Tag Archives: Surveillance

The global burden of crypto in children under 5

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The protozoan Cryptosporidium is a leading cause of diarrhoea morbidity and mortality in children younger than 5 years. However, the true global burden of Cryptosporidium infection in children younger than 5 years might have been underestimated in previous quantifications because it only took account of the acute effects of diarrhoea. We aimed to demonstrate whether there is a causal relation between Cryptosporidium and childhood growth and, if so, to quantify the associated additional burden.

Methods

The Global Burden of Diseases, Injuries, and Risk Factors study (GBD) 2016 was a systematic and scientific effort to quantify the morbidity and mortality associated with more than 300 causes of death and disability, including diarrhoea caused by Cryptosporidium infection. We supplemented estimates on the burden of Cryptosporidium in GBD 2016 with findings from a systematic review of published and unpublished cohort studies and a meta-analysis of the effect of childhood diarrhoea caused by Cryptosporidium infection on physical growth.

Findings

In 2016, Cryptosporidium infection was the fifth leading diarrhoeal aetiology in children younger than 5 years, and acute infection caused more than 48 000 deaths (95% uncertainty interval [UI] 24 600–81 900) and more than 4·2 million disability-adjusted life-years lost (95% UI 2·2 million–7·2 million). We identified seven data sources from the scientific literature and six individual-level data sources describing the relation between Cryptosporidium and childhood growth. Each episode of diarrhoea caused by Cryptosporidium infection was associated with a decrease in height-for-age Z score (0·049, 95% CI 0·014–0·080), weight-for-age Z score (0·095, 0·055–0·134), and weight-for-height Z score (0·126, 0·057–0·194). We estimated that diarrhoea from Cryptosporidium infection caused an additional 7·85 million disability-adjusted life-years (95% UI 5·42 million–10·11 million) after we accounted for its effect on growth faltering—153% more than that estimated from acute effects alone.

Interpretation

Our findings show that the substantial short-term burden of diarrhoea from Cryptosporidium infection on childhood growth and wellbeing is an underestimate of the true burden. Interventions designed to prevent and effectively treat infection in children younger than 5 years will have enormous public health and social development impacts.

Morbidity, mortality, and long-term consequences associated with diarrhoea from cryptosporidium infection in children younger than 5 years: A meta-analyses study

The Lancet Global Health, DOI: https://doi.org/10.1016/S2214-109X(18)30283-3

Ibrahim A Khalil, Christopher Troeger, Puja C Rao…

https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(18)30283-3/abstract#.WyQRPA3swGY.twitter

Funding

The Bill & Melinda Gates Foundation.

Reality research: Norovirus in restaurant bathrooms

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Long-time friend and friend of the barfblog.com, Don Schaffner, a professor of microbiology at Rutgers University (right, sort of as shown) writes:

More than seven years ago I had the good fortune to be contacted by my colleague, Dr. Lee-Ann Jaykus (below, left, exactly as shown).

She asked if I wanted to be involved in what was at the time going to be a remarkable endeavor. She was going to lead a team of scientists competing to earn a $25 million grant from the USDA focused on understanding Norovirus.

Norovirus causes more foodborne disease than any other microorganism. Because it is often self-limiting, and seldom fatal, it gets a little attention. It’s also a remarkably difficult organism to study. One of the reasons it has been difficult to study is that there had no way to culture the organism outside it’s human host. This meant that anyone wanting to do research with the organism had to have a supply of frozen poop containing the virus.

One of the goals of the ambitious project lead by Dr. Jaykus was to finally crack the code which would allow scientists to culture the virus in the laboratory. Spoiler alert, we got the grant. We were all excited to learn recently that thanks in large measure to the USDA Grant, that riddle has been solved.

This USDA Grant also allowed a number of other research projects too numerous to recount here, but I do want to tell the story of one.

Early on in our efforts on the ground, my colleague, Angie Fraser reached out and asked if I wanted to be part of an extensive survey of restaurant bathroom for Norovirus. I was delighted to say yes, and we began

I have to express my sincere appreciation to Cortney Leone whom led the project. She had the unenviable task of having to oversee researchers in three U.S. states, charged with collection of the data for this project. I also owe huge debt of gratitude to my graduate student Hannah Bolinger who led our data collection efforts in New Jersey.  Thanks also to the NJ team of graduate students, undergraduate students and significant others who visited public bathrooms around the state (Louis Huang, Pierce Gaynor, Sarah Hossain, Sneha Sreekumar, Jenny Todd-Searle, and Arthur Todd-Searle).

(Schaffner, this isn’t an Academy Award acceptance speech, on with it — dp.)

Because we wanted to ensure that our data were representative, we collected data from nine different counties in New Jersey. This turned out to be a lot harder than you might think. New Jersey is a home rule state.

