When a strain of shiga toxin producing E. coli (VTEC O8:H19) was found in Spanish cucumbers in May 2011 during the Germany-based sprout outbreak that killed 53 – and subsequently proven to not be the outbreak strain – producers and politicians focused on how public health got it wrong, and demands for compensation.

Shouldn’t it have been worrisome that any shiga-toxin producing E. coli was found at retail, in a cucumber?

Researchers in Sweden are now reporting that microsporidia may be an underreported source of foodborne illness after cucumbers were linked to dozens of sick people visiting a hotel in Sweden. Abstract below.

Microsporidia are spore-forming intracellular parasites that infrequently cause disease in immunocompetent persons. This study describes the first report of a foodborne microsporidiosis outbreak which affected persons visiting a hotel in Sweden.

Enterocytozoon bieneusi was identified in stool samples from 7/11 case-patients, all six sequenced samples were genotype C. To confirm that this was not a chance finding, 19 stool samples submitted by healthy persons from a comparable group who did not visit the hotel on that day were tested; all were negative for microsporidia. A retrospective cohort study identified 135 case-patients (attack rate 30%). The median incubation period was 9 days.

Consumption of cheese sandwiches [relative risk (RR) 4·1, 95% confidence interval (CI) 1·4–12·2] and salad (RR 2·1, 95% CI 1·1–4) were associated with illness. Both items contained pre-washed, ready-to-eat cucumber slices.

Microsporidia may be an under-reported cause of gastrointestinal outbreaks; we recommend that microsporidia be explored as potential causative agents in food- and waterborne outbreaks, especially when no other organisms are identified.

Epidemiology and Infection March 2012, 140:519-527

V. Decraene, M. Lebbad, S. Botero-Kleiven, A.-M. Gustavsson and M. Lofdahl

An alarming number of outbreaks of stomach illness across the state should be a reminder to Iowans participating in gatherings where food is served. With more than a week remaining for holiday and year-end celebrations, the Iowa Department of Public Health (IDPH) is asking sick Iowans to think twice before preparing food for others.

"If you're healthy and you've been healthy for the last few days, go ahead and mix up a batch of cookies or slice up a fruit tray," said IDPH Medical Director Dr. Patricia Quinlisk. "But if you've had any sort of stomach illness, do not prepare food of any kind for others. In particular, symptoms such as vomiting and diarrhea should be your ticket out of the kitchen until 48 hours have passed since your recovery."

In the last 10 days, IDPH has been investigating reports of eight medium-to-large outbreaks of probable norovirus in five counties.

Three groups got ill after eating at a restaurant where several food handlers had also been ill. Outbreaks were also associated with events like holiday parties and holiday potlucks, where foods were likely prepared and served by recently ill people.

"We're also getting lots anecdotal reports of probable norovirus outbreaks in other areas of the state," Quinlisk added. "This virus can be a real holiday spoiler, making your friends and loved ones sick for several days. So, if you are or have been sick, you'll just have to wait for the next opportunity to make your signature fudge - you're off kitchen duty until 48 hours after your symptoms have stopped."

In Aug. 2009, reports of patients with Salmonella Enteritidis phage type 8 began to increase in Portsmouth, UK.

Health types launched an investigation centered on one restaurant that served up to 250 customers today, which at the time was identified by local media as Tenth Hole Tea Rooms in Southsea.

In results published in the current issue of Epidemiology and Infection, investigators identified 75 people sickened. The abstract is below. But the paper contains some unplucked gems on how – or how not – to run a restaurant and the role of designing microbiological safety into operations. Among the observations, all which contributed to the outbreak:

• SE PT8 was isolated from a cloth in the pot wash area. A sample of precooked pasta had a total viable count of 1.3r 108 /g of SE PT8 suggestive of poor hygiene.

• The supplier of lettuce had been changed prior to the outbreak resulting in the replacement of ready washed lettuce to lettuce which required washing. The new lettuce was washed in a sink also used for washing raw chicken.

• Although some staff had defined working responsibilities, there was a complex system of rotas and responsibilities between full-time/part-time staff due to long opening hours (07:00–20:00 hours) with up to 250 customers per day. During the investigation, it became clear that processes and procedures were complex as well. Staff would quickly change working responsibilities at short notice, depending on the demands at the time, increasing the risk of contamination unless satisfactory standards of hygiene were continually observed.

• Staff were assigned to one of four roles on the work rota. These were front of house, chefs and kitchen, wash up and runners, with a large amount of interchange and multitasking. Positive Salmonella results were obtained from staff in each of these work areas.

Don’t wash lettuce in the same sink as raw chicken; don’t even wash raw chicken; and don’t let sick workers work.

Large outbreak of Salmonella Enteritidis PT8 in Portsmouth, UK, associated with a restaurant***
15.dec.11
Epidemiology and Infection, FirstView Article : pp 1-9
E. Severi, L. Booth, S. Johnson, P. Cleary, M. Rimington, D. Saunders, P. Cockcroft and C. Ihekweazu
http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=8456721
SUMMARY
Seventy-five individuals with Salmonella infection were identified in the Portsmouth area during August and September 2009, predominantly Salmonella Enteritidis phage type 8. Five patients were admitted to hospital. A case-case comparison study showed that a local restaurant was the most likely source of the infection with a risk of illness among its customers 25-fold higher than that of those who did not attend the restaurant. A case-control study conducted to investigate specific risk factors for infection at the restaurant showed that eating salad was associated with a threefold increase in probability of illness. Changing from using ready washed lettuces to lettuces requiring washing and not adhering strictly to the 48 hours exclusion policy for food handlers with diarrhoea were likely to have contributed to the initiation and propagation of this outbreak. Possibilities for cross-contamination and environmental contamination were identified in the restaurant.

With two boys under four, I get pretty emotional when I read a story about a child getting sick from foodborne illness. This week Jack had a cold, and I felt helpless when he said "make me feel better." I can't imagine what Thomas Miller's parents felt like over the past two years as they saw him battling the effects of E. coli infection complications which included a septicemia and rare brain impacts. Thomas'  illness was linked to eating contaminated burgers and is being reported as the first time an individual in the UK has recovered from these complications.

The youngster, who was two-years-old at the time, fell ill just 24 hours after eating a beef burger on a family day out in Scotland in 2009.

His older brother James, then seven, suffered diarrhoeaand a day later Thomas started to pass blood.
‘We just didn’t know what was happening. It was frightening,’ said 37-year-old Mrs Miller, from Aspatria,Cumbria. ‘He went for an operation that day and had to have dialysis.
‘He was holding his head and screaming, he couldn’t move and was as stiff as a board.’

The E.coli had entered Thomas’ bloodstream but further scans revealed it was also attacking his brain.
Two golf ball-sized abscesses on his brain, which had caused him to go blind, were drained in August 2009 – allowing him to see again.

But his ordeal wasn’t over as he developed more abscesses on the brain and even suffered an allergic reaction to the medication, which ‘burned’ his skin. Finally last year, after having all the abscesses removed, he was given the all clear. ‘I’ll never forget the day he came out of intensive care,’ said Mrs Miller. ‘It’s only really this year that I’ve been able to relax.’