Power of going public: 30 children in Jerusalem daycare sick with Salmonella

Arutz Sheva of Israel National News reports that on April 30, a report was received from the mother of an infant enrolled in an Emunah daycare in Jerusalem claiming infants and toddlers in one of the daycare’s classes were suffering stomachaches and intestinal disturbances.

According to Ynet, an investigation by the Jerusalem District Health Office found the problems had begun several days earlier, in the daycare’s 2-year-old class, when 15 of the class’s 24 children became ill and one was hospitalized.

In the infants’ group, 15 out of 18 infants became ill, and one was hospitalized.

Last Wednesday, the Health Office received the results of the various tests performed, and found that one of the sick children tested positive for salmonella.

A district health supervisor was immediately sent to the daycare, where they found that both breakfast and lunch were served hot and made on the premises. The supervisor also made a list of health hazards which the daycare will need to fix.

During the visit, the supervisor took samples of food stored in the daycare since April 28. Though the samples did not test positive for salmonella, they did test positive for several other pathogens.

Ron Doering: Of course I’m proud of CFIA, why isn’t the rest of Canada?

Doering writes: The 20th anniversary of the Canadian Food Inspection Agency (CFIA)  seems to have gone by unnoticed, even by the CFIA. Has it lived up to the original vision? Has it achieved its promise from 20 years ago?

Of course I‘m not an unbiased observer. In April, 1995 I was given the lead responsibility to carry out the consultation on how Canada should reorganize its food inspection and related activities. I put together the team to carry out the review.  We called ourselves the Office of Food Inspection Systems (OFIS). When we completed the consultation, we  recommended the most ambitious of the options reviewed–that the government should create a new independent legislated agency with the full regulatory authority for the whole food chain. Our Minister Ralph Goodale went to Cabinet in  the late fall of 1995 and the Chretien Government adopted our recommendation. OFIS was also given the lead to set it up and we got the historic legislation through in time to open the doors on April 1, 1997. Later I served as its President until I retired from the public service. 

Looking back on the original OFIS documents, the CFIA was created to meet five broad objectives. How well have these been met? 

Enhance the effectiveness and efficiency of federal food inspection and related services. The CFIA clearly met this goal. $44 million dollars were saved.  Overlap and duplication was reduced. Sixteen programs that had formerly been delivered by four different departments were brought under one roof. Consumers and industry now have one point of contact. 

Provide integrated governance of food safety, plant health and animal health. This was fully achieved.    We are still the only jurisdiction in the world that brings under one agency the whole food chain: feed, seeds, fertilizer, all food including fish as well as animal and plant health. The value of this integration has been widely recognized. For example, Canada managed the challenge of BSE better than most countries because senior officials in charge of animal health were also in charge of food safety. This integration also accounts for our fully integrated investigation and recall system led by the widely-respected Office of Food Safety and Recall (OFSR). Canadians now take this single point of contact for granted. Remember, for example, that in the US it is still the case that a vegetarian pizza is the responsibility of FDA but a pepperoni pizza falls under the jurisdiction of USDA etc.

Enhance international market access.  The CFIA has harmonized technical trade areas, negotiated many international equivalency agreements, challenged misuse of technical measures and played a major role in influencing international standards. Former OFIS member and afterwards CFIA Vice-President Peter Brackenridge has noted that “with the changing international trade environment, a single organization like the CFIA is well placed to manage the challenge of protectionism by the misuse of technical standards.”

Enhance Provincial and Federal regulatory harmonization.  Former OFIS member and afterwards CFIA Vice-President Cam Prince notes that this is one area where progress has not met our original expectations. This issue may take on increased impetus in light of the recently announced Canadian Free Trade Agreement but there continues to be major international trade law barriers to full intergovernmental harmonization.

Modernize Canadian Food Law. In 1999 the CFIA introduced  First Reading of Bill C-80 which would have provided a truly modernized legal basis for the regulation of food and related activities but it did not proceed for political reasons. With the current Safe Food for Canadians Act (and Regulations) now being completed, finally we will have a more modern legal foundation for the future, though not as integrated as the former Bill would have provided. 

With an annual budget of over $700 million and over 6,000 staff the CFIA is, by far, Canada’s largest science-based regulatory agency, respected within the federal system, by the provinces and admired around the world as a model. 