This means that public health operates at the municipal level, with minimal oversight from the state. Our first task was to compile lists of food service establishment from the three regions of New Jersey.

This was easy to do in less densely populated regions, where the municipal entity was the county. We could simply contact the county, and through appropriate freedom of information act paperwork, obtain a list of all of the restaurants in the county. This was far more difficult in the densely settled parts of the state, where obtaining a list require contacting each and every municipality in the county, and filling out each municipalities’ different paperwork, in some cases mailing a paper check to cover photocopying costs, and then eventually taking the information we received back, and putting it into a standardized database. All of this was required before we could even begin to collect the first piece of data.

Thanks to Hanna’s outstanding work, we were eventually able to produce a robust enough database that we could proceed with data collection. Hannah lead a team of students that visited restrooms in and around New Jersey. This was harder than it sounded, as often the information provided by the  municipalities was out of date, and the students arrived at a location, only to learn that the restaurant was closed, or the location was incorrect.

Eventually, the teams in all three states had collected enough swabs and sent the samples back to CDC for analysis.

The end result of all this work was published in the Journal of Food Protection. Although our goal was to visit 750 commercial food establishments, we actually visited 751 establishments, in which 1,044 bathrooms and 4,163 surfaces were swabbed.  Four swab samples were collected from each bathroom: (i) the underside of the toilet seat where it connects to the toilet bowl, (ii) the flush handle of the toilet, (iii) the inner door handle of the stall door or, when there was no stall door, the inner door handle of the outer door, and (iv) the hot water knob of the sink faucet.

In the end 61 (1.5%) of 4,163 swabs were presumptively positive for human norovirus, and 9 of these were confirmed by sequencing.  This is similar to what others have found.

Almost half (30) of positive swabs were found on the underside of the toilet seat. About 20% were found on the toilet flush handle (13) and the inner handle of the stall or outer door (11). Only 11% (7) of positive swabs were found on the sink faucet handle.  Our results suggest that areas further away from the toilet are less likely to harbor norovirus contamination; toilet surfaces (especially the underside of the seat) would be closest to vomiting and diarrheal events during which high numbers of norovirus particles could be shed.

Chain restaurants had significantly more positive samples than non-chains (p = 0.0273). Unisex bathrooms had significantly more positive samples than female bathrooms (p = 0.0163).  Bathrooms with bar soap had significantly more positive samples than liquid soap bathroom (p = 0.0056) and foam soap bathrooms (p = 0.0147), but note that only 3 bathrooms out of 751 actually used bar soap. Bathrooms containing a trash can attached to the paper towel dispenser had significantly more positive samples than bathrooms with a free-standing trash can (p = 0.0004).

Although[the NoroCORE grant recently ended,I know there will be continued publications coming for many years, several of which will come from my lab, that will serve to further advance our understanding of Norovirus, and the means by which it can be controlled.

Prevalence of Human Noroviruses in Commercial Food Establishment Bathrooms

CORTNEY M. LEONE, MUTHU DHARMASENA, CHAOYI TANG, ERIN DiCAPRIO, YUANMEI MA, ELBASHIR ARAUD, HANNAH BOLINGER, KITWADEE RUPPROM, THOMAS YEARGIN, JIANRONG LI, DONALD SCHAFFNER, XIUPING JIANG, JULIA SHARP, JAN VINJÉ, and ANGELA FRASER (2018) Prevalence of Human Noroviruses in Commercial Food Establishment Bathrooms. Journal of Food Protection: May 2018, Vol. 81, No. 5, pp. 719-728.

https://doi.org/10.4315/0362-028X.JFP-17-419

http://jfoodprotection.org/doi/abs/10.4315/0362-028X.JFP-17-419?code=fopr-site

Although transmission of human norovirus in food establishments is commonly attributed to consumption of contaminated food, transmission via contaminated environmental surfaces, such as those in bathrooms, may also play a role. Our aim was to determine the prevalence of human norovirus on bathroom surfaces in commercial food establishments in New Jersey, Ohio, and South Carolina under nonoutbreak conditions and to determine characteristics associated with the presence of human norovirus. Food establishments (751) were randomly selected from nine counties in each state. Four surfaces (underside of toilet seat, flush handle of toilet, inner door handle of stall or outer door, and sink faucet handle) were swabbed in male and female bathrooms using premoistened macrofoam swabs. A checklist was used to collect information about the characteristics, materials, and mechanisms of objects in bathrooms. In total, 61 (1.5%) of 4,163 swabs tested were presumptively positive for human norovirus, 9 of which were confirmed by sequencing. Some factors associated with the presence of human norovirus included being from South Carolina (odd ratio [OR], 2.4; 95% confidence interval [CI], 1.2 to 4.9; P < 0.05) or New Jersey (OR, 1.7; 95% CI, 0.9 to 3.3; 0.05 < P < 0.10), being a chain establishment (OR, 1.9; 95% CI, 1.1 to 3.3; P < 0.05), being a unisex bathroom (versus male: OR, 2.0; 95% CI, 0.9 to 4.1; 0.05 < P < 0.10; versus female: OR, 2.6; 95% CI, 1.2 to 5.7; P < 0.05), having a touchless outer door handle (OR, 3.3; 95% CI, 0.79 to 13.63; 0.05 < P < 0.10), and having an automatic flush toilet (OR, 2.5, 95% CI, 1.1 to 5.3; 0.05 < P < 0.10). Our findings confirm that the presence of human norovirus on bathroom surfaces in commercial food establishments under nonoutbreak conditions is a rare event. Therefore, routine environmental monitoring for human norovirus contamination during nonoutbreak periods is not an efficient method of monitoring norovirus infection risk.

