Lynne Terry of The Oregonian writes that an unusual museum stocked with food packages including everything from ground beef to alfalfa sprouts has gone live on the internet.
The Outbreak Museum, physically located in Portland, showcases the culprits in food poisoning cases.
The museum was the brainchild of Oregon’s star epidemiologist William Keene, who died suddenly at the end of 2013. He cracked dozens, if not hundreds of outbreaks that sickened people from Portland, Oregon to Portland, Maine with food tainted by E. coli, salmonella, norovirus, campylobacter and listeria. He worked with manufacturers and health officials alike with one goal in mind: prevent consumers from getting sick.
He collected packages of tainted items in outbreaks he worked on and other public health officials sent him containers from their investigations. The museum includes items from the 1999 salmonella outbreak traced to alfalfa sprouts, the 2006 E. coli outbreak involving spinach and the 2012 E. coli outbreak traced to raw milk.
Dr. Paul Cieslak, medical director of Oregon’s immunization program, said the museum is designed to educate younger epidemiologists about the significance of past outbreaks and how they influenced public health decisions and epidemiological investigations.
“It’s mainly meant to be instructure,” Cieslak said.
The items are open to public health students and school groups by appointment. The website includes more extensive information on 12 outbreaks.
A team of far too curious Danish researchers has been collecting feces from airplane bathrooms to study bacteria by region, which could help scientists understand disease outbreaks.
To conduct the study, the scientists literally transported feces back to a lab where they fed it through a DNA sequencing machine. The technology reveals antimicrobial resistance genes and any pathogens. From this data, they are able to analyze any patterns occurring in the plane’s country of origin.
For example, scientists detected far more genetic microbial resistance among people from South America. They even found specific differences between certain bacteria like Salmonella, which occurred more frequently in South Asia versus Clostridium, which was more common in North America.
As far as outbreaks, the report showed that analyzing feces could be a faster way to detect an epidemic than just analyzing doctor reports because the DNA sequencing shows sudden spikes in certain bacteria.
In 2007, Amy and I spent a few weeks in France, and being the food safety nerd, I was struck by the indifference many of the people I met showed to foodborne illness.
It seemed to be a point-of-pride amongst the locals to not report foodborne illness.
I’m familiar with the French desire for food to be alive, sexy, and part of a life well-lived, but also saw a lot of people going to McDonald’s.
We stayed for a week at a friend’s cottage in a small town in the south, and we would visit the butcher, who cross-contaminated everything.
We had dinner at a neighbor’s place one night and he confessed, that butcher, “he made me so sick with his chicken.”
And when I got home, someone told me my don’t eat poop story made it onto Letterman, while Amy developed the look.
Researchers report that community incidence estimates are necessary to assess the burden and impact of infections on health and to set priorities for surveillance, research, prevention, and control strategies.
The current study was performed to estimate the community incidence of campylobacteriosis and nontyphoidal salmonellosis in France from the number of laboratory-confirmed cases reported to the national reference center (NRC). The probabilities of a case in the community visiting a doctor, having a stool sample requested, having a positive laboratory test, and having the case reported to the NRC were estimated using data of national surveillance systems, national hospitalization and health insurance databases, and specific surveys informing about these parameters. Credible intervals (CrI) were calculated using Monte Carlo simulation. In addition, we estimated the number of hospitalizations for both infections in France.
The annual community incidence rate in France is estimated at 842 cases per 100,000 (90%CrI 525–1690) for campylobacteriosis and 307 cases per 100,000 (90%CrI 173–611) for salmonellosis. The annual number of hospitalizations is estimated at 5182 for campylobacteriosis and 4305 for salmonellosis. The multiplicationfactors between cases ascertained by the surveillance system and cases in the community were 115 for campylobacteriosis and 20 for salmonellosis.
They are consistent with estimates reported in other countries, indicating a high community incidence of campylobacteriosis and salmonellosis in France.
Community incidence of campylobacteriosis and nontyphoidal salmonellosis, France, 2008–2013
Foodborne Pathogens and Disease. 2015 ahead of print. doi:10.1089/fpd.2015.1964.