The CFIA has met most of our original expectations. While there have been bumps along the road, Canadians should be proud of the CFIA’s many achievements. Its anniversary should be celebrated.

Stop making sense: Why risk communication sucks

I was lying on the floor, ordered to remove my shoes, and asked: “What do I think of when I hear the term, GMO.”

This was about 1995, and the Ontario Ministry of Agriculture and Food – always a Ministry, stick with the gospel – had brought in some French marketing guru who apparently got famous selling coffee on the aroma, and he was now going to tell us how to sell genetically engineered foods.

We also got to sit behind one-way mirrors and watch people react to terms which, while voyeuristic, was completely dumb and cost taxpayers a few hundred thousand.

It was at that point I solidified my view of stop the bullshit, you wanna sell genetically engineered food, brag about it or go home.

Now, after a decade of disappointing results to reduce the number of people barfing from foodborne illness – nothing to do with GE foods — it’s time for fresh approaches.

Same as it ever was.

barfblog.com has no sponsors – government, industry or academic – so we’ll try a few things.

It won’t be polite.

People barfing and dying from a meal is unacceptable in a so-called advanced society.

And look for our new boy band (of writers) Food Safety Assholes.

My PhD is in food science, but it was really risk communication as related to food.

That was over 20 years ago.

Academics and consultants are still reinventing the wheel and still making a good buck at it.

Caitlin Dewey of The Washington Post reports the U.S. Food and Drug Administration will fund a campaign to promote genetically modified organisms in food under a bipartisan agreement to keep the government funded through the end of September.

People don’t want to be educated, they want to be compelled, with decent stories.

More than 50 agriculture and food industry groups had signed on to an April 18 letter urging the funding to counter “a tremendous amount of misinformation about agricultural biotechnology in the public domain.” 

As David Brooks of the N.Y Times wrote about Donald Trump, he’s a “political pond skater — one of those little creatures that flit across the surface, sort of fascinating to watch, but have little effect as they go.”

Same with all the GMO social actors in this 20-year-old fairytale.

Been there, done that. The ditch is more interesting than the road.

A comparative study of communication about food safety before, during, and after the “Mad Cow” crisis

The Oxford Handbook on the Science of Science Communication, Matteo Ferrari, 2017

https://books.google.com/books?hl=en&lr=lang_en&id=HSjADgAAQBAJ&oi=fnd&pg=PA133&ots=mJpAHnOqBA&sig=59L03Bb3gH2bnlnpEfuAhIv4H-8#v=onepage&q&f=false

The “mad cow’ saga provides useful insights into the complexities that surround public communication on food safety issues. The first part of the chapter describes the most important scientific characteristics of bovine spongiform encephalopathy (BSE) and its human counterpart, variant Creutzfeldt-Jakob disease. The second section offers an account of the unfolding of the public communication before, during, and after the BSE crisis, including the diverse positions adopted by different countries and the legal reforms enacted to improve risk communication. The final part provides an analysis of the key features of the mad cow crisis: the importance of trust and transparently, the uncertainties that can characterize scientific information, the effects of cognitive bias, and the role of cultural context. All these factors contributes to both the amplifying and downplaying-depending on the place and time- of the BSE risk in the public mind. 

840X greater risk from raw milk and products

Risk comparisons are generally risky.

I avoid them.

But if some folks are going to push a point, expect some push back.

Risk comparisons depend on meals consumed. Not many Americans consume raw milk or raw milk cheese, yet the products are continuously the source of outbreaks.

The following abstract of a paper takes a stab at quantifying the per-meal problem.

Why has no one published about the imagined safety of raw milk products in a scientific journal?

Because it’s another food safety fairytale.

Until credible data is presented, all the naturalist wankers can take the advice of novelist Kurt Vonnegut, “Why don’t you take a flying fuck at a rolling doughnut? Why don’t you take a flying fuck at the mooooooooooooon?”

And stop wasting public health resources, assholes.

Outbreak-related disease burden associated with consumption of unpasteurized cow’s milk and cheese, United States, 2009-2014

Emerging Infectious Diseases, vol. 23, no. 6, June 2017, Solenne Costard , Luis Espejo, Huybert Groenendaal, and Francisco J. Zagmutt

https://wwwnc.cdc.gov/eid/article/23/6/15-1603_article
The growing popularity of unpasteurized milk in the United States raises public health concerns. We estimated outbreak-related illnesses and hospitalizations caused by the consumption of cow’s milk and cheese contaminated with Shiga toxin–producing Escherichia coli, Salmonella spp., Listeria monocytogenes, and Campylobacter spp. using a model relying on publicly available outbreak data. In the United States, outbreaks associated with dairy consumption cause, on average, 760 illnesses/year and 22 hospitalizations/year, mostly from Salmonella spp. and Campylobacter spp.