105 sickened, 1 death linked to Salmonella Newport outbreak originating in beef from dairy cattle, 2016-17

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Contaminated ground beef was the likely source of a protracted outbreak of 106 Salmonella Newport infections, 42 hospitalizations, and one death in 21 states during October 2016–July 2017. While no direct link was found, whole genome sequencing suggests dairy cows were the ultimate outbreak source.

Foodborne outbreak investigations could be enhanced by improvements in the traceability of cows from their originating farms or sale barns, through slaughter and processing establishments, to ground beef sold to consumers.

In January 2017, the U.S. Centers for Disease Control (CDC) identified a cluster of Salmonella enterica serotype Newport infections with isolates sharing an indistinguishable pulsed-field gel electrophoresis (PFGE) pattern, JJPX01.0010 (pattern 10), through PulseNet, the national molecular subtyping network for foodborne disease surveillance. This report summarizes the investigation by CDC, state and local health and agriculture departments, and the U.S. Department of Agriculture’s Food Safety and Inspection Service (USDA-FSIS) and discusses the possible role of dairy cows as a reservoir for strains of Salmonella that persistently cause human illness. This investigation combined epidemiologic and whole genome sequencing (WGS) data to link the outbreak to contaminated ground beef; dairy cows were hypothesized to be the ultimate source of Salmonella contamination.

A case was defined as infection with Salmonella Newport with PFGE pattern 10 closely related to the outbreak strain by WGS, with bacterial isolation during October 1, 2016, through July 31, 2017. A total of 106 cases were identified in 21 states (Figure 1). Most illnesses ([72%]) were reported from southwestern states, including Arizona (30), California (25), New Mexico (14), and Texas (seven). Illness onset dates ranged from October 4, 2016, through July 19, 2017. Patients ranged in age from <1–88 years (median = 44 years), and 53 (50%) were female. Among 88 (83%) patients with known outcomes, 42 (48%) were hospitalized, and one died.

Initial interviews identified consumption of ground beef as a common exposure among patients. A focused questionnaire was developed to collect detailed information on ground beef exposure and to obtain shopper card information and receipts. Among 65 interviewed patients, 52 (80%) reported eating ground beef at home in the week before illness began. This percentage was significantly higher than the 2006–2007 FoodNet Population Survey, in which 40% of healthy persons reported eating ground beef at home in the week before they were interviewed (p<0.001) (1). Among the 52 patients who ate ground beef at home, 31 (60%) reported that they bought it or maybe bought it from multiple locations of two national grocery chains, and 21 (40%) reported that they bought ground beef from locations of 15 other grocery chains. Specific ground beef information was available for 35 patients. Among these, 15 (43%) purchased ground beef as chubs (rolls) of varying sizes (range = 2–10 lbs), 18 purchased it on a tray wrapped in plastic, and two purchased preformed hamburger patties. Twenty-nine patients reported that they bought fresh ground beef, four bought frozen ground beef, and four did not recall whether it was fresh or frozen when purchased. When asked about ground beef preparation, 12 (36%) of 33 patients reported that they definitely or possibly undercooked it.

Traceback Investigation

USDA-FSIS conducted traceback on ground beef purchased within 3 months of illness onset for 11 patients who provided shopper card records or receipts. Approximately 20 ground beef suppliers belonging to at least 10 corporations were identified; 10 of the 11 records traced back to five company A slaughter/processing establishments, seven of 11 traced back to five company B slaughter/processing establishments, and four of 11 traced back to two company C slaughter/processing establishments.

Product and Animal Testing

Opened, leftover samples of ground beef from three patients’ homes were collected for testing. All were purchased from one of two national grocery chains that had been identified by a majority of patients. One sample, collected from ground beef removed from its original packaging, yielded the outbreak strain. The other two samples did not yield Salmonella.

