Tag Archives: Outbreaks

Surveillance for waterborne disease outbreaks associated with drinking water – United States, 2011-2012

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The U.S. Centers for Disease Control reports in Morbidity and Mortality Weekly that advances in water management and sanitation have substantially reduced waterborne disease in the United States, although outbreaks continue to occur (1). Public health agencies in the U.S. states and territories* report information on waterborne disease outbreaks to the CDC Waterborne Disease and Outbreak Surveillance System (http://www.cdc.gov/healthywater/surveillance/index.html).

water.wellFor 2011–2012, 32 drinking water–associated outbreaks were reported, accounting for at least 431 cases of illness, 102 hospitalizations, and 14 deaths. Legionella was responsible for 66% of outbreaks and 26% of illnesses, and viruses and non-Legionella bacteria together accounted for 16% of outbreaks and 53% of illnesses. The two most commonly identified deficiencies† leading to drinking water–associated outbreaks were Legionella in building plumbing§ systems (66%) and untreated groundwater (13%). Continued vigilance by public health, regulatory, and industry professionals to identify and correct deficiencies associated with building plumbing systems and groundwater systems could prevent most reported outbreaks and illnesses associated with drinking water systems.

This report provides information on drinking water–associated¶ waterborne disease outbreaks in which the first illness occurred in 2011 or 2012** (http://www.cdc.gov/healthywater/surveillance/drinking-surveillance-reports.html), and summarizes outbreaks reported to the Waterborne Disease and Outbreak Surveillance System through the electronic National Outbreak Reporting System (http://www.cdc.gov/nors/about.html) as of October 30, 2014. For an event to be defined as a waterborne disease outbreak, two or more persons must be linked epidemiologically by time, location of water exposure, and case illness characteristics; and the epidemiologic evidence must implicate water as the probable source of illness. Data submitted for each outbreak include 1) the number of cases, hospitalizations, and deaths; 2) the etiologic agent (confirmed or suspected); 3) the implicated water system; 4) contributing factors in the outbreak; and 5) the setting of exposure.

Karlyn D. Beer, PhD1,2; Julia W. Gargano, PhD2; Virginia A. Roberts, MSPH2; Vincent R. Hill, PhD2; Laurel E. Garrison, MPH3; Preeta K. Kutty, MD3; Elizabeth D. Hilborn, DVM4; Timothy J. Wade, PhD4; Kathleen E. Fullerton, MPH2; Jonathan S. Yoder, MPH, MSW2

Norovirus confirmed in PA university outbreak

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There’s a lot of norovirus on campuses this time of year. A bunch of Virginia colleges dealt with the pathogen a couple of weeks ago, and it looks like N.C. State did too. According to mcall.com, the virus caused over 150 illnesses at East Stroudsburg University in Pennsylvania.

The vomiting, diarrhea and stomach pain that affected 154 students at East Stroudsburg University last week was the result of a highly contagious virus, the state Health Department said Thursday.

The Department of Health has determined that there is now enough accumulated evidence to say the recent ESU outbreak is due to norovirus,” department spokesman Wes Culp said.

The illnesses swept through the campus so fast that doctors and medical staffs could not identify its cause with certainty, though doctors did suspect norovirus. The outbreak affected 2.5 percent of ESU students.

Here are some campus-specific food safety infosheets. Click on the pics to download.

Norovirus outbreak linked to ill food handlers
Screen Shot 2015-02-03 at 11.22.56 PMPuking cheerleader leads to outbreak
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Norovirus is a problem for campuses and cafeterias
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Careful with the guac: emergence of salsa and guacamole as frequent vehicles of foodborne disease outbreaks in the US 1973–2008

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American researchers report fresh salsa and guacamole often contain diced raw produce, are often made in large batches, and are often poorly refrigerated, which may make them prone to contamination that can cause foodborne illness.

The safety of salsa and guacamole is increasingly important as these foods gain popularity. Since 1973, local, state, and territorial health departments guacamole2have voluntarily reported foodborne disease outbreaks to the Centers for Disease Control and Prevention’s Foodborne Disease Outbreak Surveillance System (FDOSS) using a standard reporting form. FDOSS used paper-based reporting for 1973–1997 and switched to electronic reporting for 1998–2008.

We reviewed all reports of outbreaks during 1973–2008 in which salsa or guacamole was reported as a vehicle. We found 136 outbreaks in which salsa or guacamole was reported as a possible vehicle, which resulted in 5,658 illnesses.

Of these 136 salsa- or guacamole-associated (SGA) outbreaks additional possible food vehicles were reported for 33 (24%) outbreaks. There were no SGA outbreaks reported before 1984.

Among reported outbreaks, most were caused by norovirus (24%), nontyphoidal Salmonella (19%), and Shigella (7%). Eighty-four percent of outbreaks were caused by foods prepared in restaurants or delis; of these, OLYMPUS DIGITAL CAMERA19% reported ill foodworkers, and 29% reported improper storage as possible contributing factors.