Van Cauteren Dieter, De Valk Henriette, Sommen Cecile, King Lisa A., Jourdan-Da Silva Nathalie, Weill François-Xavier, Le Hello Simon, Mégraud Francis, Vaillant Veronique, and Desenclos Jean C.
Roughly one-fourth of Texas cases involving Listeria, which contaminated Blue Bell ice cream and forced a crippling national recall in April, are not submitted to public health officials as required by law and go untracked, a newspaper reported Sunday.
Texas is not alone: Many state health departments in the U.S. don’t receive samples in 10 to 40 percent of confirmed Listeria cases to enter into databases, which can leave regulators unable to trace an outbreak, leave deadly food on the market and help companies avoid responsibility, the Houston Chronicle reported.
The Blue Bell outbreak could have been identified sooner had Listeria reporting been better around the country, said Richard Danila, assistant state epidemiologist for the Minnesota State Health Department.
“The clinical laboratory is there for the diagnosis and treatment of the patient,” said Shari Shea, director of food safety for the Association of Public Health Laboratories. “There’s not always appreciation for the way it fits into the public health system.”
At least 19 states don’t have laws requiring laboratories to submit confirmed Listeria samples, or “isolates,” to state health officials. Of those that do, Texas hovers around the middle of the pack in states missing samples in confirmed cases, according to the Council to Improve Foodborne Outbreak Response.
But despite Texas requiring laboratories to submit samples, the state has never enforced the mandate. Texas Department of State Health Services spokeswoman Carrie Williams said the agency instead prefers to work with labs and health providers to educate them and bring them into compliance.
Penalties are almost never enforced in any state, said Craig Hedberg, epidemiologist at the University of Minnesota. He said part of the reason is that public health departments depend on relationships with laboratories.
At a McDonald’s plant outside Mumbai, 200 workers walk through air dryers and disinfectant pools, then get to work making the day’s 25,000 patties from chicken painstakingly sourced in a country with one of the world’s worst food safety records.
To safeguard its multibillion-dollar brand, McDonald’s says more than 100 checks it applies across its international operations are then carried out after that.
India’s tainted water, patchy cold storage network and a retail sector made up of tiny local grocers present a major risk for international food brands, whose reputation can suffer globally from one local slip.
This can mean educating hundreds of small, often illiterate, farmers – critical in a fragmented farming sector that in some cases still uses “night soil”, or human faeces, for composting.
“There are thousands of farmers you need to reach out to, each with maybe an acre, two acres of land,” said Vikram Ogale, who looks after the supply chain and quality assurance for McDonald’s India.
Swiss food group Nestle is currently battling India’s biggest food scare in a decade and an unprecedented branding crisis in the country, after regulators reported some packets of its noodles contained excess lead, a finding the company disputes.
Its woes have laid bare the risks of operating in a country where it is difficult to build a watertight supply chain, and where state food safety infrastructure is minimal, at best.
Nestle uses external audit firms to check suppliers.
Wal-Mart, which operates as a wholesaler in India, says its checks mean rejecting 10-11 percent of produce daily.
Nestle is now pushing ahead with India’s first ever national recall, pulling some 27,400 tonnes of its popular Maggi noodles off India’s shelves, a process that will take at least 40 days.
The objectives of this study were to (1) determine the prevalence of “top 6” non-O157 plus O157:H7 EHEC (EHEC-7) on feedlot cattle hides and their matched preintervention carcasses; (2) assess the agreement among detection methods for these matrices; and (3) conduct a molecular risk assessment of EHEC-7 isolates. Samples from 576 feedlot cattle were obtained at a commercial harvest facility and tested for EHEC-7 by a culture-based method and the polymerase chain reaction/mass spectrometry–based NeoSEEK™ STEC Detection and Identification test (NS).
Prevalence data were analyzed with generalized linear mixed models. The cumulative prevalence of EHEC-7 in hide samples as detected by NS was 80.7%, with a distribution of 49.9%, O145; 37.1%, O45; 12.5%, O103; 11.0%, O157; 2.2%, O111; 2.0%, O121; and 0.2%, O26. In contrast, the cumulative prevalence of EHEC-7 in hide samples by culture was 1.2%, with a distribution of 0.6%, O157; 0.4%, O26; 0.2%, O145; and 0%, O45, O103, O111, and O121.
