Germany

  • Posted: December 15th, 2011 - 2:23pm by Doug Powell

    "There are only two things I can't stand in this world. People who are intolerant of other people's cultures and the Dutch."

    Michael Caine in Austin Powers, Goldmember

    The freaky dekey Dutch got some salmonella in their groovy hemp seed flour and it made a bunch of Germans sick.

    In March 2010 the Rapid Alert System for Food and Feed (RASFF) was used to inform about Salmonella Montevideo in a herbal food supplement, formulated in capsules, distributed under a Dutch label in Germany.

    Simultaneous to the first RASFF notice, in the last two weeks of March 2010 an unusual number of 15 infections with S. Montevideo was notified within the electronic reporting system for infectious diseases at the Robert Koch Institute. Adult women (median age: 43, range: 1–90 years) were mainly affected.

    An outbreak was suspected and the food supplement hypothesised to be its vehicle. Cases were notified from six federal states throughout Germany, which required efficient coordination of information and activities. A case–control study (n=55) among adult women showed an association between consumption of the specific food supplement and the disease (odds ratio (OR): 27.5, 95% confidence interval (CI): 3.1–infinity, p-value=0.002). Restricting the case–control study to the period when the outbreak peaked (between 29 March and 11 April 2010) resulted in an OR of 43.5 (95% CI: 4.8–infinity, p-value=0.001).

    Trace-back of the supplement’s main ingredient, hemp seed flour, and subsequent microbiological testing by pulsed-field gel electrophoresis supported its likely role in transmission. This outbreak investigation illustrates that information from RASFF may aid in hypothesis generation in outbreak investigations, though likely late in the outbreak.

    The authors note in the discussion that, “while investigations of the food safety authorities were thorough, without delay, and strictly following regulations, it is worth noting that the process from the beginning of the analysis of the first positive sample from an opened package to the recall took more than five weeks. In potential outbreak situations, strength of evidence for a suspected food product ought to be weighed against the potential harm to the consumers posed by the suspected food.

    "Interestingly, in the end there was no international aspect to this outbreak (as the Dutch label on the product did not correspond to sales in the Netherlands). … In Germany, unfortunately, currently there is no general requirement to communicate non-international food contamination events to the public health authorities."

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  • Posted: December 10th, 2011 - 3:36pm by Doug Powell

    An unidentified Scrooge poisoned visitors to two of Berlin's popular Christmas markets with an offer of tiny bottles of liquor that were laced with vomit-inducing chemicals, police said on Friday.

    The suspect, who was in his mid-40s, hit two of the traditional holiday fairs on Thursday and at the first, spoke to two foreign students, a man and a woman in their mid-20s, in English.

    "He told them about the purported birth of his daughter and handed out little schnapps bottles for a toast," police said in a statement.

    "After they drank, the two victims began experiencing severe cramps and vomiting."

    The woman lost consciousness and had to be hospitalised.

    Later at another Christmas market, what appeared to be the same blond man approached a group of three women in their early 20s with the same story. They also accepted a drink and later had to be treated in hospital.

     

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  • Posted: November 15th, 2011 - 8:17pm by Doug Powell

    Six months after 53 people were killed and over 4,000 sickened with E. coli O104 in raw sprouts, the European Food Safety Authority (EFSA) said today that producers of sprouted seeds should tighten safety measures along the production chain.

    Duh.

    Pathogenic bacteria such as Escherichia coli (E.coli) can contaminate the seeds intended for sprouting during production, storage and distribution through contaminated irrigation water and soil particles, in a statement on Tuesday.

    The high temperatures and humidity needed for the germination and sprouting of seeds are also favorable conditions for bacteria to grow and spread, while consumption of raw or minimally processed sprouted seeds pose additional safety concerns, EFSA said.

    Producers should ensure safe use of fertilizers and irrigation water, minimize contamination of seeds with soil during harvest and prevent mechanical damage of seeds, it said.
    Producers should also make sure that seeds are transported, processed and stored under conditions minimizing the potential for microbial contamination.

    They should remove damaged seeds and improve the ability to trace seed lots, it said.