The outbreak strain was also isolated from four New Mexico dairy cattle. One was collected from a spontaneously aborted fetus in July 2016, and one was isolated from feces from a young calf in November 2016. The third isolate was identified by searching the USDA Animal and Plant Health Inspection Service National Veterinary Services Laboratory (USDA-APHIS NVSL) database for Salmonella Newport isolates collected from cattle in Arizona, California, Texas, New Mexico, and Wisconsin during January 2016–March 2017. Eighteen Salmonella Newport isolates were identified, including 13 from Texas, three from New Mexico, and two from Wisconsin. The only Salmonella Newport pattern 10 isolate identified was from a fecal sample from a New Mexico dairy cow collected during November 2016. The fourth isolate was from a USDA-FSIS routine cattle fecal sample collected at a Texas slaughter establishment in December 2016; USDA-FSIS determined the sample was from a dairy cow and identified the New Mexico farm of origin. Because of confidentiality practices, officials were not able to identify the farm or farms of origin for the dairy cows associated with the other three samples or whether the four dairy cows were associated with a single farm. None of the 11 patients with information for traceback ate ground beef produced at the Texas slaughter establishment.

Whole genome high-quality single nucleotide polymorphism (SNP) analysis* showed that 106 clinical isolates were closely related to each other genetically, to the four dairy cattle isolates, and to the leftover ground beef isolate (range = 0–12 SNP differences), suggesting that the Salmonella bacteria found in patients, ground beef, and dairy cattle all shared a common source. Thirty-nine additional clinical isolates with PFGE pattern 10 were determined to not be closely related and were excluded from the outbreak. No antibiotic resistance was detected among three clinical isolates tested by CDC’s National Antimicrobial Resistance Monitoring Laboratory.†

Because the USDA-FSIS traceback investigation did not converge on a common production lot of ground beef or a single slaughter/processing establishment, and no ground beef in the original packaging yielded the outbreak strain, a recall of specific product was not requested. A public warning was not issued to consumers because specific, actionable information was not available (e.g., a specific brand or type of ground beef). Officials in New Mexico visited the dairy farm that was the source of the cow at the Texas establishment and noted no concerns about conditions or practices. However, this visit occurred late in the investigation, and conditions at the time of the visit might not have represented those present immediately before and during the outbreak. No samples from the environment or cows were collected during this visit.

Epidemiologic and laboratory evidence indicated that contaminated ground beef was the likely source of this protracted outbreak of Salmonella Newport infections. A significantly higher percentage of patients than expected ate ground beef at home, and a patient’s leftover ground beef yielded the outbreak strain. Dairy cows colonized or infected with the outbreak strain before slaughter are hypothesized to be the ultimate outbreak source. Most U.S. ground beef is produced from beef cattle; however, 18% is produced from dairy cows (2). Dairy cows are sold for beef production through sale barns or directly to slaughter establishments as they age or if their milk production is insufficient (2). Previous studies have demonstrated long-term persistence of Salmonella Newport in dairy herds (3,4), and a 1987 Salmonella Newport outbreak was linked to contaminated ground beef from slaughtered dairy cows (5). In the current outbreak, as has been observed in previous outbreaks, ground beef purchases traced back to numerous lots and slaughter/processing establishments (6). One possible explanation is that dairy cows carrying a high Salmonella load that overwhelmed antimicrobial interventions could have gone to multiple slaughter/processing establishments (7), resulting in contamination of multiple brands and lots of ground beef. This might explain the reason for failure to identify a single, specific source of contaminated ground beef.

This investigation identified the outbreak strain only in samples from dairy cattle from New Mexico. All four isolates from dairy cattle samples were closely related genetically by WGS to isolates from patients, providing further evidence of a connection between dairy cattle in New Mexico and the outbreak. The disproportionate geographic distribution of cases in the U.S. Southwest, including New Mexico, also suggests a possible regional outbreak source. Although limited in scope, the query of the USDA-APHIS NVSL data identified the outbreak strain only from one New Mexico dairy cow (isolate 3), and the sample collection date was consistent with the timing of illnesses in this outbreak. The overall prevalence and geographic distribution of the outbreak strain in cattle is not known, and it is possible that cattle in states other than New Mexico might have been infected or colonized with the outbreak strain.

This was a complex and challenging investigation for several reasons. First, the PFGE pattern in the outbreak was not uncommon in PulseNet, making it difficult to distinguish outbreak cases from sporadic illnesses associated with the same Salmonella Newport pattern. WGS analysis provided more discriminatory power to refine the outbreak case definition and excluded 39 cases of illness from the outbreak. However, sequencing is not currently performed in real time for Salmonella, thereby slowing the process of determining which cases were likely outbreak-associated. In addition, a direct pathway linking outbreak cases to dairy cows infected with the outbreak strain of Salmonella Newport could not be established. This is because product traceback did not converge on a single contaminated lot of ground beef, and investigators were unable to ascertain a link between the beef slaughter/processing establishments identified during traceback and the farms with dairy cows that yielded the outbreak strain. Tracing back ground beef purchased by patients to slaughter/processing establishments requires documentation such as receipts or shopper card records, and only 10% of patients had this information available. For this outbreak, tracing back cows at slaughter/processing establishments to the farm from which they originated was problematic because cows were not systematically tracked from farm to slaughter/processing establishments.