Among all foodborne disease outbreaks with a reported food vehicle during 1984–1997, 26 (0.9%) of 2,966 outbreaks were SGA, and during 1998–2008, 110 (1.4%) of 7,738 outbreaks were SGA. The number of reported foodborne disease outbreaks attributable to salsa or guacamole increased in the United States from 1984 to 2008, especially in later years, and especially in restaurants.

Fresh salsa and guacamole require careful preparation and storage. Focused prevention strategies should reduce the risk of illness and ensure that these foods are enjoyed safely.

Foodborne Pathogens and Disease. April 2013, 10(4): 316-322

Magdalena E. Kendall, Rajal K. Mody, Barbara E. Mahon, Michael P. Doyle, Karen M. Herman, and Robert V. Tauxe

Nosestretcher alert: small farms produce safest food?

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Are small farms incompatible with food safety rules?

Deborah Stockton, executive director of the National Independent Consumers and Farmers Association (NICFA), said today,

"Small farms produce the safest food available, without regulation. … Just like family farms brought us out of the Great Depression, they can bring us out of the food safety problem and this recession, if they are allowed to thrive.”

Sounds like someone is compensating for inadequacy issues and responding with exaggeration, like a 50-year-old in a Miata rag-top.

The idea that food grown and consumed locally is somehow safer than other food, either because it contacts fewer hands or any outbreaks would be contained, is the product of wishful thinking.?

Maybe the majority of foodborne outbreaks come from large farms because the vast majority of food and meals is consumed from food produced on large farms. To accurately compare local and other food, a database would have to somehow be constructed so that a comparison of illnesses on a per capita meal or even ingredient basis could be made.

NICFA is gonna lobby Washington, D.C. types and then hold a local foods feast for Congress tomorrow night. I hope no one gets sick – faith-based food safety is a lousy approach.

From the mine is bigger than yours file: How much does foodborne illness cost?

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At the start of pretty much every talk I’ve given in the past 3 years I have a slide about the societal cost and estimated burden of foodborne illness. I somewhat robotically spout out these two statistics:

– About 1-in 3 to 1-in-4 individuals will acquire illnesses from food each year
– The societal burden of these illnesses is estimated to be $1.4 trillion

The statistics I use come from a variety of sources including USDA Economic Research Service, WHO, CDC, Canadian health officials and Australian public health.

Today I woke up to a press release from the Produce Safety Coalition, the Make our Food Safe Coalition and the Pew Charitable Trust that cited a “landmark  study” estimating the cost of foodborne illness to be $152 billion annually.

From the report:
There are a number of ways to estimate the economic impact of foodborne illness. This report uses an FDA cost-estimate approach: health-related costs are the sum of medical costs (physician services, pharmaceuticals, and hospital costs) and losses to quality of life (lost life expectancy, pain and suffering, and functional disability).

Hardly landmark, unless you mean this estimate represents  a reduction of almost a factor of 10 in estimated costs since 2007 (I don’t think that was what was intended). Tanya Roberts published a paper in 2007 estimating the cost of foodborne illness from a willingness-to-pay (WTP) standpoint at $1.4 trillion. According to Roberts, WTP is endorsed in the literature as the valuation method most consistent with economic theory and her calculation included all seventy-six million cases of acute food-borne illness. Previous estimates examined only a few specific pathogens.

Sure, the numbers matter when it comes to prioritizing the need to address or fund food safety work. Whether it’s $6 billion, $152 billion, $1.4 trillion or $2,500-$8,000 per case (pathogen dependant) it’s a huge number. But it’s also very abstract.

The statistics are nice, but they really don’t grab foodhandlers’ attention. More compelling is where the real cost of foodborne illness is born: with the individuals and in the families of those who have been affected by it. Billions and trillions are fodder for discussions with politicians and boards of directors. Where the real food safety work occurs, both positive and negative, is on the farm, in the restaurant kitchen, supermarket deli and homes. And the numbers don’t really matter there, what resonates is that foodborne illness sucks.

What matters so much more to individual food handlers who protect public health in the US are the stories of real people being affected by food they trusted would not make them ill.

The disconnect between statistics and stories is why I follow up the burden slide with more impactful tales of outbreaks that happen weekly.  Like those who have affected real people including Mason Jones and Stephanie Smith both of whom were severely affected by E. coli O157. Tragically, Mason died at only 5 years of age and Stephanie, who is now 23, will probably never walk again.  The numbers, while nice, don’t really do these stories justice.

 

If cruising on a ship you’re now less likely to barf; norovirus outbreaks down

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USA Today today says the U.S. Centers for Disease Control in Atlanta recorded just 13 outbreaks of gastrointestinal illness on cruise ships in 2009, down from 15 in 2008, 21 in 2007 and 34 in 2006.

