Outbreak

  • Posted: February 6th, 2012 - 11:26pm by Doug Powell

    Those supermarket loyalty cards helped pin down an outbreak of salmonella in sausage in France last year.

    Researchers reported in Eurosurveillance last week that an outbreak of the monophasic variant of Salmonella enterica serotype 4,[5],12:i:- occurred in November and December 2011 in France. Epidemiological investigation and food investigation with the help of supermarket loyalty cards suggested dried pork sausage from one producer as the most likely source of the outbreak. Despite the absence of positive food samples, control measures including withdrawal and recall were implemented.

    Between 31 October and 18 December (week 44 to week 50), a total of 337 cases of Salmonella enterica serotype 4,[5],12:i:- were identified. The median age was 10 years (range: 0–90 years) with about 30% of children under five. A majority of women were affected (female to male sex ratio: 1.22). Cases were reported throughout France.

    An epidemic of Salmonella enterica 4,[5],12:i:- was already observed about three months prior to this outbreak. Between 1 August and 9 October, 682 cases were reported (Figure 1), of whom 100 cases were interviewed at the time but no common vehicle of infection could be identified. In comparison, 212 cases with this serotype had been isolated during the same period in 2010.

    Epidemiological investigations pointed to a dried pork sausage purchased principally at supermarket chain A and consumed after week 44, 2011. Therefore purchases of pork delicatessen at supermarkets A and B up to four weeks prior to symptom onset were investigated by the DGAL using data recorded through supermarket loyalty cards.

    The use of the loyalty card from supermarket chain A was important to identify the vehicle of infection and the local producer involved in this outbreak. These cards are used more and more and prove helpful in the investigation of food-related outbreaks. Nevertheless we should keep in mind that they do not necessarily reflect the consumption of cases perfectly. For instance, the card may not be used systematically, the household can purchase foods in additional shops and markets for which they have no loyalty cards, many food products are consumed outside the household and not recorded on the card, and the central database of the supermarket does not always contain data on all foods sold such as foods directly purchased by the retailers. For these reasons the data have to be interpreted together with the results from epidemiological and microbiological investigations.

    That the producer and microbiological analysis did not find Salmonella does not exclude contamination. The limited number of samples and the processing of the food (especially salting and drying) reduce the likelihood of isolating the bacteria. Implementing checks earlier in the process (before salting and drying) and using additional methods of testing such as polymerase chain reaction (PCR) should be considered.

    This is the second described outbreak in France involving dried pork sausage, and indicates that this food item might be a likely vehicle of infection and further outbreaks in humans may be expected.

    Given the limitations to detect Salmonella in dried sausages, the ability of the standard reference method to detect of monophasic variant strains in dried sausages is questionable. Additional methods should be explored in order to improve monitoring protocols.

    The complete report is available at http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=20071.
     

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  • Posted: January 22nd, 2012 - 11:38pm by Doug Powell

    This sounds like norovirus. And some investigators discovering that youngsters use different ways to communicate.

    Michelle Ferguson tried to avoid it, but the rapid onslaught of nausea took its toll on her body when she suddenly vomited in the back seat of a school bus last weekend.

    She and her fellow delegates, attending a journalism conference in downtown Victoria, were on their way to the Vertigo nightclub for the final gala when dozens of formally dressed students started vomiting on the buses, in their hotel and at the club.

    Almost instantly, messages on Twitter told the stories of people suffering from extreme stomach pain, vomiting and diarrhea. Staff at Canadian University Press, who organize the conference every year, contacted health officials as the numbers increased. Within minutes, delegates were asked to return to the Harbour Towers Hotel and Suites.

    The well-documented outbreak is considered a successful example of the effectiveness of communicating through social media. The conference's Twitter hashtag, #nash74, led news agencies to the story, became a slick crisis-control tool and has inspired health officials to consider using similar methods to monitor outbreaks.