Unpasteurized milk, consumed by only 3.2% of the population, and cheese, consumed by only 1.6% of the population, caused 96% of illnesses caused by contaminated dairy products. Unpasteurized dairy products thus cause 840 (95% CrI 611–1,158) times more illnesses and 45 (95% CrI 34–59) times more hospitalizations than pasteurized products. As consumption of unpasteurized dairy products grows, illnesses will increase steadily; a doubling in the consumption of unpasteurized milk or cheese could increase outbreak-related illnesses by 96%.

‘Some will rob you with a 6-gun, some with a fountain pen’ Why people are smuggling butter into Wisconsin

Maple syrup thefts in Quebec; adulterated olive oil from Italy; horse meat filler in the EU and apparently everywhere.

The mob’s got its fingers in all kinds of food fraud, but leave it to Wisconsin to quaintly produce a butter smuggler.

Whenever Jean Smith leaves her home in Waukesha, Wisconsin, to visit relatives out of state, she’ll stop in Nebraska to load up on blocks of Kerrygold butter, imported from Ireland, which is banned in the state that calls itself, “America’s Dairyland.”

“Ms. Smith brings back as much Kerrygold butter with her when she visits family in Nebraska,” said a civil lawsuit she and three other butter-lovers filed against Wisconsin in a state court last month. “She keeps large amounts of the butter in her home refrigerator in the hopes that she will have enough to last her until her next out-state trip.”

Kerrygold says the “winds, rain and warming influence of the Gulf Stream all contribute to the lush grass” where the Ireland-based company’s happy cows graze before they’re milked to create butter that’s “silky and creamy and glow a healthy, golden yellow.”

It may be specially crafted but the product is what’s called “ungraded butter,” which doesn’t carry the familiar USDA stamp of approval or in this case a Wisconsin grade. The state is the only one in the U.S. to declare it “unlawful to sell, offer or expose for sale, or have in possession with intent to sell, any butter at retail unless it has been graded.”

M. L. Nestel of The Daily Beast writes that Smith’s lawsuit is the first of three dealing with the butter law this year. In one federal lawsuit, Kerrygold accuses a competitor of trademark infringement for selling “Irishgold” butter. In another federal lawsuit, a small ungraded artisanal butter company called Minerva claims its butter is getting cut out of the Wisconsin market over an outdated technicality.

The 1953 law was rarely enforced until now, maybe because the grading process is grueling.

A grader has to assess in sequential steps the “flavor and aroma, body and texture, color, salt, package and by the use of other tests or procedures approved by the department for ascertaining the quality of butter in whole or part,” according to the state’s website on the matter.

The story goes on to outline the minutia of grading standards, protectionism and bullshit claims.

And, like most food porn, has nothing to do with safety.

Mancini speaks: Central Atlantic States Association of Food and Drug Officials 101 Annual Educational and Training Seminar

Our resident non-aging television personality and food safety dude, Rob Mancini, writes that he’ll be speaking at the CASA Educational Conference on May 2nd, 2017 in Saratoga Springs, NY regarding his research on alternate modes of food safety training.

The importance of training food handlers is critical to effective food hygiene; however, there have been limited studies on the effectiveness of such training.

Food safety training courses are administered worldwide in attempts to reduce outbreaks in food service, retail and temporary food service establishments. However, food handlers often exhibit a poor understanding of microbial or chemical contamination of food and the measures necessary to correct them.

Studies suggest that the provision of a hands-on format of training would be more beneficial than traditional classroom-based programs. The delivery of such a program may assist in changing ones’ food safety behaviours and aid in the retention of knowledge that are necessary to reduce the incidence of foodborne illness.

4 Hours at the White House with Ted Nugent, Sarah Palin and Kid Rock

There was this time, I was 17-years-old, and I drove from Brantford to Kitchener, Ontario, Canada, with my girlfriend and her mom.

Mom sat in the front, so I decided to crank up my 8-track (seriously, it was an 8-track) and put on something offensive: Ted Nugent’s Wango Tango.

