Tag Archives: Germany

Shiga toxin-producing E. coli in feces and lymphatic tissue of free-ranging deer in Germany

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I sorta cringe, or maybe sigh, every time someone faithfully repeats the dogma that factory-farmed cattle are the source of E. coli O157:H7 and other shiga-toxin producing E. coli (STEC).

All ruminants carry STEC naturally, and there are well-documented and tragic outbreaks involving deer, goats, sheep, elk and others.

German researchers report on the occurrence of STEC in deer in Germany in the current issue of Epidemiology and Infection.

Deer poop has been directly or indirectly linked to several outbreaks:

• 1 dead and 14 sickened from E. coli O157:H7 from deer feces contaminating strawberries in Oregon in Aug. 2011;

• deer feces were a possible source of E. coli O157 in Oregon hazelnuts that sickened 8 in March 2011;

• 29 Minnesota high school students sickened with E. coli O103 and E. coli O145 after butchering and processing deer into venison in 2010;

• deer meat was involved in at least two recognized E. coli outbreaks; and,

• an E. coli O157:H7 outbreak in Oct. 1996 that killed a 16-month-old and sickened 76 others who drank juice which contained unpasteurized apple cider that was probably contaminated with deer feces.

In the current study, the Germans studied the virulence genes eae, e-hlyA and saa, thestx subtypes, pulsed-field gel electrophoresis (PFGE) patterns and serovars. In total, 120 samples of 60 animals were screened by real-time polymerase chain reaction (PCR). The PCR results showed a high detection rate of stx genes (83%). Mainly faecal samples, but also some lymphatic tissue samples, tested stx-positive. All isolates carried stx2, were eae-negative and carried e-hlyA in 38% and saa in 9% of samples. Serovars (O88:[H8], O174:[H8], O146:H28) associated with human diseases were also identified. In some animals, isolates from lymphatic tissue and faecal samples showed undistinguishable PFGE patterns. The examined deer were shown to be relevant reservoirs of STEC with subtype stx2b predominating.

The complete paper is available at http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=8501556.

Four more cases of EHEC – E. coli O157 — in Hamburg

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Aerztezeitung.de is reporting that four more cases of enterohaemorrhagic Escherichia coli (EHEC) have emerged in Hamburg, Germany, following the death of a 6-year-old girl last week.

An 11-year-old boy and a 3-year-old kindergartner tested positive earlier this week, and two women aged between 68 and 88 years were earlier diagnosed with EHEC. Tests have identified the strain as E. coli O157.

Six-year-old girl dies from E. coli in Germany

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The translation is rough and details sketchy, but Focus is reporting a 6-year-old girl from Hamburg died over the weekend from the effects of EHEC, which probably means some strain of shiga-toxin producing E. coli.

A spokesman for the Health Authority of the City of confirming the news agency on Sunday evening, a case of illness with the pathogen.According to the newspaper "Die Welt" on Monday, the child died in the early hours of Sunday. The first grader had shown since the beginning of last week, symptoms of infection with the aggressive food germ, the head of a primary school in Hamburg-Blankenese said on Sunday. She was treated at a hospital. Apparently it was an isolated case

"This is an isolated incident," said the spokesman. "It is not at all comparable to the situation last year" (meaning sprouts and E. coli O104, in which 53 people died).

Carnage of the sprouts: Jimmy John’s and lessons from Germany

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Those Jimmy John’s clover sprouts that have sickened at least 12 people in the Midwest with E. coli O26 may have been grown on a farm in Kansas.

I can’t wait to find out who the third-party auditor was.

Missouri’s News-Leader reports the restaurants in Springfield had obtained the sprouts from a farm in Kansas, but neither the restaurants or the farm appeared to be the source of the contamination.

But the restaurant chose to sell raw sprouts.

John Hershberger, the owner of Sweetwater Farms in Inman, Kansas, said federal investigators have not conclusively linked the seeds to the outbreak. He said an investigator from the U.S. Department of Food and Drug Administration was at his farm last week but didn’t find any contamination at the farm.

