30 norovirus cases linked to Minnesota Chuck E. Cheese

Posted on January 7, 2015 by Ben Chapman

There’s a Chuck E. Cheese that I drive by with Sam a couple of times a week. Every time we go by he wants to go back: we took him there on his third birthday (on a weekday afternoon) and he went nuts for Skee-Ball and the arcade games.

Running food safety and infection control at a kids arcade-style restaurant is probably nerve-wracking. According to KAAL ABC Chanel 6, a norovirus outbreak is being investigated at a Minnesota Chuck E. Cheese outlet.

The Washington County Public Health Department is investigating a norovirus outbreak at a Woodbury Chuck E. Cheese restaurant that sickened at least 30 last weekend.

The restaurant was scheduled to be closed until 1 p.m. Wednesday while staff cleaned, said Fred Anderson, an epidemiologist for Washington County Public Health. The restaurant was open until 8 p.m. Tuesday.

Washington County is still trying to determine how the norovirus got started. Several patrons reported getting sick Saturday. Public Health has interviewed about 60 people and half have reported getting sick.

Washington County Public Health reviewed the reservations made for Friday, Saturday and Sunday and determined about 1,000 people were in the restaurant during that time, Anderson said.

A decent recipe for an outbreak is a bunch of kids, with questionable hygiene, in a place with a lot of stuff to touch, and eat, at the height of norovirus season.

5 dead, 29 sick: Prepackaged caramel apples as a source of Listeria, what was the source?

Posted on December 23, 2014 by Douglas Powell

The U.S. Centers for Disease Control and Prevention has updated its information on listeria in caramel apples outbreak, as the first lawsuit was filed.

CDC is collaborating with public health officials in several states and with the U.S. Food and Drug Administration (FDA) to investigate an outbreak of Listeria monocytogenes infections (listeriosis) linked to commercially produced, prepackaged caramel apples. Listeria can cause a serious, life-threatening illness.
The information CDC has at this time indicates that commercially produced, prepackaged caramel apples may be contaminated with Listeria and may be causing this outbreak.
Out of an abundance of caution, CDC recommends that U.S. consumers do not eat any commercially produced, prepackaged caramel apples, including plain caramel apples as well as those containing nuts, sprinkles, chocolate, or other toppings, until more specific guidance can be provided.
Although caramel apples are often a fall seasonal product, contaminated commercially produced, prepackaged caramel apples may still be for sale at grocery stores and other retailers nationwide or may be in consumers’ homes.
This investigation is rapidly evolving. New information will be provided as it becomes available.
As of December 22, 2014, a total of 29 people infected with the outbreak strains of Listeria monocytogenes have been reported from 10 states.
All 29 ill people have been hospitalized and, five deaths have been reported. Listeriosis contributed to three of these deaths and it is unclear whether it contributed to a fourth. The fifth death was unrelated to listeriosis.
Nine illnesses were pregnancy-related (occurred in a pregnant woman or her newborn infant).
Three invasive illnesses (meningitis) were among otherwise healthy children aged 5–15 years.
To date, 20 (87%) of the 23 ill people interviewed reported eating commercially produced, prepackaged caramel apples before becoming ill.
At this time, no illnesses related to this outbreak have been linked to apples that are not caramel-coated and not prepackaged or to caramel candy.
Investigators are working quickly to determine specific brands or types of commercially produced, prepackaged caramel apples that may be linked to illnesses and to identify the source of contamination.
This investigation is rapidly evolving, and new information will be provided as it becomes available.

The family of a California woman whose death was linked to the prepackaged caramel apples is suing the Safeway grocery chain for selling her the product.

The lawsuit filed in Santa Cruz County Superior Court Monday alleges that 81-year-old Shirlee Jean Frey bought caramel apples from a Safeway in Felton a few days before Halloween. She died on Dec. 2 after suffering from a listeria infection.

Frey’s family said health officials confirmed she was sickened with the same strains of listeria as four others whose deaths were linked to the caramel apples.

Safeway responded by pulling caramel apples off shelves as precaution.

Minnesota has a bunch of norovirus

Posted on December 23, 2014 by Ben Chapman

Last week something respiratory knocked me out of action for a few days. Between Nyquil, Tylenol and the bug I was writing emails and texts from a world of delirium. But nothing quite compares to the feeling of norovirus: stomach cramps, projectile vomiting and pooping liquid.

