29 sick: An outbreak of Shiga toxin-producing Escherichia coli O121 infections associated with flour- Canada, 2016-2017

On December 29, 2016, PulseNet Canada identified a cluster of six Escherichia coli non-O157 isolates with a matching pulsed-field gel electrophoresis (PFGE) pattern combination that was new to the PulseNet Canada database. The patients resided in three geographically distinct provinces. In January 2017, the Public Health Agency of Canada (PHAC) initiated an investigation with local, provincial, and federal partners to investigate the source of the outbreak.

A case was defined as isolation of E. coli non-O157 with the outbreak PFGE pattern or closely related by whole genome sequencing (WGS) in a Canadian resident or visitor with onset of symptoms of gastroenteritis on or after November 1, 2016. Patients’ illness onset dates ranged from November 2016 to April 2017 (Figure). As of May 23, 2017, a total of 29 cases were identified in six provinces (Alberta, British Columbia, Newfoundland and Labrador, Ontario, Quebec, and Saskatchewan). One additional case was identified in a U.S. resident who traveled to Canada during the exposure period. Patients’ ages ranged from 2–79 years (median = 23.5 years) and 50% were female. Eight patients were hospitalized, and one developed hemolytic uremic syndrome. Clinical isolates were typed as E. coli O121:H19 (one case was typed as E. coli O121:H undetermined) with Shiga toxin 2–producing genes by in silico toxin testing and had closely related PFGE patterns and WGS.

Initial investigation into the source of the outbreak did not identify any clear hypotheses; common exposures were ground beef, sausage style deli-meats, pizza, and pork, but the data did not converge on any specific products. Patients were reinterviewed by PHAC using an open-ended approach. Knowledge of a recent E. coli O121 flour-associated outbreak prompted interviewers to ask about baking and exposure to raw flour or dough (1). Patients were also asked if any food items of interest, including flour, were available for testing.

In March 2017, E. coli O121 with the outbreak PFGE pattern was isolated from an open flour sample from a patient’s home and a closed sample collected at a retail store, both of the same brand and production date. The clinical and flour isolates grouped together, with only 0–6 whole genome multilocus sequence typing allele differences. As a result of these findings, a product recall was issued. Based on possible connections to the recalled lot of flour, market sampling of flour within certain periods was initiated. The investigation led to additional recalls of flour and many secondary products (2).

As of May 23, 2017, 22 patients had been asked about flour exposure in the 7 days before illness onset; 16 (73%) reported that the implicated brand of flour was used or probably used in the home during the exposure period. Comparison data on the expected proportion with exposure to this brand of flour were not available. Eleven of these sixteen patients reported they ate or probably ate raw dough during their exposure period.

This is the first national outbreak of non-O157 Shiga toxin–producing E. coli infections identified in Canada and the first Canadian outbreak linked to flour. An open-ended interview approach and flour sampling were used to implicate flour as the source. Because of the recent emergence of E. coli outbreaks linked to flour, public health professionals should consider flour as a possible source in E. coli outbreaks and communicate the risk associated with exposure to flour, raw batter, and dough in public health messaging.

Food Safety Talk 129: Unusual Sized Dumper

Don and Ben are in IAFP preparation mode but take time to talk about the efficiencies of university settings; donairs, gyros, kebabs and other meat-on-a-cone offerings (and risks associated with the products); mice and norovirus; food safety is definitely competitive and iced coffee/fecal matter and the perils of using the fecal coliform assay.

Episode 129 can be found here and on iTunes.

Show notes so you can follow along at home:

Tough mudders and cyclists, beware the agri-land: Outbreaks amongst participants in Norway, Scotland

NRK reports that some 50 of 300 participants became sick with Campylobacter in a cycling event in Norway.

Competitors at the start of the 2015 Tough Mudder Scotland at Drumlanrig Castle, Dumfries and Galloway

Earlier, several people were stricken by E. coli O157 in a tough mudder event which was held at Drumlanrig Castle in Scotland on June 17 and 18.