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  • Posted: October 27th, 2011 - 12:50am by Doug Powell

    People who forgot to mention they had eaten sprouts may have thrown disease trackers off the trail as they sought to trace the source of the deadly strain of E. coli that sickened more than 4,300 people and killed at least 50 in Europe this year, according to a study published in the New England Journal of Medicine.

    While a definitive genetic link remains elusive, three separate lines of investigation point to sprouts as the means by which the deadly O1O4:H4 strain of the bacteria was spread, researchers led by Udo Buchholz at the Robert Koch Institute in Berlin, Germany’s disease-control agency.

    Buchholz and colleagues wrote, “The one dish that frequently exposed guests to sprouts was the side salad, which contained tomatoes, cucumbers, three sorts of leaf salads, and sprouts. Sprouts may have been the ingredient that visitors recalled least in such a mixed salad.”

    Buchholz and colleagues conducted three studies in parallel. The first involved asking patients hospitalized with E. coli infection about their recent food consumption, and comparing that with food eaten by uninfected people. It found that “the only significant variable was sprouts.”

    The second study identified 10 groups of diners who ate at a restaurant in Luebeck between May 12 and 16. It found that among 115 people who had been served sprouts, 31 fell ill, compared with none of those who had not eaten sprouts.

    The third investigation traced 41 clusters of infections to a producer in Lower Saxony, who grew sprouts from seeds that came from a “supplier X,” Buchholz and colleagues wrote, without identifying either the producer or the supplier. A European Commission task force said in July that the sprouts were probably grown from fenugreek seeds imported from Egypt in 2009. The researchers still don’t know whether the seeds were contaminated before, during or after export from Egypt.

    In an accompanying editorial, Martin J. Blaser, M.D. from the Departments of Medicine and Microbiology, New York University, writes the chain of transmission appears to have begun in Egypt, with fecal contamination of fenugreek seeds by either humans or farm animals during storage or transportation, perhaps as long ago as 2009. The seeds then went to a European distributor and from there to farms in several countries. During sprout germination, bacteria multiplied and moved from farm to restaurants and consumers, as Buchholz et al. extensively detail in their study. The evidence for such a series of events is compelling, even though the organism was not identified at the earliest steps, since the trail often is cold in point-source outbreaks by the time investigators are able to conduct trace-back investigations.

     

    German outbreak of Escherichia coli O104:H4 associated with sprouts
    26.oct.11
    The New England Journal of Medicine
    Udo Buchholz, M.D., M.P.H., Helen Bernard, M.D., Dirk Werber, D.V.M., Merle M. Böhmer, Cornelius Remschmidt, M.D., Hendrik Wilking, D.V.M., Yvonne Deleré, M.D., Matthias an der Heiden, Ph.D., Cornelia Adlhoch, D.V.M., Johannes Dreesman, Ph.D., Joachim Ehlers, D.V.M., Steen Ethelberg, Ph.D., Mirko Faber, M.D., Christina Frank, Ph.D., Gerd Fricke, Ph.D., Matthias Greiner, D.V.M., Ph.D., Michael Höhle, Ph.D., Sofie Ivarsson, M.Sc., Uwe Jark, D.V.M., Markus Kirchner, M.D., M.P.H., Judith Koch, M.D., Gérard Krause, M.D., Ph.D., Petra Luber, Ph.D., Bettina Rosner, Ph.D., M.P.H., Klaus Stark, M.D., Ph.D., and Michael Kühne, D.V.M., Ph.D.
    http://www.nejm.org/doi/full/10.1056/NEJMoa1106482?query=featured_home
    Human infection with Shiga-toxin–producing Escherichia coli is a major cause of postdiarrheal hemolytic–uremic syndrome. This life-threatening disorder, which is characterized by acute renal failure, hemolytic anemia, and thrombocytopenia, typically affects children under the age of 5 years. Shiga-toxin–producing E. coli O157 is the serogroup that is most frequently isolated from patients with the hemolytic–uremic syndrome worldwide.1
    In May 2011, a large outbreak of the hemolytic–uremic syndrome associated with the rare E. coliserotype O104:H4 occurred in Germany.2-5 The main epidemiologic features were that the peak of the epidemic was reached on May 21 and May 224,5 and that the vast majority of case subjects either resided or had traveled in northern Germany. Almost all patients from other European countries or from North America had recently returned from northern Germany.2,6,7 Of the affected case subjects, 90% were adults, and more than two thirds of case subjects with the hemolytic–uremic syndrome were female.4
    Early studies in Hamburg suggested that infections were probably community-acquired and were not related to food consumption in a particular restaurant. A first case–control study that was conducted on May 23 and 24 suggested that raw food items, such as tomatoes, cucumbers, or leaf salad,3 were the source of infection. The consumption of sprouts, which was previously implicated in outbreaks of Shiga-toxin–producing E. coli in the United States8 and Japan,9 was mentioned by only 25% of case subjects in exploratory interviews, so consumption of sprouts was not tested analytically.
    This report describes the investigations that were conducted by the federal agencies under the auspices of the German Ministry of Health and the Ministry of Food, Agriculture, and Consumer Protection, as well as by the respective state agencies, to identify the vehicle of infection of this international outbreak.