The cumulative prevalence of EHEC-7 on matched preintervention carcasses as detected by NS was 6.0%, with a distribution of 2.8%, O157; 1.6%, O145; 1.2%, O103; 1.1%, O45; 0.2%, O26; and 0.0%, O111 and O121. Although the culture-based method detected fewer positive hide samples than NS, it detected EHEC in five hide samples that tested negative for the respective organism by NS.
McNemar’s chi-square tests indicated significant (p<0.05) disagreement between methods. All EHEC-7 isolates recovered from hides were seropathotype A or B, with compatible virulence gene content.
This study indicates that “top 6” and O157:H7 EHEC are present on hides, and to a lesser extent, preintervention carcasses of feedlot cattle at harvest. However, continued improvement in non-O157 detection methods is needed for accurate estimation of prevalence, given the discordant results across protocols.
Prevalence of enterohemorrhagic Escherichia coli O26, O45, O103, O111, O121, O145, and O157 on hides and preintervention carcass surfaces of feedlot cattle at harvest
Foodborne Pathogens and Disease, ahead of print. doi:10.1089/fpd.2015.1945.
Stromberg Zachary R., Baumann Nicholas W., Lewis Gentry L., Sevart Nicholas J., Cernicchiaro Natalia, Renter David G., Marx David B., Phebus Randall K., and Moxley Rodney A.
Infection with Shiga-toxin producing E. coli O157, which can sometimes lead to kidney failure, decreased 32 percent when compared with 2006-2008 and 19 percent when compared with the most recent three years. These infections are often linked to consumption of undercooked ground beef and raw leafy vegetables. Salmonella Typhimurium, which has been linked to poultry, beef, and other foods, was 27 percent lower than it was in 2006-2008, continuing a downward trend begun in the mid-1980s. Two other less common types of Salmonella, Javiana and Infantis, more than doubled for reasons that are unclear. Salmonella Javiana is concentrated in the southeastern United States, but has been spreading within the Southeast and to other areas of the country. However, when all Salmonella serotypes are combined, there was no change in 2014.
Campylobacter increased 13 percent and Vibrio increased 52 percent compared with 2006-2008. Yersinia has declined enough to meet the Healthy People 2020 goal.
The data are from FoodNet, CDC’s active surveillance system that tracks nine common foodborne pathogens in 10 states and monitors trends in foodborne illness in about 15 percent of the U.S. population. Today’s report compares the 2014 frequency of infection with the frequency in the baseline period 2006-2008 and in the three most recent years. Overall in 2014, FoodNet logged just over 19,000 infections, about 4,400 hospitalizations, and 71 deaths from the nine foodborne germs it tracks. Salmonella and Campylobacter were by far the most common– accounting for about 14,000 of the 19,000 infections reported.
“We’re cautiously optimistic that changes in food safety practice are having an impact in decreasing E. coli and we know that without all the food safety work to fight Salmonella that more people would be getting sick with Salmonella than we are seeing now,,” said Robert Tauxe, M.D., deputy director of CDC’s Division of Foodborne Waterborne and Environmental Diseases. “The increasing use of whole genome sequencing to track foodborne illness cases will also help; however, much more needs to be done to protect people from foodborne illness.”
The recent decline in the incidence of Shiga toxin-producing E. coli (STEC) O157 follows several years of increasing scrutiny for beef products. Since 1994, the Food Safety and Inspection Service of the U.S. Department of Agriculture has taken STEC O157:H7 extremely seriously and made a number of changes in its regulatory oversight of the beef industry to protect public health.”We are encouraged by the reduction of STEC O157:H7 illnesses, which reflects our science-based approach to beef inspection, and we look forward to seeing further reductions in Salmonella and Campylobacter infections as our improved standards for poultry take effect later this year, ” said Al Almanza, Deputy Under Secretary for Food Safety at USDA. “Data sources like FoodNet allow us to be strategic in developing our food safety policies, and we will do everything within our power to keep reducing cases of foodborne illness from all meat and poultry products.”
Under the provisions of the FDA Food Safety Modernization Act, the U.S. Food and Drug Administration is planning to publish major new regulations in 2015. The regulations are geared toward ensuring produce safety, implementing preventive controls on processed foods, and improving the safety of imported foods.