Four points along the “farm to fork” continuum provide opportunities to prevent consumers from becoming ill from contaminated ground beef. First, farms can implement good management practices for cattle health, including vaccination, biosecurity (e.g., controlling movement of persons and animals on farms, keeping a closed herd [so that no animals on the farm are purchased, loaned to other farms, or have contact with other animals], planning introduction of new animals and quarantining them, and performing microbiologic testing of animals), and cleaning and disinfection measures to decrease Salmonella burden in animals and the environments in which they reside, reducing the likelihood that Salmonella will enter beef slaughter/processing establishments (8). Second, slaughter/processing establishments are required to maintain Hazard Analysis and Critical Control Points systems to reduce Salmonella contamination as well as slaughter and sanitary dressing procedures to prevent carcass contamination (9). Third, although Salmonella is not considered an adulterant in not-ready-to eat (NRTE) meat products, USDA-FSIS likely will consider the product to be adulterated when NRTE meat products are associated with an outbreak (9). Finally, consumers are advised to cook ground beef to 160°F (71°C) as measured by a food thermometer to destroy any bacteria that might be present. Consumers are also advised to wash hands, utensils, and surfaces often; separate and not cross-contaminate foods; and refrigerate foods promptly and properly.

This investigation emphasizes the utility of WGS during outbreak investigations and identifies the need for improvements in traceability from the consumer to the farm. It also highlights the importance of continued evaluation of farm practices to help reduce persistent Salmonella contamination on farms, contamination of ground beef, and ultimately human illness.

Protracted outbreak of Salmonella Newport infections linked to ground beef: Possible role of Dairy Cows-21 states, 2016-2017

CDC

https://www.cdc.gov/mmwr/volumes/67/wr/mm6715a2.htm

Kis Robertson Hale, Food Safety and Inspection Service, U.S. Department of Agriculture; territorial, state, city, and county health departments and laboratories; Danya Alvarez, John Crandall, Hillary Berman-Watson, California Department of Public Health Microbial Diseases Laboratory.

 

Farm animals quarantined following crypto at Rhode Island petting zoo

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I’m getting too old for this shit.

As John Prine famously sang, all the news just repeats itself.

Animals at a Middletown farm are being quarantined after three people got sick, Rhode Island health officials announced last week.

The Rhode Island Department of Environmental Management said one child and two adults came down with cryptosporidiosis after having contact with goats during “pet and cuddle” events at Simmons Farm on West Main Road on March 25 and 31.

“I have never been so sick,” one woman, who did not want to be identified, told NBC 10 News. “I had visited the farm on Saturday, March 31 and by Friday evening, I was extremely ill and it progressively got worse from there.”

She said she went to the hospital April 10 and a doctor asked if she had been to a farm.

“Today, I have had my first real meal and my stomach is already gurgling,” she said. “Up until tonight, I had six Saltines.”

About 60 goats and five cows are being quarantined, Simmons Farm owners told NBC 10 News. They will also be screened.

NZ poultry industry calls chicken contamination findings ‘scaremongering’

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That didn’t take long.

Nor should it.

But the so-called experts undermine their case by not advocating the use of a tip-sensitive digital thermometer and instead relying on the woefully unreliable color test (‘chicken must be fully cooked through until juices run clear) for safety.

A new University of Otago, Wellington study, published last week in the international journal BMC Public Health found an overwhelming majority of consumers were not aware of the widespread Campylobacter contamination.

But the Poultry Industry Association of New Zealand is challenging the findings, which it says does not reflect reported Campylobacter statistics nor consumer behaviour.

PIANZ executive director Michael Brooks said the findings did not add up with New Zealand’s soaring chicken consumption, and flat rates of reported campylobacter cases.

“Reported cases of campylobacter have sat between 6000 to 7000 for the past five years, so it’s misleading to estimate there are 30,000 cases occurring,” Brooks said.

“It is important to note that the source of these cases was not always chicken.

“Consumers contract campylobacteriosis from other sources too.”

Brooks said the poultry industry had made significant changes when it came to labelling for food safety.

The association lost control of that access to information once third parties like butchers or supermarkets started packaging their own raw chicken product.

“As an industry it is important for everyone to educate their customers on food safety practices.”

Brooks said he welcomed a collaborative approach with institutions such as Otago University, as consumer education was key to reducing cases of campylobacter.