These outbreaks follow previous, numerous outbreaks involved with playing in mud.

In Norway, the reason why the cyclists have become so bad is because animal wreckage resolved after a heavy rainfall and remained in the road. This has again sprung up on the cyclists.

“Especially if the stool is fresh and there are large amounts of water, it can sprinkle on drinking bottles and hands so you get it when you drink,” said Tor Halvor Bjørnstad-Tuveng, to NRK (something may be lost in translation).

“We have been in dialogue with the management of the race, and we have some concrete measures that we will look at. We have been very unlucky with the rides of the year, but we must definitely look at what we can do to prevent it happening again, “says Bjørnstad-Tuveng.

Per Stubban was one of those who had to go to the hospital for intravenous nutrition.

“Now I’m on my way, but there have been some tough days. Next time I will not use a handheld drink bottle, but a drinking bag, and if there is as much rain as it was now, I would probably be skeptical to start, “he said.

Participants in an endurance event at a Scottish castle have been warned to look out for symptoms of E. coli O157 after it was identified among those who took part.

NHS Dumfries and Galloway said “a small number of cases” of the bacteria have been found in those involved in the Tough Mudder event at Drumlanrig Castle last month.

It has advised anyone associated with the event who experiences symptoms to seek medical advice.

A spokesman for the health board said: “NHS Dumfries and Galloway can confirm that we are aware of a small number of cases of E.coli O157 across Scotland that appear to be associated with participation in the Tough Mudder event which was held at Drumlanrig Castle on June 17 and 18.

“Any activity undertaken on agricultural land inevitably involves a small risk of gastrointestinal infection.”

A spokesman for the event said: “The safety of Tough Mudder participants, spectators, volunteers and staff is our number one priority.

Uh-huh.

E. coli O157 is always tragic, but probably not because of the last thing you ate

McDonald’s is a big, semi-popular fast-food chain in the way Semi-Tough (the movie) depicted American professional football as big and semi-popular.

When Shiga-toxin producing E.coli were discovered in 1977 (named verotoxigenic E. coli) and then the first outbreaks were linked to human illness in 1982 at McDonald’s in White City, Ore., and Traverse City, Mich., McDonald’s completely revamped its beef sourcing and cooking procedures.

Over the past three decades, I’ve heard everyone blame McDonald’s for everything, especially on food safety, and especially what used to be known as hamburger disease.

South Korean lawyers are apparently catching up to where North Americans were 25 years ago, but perpetuate semi-stereotypes.

According to The Korea Herald, a mother on Wednesday filed a complaint against McDonalds Korea, claiming her daughter was diagnosed with the “hamburger disease” after eating a burger with an undercooked patty in one of its outlets.

“The 4-year-old victim had no health problems, but caught hemolytic uremic syndrome after eating a McDonald’s hamburger,” lawyer Hwang Da-yeon said at a press conference held in front of the Seoul District Prosecutors Office, before submitting the complaint. 

HUS is serious shit.

McDonald’s has known about it for a long time.

The complaint claims McDonald’s violated local food safety rules by serving contaminated meat that was not fully cooked.

The plaintiff also made a tearful plea, asking state prosecutors to investigate and hold McDonald’s Korea responsible for her daughter, who has suffered irreversible damage to her kidneys and must undergo eight to 10 hours of peritoneal dialysis on a daily basis.

According to the mother, the child ate a hamburger at a McDonald’s outlet in Gyeonggi Province in September and fell ill about three hours afterwards.

HUS is always tragic, and I wouldn’t wish it on anyone.

She was brought to an intensive care unit three days later, where she was diagnosed with HUS, a food-borne disease that can cause acute kidney failure. The child was discharged from the hospital two months later, but had lost 90 percent of her kidney function.

The McDonald’s outlet denied any link between its product and the child’s illness, saying the meat is machined-cooked, eliminating human error.