“Prevention of illness is the fundamental goal of our new rules under the FDA Food Safety Modernization Act,” said Michael Taylor, deputy commissioner for Foods and Veterinary Medicine at FDA. “We have worked with a wide range of stakeholders to devise rules that will be effective for food safety and practical for the many diverse elements of our food system. Once the rules are fully implemented, FoodNet will help us evaluate their impact.”
The FoodNet report also includes results of culture-independent diagnostic tests (a new method for diagnosing intestinal illnesses without needing to grow the bacteria) done in the many hospital laboratories in the FoodNet sites. In 2014, the results of more than 1,500 such tests were reported. More than two-thirds of the tests were for Campylobacter. Other tests performed were for STEC, Salmonella, Shigella and Vibrio. Some of the tests had a positive result. However, the infections were not confirmed by culture, and so CDC experts did not include them in the overall FoodNet results for 2014.
New numbers! We have some new numbers! (Everybody loves numbers!)
In a report posted online yesterday, the USDA Economic Research Service put the economic burden of fifteen foodborne pathogens at $15.5 billion per year. That’s a lot of scratch.
But haven’t we been here before?
The new report simply puts some writing and analysis around the numbers ERS put out last year in the form of detailed data tables for these same pathogens. (I’m a distant third author on this report, mostly because Sandy Hoffmann is so generous; ERS did a lot of work here to update and improve estimates Sandy and I developed a few years ago, as part of our Ranking the Risks report and related journal articles).
Most of these efforts build on CDC’s 2011 estimates of foodborne illness incidence. Whether in dollars, DALYs, QALYs, or what-have-you, these burden of disease studies consider not only how many illnesses we expect to see each year, but also the severity of those diseases and the chronic sequelae that can result. These estimates enable us to line up foodborne disease with other public health concerns, and to directly compare the impacts of specific foodborne hazards to one another.
It can be a bit confusing to decipher the swirls of numbers across these studies, each built on different assumptions, methods, and data, but it’s fair to say that they are mostly in agreement about which foodborne bugs cause the greatest burden on public health. Salmonella, Toxoplasma, Listeria, Campylobacter, and Norovirus have the highest estimated disease burden in the U.S. Other foodborne hazards that rank highly include E. coli O157, C. perfringens, ciguatoxin, and Vibrio species.
At this point, there’s nothing surprising about this list. We’ve had five years of hearing it, after all.
A few weeks ago, I gave a talk about all these estimates (slides here). I was feeling pretty good about how far we’ve come at getting a bead on the burden of foodborne disease, and how these estimates can help inform our priorities. Then I read this new commentary published in the Journal of Public Health Policy: “How useful is ‘burden of disease’ to set public health priorities for infectious diseases?”
Now, a title like that is not going to be followed by an abstract that reads, “Like, totally useful, dude.”
The authors, Ruth Berkelman of Emory University and James LeDuc of the University of Texas, make a compelling case for why low burden of disease should not equate to low public health importance. Using examples like Nipah, Ebola, and MERS, they point out that the most effective time to act for some emerging zoonotic diseases is early. For example, they write:
“If longer chains of human transmission of Nipah begin to appear, a vaccine and effective treatment would be critical. Arguments about its relatively low current burden of disease are unconvincing when the threat of introduction into densely populated urban centers is large for Nipah and for a number of other emerging infectious diseases that have the potential for spread, domestically and internationally. That it takes a long time to develop a vaccine or effective therapeutic drug is reason to start now, before an emergency starts.”
The commentary isn’t directed at food safety, but it makes two good points. First, while disease burden estimates provide useful information, let’s not fool ourselves into thinking they are the only measures to consider. For example, pathogens that impact infants, pregnant women, or other vulnerable populations may warrant special attention, as might those with very high case fatality rates, regardless of the number of annual cases.
Second, we should not only be ranking which problems are worst, but identifying which solutions are best. We should be asking which opportunities for intervention have the greatest public health bang for the buck?
I often make these same points when discussing burden of disease, but sometimes I forget, perhaps because I’m too easily lost in the analytical weeds, or too entranced by the shiny new numbers sorted from big to small. And so they bear repeating.