“They don’t know that for a fact,” Hershberger said of a possible link to the seeds.

Hershberger said he had voluntarily withdrawn clover sprouts from the market.

A paper in Arkansas, home to one of the illnesses, said, “In most sprout outbreaks the restaurant is not to blame for the contamination itself. Contamination usually happens when the seeds are grown or harvested and is often impossible to wash off.”

It’s true sprouts are often contaminated at the seed level but absolute nonsense that whoever serves those raw sprouts on sandwiches isn’t responsible, especially when raw sprouts have been the source of four previous outbreaks since 2008 at the same sandwich chain – Jimmy John’s.

Can food service learn anything from past sprout outbreaks – and there have been a lot, see http://bites.ksu.edu/sprouts-associated-outbreaks.

Eurosurveillance, reported yesterday that a bunch of experts who gathered in Nov. 2011 concluded the outbreak showed the landscape of foodborne infections is in flux, that multi-national outbreaks are a reality and that they can occur everywhere, irrespective of food safety standards.

Nothing was said about whether people should eat raw sprouts or even if raw sprouts were a high-risk food.

Another unregistered caterer makes people barf at a wedding in Germany; don’t put flowers in food

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In a triumph of food porn over food safety, an investigation into an outbreak of salmonellosis in the summer of 2010 after a wedding party in Bavaria, Germany that sickened at least 52 people failed to pinpoint a specific food source but did uncover a number of disturbing food safety practices – such as adding rose petals to food and no temperature checks — again linked to an unlicensed caterer.

German researchers report in Eurosurveillance this week that in the summer of 2010, a local health office in northern Bavaria, Germany, was informed that approximately half of the 110 guests of a wedding that had taken place the preceding weekend had contracted gastroenteritis. At the wedding party, soup and a late-lunch buffet (served from 3 p.m.) and a cold dinner buffet (served from 10 p.m.) had been provided by an out-of-town caterer. In addition, a wedding cake made by a local bakery and a number of cakes and desserts contributed by different wedding guests were served by the catering staff at 20.00. The food served at the wedding was suspected to be the source of the outbreak. Initial laboratory results of stool samples of some guests who became ill indicated Salmonella enterica subsp. enterica serovar Enteritidis (S. Enteritidis) as the causative pathogen.

According to the caterer, only the meat dishes were prepared at the caterer’s facilities in advance. All sauces, antipasti and salads were made from commercially produced ingredients and were prepared at the wedding party venue. Food items that required cooling were transported in cooling boxes and stored in cooling units at the venue. At the venue, the lunch buffet was set up for six hours, between 2 p.m. (the buffet was set up one hour before it was available to guests) and 8 p.m. No checks were carried out of holding temperatures of the warm or cold dishes. Salads and other cold dishes were not cooled during this period. Photographs of the buffet showed that a number of the cold dishes were decorated with non-edible flowers (such as roses), which were inserted into the food. The flowers had been purchased at a wholesale retailer. Cakes supplied by a number of wedding guests were stored without cooling until they were served at 20:00. The dishes of the dinner buffet were not cooled. They were first served at 10 p.m. It is unclear for how long the dishes of the dinner buffet were served; however, it is known that the catering personnel departed at 00.30.

Inspection of the catering facilities and interview of the catering staff revealed a number of shortcomings contravening European food hygiene regulations. The facilities used by the caterer were not registered with the local authorities. There were no records of the required staff training on food hygiene. No temperature controls of cooling devices or transport boxes were carried out, nor were temperatures monitored during preparation or serving of warm dishes. There were no records of HACCP concept planning or implementation. The company was banned from catering until proof of changes in their practices had been provided to the local authorities.

The cohort study showed that a variety of dishes were associated with a significantly increased risk of infection: in particular consumption of a group of lunch dishes containing mayonnaise was associated with a high relative risk. Despite the constraint of a two-week delay between the wedding party and the questionnaires being sent out, participants appeared to recollect well which dishes they had consumed.