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  • Posted: October 17th, 2011 - 3:36am by Doug Powell

    Dr. Dr. Chuck Dodd (DVM, PhD), program manager for veterinary services in the U.S. Army Public Health Command Region – Europe, shared his experiences from the midst of the E. coli O104 outbreak associated with raw sprouts centered in Germany earlier this year.

    The video of Dr. Dr. Dodd, looking sharp in his military fatigues and fresh from another of his 100-mile ultra-marathons, is available at http://bites.ksu.edu/dodd-lecture as are the PowerPoint slides.

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  • Posted: October 11th, 2011 - 1:36pm by Doug Powell

    Fresh from a months-long tour of Europe – or at least one part of Germany – Dr. Chuck Dodd returns to Kansas State to share his experiences from the E. coli O104 outbreak in raw sprouts centered in Germany earlier this year, which killed 53 people and sickened some 4,400.

    Dr. Dr. Dodd (DVM, PhD, right, pretty much as shown) is the program manager for veterinary services in the U.S. Army Public Health Command Region – Europe. He will speak at 4 p.m. on Thurs. Oct. 13, 2011 in 407 Trotter Hall, in the College of Veterinary Medicine at Kansas State University. My team will be on-hand to record the talk and, technology willing, throw it up on the web.

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  • Posted: October 10th, 2011 - 3:56pm by Doug Powell

     Maybe something was lost in translation, but Prof. Christian Gerloff, Head of Neurology at the Hamburg-Eppendorf University Hospital (UKE), told the annual congress of the German Society for Neurology in Wiesbade on Sept. 28, 2011, that despite their life-threatening infection, most E. coli O104-in-raw-sprouts patients have recovered well from the summer's epidemic.

    The professor described how the wave of illness, caused by contaminated bean sprouts, was new territory for neurology. The neurology department had to help "in the crisis management of an epidemic for the first time."

    According to the Robert Koch Institute, almost 3,500 EHEC cases were registered in Germany between May and July 2011. 50 patients, who were infected with the aggressive intestinal germ, died of the disease.

    Gerloff stated that, of the around 100 patients who were treated for the most intense course of the disease, only three are still displaying symptoms, such as paralysis or lalopathy. He explained that everyone else has recovered very well.

    In each case, the illness began with diarrhea. However, every third patient was also hit by a life-threatening kidney failure –hemolytic-uremic syndrome (HUS). In addition, every sixth patient developed acute neurological disorders; in some cases seizures, in other cases epileptic fits, said Gerloff. "Patients fell into a coma within a few days."

    Gerloff also reported that some EHEC cases resulted in neurological disorders without HUS. As such, the disorders do not always relate to the kidney failure.

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  • Posted: September 13th, 2011 - 12:45am by Doug Powell

     In early 2008, eight cases of Salmonella Tennessee were reported in infants in Germany; normally there is about one case per year.