The decline, moreover, came even as the number of people cruising continued to rise. The Cruise Lines International Association says the industry carried 13.2 million passengers in 2008, the last year for which data is available, up from 12.6 million in 2007 and 12.0 million in 2006.

Cruise ships arriving in U.S. ports must report all cases of gastrointestinal illness treated by on-board medical staff to the CDC’s Vessel Sanitation Program division, and a separate notification is required when the number of cases exceeds 2% of passengers and crew. When the number of cases exceeds 3% of passengers and crew the CDC issues a public report.

A selection of leafy green outbreaks since 1993; over 1300 ill

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Because of a historical risk, leafy greens have been identified by the US FDA as a priority with in fresh produce safety (along with tomatoes, melons, sprouts and fresh herbs).

Here’s why: over 1300 illnesses in at least 34 outbreaks since 1993. See the below table for more details (or download it here).

Food safety quick hits

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KETV in Omaha is reporting that Girl Scout cookies are safe to eat — the peanut butter products that are used to make them are not produced by Peanut Corp of America:

The peanut butter supplier associated with the recent salmonella outbreak does not supply peanut butter to Girl Scout Cookies, according to the Girl Scouts organization.

The Girl Scout organization’s supplier is Hampton Farms in North Carolina.

In the somewhat-related-to-food-safety category, a man who helped create the science behind the microwave oven has died. Robert Decareau of Amherst, NH passed away on Sunday at 82.

According to his family, Decareau was a Massachusetts native who went to work for Raytheon after earning his doctorate in chemistry. It was there that he started working on microwave energy food applications, and he was one of the first to call himself a food scientist.

Decareau’s daughter, Karen Ross of Auburn, Maine, says she remembers her father experimenting with a refrigerator-sized prototype microwave oven in the family’s basement in the 1960s.

Frozen, raw or partially cooked foods have been problematic for consumers — especially when they contain pathogens.  There have been at least eight outbreaks linked to, as Doug likes to call them, chicken thingies since 1998.  Using a microwave has been reported as a factor in these outbreaks. Pot pies have also been linked to microwave problems. Uneven heat distribution makes microwaving a not-so-good method to cook raw foods especially if digital tip-sensitive thermometers aren’t used.  Sarah DeDonder presented some of our research at IAFP last year on microwave cooking practices in a model kitchen. A paper on the research will be published later this year.

Dedonder, S., Powell, D.A., Jacob, C., Surgeoner, B., Chapman, B., and Phebus, R. 2008. Beyond Intent — Direct Observation Of Meal Preparation Procedures In A Home Kitchen Setting.

Abstract

Purpose – This study used a novel video capture system to observe the food preparation practices of 41 consumers – 21 primary meal preparers and 20 adolescents – in a mock domestic kitchen using uncooked, frozen, breaded chicken products, and to determine if differences exist between consumers’ reported safe food handling practices and actual food handling behavior as prescribed on current product labels.

Design/methodology/approach – A convenience sample was utilized and all participants were video-recorded preparing food in one-of-two model kitchens at Kansas State University. Participants were asked to complete a survey reporting food handling behaviors that would be typical of their own home kitchen.

Findings – Differences between self-reported and observed food safety behaviors were seen across both groups of consumers. Many participants reported owning a food thermometer (73 per cent) and indicated using one when cooking raw, breaded chicken entrées (19.5 per cent); however, only five participants were observed measuring the final internal temperature with a food thermometer despite instructions on the product packaging to do so; only three used the thermometer correctly.

Significance – Data collected through direct observation more accurately reflects consumer food handling behaviors than data collected through self-reported surveys, and label instructions are rarely followed.

Originality/value – This study contributes to the overall understanding of consumer behaviors associated with consumers’ intentions and actual behaviors while preparing meat and poultry products, such as frozen, uncooked, breaded chicken products.

Unpasteurized milk poses health risks without benefits

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With disease outbreaks linked to unpasteurized milk rising in the United States, a review published in the January 1, 2009 issue of Clinical Infectious Diseases examines the dangers of drinking raw milk.

Milk and dairy products are cornerstones of a healthy diet. However, if those products are consumed unpasteurized, they can present a serious health hazard because of possible contamination with pathogenic bacteria. An average of 5.2 outbreaks per year linked to raw milk have occurred in the United States between 1993 and 2006—more than double the rate in the previous 19 years, according to co-authors Jeffrey T. LeJeune and Päivi J. Rajala-Schultz of the College of Veterinary Medicine in Columbus, Ohio. …

Raw milk advocates claim that unpasteurized milk cures or prevents disease, but no scientific evidence supports this notion. Testing raw milk, which has been suggested as an alternative to pasteurization, cannot ensure a product that is 100 percent safe and free of pathogens. Pasteurization remains the best way to reduce the unavoidable risk of contamination, according to the authors.