US: Economic burden of major foodborne illnesses acquired in the United States
13.may.15
United States Department of Agriculture
Sandra Hoffmann, Bryan Maculloch, and Michael Batz
Each year, one in six people in the United States is sickened by a foodborne illness. Government, industry, and others expend considerable resources in trying to prevent these foodborne illnesses. To best marshall these resources, food industry managers and policy- makers need to know both the value of these efforts to society and how to target use of these resources. Estimates of the economic burden of illness provide a conservative measure of how much people are willing to pay to prevent these illnesses. This report provides an overview of recent estimates of the economic burden imposed annually by 15 leading foodborne pathogens in the United States. It also provides individual pathogen “pamphlets” that include:
a description of the course of illness that can follow an infection with the pathogen;
a summary of information about the pathogen’s annual foodborne illness incidence and economic burden relative to other foodborne pathogens;
a disease-outcome tree showing how many people experience different outcomes from food- borne exposure to the pathogen in the United States each year; and
a pie chart showing the annual economic burden associated with different health outcomes resulting from infection with the pathogen.
What Did the Study Find?
Foodborne pathogens impose over $15.5 billion (2013 dollars) in economic burden on the U.S. public each year. Just five pathogens cause 90 percent of this burden. Estimates of economic burden per case vary greatly, ranging from $202 for Cyclospora cayetanensis to $3.3 million for Vibrio vulnificus.
Fifteen pathogens cause 95 percent or more of the foodborne illnesses, hospitalizations, and deaths in the United States for which a specific pathogen cause can be identified. They are Campylobacter spp., Clostridium perfringens, Cryptosporidium spp., Cyclospora cayeta- nensis, Listeria monocytogenes, Norovirus, Salmonella non-typhoidal species, Shigella spp., STEC O157, STEC non-O157, Toxoplasma gondii, Vibrio vulnificus, Vibrio parahaemo- lyticus, Vibrio other non-cholera species, and Yersinia enterocolitica.
Eighty-four percent of the economic burden from these 15 pathogens is due to deaths. This reflects both the importance the public places on preventing deaths and the fact that the measure of economic burden used for nonfatal illnesses (medical costs + productivity loss) is a conservative measure of willingness to pay to prevent nonfatal illness.
Pathogens’ rankings by total economic burden generally follow their rankings by economic burden due to pathogen-related deaths, with notable exceptions. Campylobacter causes slightly more deaths per year than Norovirus, yet because of the very large number of nonfatal cases caused by Norovirus, its economic burden is higher than that of Campylobacter. The high medical costs and productivity losses caused by Clostridium perfringens contribute to its total economic burden exceeding those of three other pathogens with higher economic burden due to deaths (Vibrio vulnificus, Yersinia enterocolitica, and STEC O157).
Estimates of the incidence of foodborne disease acquired in the United States, and therefore economic burden estimates, are very uncertain. The U.S. Centers for Disease Control and Prevention (CDC) estimates that the foodborne disease incidence from these 15 pathogens could range from 4.6 million to 15.5 million cases in a typical year. Based on this range of incidence estimates, economic burden could range from $4.8 billion to $36.6 billion (2013 dollars).
How Was the Study Conducted?
This report provides estimates of the costs of foodborne illnesses based on recently published journal articles. The estimates from that research, updated for inflation and income growth to 2013 values, are available in ERS’s Cost-of-Illness Estimates for Major Foodborne Illnesses in the U.S. data product at http://www.ers.usda. gov/data-products/cost-estimates-of-foodborne-illnesses.aspx.
This report summarizes the findings from the ERS data product and provides additional educational materials based on the data product and journal articles targeted to a broad audience. The data product website allows users to explore the sensitivity of economic burden estimates to modelling assumptions. The data product also provides the information needed to update estimates for inflation and income growth over time.
The estimates underlying this report extend and update prior ERS cost-of-illness estimates by adding 11 patho- gens and updating cost estimates for 4 other pathogens. These new estimates combine a cost-of-illness measure of economic burden for nonfatal illnesses and a willingness-to-pay measure for deaths. The estimates for new pathogens are based on a synthesis of data sources, including National Inpatient Sample data on hospitalization costs, and existing scientific literature. Estimates for all pathogens use 2011 CDC estimates of the incidence of foodborne illnesses acquired in the United States and associated hospitalizations and deaths. In modeling the likelihood of other health outcomes, the estimates rely on FoodNet data and reviews of scientific literature. In modeling the duration of illnesses and severity of health outcomes, the estimates rely on a review of clinical medical literature.