    Using a case–control study to identify the source of infection, German researchers report in the current issue of Vector-Borne and Zoonotic Diseases they identified 18 cases less than 3-years-old. Ten children were male; median age was 3 months (1–32 months). In 8 of 16 case households reptiles were kept. Although direct contact between child and reptile was denied, other forms of reptile contact were reported in some cases. Identical Salmonella Tennessee strains of child and reptile kept in the same household could be shown in 2 cases.

    The researchers conclude that indirect contact between infants and reptiles seems to be sufficient to cause infection and should therefore be avoided.

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  • Posted: September 2nd, 2011 - 1:37am by Doug Powell

    Why are outbreaks of foodborne illness, like when 53 are killed and 4,400 sickened from eating sprouts produced in Germany from Egyptian seeds, referred to in media reports as ‘scares.’

    This wasn’t a scare, it was a sprout shitstorm. Neither the first nor last.

    Afrique en ligne reports the European Union will soon lift a ban on Egyptian sprout seeds after an EU delegation, which just wrapped up a visit to Egypt, produces a report in about 10 days.

    Egypt's Agriculture Export Council chairman, Sherif Al-Beltaguy stated that the national reports from agricultural and health authorities on seeds in Egypt were good and that the EU delegation found them acceptable.

    Egypt had denied responsibility for the E.coli outbreak, saying the suspected batch dated back to November 2009 and contained dried seeds, arguing the bacteria could not have survived for so long.

    I look forward to some sort of data, especially E. coli testing of germinated seeds.
     

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  • Posted: August 20th, 2011 - 6:03pm by Doug Powell

    The Aug/Sept. issue of Food Quality magazine contains a package of articles about lessons learned from this year’s E. coli O104 outbreak in Germany linked to raw sprouts grown from seeds produced in Egypt.

    My own contribution was an attempt, at the editor’s request, to capture the uncertainty and vagaries that characterize outbreaks of food- or waterborne illness.

    My friend Jim called on a Friday afternoon. Jim is a dairy farmer located on the edge of a town in Ontario, Canada, called Walkerton, and he said a lot of people were getting sick. The community knew there was a problem several days before health types went public.

    On Sunday, May 21, 2000, at 1:30 p.m., the Grey Bruce Health Unit in Owen Sound, Ontario posted a notice on its website to hospitals and physicians to make them aware of a boil water advisory and inform them that a suspected agent in the increase of diarrheal cases was E. coli O157:H7.

    There had been a marked increase in illness in the town of about 5,000 people, and many were already saying the water was suspect. But because the first public announcement was also the Sunday of the Victoria Day long weekend, it received scant media coverage.

    It wasn’t until Monday evening that local television and radio began reporting illnesses, stating that at least 300 people in Walkerton were ill.

    At 11 a.m. on Tuesday, May 23, the Walkerton hospital held a media conference jointly with the health unit to inform the public of the outbreak, to make people aware of the potential complications of the E. coli O157:H7 infection, and to warn them to take the necessary precautions. This generated a print report in the local paper the next day, which was picked up by the national wire service Tuesday evening, and subsequently appeared in papers across Canada on May 24.

    These public outreach efforts were neither speedy nor sufficient. Ultimately, 2,300 people were sickened and seven died—in a town of 5,000. All the gory details and mistakes and steps for improvement were outlined in the report of the Walkerton inquiry
    (www.attorneygeneral.jus.gov.on.ca/english/about/pubs/walkerton).

    The E. coli O157:H7 was thought to have originated on a farm owned by a veterinarian and his family at the edge of town, someone my friend Jim knew well, a cow-calf operation that was the poster farm for Environmental Farm Plans. Heavy rains washed cattle manure into a long abandoned well-head, which was apparently still connected to the municipal system. The brothers in charge of the municipal water system for Walkerton, who were found to have been adding chlorine based on smell rather than something minimally scientific like test strips, were criminally convicted.

    But the government-mandated reports don’t capture the day-to-day drama and stress that people like my friend experienced. Jim and his family knew many of the sick and dead. This was a small community. News organizations from around the province descended on Walkerton for weeks. They had their own helicopters, but the worst was the medical helicopters flying patients with hemolytic uremic syndrome to the hospital in London. Every time Jim saw one of those, he wondered if it was someone he knew.

