What makes people sick in Connecticut

Foodborne pathogens cause >9 million illnesses annually. Food safety efforts address the entire food chain, but an essential strategy for preventing foodborne disease is educating consumers and food preparers.

connecticut.foodTo better understand the epidemiology of foodborne disease and to direct prevention efforts, we examined incidence of Salmonella infection, Shiga toxin–producing Escherichia coli infection, and hemolytic uremic syndrome by census tract–level socioeconomic status (SES) in the Connecticut Foodborne Diseases Active Surveillance Network site for 2000–2011.

Addresses of case-patients were geocoded to census tracts and linked to census tract–level SES data. Higher census tract–level SES was associated with Shiga toxin–producing Escherichia coli, regardless of serotype; hemolytic uremic syndrome; salmonellosis in persons ≥5 years of age; and some Salmonella serotypes. A reverse association was found for salmonellosis in children <5 years of age and for 1 Salmonella serotype. These findings will inform education and prevention efforts as well as further research.

Socioeconomic status and foodborne pathogens in Connecticut, USA, 2000–20111

Emerging Infectious Diseases, Volume 21, Number 9—September 2015

Bridget M. Whitney, Christina Mainero, Elizabeth Humes, Sharon Hurd, Linda Niccolai, and James L. Hadler

http://wwwnc.cdc.gov/eid/article/21/9/15-0277_article

Foodborne illness in Denmark

I have a soft spot for the Danes. Spending five summers hammering nails with a couple of Danish homebuilders in Ontario taught me the value of being well-read and beer at morning coffee, lunch, and afternoon coffee. My friend John Kierkegaard would say, the beer is nice, but the work, it isn’t really so good.

quotes-1600-900-wallpaperWhen I went to Copenhagen for a scientific meeting, sure enough, there was beer at morning coffee.

The Technical University of Denmark reports that almost every other registered salmonella infection in Denmark in 2014 was brought back by Danes travelling overseas. Travel thus remains the largest cause of salmonella infections. An outbreak of salmonella from Danish eggs was also recorded in 2014, which is the first time in five years and illness was again attributed Danish chicken meat.

These are some of the findings presented in the annual report on the occurrence of diseases that can be transmitted from animals and food to humans. The report was prepared by the National Food Institute, Technical University of Denmark, in cooperation with Statens Serum Institut, the national institute of public health, and the Danish Veterinary and Food Administration.

In 2014 a total of 1,122 salmonella infections were reported among Danes, which is equivalent to 19.9 infected cases per 100,000 inhabitants. The figure is in line with the previous year when a historically low number of Danes was infected with salmonella.

In all, 48% became ill with salmonella after travelling overseas in 2014. Most of those who returned home with a travel-related infection had been to Thailand (17.5%), Turkey (15.4%) and Spain (6.4%).

Thus, foreign travel is still the largest cause of salmonella infections among Danes.

tasting-midtfyns-jule-stoutIn the annual source account which the National Food Institute calculates, salmonella infections were attributed Danish chicken meat for the first time since 2011. In total 2% of the infections were estimated to be attributed this source.

“For two decades Danish producers, authorities and researchers have successfully worked hard to make fresh chicken salmonella-free. It is not allowed to sell fresh meat from Danish chickens if the flock is positive for salmonella. There will always be a small risk that positive fresh meat goes under the surveillance radar and makes its way to store refrigerators. This is why it is important to continue to have a close monitoring,” Senior Academic Officer Birgitte Helwigh from the National Food Institute says.

The first salmonella outbreak from Danish eggs for five years has also been registered in 2014. “It has been five years since we last had a foodborne outbreak caused by Danish eggs. The outbreak was associated with an outbreak of acute salmonella illness in the flock, which is extremely rare. The results show how important it is that producers and authorities continue to focus on maintaining the low incidence of salmonella in the egg production,” says Birgitte Helwigh says.