The isolation of S. Enteritidis from two of the food samples at the wedding party was judged to show that the food served posed a health risk, as all the food items were ready for consumption without requiring further preparation or heating. The isolation of indistinguishable Salmonella strains from the food samples as well as from stool samples of respondents and catering personnel supported the hypothesis that the outbreak was foodborne.

There are several possibilities for the source of the Salmonella contamination in this outbreak. Mayonnaise is a well-recognized vehicle of contamination when raw egg is used as an ingredient. However, in this outbreak all cold dishes and salads were made from commercially prepared ingredients. As commercially produced mayonnaise and sauces are conventionally based on pasteurized ingredients, it is unlikely that they would be the primary source of contamination. Commercial mayonnaise by itself is also not suitable for Salmonella propagation, due to its low pH adjusted by acetic acid. However, addition of mayonnaise to other salad ingredients may alter the overall acetic acid concentration of the mixture, thus providing a suitable base for proliferation once the pathogen has been introduced by secondary contamination.

The environmental investigation revealed a number of infringements of food safety regulations, including a lack of staff training and the absence of records of a food safety concept according to the HACCP principles. Lack of temperature controls for food storage and transport as well as prolonged presentation of buffet dishes at room temperature provided ideal conditions for pathogen proliferation, regardless of the primary source of contamination.

While they do not replace official controls, the HACCP principles are central to the European concept of food safety by helping food business operators to attain a high standard of food safety. Successful implementation of procedures based on the HACCP principles requires the full cooperation and commitment of food business employees. Adequate training of personnel is central to achieving this goal.

The outbreak investigated in this study demonstrates the consequences of lack of staff training and the failure to identify hazards to food safety, as well as failure to implement control measures to mitigate such hazards. The use of flowers as food decoration demonstrated insufficient understanding of the potential for contamination through products that are not intended for food production and therefore not subject to food hygiene regulations.

Intelligently implemented food hygiene concepts not only benefit the consumer but are also very much in the interest of the food business operator, whose business can be threatened by food-borne outbreaks. Initial hygiene and food safety training for food business operators should therefore also explain microbiological principles underlying food safety practices in order to equip the businesses with the required background knowledge and motivation to design and implement an intelligent food safety/HACCP concept, including the consideration and identification of potential sources of contamination. Explicit mention of the dangers of the use of non-edible flowers for decoration should be considered in guides to good practice, which are a valuable instrument to aid food business operators with compliance with food hygiene rules and with the application of the HACCP principles.

The complete paper is available at http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=20076.

It was the hemp seed flour from the Dutch; dietary supplement sickens 15 with Salmonella Montevideo in Germany, 2010

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"There are only two things I can’t stand in this world. People who are intolerant of other people’s cultures and the Dutch."

Michael Caine in Austin Powers, Goldmember

The freaky dekey Dutch got some salmonella in their groovy hemp seed flour and it made a bunch of Germans sick.

In March 2010 the Rapid Alert System for Food and Feed (RASFF) was used to inform about Salmonella Montevideo in a herbal food supplement, formulated in capsules, distributed under a Dutch label in Germany.

Simultaneous to the first RASFF notice, in the last two weeks of March 2010 an unusual number of 15 infections with S. Montevideo was notified within the electronic reporting system for infectious diseases at the Robert Koch Institute. Adult women (median age: 43, range: 1–90 years) were mainly affected.

An outbreak was suspected and the food supplement hypothesised to be its vehicle. Cases were notified from six federal states throughout Germany, which required efficient coordination of information and activities. A case–control study (n=55) among adult women showed an association between consumption of the specific food supplement and the disease (odds ratio (OR): 27.5, 95% confidence interval (CI): 3.1–infinity, p-value=0.002). Restricting the case–control study to the period when the outbreak peaked (between 29 March and 11 April 2010) resulted in an OR of 43.5 (95% CI: 4.8–infinity, p-value=0.001).

Trace-back of the supplement’s main ingredient, hemp seed flour, and subsequent microbiological testing by pulsed-field gel electrophoresis supported its likely role in transmission. This outbreak investigation illustrates that information from RASFF may aid in hypothesis generation in outbreak investigations, though likely late in the outbreak.

