbecue-associated Salmonella outbreak was conducted to describe the burden of disease and to identify the outbreak vehicle. Dose–response relationships were tested with Fisher’s exact and Wilcoxon rank sum tests (alpha=0·05). S. Enteritidis isolates were cultured and phage-typed. Information was available for 11 out of 14 individuals attending the barbecue; all were healthy young adults (median age 27 years). The attack rate was 100%. Three cases were hospitalized and two developed acute pancreatitis. The exposure common to all cases was a vegetable pasta salad that had been stored unrefrigerated for 23 h. Consuming higher doses was associated with longer median symptom duration (7 days vs. 4 days, P=0·11). S. Enteritidis was found in the stools of nine barbecue guests. Phage type 8/7 was identified in the stools of the salad preparer and one barbecue guest. This outbreak shows that S. Enteritidis can cause serious infection in young healthy individuals without well-known risk factors.
A recent study by the Robert Koch Institute found that even small children in Germany eat raw meat more often than expected, so the Federal Institute for Risk Assessment (BfR) decided to remind Germans that raw meat for children is a bad idea.
"Raw animal foods are often contaminated with pathogens", explains Professor Dr. Dr. Andreas Hensel, president of BfR. "For this reason, especially vulnerable sections of the population, such as small children, pregnant women, the elderly and people with a weakened immune system, should as a rule not eat these foods raw."
Raw meat can transmit, among other things, salmonella, Campylo¬bacter, E. coli including EHEC, Yersinia, Listeria and also viruses and parasites.
A recent study by the Robert Koch Institute published in the Epidemiological Bulletin has shown that raw minced pork is the most important risk factor for contracting yersiniosis. Yesiniosis is a gastro-intestinal disease which is notably caused by the bacterium Yersinia enterocolitica. Yersinia are predominantly spread through food, especially raw pork. Pork, for example minced pork and seasoned minced meat, is often eaten raw in Germany. One of the surprising findings of the published study was the high number of children who had eaten raw minced pork. Even of children who were one-year-old or younger it was reported that almost 30% of those who had fallen ill (and 4 % of the control persons) had eaten raw minced pork.
In Germany and other European countries, Campylobacter is now the most prevalent bacterial pathogen for enteric infections in humans. In the year 2011, more than 70,000 human campylobacteriosis cases were reported.
Campylobacter bacteria are notably found in raw or insufficiently heated poultry meat, but also in raw meat of other animals as well as raw milk and hen’s eggs.
The number of reported salmonellosis cases in humans, especially from Salmonella Enteritidis, has fallen significantly in the last three years.
In contrast, human infections with Salmonella Typhimurium have decreased to a lesser extent. SalmonellaTyphimurium are especially common in turkey meat and pork. As part of zoonosis monitoring, salmonella, most frequently Salmonella Typhimurium, were detected in 5 % of minced meat samples in 2009. This finding confirms that raw minced meat can be a source of infection for humans.
To protect themselves against often severe cases of foodborne infections, especially vulnerable sections of the population such as children under five, pregnant women, elderly and persons with a weakened immune system should as a matter of principle refrain from eating raw foods. They should therefore avoid consuming raw mince or seasoned minced meat, raw sausage, raw milk and raw-milk cheese, raw fish (e.g. sushi) and certain fishery products (e.g. smoked and gravad salmon) as well as raw seafood (e.g. raw oysters).
All that and no mention of raw sprouts? In Germany? The risk assessors did say consumers can “protect themselves by cooking meat and poultry sufficiently and evenly” and that “such meat must be cooked until the juices run clear and the meat has a whitish (poultry), gray-pink (pork) or gray-brown (beef) color. The inside temperature of the meat should be at least 70 °C for two minutes. If in doubt, consumers can measure this temperature by means of a meat thermometer.”
Some risk assessors. Color is a lousy indicator and consumers should be using a tip-sensitive digital thermometer to erase doubt. And stop making little kids barf.
Blame the media is a routine strategy for politicians and scientists (no difference when speaking on the public stage) but one that is rarely valid.
Except most media these days opts for puppy-eyed compliance rather than critical questions.
Dr. Rainer Wessel, director of the CI3 excellence cluster of the German Rhein-Mainz region, managed to keep a straight face as he told an audience in Berlin last week that the death toll in the E. coli O104 outbreak in sprouts last year that killed 53 was “minimal” and paled in comparison to the daily death toll of car accidents.
Risk comparisons are risky.
Because only 53 people died, Wessel viewed the reaction of the public health surveillance system as a success, adding, “Biological threats are complicated. The machine was working pretty well, even if some reactions were slow.” But this can be improved, it depends how much society wants to invest in it.
Maybe something was lost in translation.
According to the Future Challenges website, Wessel argued the media played a big role in frightening the population and creating a unnecessary outburst in society.
“The media are also enterprises, they have to sell too.”
Wessel didn’t mention that during two weeks the public received contradictory information, which wasn’t invented by journalists, but given by government officials.
On the 22th of May 2011, German health authorities said: “Clearly, we are faced with an unusual situation“ and didn’t deliver further information on the origin of the outbreak.
On the 25th, the Health Minister of Hamburg Cornelia Storck declared that the disease was carried by Spanish cucumbers. The German federal government withdrew them from the market causing €51 million in losses to Spanish agriculture, according to the Spanish environment minister. After some tests, the cucumbers were invalidated as the source of the epidemic.
On the 4th of June, German officials alleged that a restaurant in Lübeck, North Germany, was the starting point of the outbreak.
On the 5th, officials pointed to a farm in Lower Saxony being the source of the epidemic, an information that was invalidated and then finally confirmed again on the 10th of the same month.
Wessel maintains that the press should be better informed, which is always good. In case of risk, the Robert-Koch-Institut, the German official health surveillance agency, should receive funding for a small press room in order to give correct information and respond to the questions of journalists, “to avoid that a second or third grade scientist gets interviewed on a local level.”
about 4,500 to 8,400.
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My whiny kid didn’t help either..jpeg)
since contaminated sprouts were in all likelihood the cause of the numerous infections at the time. Independently of the past EHEC outbreak, the BfR had already earlier drawn attention to the risk of contracting disease resulting from the consumption of raw sprouts. 
eating a salad,” the Interfax news agency reported Thursday.
Palatine.
Yesiniosis is a gastro-intestinal disease which is notably caused by the bacterium Yersinia enterocolitica. Yersinia are predominantly spread through food, especially raw pork. Pork, for example minced pork and seasoned minced meat, is often eaten raw in Germany. One of the surprising findings of the published study was the high number of children who had eaten raw minced pork. Even of children who were one-year-old or younger it was reported that almost 30% of those who had fallen ill (and 4 % of the control persons) had eaten raw minced pork..jpg)
“such meat must be cooked until the juices run clear and the meat has a whitish (poultry), gray-pink (pork) or gray-brown (beef) color. The inside temperature of the meat should be at least 70 °C for two minutes. If in doubt, consumers can measure this temperature by means of a meat thermometer.”
the E. coli O104 outbreak in sprouts last year that killed 53 was “minimal” and paled in comparison to the daily death toll of car accidents.