8 dead, 25 hospitalized from trichinellosis in Cambodia

Cambodia’s Ministry of Health confirmed on Tuesday an outbreak of Trichinellosis in an area in central Kampong Thom province that has left eight people dead and 25 others hospitalized.

In its statement, the ministry said 33 villagers living in Prey Long (forest) area in Sandan district had fallen ill earlier this month, about three weeks after they ate contaminated wild meat that was undercooked, and eight of them had subsequently died in recent weeks.

“The samples of 3 patients’ muscle tissue were tested by the Calmette Hospital’s laboratory and the result confirmed that there were Trichinella larvae in their muscle tissue,” the statement said.

It added that another test on the blood samples from other nine patients by a Vietnamese hospital’s laboratory confirmed that “there were eggs of Trichinalla worms” in their blood.

Cambodian Minister of Health Mam Bunheng said,  “I’d like to appeal to the people to stop eating raw or undercooked meat in order to prevent themselves from infecting Trichinellosis and other diseases.”

 

Raw is risky: Ceviche source of V. cholera 01 in Minn

As we drove the five hours yesterday to Sawtell, NSW, for a week of (ice) hockey for Sorenne, and some R&R for me and Amy (mainly me), Amy was telling me about this one time, she went to Senegal (they speak French) in 2005, and the hosts offered her Tang but she didn’t want to drink it because she had been warned about the water.

Turns out there was an on-going cholera outbreak.

I was driving and thought, should I tell her that cholera is a member of the Vibrio genus?

I kept driving.

Today, while Sorenne is working it on the ice, I’m catching up and came across this report from friends at the Minnesota Department of Health (MDH) published by the U.S. Centers for Disease Control.

On August 20, 2016, the Minnesota Department of Health (MDH) was notified of a case of Vibrio cholerae infection. The isolate was identified as serogroup O1, serotype Inaba at MDH. CDC determined that the isolate was nontoxigenic. The patient was a previously healthy woman, aged 43 years, with history of gastric bypass surgery. On August 16, she experienced profuse watery diarrhea, vomiting, abdominal cramps, and headache. On August 18, she sought care and submitted the stool specimen that yielded the V. cholerae isolate. She reported no recent travel. However, she had consumed ceviche made with raw shrimp and raw oysters at restaurant A on August 14, 49 hours before illness onset. Her husband had a similar illness with a similar incubation period after eating the same foods at restaurant A.

On August 22, MDH sanitarians visited restaurant A and obtained tags and invoices for oyster and shrimp products; the oysters were a product of the United States, and the shrimp was a product of India. Sanitarians also gathered patron contact information and credit card receipts for August 12–14. Two additional patrons reported experiencing a gastrointestinal illness that met the case definition of three or more episodes of watery stool in a 24-hour period within 5 days of eating at restaurant A; one reported eating ceviche and oysters at restaurant A. Review of complaints to the MDH foodborne illness hotline revealed a previous complaint from two persons who reported experiencing watery diarrhea after eating raw shrimp ceviche (but no oysters) at restaurant A on August 2. These persons did not provide stool specimens, but their gastrointestinal illnesses met the case definition, resulting in a total of six cases, including one laboratory-confirmed case. No other V. cholerae O1 Inaba cases were reported in the United States during this outbreak.

The Minnesota Department of Agriculture facilitated sampling of shrimp at the distributor from the same lots served at restaurant A on August 14, and most likely during August 2–13, and sent them to the Food and Drug Administration for culture. Shrimp samples yielded V. cholerae non-O1, non-O139, but V. cholerae O1 was not isolated. In response to the outbreak results, restaurant A placed consumer warnings on their menus about the risks of consuming raw or undercooked food items and identified raw menu items for consumers. Restaurant A also focused on other actions that might facilitate reduction of V. cholerae, including appropriate freezing of food items, and allowing raw food items to soak in lime juice before being served, rather than serving the items immediately after adding lime juice (1,2).

V. cholera has over 150 serogroups and has been identified in a wide range of aquatic life, including seafood (3). Whereas multiple serogroups can cause vibriosis, only serogroups O1 and O139 that also contain the cholera toxin are classified as causes of cholera (4). Previous studies have documented the presence of nontoxigenic V. cholerae O1 from environmental and shrimp samples in India and Southeast Asia (5–7).