I understand with the hindsight of age I was acting out, trying to get attention, or was just an asshole.

Mom didn’t flinch, just politely indulged me for the little child I was being.

If that 17-year-old became President of the U.S., there may be some problems.

Yet there was President Trump, hosting Ted Nugent, Kid Rock and Sarah Palin  for several hours Wednesday night to a white-china private dinner, a room-by-room tour and free-range policy chat.

(Hopefully, Trump steaks weren’t served).

“We were there for four hours, man!” Mr. Nugent, a 68-year-old Detroit native, said in a telephone interview on Thursday, using a four-letter expletive to signal his amazement at Mr. Trump’s willingness to spend so much time with his three casually dressed visitors.

“He gave us a wonderful personal tour of every room and talked about the origins of every carpet and every painting — there was a Monet — and then we had dinner,” said Mr. Nugent, who has referred to former President Barack Obama as a “mongrel” and to Hillary Clinton with an array of unflattering epithets.

Ted, an avowed bow hunter (so was Hubbell) may want to be careful with his cull, after the Lorain County General Health District in Ohio warned anyone who purchased or received deer meat processed at Ketchem’s Country Meats during the 2016-2017 hunting season.

The district is urging anyone who may fall into that category to call 440-322-6367.

Officials say it’s a preventative measure.

There have been no reported cases of foodborne illnesses associated with Ketchem’s as of Wednesday.

While investigating an odor nuisance, public health professionals found that the facility did not have water or electricity for refrigeration and yet was still processing deer. In order to prevent foodborne illness, all perishable foods must be properly refrigerated.

Palin said, “Asked why I invited Kid Rock and Ted Nugent, I joked, ‘Because Jesus was booked.’”

These 675 people make your meals: Illinois man gets 18 months for food safety bribes

A Lynwood, Illinois man has been sentenced to 18 months in federal prison for accepting bribes in exchange for allowing students in his food safety training classes to bypass sanitation certification testing, according to the U.S. attorney’s office in Chicago.

Ernest Griffin, 71, was sentenced Wednesday and also ordered to pay a $5,000 fine, according to the office.

Griffin had pleaded guilty in March 2016 to one count of federal program bribery, according to court records.

His business, Food Safety Awareness, contracted with the Illinois Department of Public Health to offer food handling courses. Students needed to complete a 15-hour course and take an exam in order to receive sanitation certificates from the health department.

In exchange for bribes, Griffin submitted false certifications and false test results to the department, although prosecutors and Griffin’s lawyer disagreed on the total amount of bribes the man received, court documents show.

Prosecutors said that starting in at least 2008 and continuing through January 2015 Griffin received bribes from students, taking in a total of almost $152,000. His lawyer, in a filing, said that Griffin admitted to receiving more than $5,000 a year in bribes from 2010 through 2014.

The government said that Griffin’s bribery scheme ended only after he was confronted by FBI agents in January 2015.

The government contended that during that four-year period, about 675 students who hadn’t taken the required class or exam were given sanitation certificates.

Kids, kids: Foodnet report is out

It’s my favorite day of the year: The annual U.S. Foodnet report, where data is presented, mulled over, and then crammed into politically suitable food safety fairytales.

When a scientific report leads with, “The incidence of infections transmitted commonly through food has remained largely unchanged for many years,” isn’t it time to try something different?

The U.S. Centers for Disease Control reports reducing foodborne illness depends in part on identifying which illnesses are decreasing and which are increasing. Yet recent changes in the use of tests that diagnose foodborne illness pose challenges to monitoring illnesses and progress toward preventing foodborne disease, according to a report published today in CDC’s Morbidity and Mortality Weekly Report.

Rapid diagnostic tests help doctors diagnose infections quicker than traditional culture methods, which require growing bacteria to determine what is causing illness. But without a bacterial culture, public health officials cannot get the detailed information needed to detect and prevent outbreaks, monitor disease trends, and identify antibiotic resistance.

The MMWR article includes the most recent data from CDC’s Foodborne Diseases Active Surveillance Network, or FoodNet, which collects data on 15% of the U.S. population. It summarizes preliminary 2016 data on nine germs spread commonly through food. In 2016, FoodNet reported 24,029 infections, 5,512 hospitalizations, and 98 deaths. This is the first time the numbers used for calculations of trends include bacterial infections diagnosed only by rapid diagnostic tests as well as those confirmed by traditional culture-based methods. Previously, these calculations used only those bacterial infections confirmed by culture-based methods. The most frequent causes of infection in 2016 were Salmonella and Campylobacter, which is consistent with previous years.