Escherichia coli O26 has been identified as the most common non-O157 Shiga toxin-producing E. coli (STEC) serogroup to cause human illnesses in the United States and has been implicated in outbreaks around the world. E. coli has high genomic plasticity, which facilitates the loss or acquisition of virulence genes.
Attaching and effacing E. coli (AEEC) O26 strains have frequently been isolated from bovine feces, and there is a need to better characterize the relatedness of these strains to defined molecular pathotypes and to describe the extent of their genetic diversity.
High-throughput real-time PCR was used to screen 178 E. coli O26 isolates from a single U.S. cattle feedlot, collected from May to July 2011, for the presence or absence of 25 O26 serogroup-specific and virulence-associated markers. The selected markers were capable of distinguishing these strains into molecularly defined groups (yielding 18 unique marker combinations). Analysis of the clustered regularly interspaced short palindromic repeat 1 (CRISPR1) and CRISPR2a loci further discriminated isolates into 24 CRISPR types. The combination of molecular markers and CRISPR typing provided 20.8% diversity. The recent CRISPR PCR target SP_O26-E, which was previously identified only in stx2-positive O26:H11 human clinical strains, was identified in 96.4% (161/167 [95% confidence interval, 99.2 to 93.6%]) of the stx-negative AEEC O26:H11 bovine fecal strains. This supports that these stx-negative strains may have previously contained a prophage carrying stx or could acquire this prophage, thus possibly giving them the potential to become pathogenic to humans.
These results show that investigation of specific genetic markers may further elucidate our understanding of the genetic diversity of AEEC O26 strains in bovine feces.
Genetic diversity and pathogenic potential of attaching and effacing Escherichia coli O26:H11 strains recovered from bovine feces in the United States
Shiga toxin-producing Escherichia coli (STEC) is a foodborne pathogen that may be responsible for severe human infections. Only a limited number of serotypes, including O26:H11, are involved in the majority of serious cases and outbreaks. The main virulence factors, Shiga toxins (Stx), are encoded by bacteriophages.
Seventy-four STEC O26:H11 strains of various origins (including human, dairy, and cattle) were characterized for their stx subtypes and Stx phage chromosomal insertion sites. The majority of food and cattle strains possessed the stx1a subtype, while human strains carried mainly stx1a or stx2a. The wrbA and yehV genes were the main Stx phage insertion sites in STEC O26:H11, followed distantly by yecE and sbcB. Interestingly, the occurrence of Stx phages inserted in the yecE gene was low in dairy strains. In most of the 29 stx-negative E. coli O26:H11 strains also studied here, these bacterial insertion sites were vacant. Multilocus sequence typing of 20 stx-positive or stx-negative E. coli O26:H11 strains showed that they were distributed into two phylogenetic groups defined by sequence type 21 (ST21) and ST29. Finally, an EspK-carrying phage was found inserted in the ssrA gene in the majority of the STEC O26:H11 strains but in only a minority of the stx-negative E. coli O26:H11 strains.
The differences in the stx subtypes and Stx phage insertion sites observed in STEC O26:H11 according to their origin might reflect that strains circulating in cattle and foods are clonally distinct from those isolated from human patients.
Diversity of shiga toxin-producing Escherichia coli (STEC) O26:H11 strains examined via stx subtypes and insertion sites of stx and espk bacteriophages
They were stunned to learn the school’s current system doesn’t keep track of dates such as when food shipments arrived or when it was time to throw unused food away.
School board members came to realize there’s been almost no such plan up to this point.
“People got it, it was normal and it was a just no. it was not normal once you tasted it obviously,” said Olivia Ewing, Cherokee High School senior.
On Thursday, 10News reported that some schools in the system had served six-year-old pork last week. The meat had been frozen up until preparation.
Board of Education Chairman Chris Christian is working to find out when the meat arrived at the schools.