WGS links Salmonella in egg outbreaks in Australia

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Building on their work with whole genome sequencing and eggs – because there’s a lot of outbreaks of Salmonella in eggs — a group of Australian researchers have reported on seven outbreaks of Salmonella Typhimurium multilocus variable-number tandem-repeat analysis (MLVA) 03-26-13-08-523 (European convention 2-24-12-7-0212) in three Australian states and territories investigated between November 2015 and March 2016.

We identified a common egg grading facility in five of the outbreaks. While no Salmonella Typhimurium was detected at the grading facility and eggs could not be traced back to a particular farm, whole genome sequencing (WGS) of isolates from cases from all seven outbreaks indicated a common source. WGS was able to provide higher discriminatory power than MLVA and will likely link more Salmonella Typhimurium cases between states and territories in the future. National harmonization of Salmonella surveillance is important for effective implementation of WGS for Salmonella outbreak investigations.

Seven Salmonella Typhimurium outbreaks in Australia linked by trace-back and whole genome sequencing

Foodborne Pathogens and Disease, March, 2018, 10.1089/fpd.2017.2353

Laura Ford Qinning Wang Russell Stafford,Kelly-Anne Ressler, Sophie Norton, Craig Shadbolt, Kirsty Hope, Neil Franklin, Radomir Krsteski, Adrienne Carswell,Glen P. Carter, Torsten Seemann,Peter Howard, Mary Valcanis,10 Cristina Fabiola Sotomayor Castillo, John Bates, Kathryn Glass,Deborah A. Williamson, Vitali Sintchenko, Benjamin P. Howden and Martyn D. Kirk1

Tests show NZ beef sector so far free of M. bovis

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Emma left this morning.

Emma has always been a special person in our lives, and especially Sorenne’s.

When Amy was pregnant almost 10 years ago at Kansas State University, we talked about getting some early childhood education students to help out, so I could work and Amy could write.

Never had to post the ad.

Emma was a student in one of Dr. Amy’s French classes, noticed she was pregnant, and asked, are you going to need help with that baby?

Emma became one of our helpers.

This was in the U.S., with six weeks maternity leave, rather than Canada, with six months maternity leave (plus a whole bunch more parental leave, in Canada).

Emma now lives in New Zealand with her partner, the veterinarian, and took advantage of the long weekend to have a visit.

To watch Emma and her partner experiment and flourish over the past 10 years has been a delight.

But this story is for the dude, since he works at MPI in New Zealand, whose $3 billion beef export sector seems to be free so far of the serious new cattle disease Mycoplasma bovis.

The Ministry for Primary Industries, which is attempting to contain an outbreak of the disease in dairy cattle by a mass slaughter of more than 22,000 dairy cattle before the beginning of June, said there had been no positive results from its testing of beef animals.

The beef and dairy sectors work closely in New Zealand through dairy calf rearing and dairy grazing with about 80 per cent of premium beef cattle production originating from the dairy herd.

In response to a Herald inquiry, an MPI spokeswoman said the risk profile for M. bovis in beef farming was very different to that of dairying because of how beef is raised in New Zealand.

“Generally beef cattle are farmed extensively in pasture and are not fed risky discarded calf milk.

“We looked into this carefully and determined the beef stock at greatest risk were those that were raised in feed lots – not that common in New Zealand.”

With the support of industry good organisation Beef+Lamb, MPI had carried out some surveillance of cattle in feed lots, mostly in the South Island, the epicentre of the M. bovis outbreak.

“The animals were tested at slaughter in order to take samples … there were no positive results,” the spokeswoman said.

“We also consider that many dairy beef animals were tested in the response as part of our tests on neighbouring farms to infected properties. Again, no positives were found.”
Meanwhile, newly released MPI reports on M. bovis investigations since the first outbreak last July said “confluence of multiple rare events” could have allowed the bacterial disease into New Zealand, possibly as long ago as 2015.

One of the three released reports identifies seven potential pathways for the disease but finds all “improbable – yet one of them resulted in entry”.

The risk pathways investigated were imported embyros, imported frozen bull semen, imported live cattle, imported feed, imported used farm equipment, and other imported live animals. A seventh pathway was redacted from the reports along with all discussion about it, but the Herald can confirm it was imported veterinary medicines and biological products.

MPI has opted to try to contain the disease with a mass cull of cattle on 28 quarantined properties, all but one in the South Island, because it believes it is not yet well established in New Zealand. The first outbreak of the disease was on a large-scale dairying business in the South Island. However, the MPI reports suggest it may have been introduced in mid-2016 or even earlier.

Kids, kids, the FoodNet data is back

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The incidence of infections transmitted commonly through food has remained largely unchanged for many years. Culture-independent diagnostic tests (CIDTs) are increasingly used by clinical laboratories to detect enteric infections. CIDTs benefit public health surveillance by identifying illnesses caused by pathogens not captured routinely by previous laboratory methods.