 Incidence and Trends of Infections with Pathogens Transmitted Commonly Through Food and the Effect of Increasing Use of Culture-Independent Diagnostic Tests on Surveillance — Foodborne Diseases Active Surveillance Network, 10 U.S. Sites, 2013–2016

Marder EP, Cieslak PR, Cronquist AB, et al.

MMWR Morb Mortal Wkly Rep 2017;66:397–403. DOI: http://dx.doi.org/10.15585/mmwr.mm6615a1

https://www.cdc.gov/mmwr/volumes/66/wr/mm6615a1.htm?s_cid=mm6615a1_e#suggestedcitation

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.

What is added by this report?

Compared with the 2013–2015 average annual incidence, the 2016 incidence of confirmed Campylobacter infections was lower, incidences of confirmed Shiga toxin-producing Escherichia coli (STEC), Yersinia, and Cryptosporidium infections were higher, and incidences of confirmed or CIDT positive–only STEC and Yersinia infections were higher. However, CIDTs complicate the interpretation of surveillance data; testing for pathogens might occur more frequently because of changes in either health care provider behaviors or laboratory testing practices. A large proportion of CIDT positive specimens were not reflex cultured, which is necessary to obtain isolates for distinguishing pathogen subtypes, determining antimicrobial resistance, monitoring trends, and detecting outbreaks.

What are the implications for public health practice?

Some information about the bacteria causing infections, such as subtype and antimicrobial susceptibility, can only be obtained for CIDT positive specimens if reflex culture is performed. Increasing use of CIDTs affects the interpretation of public health surveillance data and ability to monitor progress toward prevention measures.

Foodborne diseases represent a substantial public health concern in the United States. CDC’s Foodborne Diseases Active Surveillance Network (FoodNet) monitors cases reported from 10 U.S. sites* of laboratory-diagnosed infections caused by nine enteric pathogens commonly transmitted through food. This report describes preliminary surveillance data for 2016 on the nine pathogens and changes in incidences compared with 2013–2015. In 2016, FoodNet identified 24,029 infections, 5,512 hospitalizations, and 98 deaths caused by these pathogens. The use of culture-independent diagnostic tests (CIDTs) by clinical laboratories to detect enteric pathogens has been steadily increasing since FoodNet began surveying clinical laboratories in 2010 (1). CIDTs complicate the interpretation of FoodNet surveillance data because pathogen detection could be affected by changes in health care provider behaviors or laboratory testing practices (2). Health care providers might be more likely to order CIDTs because these tests are quicker and easier to use than traditional culture methods, a circumstance that could increase pathogen detection (3). Similarly, pathogen detection could also be increasing as clinical laboratories adopt DNA-based syndromic panels, which include pathogens not often included in routine stool culture (4,5). In addition, CIDTs do not yield isolates, which public health officials rely on to distinguish pathogen subtypes, determine antimicrobial resistance, monitor trends, and detect outbreaks. To obtain isolates for infections identified by CIDTs, laboratories must perform reflex culture; if clinical laboratories do not, the burden of culturing falls to state public health laboratories, which might not be able to absorb that burden as the adoption of these tests increases (2). Strategies are needed to preserve access to bacterial isolates for further characterization and to determine the effect of changing trends in testing practices on surveillance.

FoodNet is a collaboration among CDC, 10 state health departments, the U.S. Department of Agriculture’s Food Safety and Inspection Service, and the Food and Drug Administration. FoodNet personnel conduct active, population-based surveillance for laboratory-diagnosed infections caused by Campylobacter, Cryptosporidium, Cyclospora, Listeria, Salmonella, Shiga toxin-producing Escherichia coli (STEC), Shigella, Vibrio, and Yersinia for 10 sites covering approximately 15% of the U.S. population (an estimated 49 million persons in 2015). Confirmed bacterial infections are defined as isolation of the bacterium from a clinical specimen by culture. Confirmed parasitic infections are defined as detection of the parasite from a clinical specimen by direct fluorescent antibody test, polymerase chain reaction, enzyme immunoassay, or light microscopy. CIDTs detect bacterial pathogen antigen, nucleic acid sequences, or for STEC, Shiga toxin or Shiga toxin genes, in a stool specimen or enrichment broth.§ A CIDT positive–only bacterial infection is a positive CIDT result that was not confirmed by culture. Hospitalizations occurring within 7 days of specimen collection are recorded. The patient’s vital status at hospital discharge (or 7 days after specimen collection if not hospitalized) is also recorded. Hospitalizations and deaths occurring within 7 days of specimen collection are attributed to the infection. FoodNet also conducts surveillance for physician-diagnosed postdiarrheal hemolytic uremic syndrome (HUS), a potential complication of STEC infection, by review of hospital discharge data through a network of nephrologists and infection preventionists. This report includes HUS cases among persons aged <18 years for 2015, the most recent year with available data.