According to KARE 11, that’s what a bunch of folks in Minnesota (and elsewhere are experiencing right now).

The Minnesota Department of Health (MDH) announced Monday that approximately 40 outbreaks of norovirus illness have been reported since the beginning of November. Those outbreaks have occurred in a variety of settings, including restaurants, schools, nursing homes and private gatherings.

When people think of “stomach flu,” they often don’t appreciate that they could have gotten their illness from food or that they could pass the virus to others through food. Prevention of norovirus infections is simple in principle, officials say. Just practice good personal hygiene and observe appropriate food-handling procedures.

“People need to remember to wash their hands, thoroughly” said Dr. Kirk Smith, who heads the Foodborne Diseases Unit at MDH. “Wash your hands after using the toilet, before consuming food, and before preparing food for yourself or others. If everybody did that, we could prevent a majority of the illness caused by these viruses.”

Outbreaks associated with cantaloupe, watermelon, and honeydew in the United States, 1973–2011

Posted on December 19, 2014 by Douglas Powell

Fresh fruits and vegetables are an important part of a healthy diet.

Melons have been associated with enteric infections. We reviewed outbreaks reported to the Centers for Disease Control and Prevention’s Foodborne Disease Outbreak Surveillance System during 1973–2011 in which the implicated food was a single melon type. We also reviewed published literature and records obtained from investigating agencies.

During 1973–2011, 34 outbreaks caused by a single melon type were reported, resulting in 3602 illnesses, 322 hospitalizations, 46 deaths, and 3 fetal losses. Cantaloupes accounted for 19 outbreaks (56%), followed by watermelons (13, 38%) and honeydew (2, 6%). Melon-associated outbreaks increased from 0.5 outbreaks per year during 1973–1991 to 1.3 during 1992–2011. Salmonella was the most common etiology reported (19, 56%), followed by norovirus (5, 15%). Among 13 outbreaks with information available, melons imported from Mexico and Central America were implicated in 9 outbreaks (69%) and domestically grown melons were implicated in 4 outbreaks (31%).

The point of contamination was known for 20 outbreaks; contamination occurred most commonly during growth, harvesting, processing, or packaging (13, 65%). Preventive measures focused on reducing bacterial contamination of melons both domestically and internationally could decrease the number and severity of melon-associated outbreaks.

Probably staph: 55 people treated for possible food poisoning at Florida office

Posted on December 12, 2014 by Douglas Powell

The Maitland Fire Rescue treated about 40 people Wednesday in a possible case of food poisoning at an office building, officials said.

Deputy Fire Chief Will Watts said the office was having a “large catered event” when the employees started getting sick around 3:30 p.m. More than 15 people were hospitalized and were listed in stable condition.

“There’s a significant number of patients that have symptoms that are consistent with a stomach illness,” Watts said.

Dain Weister, a spokesman for the Florida Department of Health, said people were vomiting and had diarrhea.

“It’s a pretty big outbreak to have so many people become sick in one location,” he said. “It’s not too often that we have so many people sick.”

Outbreak of foodborne illness strikes Atlanta high school football banquet

Posted on December 12, 2014 by Ben Chapman

Over 15 years ago Rob Tauxe described the traditional foodborne illness outbreak as a scenario that ‘often follows a church supper, family picnic, wedding reception, or other social event.’

This scenario involves an acute and highly local outbreak, with a high inoculum dose and a high attack rate. The outbreak is typically immediately apparent to those in the local group, who promptly involve medical and public health authorities. The investigation identifies a food-handling error in a small kitchen that occurs shortly before consumption. The solution is also local.

According to the Atlanta Journal Contsitution, it could also be a high school football banquet.

Dozens of Centennial High School football players and their parents were sickened after eating at a banquet Monday night, according to the school’s principal. But the exact cause of the gastrointestinal illnesses has not been determined.

Symptoms of the illness have included nausea, vomiting, diarrhea and abdominal cramps, Principal Kibbey Crumbley wrote in a letter to a parents of students at the Roswell school.

“Unfortunately, these symptoms can be associated with many different viruses and bacteria that could possibly be related to food-borne pathogens,” Crumbley said. “The best means of controlling these types of illnesses is to stay home when sick, wash hands frequently and clean surfaces thoroughly after contact with an infected or ill individual.”