This outbreak of domestically acquired, nontoxigenic V. cholerae infections, likely from shrimp consumption, included the first V. cholerae O1 case identified in a nontraveler in Minnesota since active surveillance for Vibrio began in 1996. Since 1996, MDH has detected 26 V. cholerae infections, 21 (81%) of which were non-O1, non- O139, and five of which were O1. Among the four O1 type cases identified before the current outbreak, all patients had a recent travel history to Micronesia or India. This outbreak demonstrates the importance of investigating all seafood eaten by patients with vibriosis. In addition, investigators should include nontoxigenic V. cholerae as a possible etiology of domestic foodborne outbreaks, particularly when foods eaten include those from V. cholerae O1–endemic areas.

Notes from the field: Vibrio cholerae Serogroup O1, Serotype Inaba — Minnesota, August 2016

CDC MMWR

Victoria Hall, Carlota Medus, George Wahl, Alida Sorenson, Melanie Orth, Monica Santovenia, Erin Burdette, Kirk Smith

https://www.cdc.gov/mmwr/volumes/66/wr/mm6636a6.htm?s_cid=mm6636a6_e

 

Fancy food ain’t safe food, Mark Sergeant’s Rocksalt edition

An award-winning Folkestone, UK, restaurant run by celebrity chef Mark Sergeant has been given a low food hygiene rating.

Inspectors discovered ‘unsafe’ cooking procedures at Rocksalt, in Folkestone Harbour and the top eatery was told ‘improvement is necessary’.

Callum Wilson of Kent Live reports the damning Environmental Health report, inspectors said diners were at risk of food poisoning.

The restaurant, which has previously received rave reviews, has now had its five star rating taken away and replaced with the much lower rating ‘requires improvement’.

A Shepway District Council environmental health officer took the perfect score away after finding a ‘high risk’ chicken liver was undercooked.

The officer said: “I noted some cooking procedures that could lead to an unsafe product. For example: chicken livers maybe cooked “medium”.

“Chicken liver pate is cooked in the combi-oven. Core temperature is monitored using a probe and the product is considered cooked when it reaches 70 C.

“The time temperature combination for thorough cooking is 70C held for 2 minutes.”

In a warning to the restaurant, the officer said: “Please ensure chicken products are thoroughly cooked (as per your HACCP procedure for high risk products)”.

Rocksalt is co-owned by celebrity chef Mark Sargeant and Josh DeHaan and opened in 2011.

No one at the restaurant was available for comment.

However, a post appeared on the Rocksalt website saying: “We have requested a revisit and have addressed the single cooking technique deemed incorrect.

“We have urgently retrained all staff to our correct procedure.”

1000 sick: As North America turns to Fall, another bumper crop of Cyclospora

CDC reports that as of September 13, 2017 they have been notified of 988 laboratory-confirmed cases of cyclosporiasis in persons who became ill in 2017. This number includes persons who reported international travel as well as persons who did not report travel. The reports have come from 40 states.

  • At least 553 (56%) of these persons did not report international travel (i.e., likely were infected in the United States) and became ill on or after May 1, 2017 (a date after which cases tend to increase each year). These 553 persons were from the following 36 states: Arizona (1), California (10), Colorado (6), Connecticut (23), Florida (68), Georgia (10), Illinois (17), Indiana (4), Iowa (14), Kansas (2), Louisiana (7), Maryland (12), Massachusetts (13), Michigan (3), Minnesota (11), Mississippi (1), Missouri (13), Montana (2), Nebraska (5), New Hampshire (4), New Jersey (19), New Mexico (1), New York (excluding NYC) (15), New York City (30), North Carolina (45), Ohio (16), Pennsylvania (2), Rhode Island (2), South Carolina (7), South Dakota (4), Tennessee (3), Texas (163), Utah (1), Virginia (7), Washington (1), West Virginia (2), and Wisconsin (9).
  • At this time, no specific vehicle of interest has been identified, and investigations to identify a potential source (or sources) of infection are ongoing. It is too early to say whether cases of Cyclosporainfection in different states are related to each other or to the same food item(s).

Previous U.S. outbreaks of cyclosporiasis have been linked to various types of imported fresh produce (e.g., basil, cilantro, mesclun lettuce, raspberries, snow peas). Consumers should continue to enjoy the health benefits of eating fresh fruits and vegetables as part of a well-balanced diet.

39 sick: You’re a cute puppy, yes you are, but you have Campylobacter

The Ohio Department of Health, several other states, the U.S. Centers for Disease Control, and USDA-APHIS are investigating a multistate outbreak of human Campylobacter infections linked to puppies sold through Petland stores.

Investigators are looking for the source of infections in people and puppies so they can recommend how to stop the outbreak and prevent more illnesses in order to protect human and animal health.