Decreases in incidence of infection of Shiga toxin–producing Escherichia coli (STEC) O157 and Salmonella serotypes Typhimurium and Heidelberg have been observed over the past 10 years. These declines parallel findings of decreased Salmonella contamination of poultry meat and decreased STEC O157 contamination of ground beef.

As use of CIDTs continues to increase, higher, more accurate incidence rates might be observed. However, without isolates, public health laboratories are unable to subtype pathogens, determine antimicrobial susceptibility, and detect outbreaks. Further prevention measures are needed to decrease the incidence of infection by pathogens transmitted commonly through food.

Despite ongoing food safety measures in the United States, foodborne illness continues to be a substantial health burden. The 10 U.S. sites of the Foodborne Diseases Active Surveillance Network (FoodNet)* monitor cases of laboratory-diagnosed infections caused by nine pathogens transmitted commonly through food. This report summarizes preliminary 2017 data and describes changes in incidence since 2006.

In 2017, FoodNet reported 24,484 infections, 5,677 hospitalizations, and 122 deaths. Compared with 2014–2016, the 2017 incidence of infections with Campylobacter, Listeria, non-O157 Shiga toxin–producing Escherichia coli (STEC), Yersinia, Vibrio, and Cyclospora increased. The increased incidences of pathogens for which testing was previously limited might have resulted from the increased use and sensitivity of culture-independent diagnostic tests (CIDTs), which can improve incidence estimates (1). Compared with 2006–2008, the 2017 incidence of infections with Salmonella serotypes Typhimurium and Heidelberg decreased, and the incidence of serotypes Javiana, Infantis, and Thompson increased. New regulatory requirements that include enhanced testing of poultry products for Salmonella† might have contributed to the decreases.

The incidence of STEC O157 infections during 2017 also decreased compared with 2006–2008, which parallels reductions in isolations from ground beef.§ The declines in two Salmonella serotypes and STEC O157 infections provide supportive evidence that targeted control measures are effective. The marked increases in infections caused by some Salmonella serotypes provide an opportunity to investigate food and nonfood sources of infection and to design specific interventions.

FoodNet conducts active, population-based surveillance for laboratory-diagnosed infections caused by Campylobacter, Cryptosporidium, Cyclospora, Listeria, Salmonella, STEC, Shigella, Vibrio, and Yersinia in 10 sites that account for approximately 15% of the U.S. population (an estimated 49 million persons in 2016). FoodNet is a collaboration among CDC, 10 state health departments, the U.S. Department of Agriculture’s Food Safety and Inspection Service (USDA-FSIS), and the Food and Drug Administration (FDA). Laboratory-diagnosed bacterial infections are defined as isolation of bacteria from a clinical specimen by culture or detection by a CIDT. CIDTs detect bacterial antigens, nucleic acid sequences, or, for STEC, Shiga toxin or Shiga toxin genes.¶ A CIDT-positive–only bacterial infection is a positive CIDT result without culture confirmation. Listeria cases are defined as isolation of L. monocytogenes or detection by a CIDT from a normally sterile site or from placental or fetal tissue in the instance of miscarriage or stillbirth. Laboratory-diagnosed parasitic infections are defined as detection of the parasite from a clinical specimen. Hospitalizations and deaths within 7 days of specimen collection are attributed to the infection. Surveillance for physician-diagnosed postdiarrheal hemolytic uremic syndrome (HUS) is conducted through a network of nephrologists and infection preventionists and hospital discharge data review. This report includes pediatric HUS cases identified during 2016, the most recent year for which data are available.

Incidence per 100,000 population was calculated by dividing the number of infections in 2017 by the U.S. Census estimates of the surveillance area population for 2016. Incidence measures include all laboratory-diagnosed infections reported. A negative binomial model with 95% confidence intervals (CIs) was used to estimate change in incidence during 2017 compared with that during 2014–2016 and 2006–2008. Because of large changes in testing practices since 2006, incidence comparisons with 2006–2008 used only culture-confirmed bacterial infections, and comparisons with 2014–2016 used culture-confirmed and CIDT-positive–only cases combined. For HUS, 2016 incidence was compared with that during 2013–2015.

Preliminary incidence and trends of infections with pathogens transmitted commonly through food-foodborne diseases active surveillance network, 10 U.S. sites, 2006-2017

CDC

Ellyn Marder

https://www.cdc.gov/mmwr/volumes/67/wr/mm6711a3.htm

Acknowledgments

Workgroup members, Foodborne Diseases Active Surveillance Network (FoodNet), Emerging Infections Program, CDC; Brittany Behm, Staci Dixon, Elizabeth Greene, Logan Ray, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC; Neal Golden, Steven Mamber, and Joanna Zablotsky Kufel, U.S. Department of Agriculture’s Food Safety and Inspection Service.