Danish pork was the food source associated with the most infections among persons infected in Denmark. Overall 15% of the reported illness cases were attributed to Danish pork. There were three outbreaks where Danish pork was registered as the source of infection, which contributed 4.6% of the cases.

Approximately one fifth of all salmonella cases in Denmark were not attributed to a specific food source. The reason may be that the cases were caused by foods which were not included in the salmonella source account, e.g. fruit and vegetables, or other sources of infection such as contact with livestock and pets.

With 3,782 cases registered in 2014, campylobacter still causes the most cases of foodborne bacterial illnesses in Denmark. In 2014 a total of 92 listeria infections were registered, which is an increase of 84% compared to the year before. The increase is mainly due to an outbreak in “rullepølse” (a Danish cold cut ready-to-eat speciality) with 41 reported cases.

In 2014, a total of 60 foodborne disease outbreaks were registered compared with 74 outbreaks the year before. An outbreak is when several people become sick from the same food source. As in previous years, norovirus caused the most outbreaks (40%). These outbreaks usually take place in restaurants, where a total of 363 people were infected in 24 of the recorded outbreaks.

NARMS Now: Tool shows changes in foodborne pathogen antibiotic resistance

A new interactive tool from CDC makes it easier and quicker to see how antibiotic resistance for four germs spread commonly through food—Campylobacter, E. coli O157, Salmonella, and Shigella—has changed over the past 18 years.

Each year in the United States, antibiotic-resistant germs cause 2 million illnesses and 23,000 deaths. Antibiotic-resistant infecnarms.now.fbitions from germs spread commonly through food cause an estimated 440,000 of those illnesses.

The NARMS Now: Human Data tool contains information from the National Antimicrobial Resistance Monitoring System (NARMS).

NARMS Now: Human Data allows users to access antibiotic resistance data by bacterial serotype, antibiotic, year (1996-2013), and geographic region. Users can view data on an interactive map or in tables. NARMS Now: Human Data plans to provide access to the most up-to-date antibiotic resistance results by uploading data regularly.

NARMS Now: Human Data can be used to:

–  Inform regulatory agency action.

FDA withdrew approval for Enrofloxacin (a fluoroquinolone) used in poultry after the data showed an increase in fluoroquinolone-resistant Campylobacter infections in humans.

–  Examine the geographic distribution of resistance.

Researchers have used the data to investigate the geographic distribution of multidrug-resistant Salmonella Typhimurium and Newport infections in the United States.

narmsnow-digitaldevices_cropMonitor changing trends in resistance.

Investigators are using NARMS data to help uncover the reason for increasing antibiotic resistance in a type of Salmonella, I 4,[5],12,:i:-, which has emerged recently in the United States.

Timely Access to Data

CDC developed NARMS Now: Human Data in response to requests from Congress, consumer groups, academia, and the public for timely access to data on antibiotic resistance. The tool is an important step towards President Obama’s Open Government Initiative to foster openness in government and establish a culture of transparency, public participation, and collaboration.

The FDA, on behalf of all the NARMS partner agencies, is also making data available online, NARMS Now: Integrated Data. That data helps users to access antibiotic resistance information from isolates from retail meat and animals, and will soon add Campylobacter and non-typhoidal Salmonella from humans.

Foodborne Diseases Active Surveillance Network—2 decades of achievements, 1996–2015

The Foodborne Diseases Active Surveillance Network (FoodNet) provides a foundation for food safety policy and illness prevention in the United States.

FoodNet.pyramid.fbi.OverviewFoodNet conducts active, population-based surveillance at 10 US sites for laboratory-confirmed infections of 9 bacterial and parasitic pathogens transmitted commonly through food and for hemolytic uremic syndrome.

Through FoodNet, state and federal scientists collaborate to monitor trends in enteric illnesses, identify their sources, and implement special studies. FoodNet’s major contributions include establishment of reliable, active population-based surveillance of enteric diseases; development and implementation of epidemiologic studies to determine risk and protective factors for sporadic enteric infections; population and laboratory surveys that describe the features of gastrointestinal illnesses, medical care–seeking behavior, frequency of eating various foods, and laboratory practices; and development of a surveillance and research platform that can be adapted to address emerging issues.