I’m not sure who’s right, but Shiga-toxin producing E. coli – the kind that lead to HUS – take 2-4 days to develop – not 3 hours.

As Kate Murphy of The New York Times explained last week, when you’re fine one minute and barfing the next – what the U.S. Centers for Disease Control and Prevention calls an acute gastrointestinal event — happens to all of us at least once a year. The bouts, while extremely unpleasant, usually don’t occasion a trip to the doctor or require any medication.

But such events tend to make us spin our gears trying to pinpoint what made us so miserably sick. While it’s hard to know for sure, there are clues that might help you determine the source and reduce your risk in the future.

“People tend to blame the last thing they ate, but it’s probably the thing before the last thing they ate,” said Dr. Deborah Fisher, a gastroenterologist and associate professor at Duke University School of Medicine.

It takes the stomach around four to six hours to empty a full meal, and then the small intestine takes about six to eight hours to squeeze out all the nutrients and empty into the colon. The remains linger there for another one to three days, fermenting and being formed into what ultimately is flushed down the toilet. So-called bowel transit time varies significantly from person to person, but gastroenterologists said you can easily find out what’s normal for you by eating corn and watching for when the indigestible kernels appear in your stool.

Gross, perhaps, but with that baseline, the next time you get sick, you’ll be better able to estimate when you might have eaten the offending meal. For example, if you throw up something and don’t have diarrhea or roiling further down, it could be that what made you ill was something you ate within the last four to six hours. If you wake up in the middle of the night with cramps and diarrhea, it’s more likely something you consumed a good 18 to 48 hours earlier, depending on the results of your corn test.

We stopped at a McDonald’s on the way home from the Glass Mountains yesterday. Quality was semi-OK, but safety was there.

(No McDonald’s money was involved in this blog post; there was no money at all; I just like to write).

Always tragic regardless of religion: 2 children dead 4 others sick in E. coli outbreak linked to largely Mormon town in Utah

Two children died from E. coli in southern Utah in recent weeks, the Southwest Utah Public Health Department confirmed Monday, as reported by KSL.

Four other incidents of E. coli have also been reported in the area of the border towns of Hildale and Colorado City, Arizona, said Southwest Utah Public Health Department spokesman David Heaton.

The incidents are limited to that area, he said.

The cause for the outbreak is still being investigated, but health officials believe it can likely be traced to contamination from food or animals. Heaton says investigators don’t think the town’s water supply is the cause.

Before Monday, Heaton had refused to confirm the deaths. He declined Monday to release the names, ages or genders of the two children who died. He said the four non-fatal cases are a combination of children and adults but said he didn’t have the exact breakdown. Some of them are still being treated, though none of their conditions were released.

Multiple people who identified themselves as relatives of 6-year-old Gabriella Addison Fullerton indicated on Facebook that she was one of the victims who died. On a GoFundMe webpage* published Friday seeking donations for funeral costs, loved ones called Gabrielle “our little angel” who “has passed on to a better place.”

“Her family is completely devastated at losing such a precious and loving child. She was taken at the tender age of 6. … Hold your babies close every chance you get,” the page states.

Both Hildale and Colorado City are well-known for being largely polygamous communities, with many residents being members of the Fundamentalist Church of Latter-Day Saints.

Corned beef and pastrami with poop: New York deli flooded with ‘fecal matter’ due to bad pipes, suit says

Maya Rajamani of DNA Info reports the basement of the Stage Door Deli & Restaurant was deluged with “sewage and fecal matter” after the building’s owner failed to inspect and maintain the eatery’s pipes, a new lawsuit charges.

The restaurant at 360 Ninth Ave., between West 30th and 31st streets, was no longer able to use its basement after the pipes connecting to the city’s main utility lines broke on July 30, 2016, the suit filed against the landlord Thursday in Manhattan Supreme Court claims.

Building owner 30th Street and 9th Avenue Enterprises LLC was supposed to inspect and maintain the pipes but failed to do so, the suit notes.