Students with symptoms were urged to stay home and to see a healthcare provider, Crumbley said.

I child dead, 4 sick in Australia from raw milk; US says outbreaks quadrupled

Posted on December 11, 2014 by Douglas Powell

Amidst reports that the number of U.S. outbreaks caused by non-pasteurized milk increased from 30 during 2007–2009 to 51 during 2010–2012, a child in Victoria (that’s in Australia) has died and four have become ill from raw milk.

Unpasteurised milk is illegal to sell for human consumption in Australia, but the product consumed by the child was classed as cosmetic so was allowed on the shelves.

The child recently died on the Mornington Peninsula after drinking what was marketed as a cosmetic product and labeled “bath milk”, the Victorian Health Department said.

The U.S. Centers for Disease Control and Prevention said Wednesday that the average number of outbreaks from contaminated unpasteurized milk more than quadrupled from three a year between 1993 to 2006 to about 13 between 2007 and 2012.

Overall, there were 81 outbreaks in that last period, sickening nearly 1,000 people, including 73 who were hospitalized. The CDC said that more than 80 percent of the illnesses happened in states where retail sales of raw milk are legal.

Most outbreaks were caused by Campylobacter spp. (77%) and by nonpasteurized milk purchased from states in which nonpasteurized milk sale was legal (81%). Regulations to prevent distribution of nonpasteurized milk should be enforced.

Pasteurization is an effective way to improve milk safety; however, in the United States, illness related to consumption of nonpasteurized milk continues to be a public health problem. The first statewide requirements that dairy products be pasteurized were enacted in Michigan in 1948 (1). In 1987, the US Food and Drug Administration banned the interstate sale or distribution of nonpasteurized milk. However, the laws regulating intrastate sales are set by each state (2). Regulations for intrastate sales of nonpasteurized milk vary from complete bans to permitting sales from farms or retail outlets (2). Even in states in which sale of nonpasteurized milk is illegal, milk can often be obtained through other means. For example, some states allow cow-share or herd-share agreements, in which buyers pay farmers a fee for the care of a cow in exchange for a percentage of the milk produced (3,4).

Consumption of nonpasteurized milk has been associated with serious illnesses caused by several pathogens, including Campylobacter spp., Shiga toxin–producing Escherichia coli, and Salmonella enterica serotype Typhimurium (3,4). Despite the health risks associated with consuming nonpasteurized milk, the demand for nonpasteurized milk has increased (3,5,6). Recently, many state legislatures have considered relaxing restrictions on the sale of nonpasteurized milk (2,6). We report that the number of outbreaks associated with nonpasteurized milk increased from 2007 through 2012.

The Study

A foodborne disease outbreak is defined as the occurrence of >2 cases of a similar illness resulting from ingestion of a common food. State and local health departments voluntarily report outbreaks to the Foodborne Disease Outbreak Surveillance System of the Centers for Disease Control and Prevention through a standard web-based form (www.cdc.gov/nors). We reviewed outbreaks reported during 2007–2012 in which the food vehicle was nonpasteurized milk. Outbreaks attributed to consumption of other dairy products made with nonpasteurized milk, such as cheese, were excluded. We analyzed outbreak frequency, number of illnesses, outcomes (hospitalization, death), pathogens, and age groups of patients. Data on the legal status of nonpasteurized milk sales in each state were obtained from the National Association of State Departments of Agriculture (7–9) and an online search of state regulations. The sources from which nonpasteurized milk was obtained or purchased were categorized according to the description from the state outbreak reports, when available.

During 2007–2012, a total of 81 outbreaks associated with nonpasteurized milk were reported from 26 states. These outbreaks resulted in 979 illnesses and 73 hospitalizations. No deaths were reported. The causative agent was reported for all outbreaks. Of the 78 outbreaks with a single etiologic agent, Campylobacter spp. was the most common pathogen, causing 62 (81%) outbreaks, followed by Shiga toxin–producing E. coli (13 [17%]), Salmonella enterica serotype Typhimurium (2 [3%]), and Coxiella burnetii (1[1%]) (Figure 1). Three outbreaks were caused by multiple pathogens (Figure 1). The number of outbreaks increased from 30 during 2007–2009 to 51 during 2010–2012. During 2007–2009, outbreaks associated with nonpasteurized milk accounted for ≈2% of outbreaks with an implicated food; during 2010–2012, this percentage increased to 5%. The number of outbreaks of Campylobacter spp. infection also increased, from 22 during 2007–2009 to 40 during 2010–2012.