    "It would be fascinating to learn how to use social media to control and manage outbreaks like they did," said Dr. Murray Fyfe, chief medical health officer for the Vancouver Island Health Authority. "I'm sure some were able to limit their exposure because of it."

    Messages about the widespread vomiting were sent out on #nash74. CUP staff saw the numbers climbing and shut down the gala.

    CUP staff went door-to-door as well, but nothing worked more efficiently than Twitter, according to students.

    "I feel a lot more people would have gotten sick without Twitter," Mattern said. "This whole thing would have played out a lot differently."

    Methods for tracking and managing outbreaks could change because of the role Twitter played in this incident.

    Fyfe and his staff have analyzed the Twitter feed from the conference and could follow how the outbreak spread.

    "A traditional investigation would have trouble getting those details," he said. "We're interested in partnering with people who have expertise in social media to use it as a tool to investigate outbreaks and as a communication tool to control outbreaks."

    Contact us any time.

     

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  • Posted: January 22nd, 2012 - 8:11pm by Doug Powell

    Last May, it was reported that 195 of the 580 people served Easter Brunch at Luciano's Cotton Club in Worcester, Mass. were struck by norovirus contracted from a sick employee, and the incident was chronicled on Yelp and a food safety site called barfblog.com.

    “I would really drive home the point that they had a problem, investigated to determine what it is, and outlined a plan for what we're going to do from now on,” said Gregory Charland, founder and chief executive officer of Charland Technology, a Hubbardston-based company offering a wide range of technology services. “Organizations should use problems like that to really do some soul searching and figure out how and why this happened. The overriding concept to underline is that they are never going to have their name in the news about this again.”

    (Hint, and it’s in the blog post: don’t let sick employees work, even at an Easter buffet).

    Alex Barbosa, the restaurant's manager, declined comment.

    That’s one anecdote in a story about on-line reviewing, which some love and some hate.

    Alec Lopez dislikes consumer-driven review websites like Yelp, TripAdvisor and UrbanSpoon.

    The owner of Armsby Abey in Worcester, Mass. said, “I don't read reviews often,” Mr. Lopez said. “I hate Yelp because it's an unanswered forum for people to bitch. I feel like it's a green light to voice your opinion without consequences.”

    Worcester native Andrew Chandler, a 29-year-old medical student at the University of Massachusetts Medical School, had an unpleasant dining experience at Armsby Abbey, and chronicled it on Yelp.

    “I was really sad to have done it, but I think that when a place isn't responsive or accommodating, people should know about it. I was hoping Armsby Abbey would read it and respond. I think it goes a long way if a manager explains what the circumstances were, and how they'll prevent the problem from happening again. Today, online reviews can make or break a customer's decision.”

    In September, Harvard Business School professor Michael Luca released research that found a one-star rating increase on Yelp directly led to a 5 percent to 9 percent boost in revenue for independent restaurants, with comparable projections for independents in other industries. Despite the growing influence of Yelp and similar websites, business owners like Mr. Lopez continue to ignore — or worse, incorrectly address — negative feedback when it comes in the form of an online review.

    With 61 million monthly visitors and 22 million reviews online by the end of the third quarter last year, Yelp is the most popular online review destination for everything from dentists to dieticians. Yelp's popularity is proof that consumers trust reviews written by the average Joe, and enjoy contributing their own 2 cents.

    Wilson Wang, chef and owner of Baba Sushi in Worcester, said he checks online reviews of his restaurant “all the time,” monitoring what diners like — and don't like.

    Mr. Wang, whose customers' reviews currently rank Baba Sushi 4.5 out of 5 stars on Yelp.com, said he doesn't respond personally to people's comments but rather sees such reviews “as a mirror” to reveal what could be done better. “We are on the high level and we are really proud,” he said last week.

    Yelp and websites like it open the door for independent businesses with limited marketing budgets, giving them an opportunity to advertise through old-fashioned word of mouth in a high-tech world. They offer a safety net to consumers who, with a few keystrokes, can be reassured that trying something new — rather than falling back on the reliability of a chain — won't be a waste of their money.