The authors note in the discussion that, “while investigations of the food safety authorities were thorough, without delay, and strictly following regulations, it is worth noting that the process from the beginning of the analysis of the first positive sample from an opened package to the recall took more than five weeks. In potential outbreak situations, strength of evidence for a suspected food product ought to be weighed against the potential harm to the consumers posed by the suspected food.

"Interestingly, in the end there was no international aspect to this outbreak (as the Dutch label on the product did not correspond to sales in the Netherlands). … In Germany, unfortunately, currently there is no general requirement to communicate non-international food contamination events to the public health authorities."

Strangers with candy: German Scrooge poisons Xmas with spiked schnapps

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An unidentified Scrooge poisoned visitors to two of Berlin’s popular Christmas markets with an offer of tiny bottles of liquor that were laced with vomit-inducing chemicals, police said on Friday.

The suspect, who was in his mid-40s, hit two of the traditional holiday fairs on Thursday and at the first, spoke to two foreign students, a man and a woman in their mid-20s, in English.

"He told them about the purported birth of his daughter and handed out little schnapps bottles for a toast," police said in a statement.

"After they drank, the two victims began experiencing severe cramps and vomiting."

The woman lost consciousness and had to be hospitalised.

Later at another Christmas market, what appeared to be the same blond man approached a group of three women in their early 20s with the same story. They also accepted a drink and later had to be treated in hospital.

Sprouted seed firms should improve safety — EU watchdog

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Six months after 53 people were killed and over 4,000 sickened with E. coli O104 in raw sprouts, the European Food Safety Authority (EFSA) said today that producers of sprouted seeds should tighten safety measures along the production chain.

Duh.

Pathogenic bacteria such as Escherichia coli (E.coli) can contaminate the seeds intended for sprouting during production, storage and distribution through contaminated irrigation water and soil particles, in a statement on Tuesday.

The high temperatures and humidity needed for the germination and sprouting of seeds are also favorable conditions for bacteria to grow and spread, while consumption of raw or minimally processed sprouted seeds pose additional safety concerns, EFSA said.

Producers should ensure safe use of fertilizers and irrigation water, minimize contamination of seeds with soil during harvest and prevent mechanical damage of seeds, it said.
Producers should also make sure that seeds are transported, processed and stored under conditions minimizing the potential for microbial contamination.

They should remove damaged seeds and improve the ability to trace seed lots, it said.

I forgot I ate sprouts threw disease trackers off trail

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People who forgot to mention they had eaten sprouts may have thrown disease trackers off the trail as they sought to trace the source of the deadly strain of E. coli that sickened more than 4,300 people and killed at least 50 in Europe this year, according to a study published in the New England Journal of Medicine.

While a definitive genetic link remains elusive, three separate lines of investigation point to sprouts as the means by which the deadly O1O4:H4 strain of the bacteria was spread, researchers led by Udo Buchholz at the Robert Koch Institute in Berlin, Germany’s disease-control agency.

Buchholz and colleagues wrote, “The one dish that frequently exposed guests to sprouts was the side salad, which contained tomatoes, cucumbers, three sorts of leaf salads, and sprouts. Sprouts may have been the ingredient that visitors recalled least in such a mixed salad.”

Buchholz and colleagues conducted three studies in parallel. The first involved asking patients hospitalized with E. coli infection about their recent food consumption, and comparing that with food eaten by uninfected people. It found that “the only significant variable was sprouts.”

The second study identified 10 groups of diners who ate at a restaurant in Luebeck between May 12 and 16. It found that among 115 people who had been served sprouts, 31 fell ill, compared with none of those who had not eaten sprouts.

The third investigation traced 41 clusters of infections to a producer in Lower Saxony, who grew sprouts from seeds that came from a “supplier X,” Buchholz and colleagues wrote, without identifying either the producer or the supplier. A European Commission task force said in July that the sprouts were probably grown from fenugreek seeds imported from Egypt in 2009. The researchers still don’t know whether the seeds were contaminated before, during or after export from Egypt.