The diner, known for the corned beef and pastrami sandwiches it has served for the past 17 years, moved into the Ninth Avenue space after a rent hike forced it out of its longtime home across from Penn Station in 2015.

When the pipes broke last year, “sewage and fecal matter” seeped into the basement, “causing both substantial health concerns and damage to food products, food supplies and food preparation areas,” the complaint says.

 

Poison customers, it’s good for business: Burger row hits the grills in New Zealand; try a thermometer

New Zealand’s oldest licensed premises has pulled a burger that’s been the cornerstone of its menu – blaming it on bureaucratic red tape gone mad.

Dan Fraser, executive chef at the Duke of Marlborough restaurant in the Bay of Islands, was left stewing after a visit from a Ministry of Primary Industries inspector on Thursday. 

Nicole Lawton of The Sunday Star Times reports new food preparation guidelines from MPI state minced meat and liver needs to be cooked at high temperatures for a longer amount of time than previously, to avoid contamination. 

Fraser said the new rules were a raw deal and will now prevent him serving his signature burger The Governor’s Burger which is pink and juicy in the middle. 

The Governor’s Burger features bacon, cheese, pickle, tomato, chipotle mayonnaise and a medium rare beef mince patty.

“It’s a really good burger, we really pride ourselves in presenting it to our customers,” Fraser said.

“Basically, the ministry is telling us how our customers need to eat their food.”

MPI food and beverage manager Sally Johnston, said the new rules didn’t entirely ban medium-rare meat – but chefs would have to change how they cooked it.

“If they do want to serve a medium-rare burger, it is possible, it just might take a little more forethought and planning,” Johnston said.

“It is possible to cook a medium-rare burger safely, it just means that they need to think about the processes that they are using to do that. It might not be necessarily possible to do that on a BBQ or grill.”

She suggest sous vide methods of cooking instead – what people used to call boil-in-the-bag.

“Who the f*** wants a sous vide burger?”, Fraser said.

The new rules state meat should have an internal minimum temperature of 65°C for 15 minutes while cooked, 70°C for three minutes, or 75°C for 30 seconds.

But Fraser said those were rules drawn up by a bureaucrat and not a chef. They meant a beef mince patty would always be “rubbery and devoid of flavour”.

Johnston insists the new rules are necessary. “People have died from under cooked burgers, there is a genuine food safety risk here, we’re not doing this to take the fun out of food. Bugs that have caused people to die (such as E. coli) are frequently found in New Zealand meat.”

The new MPI guidelines detail how restaurants and food businesses should prepare, store and serve their food, and supplement the 2014 Food Act. 

Top chef Ray McVinnie told Stuff NZ that serving a medium-rare burger is “dangerous and dumb” and that any chef who complains about such regulations does not understand basic food safety.

Yesterday, the Ministry for Primary Industries decided they will be talking to chefs about ways they can serve medium rare burgers and still keep food safe for consumers.

“We’re happy to work with chefs wanting to develop a custom Food Control Plan that covers their specific menu items. It might need different methods of sourcing, storing, and handling meat to make sure consumers are still protected.”

The move by MPI to regulate chefs’ kitchens brought howls of outrage and ridicule from those interviewed by the NZ Herald.

Labour’s Damien O’Connor said it was “ridiculous overkill”.

“We’ve got strict controls on how you kill and process meat. To then look at the cooking of it is nanny-state gone mad.

Northland MP Winston Peters, who has eaten at the Duke of Marlborough often over the years, said “paternalistic bureaucrats” were killing New Zealand businesses.

Sick customers ruin biz.

I look forward to the microbiologically-based arguments the talking heads will bring to the public discussion.