    “Every time I've given a negative review and gotten some sort of constructive, non-judgmental response, I've made it a point to go back to whatever business it was and give them a clean slate,” said Amy Jamieson, a 42-year-old Yelp user and homemaker from Worcester. “If they're willing to try again, so am I.”

     

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  • Posted: January 12th, 2012 - 8:26pm by Doug Powell

    When I think Chicago, I think crabs.

    Ninety-seven people have been confirmed to have a gastrointestinal illness after eating at Bob Chinn’s Crab House in Wheeling, Illinois, out near the Chicago executive airport, a Cook County Department of Public Health official confirmed this afternoon.

    The numbers are likely to go up even more because of the popularity of the restaurant and the volume of people that go through it, health department spokeswoman Amy Poore said.

    “We don’t have any kind of confirmation about what the gastrointestinal illness is,” Poore added.

    Chinn’s reopened to serve dinner Wednesday evening after the health scare forced the eatery to shut down Tuesday afternoon.

    Restaurant general manager Deno Roumanidakis said he closed the eatery voluntarily after receiving calls Monday from a couple of patrons complaining they felt ill after eating at the restaurant, 393 S. Milwaukee Ave.

    Anyone who has recently eaten at the restaurant and is experiencing gastrointestinal illness is asked to call (708) 633-8030.

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  • Posted: January 11th, 2012 - 8:54pm by Doug Powell

    I don’t know who eats broiled chicken livers, but enough people do that 190 of them got sick in six states since April 2011, from Salmonella Heidelberg in the partially-cooked product.

    The outbreak is another talking point in the point-the-finger approach to foodborne illness: dumb consumers, you should read the labels and know these thingies need to be fully cooked. And watch the cross-contamination.

    • A total of 190 illnesses due to Salmonella Heidelberg with the outbreak pattern were reported from 6 states.
    • The number of ill persons identified in each state the product is distributed to is as follows: New York (109), New Jersey (62), Pennsylvania (10), Maryland (6), Ohio (2), and Minnesota (1).
    • Collaborative investigative efforts of state, local, and federal public health and regulatory agencies indicated that a product labeled as “kosher broiled chicken livers” is the source of this outbreak.
    • Contaminated "kosher broiled chicken livers" were recalled from grocery stores but may still be in consumers' homes.
    • Among persons for whom information is available in in these states, ill persons ranged in age from <1 to 97 years with a median age of 14 years. Forty-nine percent were female. Among the 154 ill persons with available information, 30 (19%) were hospitalized. No deaths were reported.

    Consumers may have incorrectly thought the use of the word “broiled” in the label meant the chicken liver was ready-to-eat; however, these chicken livers must be fully cooked before eating. How the hell would anyone know?

     

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  • Posted: January 11th, 2012 - 3:43pm by Doug Powell

    There were 16 multistate outbreaks of foodborne illnesses in the U.S. in 2011, with five of them involving fresh produce, according to the Centers for Disease Control and Prevention’s annual year in review.

    Coral Beach of The Packer reports fresh produce involved were: romaine lettuce, cantaloupes (two outbreaks), whole papayas and alfalfa and spicy sprouts. Two outbreaks were related to nuts, one involving Turkish pine nuts and the other involving hazelnuts. Lists for recent years are on the CDC’s website.

    According to the CDC, 2011 was the most active year in recent history for foodborne illness outbreaks that crossed statelines. In 2010 there were 12, four of them involving fresh produce: alfalfa sprouts (two outbreaks) and shredded romaine lettuce. The other case involved an unnamed Mexican fast food restaurant chain that served a variety of items, including several fresh produce commodities.

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  • Posted: January 10th, 2012 - 2:41pm by Doug Powell

    A restaurant in Ballarat, northwest of Melbourne, was closed for a week on Dec. 30, 2011, after a cluster of salmonella infections including one death, were linked to the eatery.

    A Health Department spokesman confirmed 13 cases of salmonella linked to the eatery, plus another five suspected cases.