How milk was obtained was reported for 68 (84%) outbreaks. Nonpasteurized milk was obtained from dairy farms (48 [71%] outbreaks), licensed or commercial milk sellers (9 [13%]), cow- or herd-share arrangements (8 [12%]), and other sources (3 [4%]). Of the 81 outbreaks, 66 (81%) were reported from states where the sale of nonpasteurized milk was legal in some form: Pennsylvania (17 outbreaks), New York, Minnesota (6 outbreaks each), South Carolina, Washington, and Utah (5 outbreaks each). A total of 15 (19%) outbreaks were reported in 8 states in which sales were prohibited. Among these outbreaks, the sources of nonpasteurized milk were reported as a dairy farm (6 outbreaks), cow or herd share (4 outbreaks), and unknown (5 outbreaks).

Conclusions

Within this 6-year period, the number of outbreaks associated with nonpasteurized milk increased. The number of outbreaks caused by Campylobacter spp. nearly doubled. The average number of outbreaks associated with nonpasteurized milk was 4-fold higher during this 6-year period (average 13.5 outbreaks/year) than that reported in a review of outbreaks during 1993–2006 (3.3 outbreaks/year) (4). This increase was concurrent with a decline in the number of states in which the sale of nonpasteurized milk was illegal, from 28 in 2004 to 20 in 2011 (7–9) and with an increase in the number of states allowing cow-share programs (from 5 in 2004 to 10 in 2008) (8,9). The decision to legalize the sale of nonpasteurized milk or allow limited access through cow-share programs may facilitate consumer access to nonpasteurized milk (5). The higher number of outbreaks in states in which the sale of nonpasteurized milk is legal has been reported elsewhere (4).

The legal status of nonpasteurized milk sales in 1 state can also lead to outbreaks in neighboring states. In a 2011 outbreak of Campylobacter spp. infections associated with nonpasteurized milk in North Carolina, where sales of this product were prohibited, milk was purchased from a buying club in South Carolina, where sales were legal. Another outbreak of Campylobacter spp. infection in 2012 implicated nonpasteurized milk from a farm in Pennsylvania, where sales are legal; cases from this outbreak were reported from Maryland, West Virginia, and New Jersey, all of which prohibit sale of raw milk (10). All patients residing outside Pennsylvania had traveled to Pennsylvania to purchase the milk (10).

Outbreaks associated with nonpasteurized milk continue to pose a public health challenge. Legalization of the sale of nonpasteurized milk in additional states would probably lead to more outbreaks and illnesses. This possibility is especially concerning for vulnerable populations, who are most susceptible to the pathogens commonly found in nonpasteurized milk (e.g., children, senior citizens, and persons with immune-compromising conditions). Public health officials should continue to educate legislators and consumers about the dangers associated with consuming nonpasteurized milk; additional information can be obtained at http://www.cdc.gov/foodsafety/rawmilk/raw-milk-index.html. In addition, federal and state regulators should enforce existing regulations to prevent distribution of nonpasteurized milk.

Ms Mungai is a surveillance epidemiologist at the Atlanta Research and Education Foundation and at the Centers for Disease Control and Prevention. Her interests include infectious disease epidemiology and food safety.

References

Steele JH. History, trends and extent of pasteurization. J Am Vet Med Assoc. 2000;217:175–8 . DOI PubMed

Weisbecker A. A legal history of raw milk in the United States. J Environ Health. 2007;69:62–3 .PubMed

Oliver SP, Boor KJ, Murphy SC, Murinda SE. Food safety hazards associated with consumption of raw milk. Foodborne Pathog Dis. 2009;6:793–806. DOI PubMed

Langer AJ, Ayers T, Grass J, Lynch M, Angulo FJ, Mahon BE. Nonpasteurized dairy products, disease outbreaks, and state laws—United States, 1993–2006. Emerg Infect Dis. 2012;18:385–91. DOI PubMed

Buzby JC, Gould LH, Kendall ME, Timothy FJ, Robinson T, Blayney DP. Characteristics of consumers of unpasteurized milk in the United States. J Consum Aff. 2013;47:153–66.