Assessment of risk communication about undercooked hamburgers by restaurant servers

Ellen M. Thomas, RTI International; Andrew Binder, Anne McLaughlin, Lee-Ann Jaykus, Dana Hanson, and Benjamin Chapman, North Carolina State University; and Doug Powell, powellfoodsafety.com

Journal of Food Protection

DOI: 10.4315/0362-028X.JFP-16-065

According to the U.S. Food and Drug Administration 2013 Model Food Code, it is the duty of a food establishment to disclose and remind consumers of risk when ordering undercooked food such as ground beef. The purpose of this study was to explore actual risk communication activities of food establishment servers. Secret shoppers visited restaurants (n=265) in seven geographic locations across the U.S., ordered medium rare burgers, and collected and coded risk information from chain and independent restaurant menus and from server responses. The majority of servers reported an unreliable method of doneness (77%) or other incorrect information (66%) related to burger doneness and safety. These results indicate major gaps in server knowledge and risk communication, and the current risk communication language in the Model Food Code does not sufficiently fill these gaps. Furthermore, should servers even be acting as risk communicators? There are numerous challenges associated with this practice including high turnover rates, limited education, and the high stress environment based on pleasing a customer. If it is determined that servers should be risk communicators, food establishment staff should be adequately equipped with consumer advisory messages that are accurate, audience-appropriate, and delivered in a professional manner so as to help their customers make more informed food safety decisions.

Food safety is not simple

Winnipeg, Manitoba, Canada correspondent, Rob Mancini, writes:

I’ve been told many times from various sources that Mancini’s always a cheerful guy, you can’t upset him… this is only because I find happiness with my family. I have an amazing wife and 2 incredible kids (6 years old and 19 months), all healthy.  What more can I ask for: nothing.

But when I read stories of kids dying from hemolytic uremic syndrome due to an E. coli infection, in particular when it could have been prevented, I get mad.

“We can’t hold him. We can’t love on him. All we can do is just stand at the bedside,” Lindsey Montgomery, Huston’s mom, told WFAA.

Heartbreaking.

Fox News reports A 2-year-old boy is on life support after contracting an E. coli infection from an unknown source while on vacation in Oklahoma with his family. Landon Huston, of Ennis, Texas, was experiencing stomach virus-like symptoms when a fecal sample tested positive for E. coli, WFAA reported.

Huston was taken to Children’s Medical Center Dallas where doctors discovered the infection had progressed to Hemolytic Uremic Syndrome (HUS), an abnormal destruction of red blood cells that leads to kidney failure, WFAA reported.

Huston underwent the first of two surgeries on June 14 and has had a blood transfusion. He was placed on life support after doctors discovered fluid in his lungs, a post on the family’s GoFundMe page said.

The Texas Department of Health Services is investigating any potential source of the bacteria. E. coli can be found in the environment, foods, and intestines of people and animals, according to the Centers for Disease Control and Prevention (CDC).

“Most parents like us had no idea, you know, the dangers of something like this,” Montgomery told WFAA. “And it’s everywhere. E. coli is something that’s everywhere.”

While most strains of the bacteria are harmless, others can cause diarrhea, urinary tract infections, respiratory illness and pneumonia. About 5-10 percent of patients who contract E. coli will develop (HUS), which could present as decreased frequency of urination, feeling tired and losing color in cheeks and inside the lower eyelids. Patients can recover in a few weeks but others may suffer permanent damage or die.

“I have faith he’s going to come out on top,” John Huston, the toddler’s dad, told WFAA.

I’ve taught many food safety courses and have lectured on the importance of food safety to many. I’ve used different techniques in teaching, heavily based on behavioral science amongst other antics, to stress the importance of certain food safety principles. Even did a TV show on the subject.  All of this doesn’t matter if your inherent belief system is contrary to the information provided.  Need to be compelling and understand how human behavior operates. At times I wish I know more psychology but it’s never too late.

Food safety is not simple, it is hard and anyone who says otherwise is clueless.

I always try to share personal stories and current relevant food safety stories in an attempt to connect with my audience or readers and gauge their interest. Doug taught me this and it works.

 

Norovirus in frozen raspberries: Quebecers sick

My grandfather, Homer the Canadian asparagus baron, always said if it wasn’t asparagus, he figured raspberries would be a good cash crop.