    Investigations are continuing into whether the death of an elderly man on December 30 is connected to the case.

    Health officials said the premises required “a thorough clean-up” and they ordered an extensive overhaul of the business’s food-handling procedures.

    Staff were also ordered to undertake more training in food handling.

    In another example of repetition-doesn’t-make-it-right, he owner of the business said yesterday he was shocked by the incident.

    “We’ve been using the same procedures for 21 years and never had such a thing. We don’t know what caused it but we have done everything the Health Department has asked us to do – everything – but we don’t know if it’s our fault or not.”

    The owner said he had changed his supplier of eggs.

    While the restaurant has reopened for business, it is still being monitored by Ballarat City Council.

    Acting chief executive officer Jeff Pulford declined to say whether charges were pending.

    “The matter is the subject of an ongoing investigation in conjunction with the Department of Health and as such it is inappropriate to make any comment,” he said.

    If people were getting sick in Dec., the place was shut on Dec. 30, and almost two weeks later the restaurant is reopened with no more details than we’ve changed our egg supplier, it is more than appropriate to make a comment. How are consumers to know whether they should eat at the place or not?

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  • Posted: December 23rd, 2011 - 10:49pm by Ben Chapman

    Author: 
    Ben Chapman

    Jack made it through his first child care season without much disease excitement --  just a little bit of pink eye and a couple of runny noses.  Child care facilities are notorious illness-spreading sites; children and care providers pass around pathogens like rotavirus, norovirus, Shigella and E. coli. As hand hygiene usually isn't the best in these facilities, outbreaks are often started by or extended by ill people (staff included) showing up while shedding. Cohorting (separating the already sick from the healthy) can be an effective way to limit spread.

    Except sick kids aren't always kept home and staff don't always stay away.

    In an early-release article in Pediatric Infectious Disease, investigators of an outbreak of E. coli O26:H11 linked to a Colorado child care center say that it could have been worse had health authorities hadn't pushed for cohorting. Part of the strategy was to test every staff member and child for STEC - those who were carrying the bug were separated from those who weren't. Sixty percent of the kids and staff at the center were carrying the outbreak strain (41 ill - 4 asymptomatically) and health authorities aggressively kept sick folks away until they stopped shedding.

    Some gems for child care providers from the abstract:

    - The median duration of shedding among symptomatic confirmed cases was 30.5 days.

    - The risk of being a case as in children <36 months was twice the risk among children 36-47 months.

    - Nearly half (49%) of the household contacts of confirmed cases developed a diarrheal illness.

    Outbreak of Shiga toxin-producing Escherichia coli serotype O26: H11 infection at a child care center in Colorado
    20.dec.11
    Pediatric Infectious Disease Journal
    Brown, Jennifer A. DVM, MPH; Hite, Donna S. BS; Gillim-Ross, Laura A. PHD; Maguire, Hugh F. PHD; Bennett, Janine K. MS; Patterson, Julia J. BA; Comstock, Nicole A. MSPH; Watkins, Anita K. MPH; Ghosh, Tista S. MD, MPH; Vogt, Richard L. MD
    Background: Shiga toxin-producing Escherichia coli (STEC) O26:H11 is an emerging cause of disease with serious potential consequences in children. The epidemiology and clinical spectrum of O26:H11 are incompletely understood. We investigated an outbreak of O26:H11 infection among children younger than 48 months of age and employees at a child care center.
    Methods: Every employee at the center (n=20) and every child <48 months (n=55) were tested for STEC and administered a questionnaire. Thirty environmental health inspections and site visits were conducted. A cohorting strategy for disease control was implemented.
    Results: Eighteen confirmed and 27 suspect cases were detected. There were no hospitalizations. The illness rate was 60% for children and for employees. The risk of being a case as in children <36 months was twice the risk among children 36-47 months (risk ratio: 2.10; 95% confidence interval: 1.00, 4.42). The median duration of shedding among symptomatic confirmed cases was 30.5 days (range: 14-52 days). Four (22%) confirmed cases were asymptomatic and 3 (17%) shed intermittently. Nearly half (49%) of the household contacts of confirmed cases developed a diarrheal illness. The outbreak was propagated by person-to-person transmission; cohorting was an effective disease control strategy.
    Conclusions: This was the largest reported outbreak of O26:H11 infection in the United States and the largest reported non-O157 STEC outbreak in a U.S. child care center. Non-O157 STEC infection is a differential diagnosis for outbreaks of diarrhea in child care settings. Aggressive disease control measures were effective, but should be evaluated for outbreaks in other settings.