Hepatitis A surveillance in France, 2006-2015

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(Many thanks to our correspondent in France for sending this along).
Hepatitis A surveillance has been carried out by mandatory reporting (DO) since November 2005, with the objective of detecting clustered cases in order to quickly take control measures, and estimating reporting incidence rates. The results of the analysis of cases reported during the first ten years of surveillance (2006-2015) are presented.

Methods

One case (positive anti-HAV IgM) must be notified to the Regional Health Agency using an OD card. This sheet gathers sociodemographic and clinical information as well as risky exposures (in particular cases in the entourage, stay outside the metropolis, consumption of seafood).

Results

For the period 2006-2015, 11,158 cases of hepatitis A were notified, giving an average incidence rate of 1.7 / 100,000. A downward trend in this rate has been observed since 2010. The average incidence rate of reporting in men was 1.9 / 100,000 and, in women, 1.4 / 100,000, with a downward trend for both sexes. The main exposures at risk were the presence of cases in the entourage (46%) and a stay outside metropolitan France (38%). Thirty-two percent of cases belonged to an identified episode of clustered cases. Each year, the share of grouped cases was relatively stable, ranging between 28 and 37%.

Conclusion

The annual rate of notification incidence has gradually decreased since 2010, reaching in 2015 that of a country of low endemicity for hepatitis A (1.1 / 100,000). The highest incidence of reporting was found in the under-15 age group, which is the most affected by fecal-oral transmission of the virus, favored in families and communities of children. The data collected by the OD and by the investigations of grouped episodes made it possible, in 2009, to develop vaccine recommendations in the family circle of a patient with hepatitis A and in living communities in situation precarious hygiene.

First ten years of surveillance of hepatitis A through mandatory reporting, France, 2006-2015

BEH

Elisabeth Couturier 1, Lina Mouna 2 , Marie-José Letort 1 , Dieter Van Cauteren 1 , Anne-Marie Roque-Afonso 2 , Henriette De Valk 1 

http://invs.santepubliquefrance.fr/beh/2018/5/2018_5_1.html

Everyone’s got a camera: UK meat industry under review

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The UK Food Standards Agency and Food Standards Scotland have published details of a major review into the sites where meat products are processed and stored in the UK. 

Food Standards Scotland and Food Standards Agency announced:

  • Launch of comprehensive review of hygiene controls
    • Review includes unannounced inspections and audit regimes

Food Standards Agency announced:

  • Work with industry to implement CCTV across cutting plants
    • Increased intelligence gathering through audit data sharing pilots across industry
    • Improved insight into circumstances and factors leading to non-compliances and ability to anticipate them

Jason Feeney and Geoff Ogle, Chief Executives of the Food Standards Agency and Food Standards Scotland respectively, jointly commented:

“We are concerned about recent instances of companies breaching hygiene rules. People rightly expect food businesses to keep to the rules, rules designed to keep consumers safe and to sustain public trust in food – and food businesses have a duty to follow the regulations. Our review will be far reaching and thorough and we will announce our initial findings in June.”

The review will aim to:

  • Increase public and stakeholder confidence in the meat industry and its regulation
    • Improve the ability to identify non-compliance and take prompt action to minimise the risk to public health and food safety
    • Assess how the industry currently operates across the whole supply chain.
    • Increase awareness of circumstances and factors which can lead to non-compliance

Assurance bodies, 2 Sisters Food Group and the FSA have also responded to recommendations made by the Parliamentary inquiry into poultry cutting plants. We have also published the outcome of FSA’s investigation into allegations of food hygiene and standards breaches at 2 Sisters.

In response to the inquiry the FSA will work with industry on a voluntary protocol for adoption of CCTV in meat processing plants and will consult on legislating to implement them if necessary.

FSA will also be running pilots to improve data and intelligence sharing across the industry and is pursuing increased investigatory powers for the National Food Crime Unit.

The investigation into 2 Sisters Food Group has been extensive and thorough and looked across their poultry sites.

500 hours of CCTV from the site were examined along with audit information from major retailers. The company voluntarily ceased production at one site whilst changes were made and staff re-trained. The FSA have had a permanent presence at their cutting plants for the last four months.

Jason Feeney, Chief Executive of the Food Standards Agency said:

“Our investigation found some areas for improvement but the issues were resolved promptly by the company, who co-operated fully, and at no point did we find it necessary to take formal enforcement action.”

“The business has made a wide range of improvements across all their sites to improve processes. They are already publishing the outcomes of all their audits and are in the process of installing high quality CCTV across their estate that we will have full access to. These are measures we would like the whole industry to adopt.”