    I’m not an epidemiologist, but as a scientist and journalist with 20 years of contacts, I usually find out when something is going on in the world of foodborne outbreaks.

    The uncertainties in any outbreak are enormous, and the pressures to get it right when going public are tremendous.

    The public health folks in Walkerton may have been slow by a couple of days while piecing together the puzzle; what happened in Germany this summer in the sprout-related outbreak of E. coli O104, a relative of O157, was a travesty.
    Worse, bureaucrats seemed more concerned about the fate of farmers than that of citizens. By at least one count, 53 have died, and more than 4,200 have been sickened.

    Raw sprouts are one of the few foods I won’t eat, and as many epidemiologists have pointed out, sprouts top the list of any investigation involving foodborne illness.

    We at bites count at least 55 outbreaks related to raw sprouts beginning in the U.K. in 1988, sickening thousands.

    The first consumer warning about sprouts was issued by the U.S. Centers for Disease Control and Prevention (CDC) in 1997. By July 9, 1999, the U.S. Food and Drug Administration (FDA) had advised all Americans to be aware of the risks associated with eating raw sprouts. Consumers were informed that the best way to control the risk was to not eat raw sprouts. The FDA stated that it would monitor the situation and take any further actions required to protect consumers.

    At the time, several Canadian media accounts depicted the U.S. response as panic, quoting Health Canada officials as saying that, while perhaps some were at risk, sprouts were generally a low-risk product.

    That attitude changed in late 2005, as I was flying back to reunite with a girl I had met in Kansas and 750 people in Ontario became sick from eating raw bean sprouts.

    Unfortunately, what food safety types think passes for common knowledge—don’t eat raw sprouts—barely registers as public knowledge. It’s hard to compete against food porn.

    Sprouts present a special food safety challenge because the way they are grown, with high moisture at high temperature, also happens to be an ideal environment for bacterial growth.

    Because of continued outbreaks, the sprout industry, regulatory agencies, and the academic community in the U.S. pooled their efforts in the late 1990s to improve the safety of the product, implementing good manufacturing practices, establishing guidelines for safe sprout production, and beginning chemical disinfection of seeds prior to sprouting.

    But are such guidelines being followed? And is anyone checking?

    Doubtful.

    This was demonstrated by two sprout-related outbreaks earlier this year linked to sandwiches served by Jimmy John’s, a chain of gourmet sandwich shops based in Champaign, Ill.

    Sprouts served on Jimmy John’s sandwiches supplied by a farm called Tiny Greens sickened 140 people with Salmonella, primarily in Indiana. In January, Jimmy John’s owner Jimmy John Liautaud said his restaurants would replace alfalfa sprouts, effective immediately, with allegedly easier-to-clean clover sprouts. This was one week after a separate outbreak of Salmonella sickened eight people in the U.S. Northwest who had eaten at a Jimmy John’s that used clover sprouts.

    If the head of a national franchise is that clueless about food safety, can we really expect more from others?

    Sprout grower Bill Bagby, who owns Tiny Greens Sprout Farm, said in the context of the German outbreak that, for many like him, the nutritional benefits outweigh the risk:

    “Sprouts are kind of a magical thing. That’s why I would advise people to only buy sprouts from someone who has a (food safety) program in place (that includes outside auditors). We did not have (independent auditors) for about one year, and that was the time the problems happened. The FDA determined that unsanitary conditions could have been a potential source of cross-contamination and so we have made a lot of changes since then.”

    Independent auditors? Like the ones who said everything was cool, everything was OK, at Peanut Corporation of America (nine dead, 700 sick in 2008-09) and Wright County Egg (2,000 sick in 2010)?

    Like the Walkerton E. coli O157:H7 outbreak in 2000, too many are using the filters of their politics to advance their own causes and saying too many dumb things in light of the sprout outbreak of 2011.

    It’s really about biology and paying attention to food safety basics—no matter how much that interferes with personal politics.

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