In an accompanying editorial, Martin J. Blaser, M.D. from the Departments of Medicine and Microbiology, New York University, writes the chain of transmission appears to have begun in Egypt, with fecal contamination of fenugreek seeds by either humans or farm animals during storage or transportation, perhaps as long ago as 2009. The seeds then went to a European distributor and from there to farms in several countries. During sprout germination, bacteria multiplied and moved from farm to restaurants and consumers, as Buchholz et al. extensively detail in their study. The evidence for such a series of events is compelling, even though the organism was not identified at the earliest steps, since the trail often is cold in point-source outbreaks by the time investigators are able to conduct trace-back investigations.

German outbreak of Escherichia coli O104:H4 associated with sprouts
26.oct.11
The New England Journal of Medicine
Udo Buchholz, M.D., M.P.H., Helen Bernard, M.D., Dirk Werber, D.V.M., Merle M. Böhmer, Cornelius Remschmidt, M.D., Hendrik Wilking, D.V.M., Yvonne Deleré, M.D., Matthias an der Heiden, Ph.D., Cornelia Adlhoch, D.V.M., Johannes Dreesman, Ph.D., Joachim Ehlers, D.V.M., Steen Ethelberg, Ph.D., Mirko Faber, M.D., Christina Frank, Ph.D., Gerd Fricke, Ph.D., Matthias Greiner, D.V.M., Ph.D., Michael Höhle, Ph.D., Sofie Ivarsson, M.Sc., Uwe Jark, D.V.M., Markus Kirchner, M.D., M.P.H., Judith Koch, M.D., Gérard Krause, M.D., Ph.D., Petra Luber, Ph.D., Bettina Rosner, Ph.D., M.P.H., Klaus Stark, M.D., Ph.D., and Michael Kühne, D.V.M., Ph.D.
http://www.nejm.org/doi/full/10.1056/NEJMoa1106482?query=featured_home
Human infection with Shiga-toxin–producing Escherichia coli is a major cause of postdiarrheal hemolytic–uremic syndrome. This life-threatening disorder, which is characterized by acute renal failure, hemolytic anemia, and thrombocytopenia, typically affects children under the age of 5 years. Shiga-toxin–producing E. coli O157 is the serogroup that is most frequently isolated from patients with the hemolytic–uremic syndrome worldwide.1
In May 2011, a large outbreak of the hemolytic–uremic syndrome associated with the rare E. coliserotype O104:H4 occurred in Germany.2-5 The main epidemiologic features were that the peak of the epidemic was reached on May 21 and May 224,5 and that the vast majority of case subjects either resided or had traveled in northern Germany. Almost all patients from other European countries or from North America had recently returned from northern Germany.2,6,7 Of the affected case subjects, 90% were adults, and more than two thirds of case subjects with the hemolytic–uremic syndrome were female.4
Early studies in Hamburg suggested that infections were probably community-acquired and were not related to food consumption in a particular restaurant. A first case–control study that was conducted on May 23 and 24 suggested that raw food items, such as tomatoes, cucumbers, or leaf salad,3 were the source of infection. The consumption of sprouts, which was previously implicated in outbreaks of Shiga-toxin–producing E. coli in the United States8 and Japan,9 was mentioned by only 25% of case subjects in exploratory interviews, so consumption of sprouts was not tested analytically.
This report describes the investigations that were conducted by the federal agencies under the auspices of the German Ministry of Health and the Ministry of Food, Agriculture, and Consumer Protection, as well as by the respective state agencies, to identify the vehicle of infection of this international outbreak.

Dr. Dr. Dodd speaks: safe food for the U.S. military or all the things they don’t teach in school

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Dr. Dr. Chuck Dodd (DVM, PhD), program manager for veterinary services in the U.S. Army Public Health Command Region – Europe, shared his experiences from the midst of the E. coli O104 outbreak associated with raw sprouts centered in Germany earlier this year.

The video of Dr. Dr. Dodd, looking sharp in his military fatigues and fresh from another of his 100-mile ultra-marathons, is available at http://bites.ksu.edu/dodd-lecture as are the PowerPoint slides.