He had a patch out front and as a child I could often be found in the raspberry patch, picking a few and eating many.

So I’m disappointed (how Canadian) whenever cheap raspberries are the culprit in transmitting norovirus or hepatitis A.

I’m even more disappointed when taypayer-funded bureaucrats in government and public journalism fail to ask basic questions or provide basic information so consumers can make actual food choices, away from the hucksterism.

CBC News reports the Ministry of Agriculture, Fisheries and Food (MAPAQ) has issued a warning list of raspberry and raspberry products that may have been contaminated by norovirus.

Several cases of illness have already been reported to the ministry.

Those who have products on the list are asked to avoid consuming them and return them to the facility where they were purchased, or discard them.

Media coverage notes the bad batch of raspberries that is the likely culprit has been recalled by the Canadian Food Inspection Agency.

Oddly, the only recall on the CFIA website involving norovirus and frozen raspberries happened on June 20, 2017, with almost no supporting information, other than, media should call.

Gelsius brand IQF Whole Raspberries were recalled due to norovirus,and were distributed by Farinex (113712 Canada Inc.), a Quebec-based distributor of all things food.

Here’s some questions to ask:

Where were the frozen berries grown?

Were they covered in human shit?

Why so little info from CFIA?

Montreal locations affected by the recall:

Crémerie Gélato Cielo (10414 Gouin Blvd. W.)

Raspberry gelato

Raspberry sorbet

Berry sorbet

C’Chô-Colat Inc. (1255 Bishop St.)

Raspberry gelato

Raspberry sorbet

Berry sorbet

Les Délices Lafrenaie Inc. (8405 Lafrenaie St.)

Frutti di bosco

Heavenly berry

Les gourmandises de Marie-Antoinette (4317 Ontario St. E.)

Marie-Antoinette cake

Glaces et Sorbets Kem Coba inc. (60 Fairmont Ave. W.)

Raspberry sorbet

Boulangerie Et Pâtisserie Lasalle R.D.P. Inc. (8591 Maurice-Duplessis Blvd.)

Berry cake

Gourmet Bazar inc. (9051 Charles-de-la-Tour St.)

Whole raspberries

Me thinks something is going on here.

Homer would be ashamed that raspberries got a bad name.

Lunar module to control that E. coli

Escherichia coli O157:H7 is an important foodborne pathogen that causes severe bloody diarrhea, hemorrhagic colitis, and hemolytic uremic syndrome.

Ruminant manure is a primary source of E. coli O157:H7 contaminating the environment and food sources. Therefore, effective interventions targeted at reducing the prevalence of fecal excretion of E. coli O157:H7 by cattle and sheep and the elimination of E. coli O157:H7 contamination of meat products as well as fruits and vegetables are required.

Bacteriophages offer the prospect of sustainable alternative approaches against bacterial pathogens with the flexibility of being applied therapeutically or for biological control purposes.

This article reviews the use of phages administered orally or rectally to ruminants and by spraying or immersion of fruits and vegetables as an antimicrobial strategy for controlling E. coli O157:H7. The few reports available demonstrate the potential of phage therapy to reduce E. coli O157:H7 carriage in cattle and sheep, and preparation of commercial phage products was recently launched into commercial markets.

However, a better ecological understanding of the phage E. coli O157:H7 will improve antimicrobial effectiveness of phages for elimination of E. coli O157:H7 in vivo.

Use of bacteriophages to control Escherichia coli O157:H7 in domestic ruminants, meat products, and fruit and vegetables

Foodborne Pathogens and Disease, June 2017, ahead of print, Wang Lili, Qu Kunli, Li Xiaoyu, Cao Zhenhui, Wang Xitao, Li Zhen, Song Yaxiong, and Xu Yongping, https://doi.org/10.1089/fpd.2016.2266

http://online.liebertpub.com/doi/abs/10.1089/fpd.2016.2266