Incidence of infection for each pathogen is calculated by dividing the number of infections in 2016 by the U.S. Census estimates of the surveillance area population for 2015. Incidence is calculated for confirmed infections alone and for confirmed or CIDT positive–only infections combined. A negative binomial model with 95% confidence intervals (CIs) was used to estimate changes in incidence of confirmed bacterial and parasitic infections and confirmed or CIDT positive–only bacterial infections in 2016 compared with 2013–2015, adjusting for changes in the surveillance population over time. For STEC, incidence is reported for all STEC serogroups combined because it is not possible to distinguish between serogroups using CIDTs. Insufficient data were available to assess change for Cyclospora. For HUS, the 2015 incidence was compared with incidence during 2012–2014.

Cases of Infection, Incidence, and Trends

During 2016, FoodNet identified 24,029 cases, 5,512 hospitalizations, and 98 deaths caused by confirmed or CIDT positive–only infections. The largest number of confirmed or CIDT positive–only infections in 2016 was reported for Campylobacter (8,547), followed by Salmonella (8,172), Shigella (2,913), STEC (1,845), Cryptosporidium (1,816), Yersinia (302), Vibrio (252), Listeria (127), and Cyclospora (55). The proportion of infections that were CIDT positive without culture confirmation in 2016 was largest for Campylobacter (32%) and Yersinia (32%), followed by STEC (24%), Shigella (23%), Vibrio (13%), and Salmonella (8%). The overall increase in CIDT positive–only infections for these six pathogens in 2016 was 114% (range = 85%–1,432%) compared with 2013–2015. Among infections with a positive CIDT result in 2016, a reflex culture was attempted on approximately 60% at either a clinical or state public health laboratory. The proportion of attempted reflex cultures differed by pathogen, ranging from 45% for Campylobacter to 86% for STEC and 88% for Vibrio. Among infections for which reflex culture was performed, the proportion of infections that were positive was highest for Salmonella (88%) and STEC (87%), followed by Shigella (64%), Yersinia (59%), Campylobacter (52%), and Vibrio (46%).

The incidence of confirmed infections and of confirmed or CIDT positive–only infections per 100,000 persons was highest for Campylobacter (confirmed = 11.79; confirmed or CIDT positive–only = 17.43) and Salmonella (15.40; 16.66), followed by Shigella (4.60; 5.94), Cryptosporidium (3.64; N/A**), STEC (2.85; 3.76), Yersinia (0.42; 0.62), and lowest for Vibrio (0.45; 0.51), Listeria (0.26; N/A), and Cyclospora (0.11; N/A). Compared with 2013–2015, the 2016 incidence of Campylobacter infection was significantly lower (11% decrease) when including only confirmed infections, yet was not significantly different when including confirmed or CIDT positive–only infections. Incidence of STEC infection was significantly higher for confirmed infections (21% increase) and confirmed or CIDT positive–only infections (43% increase). Similarly, the incidence of Yersinia infection was significantly higher for both confirmed (29% increase) and confirmed or CIDT positive–only infections (91% increase). Incidence of confirmed Cryptosporidium infection was also significantly higher in 2016 compared with 2013–2015 (45% increase).