The importance of FoodNet’s ongoing contributions probably will grow as clinical, laboratory, and informatics technologies continue changing rapidly.

Foodborne Diseases Active Surveillance Network—2 decades of achievements, 1996–2015

Emerging Infectious Diseases, Volume 21, Number 9,  September 2015

Olga L. Henao Comments to Author , Timothy F. Jones, Duc J. Vugia, Patricia M. Griffin, and for the Foodborne Diseases Active Surveillance Network (FoodNet) Workgroup

http://wwwnc.cdc.gov/eid/article/21/9/15-0581_article

Is there an increase in multistate foodborne disease outbreaks—United States, 1973–2010?

Food Safety Talk podcast nerds Chapman and Schaffner are forever going on about Betteridge’s Law.

For the uninitiated, Betteridge’s Law states that “any headline that ends in a question mark can be answered by the word no.”

interstate-mdBetteridge himself stated, “The reason why journalists use that style of headline is that they know the story is probably bullshit, and don’t actually have the sources and facts to back it up, but still want to run it.”

I use question marks in headlines to avoid lawsuits.

A new paper posits that changes in food production and distribution have increased opportunities for foods contaminated early in the supply chain to be distributed widely, increasing the possibility of multistate outbreaks.

In recent decades, surveillance systems for foodborne disease have been improved, allowing officials to more effectively identify related cases and to trace and identify an outbreak’s source.

Materials and Methods: We reviewed multistate foodborne disease outbreaks reported to the Centers for Disease Control and Prevention’s Foodborne Disease Outbreak Surveillance System during 1973–2010. We calculated the percentage of multistate foodborne disease outbreaks relative to all foodborne disease outbreaks and described characteristics of multistate outbreaks, including the etiologic agents and implicated foods.

Results: Multistate outbreaks accounted for 234 (0.8%) of 27,755 foodborne disease outbreaks, 24,003 (3%) of 700,600 outbreak-associated illnesses, 2839 (10%) of 29,756 outbreak-associated hospitalizations, and 99 (16%) of 628 outbreak-associated deaths. The median annual number of multistate outbreaks increased from 2.5 during 1973–1980 to 13.5 during 2001–2010; the number of multistate outbreak-associated illnesses, hospitalizations, and deaths also increased. Most multistate outbreaks were caused by Salmonella (47%) and Shiga toxin–producing Escherichia coli (26%). Foods most commonly implicated were beef (22%), fruits (13%), and leafy vegetables (13%).

Conclusions: The number of identified and reported multistate foodborne disease outbreaks has increased. Improvements in detection, investigation, and reporting of foodborne disease outbreaks help explain the increasing number of reported multistate outbreaks and the increasing percentage of outbreaks that were multistate. Knowing the etiologic agents and foods responsible for multistate outbreaks can help to identify sources of food contamination so that the safety of the food supply can be improved.

 Increase in multistate foodborne disease outbreaks—United States, 1973–2010

Foodborne Pathogens and Disease, August 18, 2015, doi:10.1089/fpd.2014.1908

Nguyen Von D., Bennett Sarah D., Mungai Elisabeth, Gieraltowski Laura, Hise Kelley, and Gould L. Hannah

http://online.liebertpub.com/doi/abs/10.1089/fpd.201

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

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

The key is supplement: Statisticians using social media to track foodborne illness

The American Statistical Association reports the growing popularity and use of social media around the world is presenting new opportunities for statisticians to glean insightful information from the infinite stream of posts, tweets and other online communications that will help improve public safety.

vomitTwo such examples–one that enhances systems to track foodborne illness outbreaks and another designed to improve disaster-response activities–were presented this week at the 2015 Joint Statistical Meetings (JSM 2015) in Seattle.