     

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  • Posted: December 19th, 2011 - 6:24pm by Ben Chapman

    Author: 
    Ben Chapman

    Cross-contamination has been identified by WHO and CDC as a risk-factor that could lead to foodborne illness. Some folks, me included, have suggested that we don't know a whole lot about cross-contamination (mechanisms for transfer and how often they happen). In a study a couple of years ago, we video recorded handling practices in food service kitchens, and saw quite a bit of cross-contamination. 

    And most of it was indirect - where equipment or utensils (like sinks and knives) was an intermediate that facilitated transfer.

    The newest food safety infosheet, a graphical one-page food safety-related story directed at food businesses, demonstrates some of the consequences of indirect cross-contamination.

    Food Safety Infosheet Highlights:
    - 75 ill with salmonellosis after eating at the Tenth Hole Tea Rooms in Southsea (U.K.)
    - Salmonella found in pre-cooked pasta and dishcloths, staff tested positive
    - Don't wash raw meats. Salmonella and other bugs can be sprayed up to 3 feet away by washing.

    Click here to download the sheet.

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  • Posted: December 19th, 2011 - 3:48pm by Ben Chapman

    Author: 
    Ben Chapman

    In the ongoing war between food businesses/events and epidemiologists, a battle over what caused 14 cases of salmonellosis in Devon (UK) has spilled into the BBC. A cluster of 14 Salmonella illnesses popped up back in April; 12 of the 14 attended and ate pork at charity hog roast. a fundraiser for the Hope Cove Life Boat. The even was put on to support the seaside village's emergency rescue vehicle.

    Graham Phillips, chairman of the lifeboat committee, said: "We are sympathetic to people that were ill but we are confident we took every step possible to make sure the catering met health regulations.

    "We would not set out to cause harm to people and we have bent over backwards to help the HPA in its investigation."

    The HPA started an investigation after a number of complaints of food poisoning from people who said they had eaten from the hog roast.
    But the HPA said there was no food left over from the event available for testing.
    It concluded: "It is not possible to confirm the source of the outbreak although the hog roast is the main link we identified between the cases."

    A spokesman for South Hams District Council said the complaints had been "fully investigated" but it had decided there was not enough evidence to link the roast with the poisoning "beyond reasonable doubt."He said: "The key element for a successful prosecution would have been to confirm the strain of salmonella from the carcass of the roast pig, and then test victims to confirm it was of the same strain.

    "However this was not possible because there was nothing left of the pig."
     
    I can't seem to find a report online with odds ratios but there often isn't much food left to test in an outbreak. But we still trust the epidemiologists and the data they produce. Not many outbreaks would be solved if the strain had to be found in the food.

    Lots of community dinners and charity events have been the source of a foodborne illnesses (here's an infosheet). As Rob Tauxe said in an article about new trends in foodborne pathogens, have created some of the easily traced foodborne illness outbreaks:

    The traditional foodborne outbreak scenario often follows a church supper, family picnic, wedding reception, or other social event. This scenario involves an acute and highly local outbreak, with a high inoculum dose and a high attack rate. The outbreak is typically immediately apparent to those in the local group, who promptly involve medical and public health authorities. The investigation identifies a food-handling error in a small kitchen that occurs shortly before consumption. The solution is also local.

    Part of the local solution is having volunteer food handlers trained to look for risks and reduce them.

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