Among 7,554 confirmed Salmonella cases in 2016, serotype information was available for 6,583 (87%). The most common serotypes were Enteritidis (1,320; 17%), Newport (797; 11%), and Typhimurium (704; 9%). The incidence in 2016 compared with 2013–2015 was significantly lower for Typhimurium (18% decrease; CI = 7%–21%) and unchanged for Enteritidis and Newport. Among 208 (95%) speciated Vibrio isolates, 103 (50%) were V. parahaemolyticus, 35 (17%) were V. alginolyticus, and 26 (13%) were V. vulnificus. Among 1,394 confirmed and serogrouped STEC cases, 503 (36%) were STEC O157 and 891 (64%) were STEC non-O157. Among 586 (70%) STEC non-O157 isolates, the most common serogroups were O26 (190; 21%), O103 (178; 20%), and O111 (106; 12%). Compared with 2013–2015, the incidence of STEC non-O157 infections in 2016 was significantly higher (26% increase; CI = 9%–46%) and the incidence of STEC O157 was unchanged.

FoodNet identified 62 cases of postdiarrheal HUS in children aged <18 years (0.56 cases per 100,000) in 2015; 33 (56%) occurred in children aged <5 years (1.18 cases per 100,000). Compared with 2012–2014, in 2015, no significant differences in incidence among all children or children aged <5 years were observed.

Discussion

The number of CIDT positive–only infections reported to FoodNet has been increasing markedly since 2013, as more clinical laboratories adopt CIDTs. Initially, increases were primarily limited to Campylobacter and STEC; followed by substantial increases in Salmonella and Shigella beginning in 2015 (6). The pattern continued in 2016, with large increases in the number of CIDT positive–only Vibrio and Yersinia infections. When including both confirmed and CIDT positive–only infections, incidence rates in 2016 were higher for each of these six pathogens. The increasing use of CIDTs presents challenges when interpreting the corresponding increases in incidence. For example, the incidence of confirmed Campylobacter infections in 2016 was significantly lower than the 2013–2015 average. However, when including CIDT positive–only infections, a slight but not significant increase occurred. For STEC and Yersinia, the incidence of confirmed infections alone and confirmed or CIDT positive–only infections in 2016 were both significantly higher than the 2013–2015 average; the magnitude of change approximately doubled when analyzing CIDT positive–only infections.

Because of the ease and increasing availability of CIDTs, testing for some pathogens might be increasing as health care provider behaviors and laboratory practices evolve (2). Among clinical laboratories in the FoodNet catchment, the use of CIDTs to detect Salmonella, for which the only CIDTs available are DNA-based gastrointestinal syndrome panels, increased from 2 per 460 laboratories (<1%) in 2013 to 59 per 421 laboratories (14%) in 2016 (FoodNet, unpublished data). This increased use paralleled significant increases in incidence of Cryptosporidium, STEC, and Yersinia, and slight but not significant increases in incidence of Campylobacter, Salmonella, Shigella, and Vibrio, all of which are also included in these panel tests. The increase in STEC incidence is driven by the increase in STEC non-O157, which is not typically included in routine stool culture testing because it requires specialized methods. Routine stool cultures performed in clinical laboratories typically include methods that identify only Salmonella, Campylobacter, Shigella, and for some laboratories, STEC O157 (4,5). The increased use of the syndrome panel tests might increase identification, and thus, improve incidence estimates of pathogens for which testing was previously limited.

Results are more quickly obtained using CIDTs than traditional culture methods (3). Because of this, health care providers might be more likely to order a CIDT than traditional culture (2). Increased testing might identify infections that previously would have remained undiagnosed. However, sensitivity and specificity vary by test type. Evaluations of DNA-based syndrome panel tests have indicated high sensitivity and specificity for most targets (3). However, among pathogens for which antigen-based CIDTs are often used, such as Campylobacter and Cryptosporidium, sensitivity and specificity have varied more widely, with a large number of false positive results (7,8). Including CIDT positive infections to calculate incidence, some of which could be false positives, might provide an inaccurate estimate. When interpreting incidence and trends in light of changing diagnostic testing, considering frequency of testing, sensitivity, and specificity of these tests is important. The observed increases in incidence of confirmed or CIDT positive–only infections in 2016 compared with 2013–2015 could be caused by increased testing, varying test sensitivity, an actual increase in infections, or a combination of these reasons.

These changes in testing are also important to consider when monitoring progress toward Healthy People 2020 objectives.†† The current objectives were created before the use of CIDTs and were based on confirmed infections. In the future, just as incidence measures should adjust for these changes, objectives should also be evaluated in light of changing diagnostics.