In a presentation titled “Digital Surveillance of Foodborne Illnesses and Outbreaks”, biostatistician Elaine Nsoesie unveiled a method for tracking foodborne illness and disease outbreaks using social media sites such as Twitter and business review sites such as Yelp to supplement traditional surveillance systems. Nsoesie is a research fellow in pediatrics at Boston Children’s Hospital.

The study’s purpose was to assess whether crowdsourcing via online reviews of restaurants and other foodservice institutions can be used as a surveillance tool to augment the efforts of local public health departments. These traditional surveillance systems capture only a fraction of the estimated 48 million foodborne illness cases in the country each year, primarily because few affected individuals seek medical care or report their condition to the appropriate authorities.

Nsoesie and collaborators tested their nontraditional approach to track these outbreaks. The results showed foods–for example, poultry, leafy lettuce and mollusks–implicated in foodborne illness reports on Yelp were similar to those reported in outbreak reports issued by the U.S. Centers for Disease Control and Prevention.

yelp.sick“Online reviews of foodservice businesses offer a unique resource for disease surveillance. Similar to notification or complaint systems, reports of foodborne illness on review sites could serve as early indicators of foodborne disease outbreaks and spur investigation by local health authorities. Information gleaned from such novel data streams could aid traditional surveillance systems in near real-time monitoring of foodborne related illnesses,” said Nsoesie.

The lack of near real-time reports of foodborne outbreaks reinforces the need for alternative data sources to supplement traditional approaches to foodborne disease surveillance, explained Nsoesie. She added Yelp.com data can be combined with additional data from other social media sites and crowdsourced websites to further improve coverage of foodborne disease reports.

Australia still has an egg problem: Salmonella up, other foodborne illnesses falling

Despite more than four million Australians getting sick from contaminated food each year, the overall national rate of food poisoning is falling.

garlic_aioliExcept, that is, when it comes to Salmonella.

A glance at Victoria’s Department of Health figures for example, shows an increase of 65 per cent in Salmonella poisoning since 2012, where 2,500 people reported ill in the 12 months to August 2015.

Queensland has seen a doubling of Salmonella cases in the past 12 months.

According to Department of Health, “overall, despite more coverage, foodborne illness is declining, from 4.3 million cases a year in 2000 to 4.1 million cases in 2010.

“Our supply chains have become more complex, our meal solutions have become a lot more complex. It’s not just chops and three veg as it used to be.

“Shelf life is stretched to the limit.

“It’s across all food items, and Australian consumers can expect to fall ill from food contamination every four or five years on average due to contaminated food.”

It is thought that consumption of frozen berries in Australia is now 30 per cent of where it was when Hep A struck earlier this year.

“While salmonella bacteria are most commonly associated with livestock and chickens, they have also been responsible for food safety outbreaks associated with fresh produce,” says the new Food Safety Guideline.

A table of raw egg related outbreaks in Australia is available at https://barfblog.com/wp-content/uploads/2015/03/raw-egg-related-outbreaks-australia-3-12-15-2.pdf or https://barfblog.com/wp-content/uploads/2015/03/raw-egg-related-outbreaks-australia-3-12-15.xlsx

Summer or winter? Effects on shiga toxin E. coli in feedlot cattle

The U.S. Department of Agriculture Food Safety and Inspection Service has declared seven Shiga toxin–producing Escherichia coli (STEC) serogroups (O26, O45, O103, O111, O121, O145, and O157) as adulterants in raw, nonintact beef products.

e.coli.stecThe objective of this study was to determine the prevalence of these seven serogroups and the associated virulence genes (Shiga toxin [stx1, stx2], and intimin [eae]) in cattle feces during summer (June–August 2013) and winter (January–March 2014) months.

Twenty-four pen floor fecal samples were collected from each of 24 cattle pens, in both summer and winter months, at a commercial feedlot in the United States. Samples were subjected to culture-based detection methods that included enrichment, serogroup-specific immunomagnetic separation and plating on selective media, followed by a multiplex polymerase chain reaction for serogroup confirmation and virulence gene detection. A sample was considered STEC positive if a recovered isolate harbored an O gene, stx1, and/or stx2, and eae genes.