David SD. Raw milk in court: implications for public health policy and practice. Public Health Rep. 2012;127:598–601 .PubMed

National Association of State Departments of Agriculture. NASDA releases raw milk survey 2011 [cited 2012 Nov 2]. http://www.nasda.org/file.aspx?id=3916

National Association of State Departments of Agriculture. Dairy division of national association of state departments of agriculture raw milk survey, November, 2004 [cited 2012 Nov 2]. http://www.nasda.org/File.aspx?id=1582

National Association of State Departments of Agriculture. NASDA releases raw milk survey 2008. [cited 2012 Nov 2]. www.nasda.org/File.aspx?id=2149

Longenberger AH, Palumbo AJ, Chu AK, Moll ME, Weltman A, Ostroff SM. Campylobacter jejuni infections associated with unpasteurized milk—multiple states, 2012. Clin Infect Dis. 2013;57:263–6. DOI PubMed

Suggested citation for this article: Mungai EA, Behravesh CB, Gould LH. Increased outbreaks associated with nonpasteurized milk, United States, 2007–2012. Emerg Infect Dis [Internet]. 2015 Jan [date cited]. http://dx.doi.org/10.3201/eid2101.140447

Vomit cruise hits New Zealand; infection control steps shared

Posted on December 9, 2014 by Ben Chapman

I’ve never been on a cruise vacation. The closest I’ve been is a river boat dinner voyage in New Orleans. Not quite the same thing. I can’t think of too many better places to conduct some reality research though. With the increased media scrutiny of infection control measures the cruise folks have had to step up their game and respond when an incident happens – and share what they are doing to keep an outbreak from spreading. That helps build trust (if they can verify that steps are correctly being followed).

According to the Otago Daily Times (NZ), when the Princess Cruise Lines’ Dawn Princess docked in Port Chalmers any affected passengers were not able to come in contact with others (on and off the ship – which was a concern for the kiwi media).

About 200 passengers have been confined to their cabins after the norovirus bug spread through the cruise ship while on a trip around New Zealand.

Canterbury Medical Officer of Health Dr Alistair Humphrey said Dawn Princess had its own doctor on board and the ship’s crew were confident they could control the situation.

The cruise line spokesman said most passengers were unaffected by the outbreak and it took relatively few cases for stringent sanitation levels to be implemented to contain any spread of the illness.

The proactive onboard response included disinfecting high-touch surfaces such as railings, door handles and lift buttons; isolating ill passengers in their cabins; closing all self-service food areas; and encouraging passengers to use their own cabin bathroom facilities, he said.

Although he would not confirm if any passengers visiting Dunedin had norovirus, if they did it was standard protocol for the relevant public health authorities to be notified and those passengers would remain isolated in their cabins.

30 sick after Thanksgiving at hotel in New Jersey

Posted on December 3, 2014 by Douglas Powell

The Princeton Health Department received 30 reports between Thanksgiving and Tuesday of individuals experiencing gastrointestinal illnesses.

All 30 people ate at the restaurant at the Nassau Inn on Thanksgiving or the day after the holiday, Princeton Health Officer Jeffrey Grosser said. Many of the people also ate at other restaurants during the time period.

The health department has increased its surveillance of retail food establishments because of the incidents, and the Nassau Inn was inspected yesterday.

Laboratory testing has not yet confirmed the cause of the illnesses yet, but Grosser said the Norovirus is suspected in most or all of reported cases because of the symptoms and the time frame for the onset of symptoms and the recovery. The Norovirus is the most common cause of gastrointestinal illness and is especially common during the winter months.

“All the phone calls we received were similar in terms of where people ate, when people became ill (Thursday and Friday) and when they started feeling better (Sunday and Monday),” Grosser said.

An inspection of the restaurant at the hotel only revealed minor issues that can easily be rectified. Grosser said the issues did not cause the illnesses. About 70 percent of all Norovirus outbreaks are spread by food workers.

’Tis the season for holiday illnesses (apparently)

Posted on December 3, 2014 by Ben Chapman

There’s a perception that there are more outbreaks around the holidays because folks don’t know how to cook turkey. The epidemiology isn’t all that strong around amateur bird preparation and illnesses – but there are a lot of parties and potluck/covered dish dinners this time of year.

And it’s also noro season.

According to Planet Princeton, over 30 people reported illnesses to health authorities after eating at the Nassau Inn over Thanksgiving – and it looks like norovirus.