CIDTs pose additional challenges because they do not yield the bacterial isolates necessary for essential public health surveillance activities, such as monitoring trends in pathogen subtypes, conducting molecular testing, detecting outbreaks and implicating vehicles, and determining antimicrobial susceptibility. Reflex culture performed to yield an isolate places an additional burden on laboratories’ budgets, personnel, and time. Specimen submission requirements differ by state and pathogen, and this responsibility often falls to state public health laboratories (9). As CIDT use increases and more pathogens are affected, state public health laboratories will be challenged to sufficiently increase their testing capacity and will likely have to prioritize specimens on which to perform reflex culture (10). Clinical laboratories should review state specimen submission requirements and the Association of Public Health Laboratories guidelines§§ for reflex culture and submission of CIDT positive specimens.

The findings in this report are subject to at least two limitations. First, the changing diagnostic landscape with unknown changes in frequency of testing, varying test performance, and decreasing availability of isolates for subtyping make interpreting incidence and trends more difficult. Second, changes in health care–seeking behavior, access to health services, or other population characteristics might have changed since the comparison period, which could affect incidence.

Foodborne illness remains a substantial public health concern in the United States. Previous analyses have indicated that the number of infections far exceeds those diagnosed; CIDTs might be making those infections more visible (11). Most foodborne infections can be prevented, and substantial progress has been made in the past in decreasing contamination of some foods and reducing illness caused by some pathogens. More prevention measures are needed. Surveillance data can provide information on where to target these measures. However, to accurately interpret FoodNet surveillance data in light of changes in diagnostic testing, more data and analytic tools are needed to adjust for changes in testing practices and differences in test characteristics. FoodNet is collecting more data and developing those tools. With these, FoodNet will continue to track the needed progress toward reducing foodborne illness.

Acknowledgments

Foodborne Diseases Active Surveillance Network staff members, Emerging Infections Program; Brittany Behm, Staci Dixon, Elizabeth Greene, Jennifer Huang, Clare Wise, and FoodNet Fast Development Team, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC.

Flipping burgers is a noble craft and needs to be done with a thermometer, otherwise people get sick

Trash-talking elites are part of the reason Donald Trump is now U.S. President.

In the new book, Shattered, journalists Jonathan Allen and Amie Parnes write that Hillary Clinton’s campaign was doomed to fail. “The portrait of the Clinton campaign that emerges from these pages is that of a Titanic-like disaster: an epic fail made up of a series of perverse and often avoidable missteps by an out-of-touch candidate and her strife-ridden staff that turned ‘a winnable race’ into another iceberg-seeking campaign ship.”

Australians are also being drawn to the right, with their own versions of Aussie-first – the aboriginal population may have some thoughts on that – in which skilled 457 visas are being eliminated.

It’s not the political drift that is surprising – Australia is a country that, as John Oliver said, has settled into their intolerance like an old resentful slipper” – it’s the response from the Group of Eight universities who wrote to Prime Minister Malcolm Turnbull on Wednesday complaining the new rules could be “extremely damaging” to academic recruitment.

Forgetting for a moment that a Group of Eight unis in a country with 23 million people is self-aggrandizing on a ridiculous scale, University of Sydney vice-chancellor Michael Spence (that’s like a university president, which is self-aggrandizing enough) told Fairfax Media, “They’re really not people flipping burgers. “If you are building world-class expertise in a cutting-edge area of science, you’re probably going to need to draw from a gene pool larger than 23 million.”

Spence, your knowledge of genetics sucks; I have a genetics degree.

In his letter to Mr Turnbull, Go8 chairman Peter Hoj said “the mere suggestion of Australia clamping down on academic mobility into Australia would be extremely damaging to academic recruitment in Australia.”

Here are my perceived limitations to academic recruitment in Australia:

  1. Get an Internet that works and is not dependent on hobbits spinning a hamster wheel. Every time it rains, the Internet goes down, because most of the connections are underground, where water pools.
  2. Offer something of value rather than appealing to money. It’s still not too late to life a life of substance.
  3. Bring Australia into the 21st century by changing laws on same sex marriage, abortion, parental leave and end-of-life.
  4. Stop casting aspersions about fast-food workers – the people who probably make your lunch Dr. vice-chancellors – and save the flipping burgers shit for your fancy club talk. Engineering geniuses still need to eat. Perhaps Australia could make it a priority that food is safe and doesn’t make people barf. The military figured this out centuries ago. Maybe universities can, eventually.