All O serogroups of interest were detected in summer months, and model-adjusted prevalence estimates are as follows: O26 (17.8%), O45 (14.6%), O103 (59.9%), O111 (0.2%), O121 (2.0%), O145 (2.7%), and O157 (41.6%); however, most non-O157 isolates did not harbor virulence genes.

The cumulative model-adjusted sample-level prevalence estimates of STEC O26, O103, O145, and O157 during summer (n=576) were 1.0, 1.6, 0.8, and 41.4%, respectively; STEC O45, O111, and O121 were not detected during summer months.

In winter, serogroups O26 (0.9%), O45 (1.5%), O103 (40.2%), and O121 (0.2%) were isolated; however, no virulence genes were detected in isolates from cattle feces collected during winter (n=576). Statistically significant seasonal differences in prevalence were identified for STEC O103 and O157 (p<0.05), but data on other STEC were sparse.

The results of this study indicate that although non-O157 serogroups were present, non-O157 STEC were rarely detected in feces from the feedlot cattle populations tested in summer and winter months.

Summer and winter prevalence of shiga toxin–producing Escherichia coli (STEC) O26, O45, O103, O111, O121, O145, and O157 in feces of feedlot cattle

Foodborne Pathogens and Disease, Volume: 12 Issue 8: August 10, 2015

Dewsbury Diana M.A., Renter David G., Shridhar Pragathi B., Noll Lance W., Shi Xiaorong, Nagaraja Tiruvoor G., and Cernicchiaro Natalia

http://online.liebertpub.com/doi/abs/10.1089/fpd.2015.1987#utm_source=ETOC&utm_medium=email&utm_campaign=fpd

 

Age and virulence influence E. coli, HUS in Norway

Shiga toxin-producing E. coli (STEC) infection is associated with hemolytic uremic syndrome (HUS).

beef.stecTherefore Norway has implemented strict guidelines for prevention and control of STEC infection. However, only a subgroup of STEC leads to HUS.

Thus, identification of determinants differentiating high risk STEC (HUS STEC) from low risk STEC (non-HUS STEC) is needed to enable implementation of graded infectious disease response.

Methods: A national study of 333 STEC infections in Norway, including one STEC from each patient or outbreak over two decades (1992-2012), was conducted. Serotype, virulence profile, and genotype of each STEC were determined by phenotypic or PCR based methods.

The association between microbiological properties and demographic and clinical data was assessed by univariable analyses and multiple logistic regression models.

Results: From 1992 through 2012, an increased number of STEC cases including more domestically acquired infections were notified in Norway. O157 was the most frequent serogroup (33.6Â %), although a decrease of this serogroup was seen over the last decade.

All 25 HUS patients yielded STEC with stx2, eae, and ehxA. In a multiple logistic regression model, age ≤5 years (OR = 16.7) and stx2a (OR = 30.1) were independently related to increased risk of HUS.

eae and hospitalization could not be modelled since all HUS patients showed these traits. The combination of low age (≤5 years) and the presence of stx2a, and eae gave a positive predictive value (PPV) for HUS of 67.5 % and a negative predictive value (NPV) of 99.0 %.

SF O157:[H7] and O145:H?, although associated with HUS in the univariable analyses, were not independent risk factors. stx1 (OR = 0.1) was the sole factor independently associated with a reduced risk of HUS (NPV: 79.7 %); stx2c was not so.

Conclusions: Our results indicate that virulence gene profile and patients’ age are the major determinants of HUS development.

 

Shiga toxin-producing Escherichia coli infections in Norway, 1992-2012: characterization of isolates and identification of risk factors for hemolytic uremic syndrome

Lin BrandalAstrid WesterHeidi LangeInger LøbersliBjørn-Arne LindstedtLine VoldGeorg Kapperud

Credits/Source: BMC Infectious Diseases 2015, 15:324