As of September 11, 2017, the outbreak includes 39 cases in 7 states (Florida, Kansas, Missouri, Ohio, Pennsylvania, Tennessee, and Wisconsin).

Illnesses began on dates ranging from September 15, 2016 through August 12, 2017. The most recent illness was reported on September 1, 2017.

Ill people range in age from <1 year to 64 years, with a median age of 22 years; 28 (72%) are female; and 9 (23%) report being hospitalized. No deaths have been reported.

Epidemiologic and laboratory findings have linked the outbreak to contact with puppies sold through Petland stores. Among the 39 ill people, 12 are Petland employees from 4 states and 27 either recently purchased a puppy at Petland, visited a Petland, or visited or live in a home with a puppy sold through Petland before illness began.

Whole genome sequencing showed samples of Campylobacter isolated from the stool of puppies sold through Petland in Florida were closely related to Campylobacter isolated from the stool of an ill person in Ohio. Additional laboratory results from people and dogs are pending.

Regardless of where they are from, any puppies and dogs may carry Campylobacter germs.

 

Sea lice threatening salmon production

Sea lice are copepods and have been around since Salmon have been in water. Not a public health concern but a massive threat for salmon farmers.

Zye Angiwan of Immortal News reports

Salmon farms are facing a large parasitic problem, which has disrupted production all over the world. An uptick in sea lice has become a growing problem in salmon farms, jacking up wholesale prices to as high as 50% from last year for salmon products, from fillets to lox. The tiny sea lice attach themselves to the fish and feed on them, eventually killing them or making them inedible, New York Daily News reports. The sea lice have infested salmon farms in the United States, Scotland, Canada, Norway and Chile – all major global suppliers of the popular fish. Scientists and fish farmers are working to control the pesky crustaceans, which costs the international aquaculture industry around $1 billion yearly.

Jake Elliott, vice president of Cooke Aquaculture in Blacks Harbour, New Brunswick, said, Our work has to be quicker than the evolution of the lice. Experts believe that the problem needs a new slew of advanced technology coupled with older tools such as pesticides. New strategies for breeding the high-protein fish for genetic resistance is necessary, as our methods such as bathing the salmon in warm water to remove the lice or using underwater lasers to take the parasites out. Salmon farmers consider sea lice the biggest threat to their industry, saying that the chronic problem is making the fish more expensive for consumers. The parasites thrive in the tightly packed ocean pens that fish farmers use, according to Shawn Robinson, a scientist with the Canadian Department of Fisheries and Oceans. “There are not enough tools right now to allow the farmer to really effectively deal with it,” he said. Atlantic salmon have managed to keep the sea lice at bay in the wild for centuries, and fish farmers have been managing them for many years. The lice were first identified as a problem in 1994, but the bigger concerns came when the sea lice started evolving to resist the tools farmers used to eradicate them. The chances of sea lice making their way to market-sold salmon is very slim, and should it happen, accidentally consuming a louse would not pose a threat to humans.

But, but mom, I don’t like beets

I called my mother the other day and she cut me short because she was jarring beets.

“You know your father likes his pickled beets.”

OK.

It was one of our go-to phrases growing up, and I have no idea why.

Probably because beets were a staple of 1970s funky glassware along with pickles and pickled onions.

But to do beets right, you may need advice from North Carolina canning queen, Ben Chapman, who produced this infosheet five years ago.

260 sickened last year: Closed and broke, Golden Ponds restaurant to hold auction

On Tuesday, September 19, the owner of the Greece restaurant, Golden Ponds, will sell everything at auction – from the freezer to the flatware.

The Monroe County Health Department says last year 260 people got sick after eating at his Thanksgiving Buffet. Health inspectors shut him down. When he finally reopened, patrons did not come back. Now he’s facing lawsuits, deep debt, and the end of his career. On Friday, he opened his doors and ended his silence for this week’s Restaurants Exposed report.

Ralph Rinaudo hasn’t changed a thing since that January day when he closed the doors for good at Golden Ponds. When News10NBC toured the restaurant, tables were still set, plates were stacked, and linens covered long tables were buffets were served.

“I left everything just the way it was, and it’s tough to just take things out,” said Rinaudo. “All the parties we had booked they just canceled because people were telling me that their friends or people don’t want to come here because they were afraid,” he admitted.

In fact, in the party room, tables are still set for a party that canceled eight months ago. Warmers await food for the buffet – an eerie reminder of the event that forced Rinaudo to close his doors. Asked if he felt guilty about the 260 people who the health department has determined were sickened at his restaurant he answered. “That’s what they said, ‘They got sick here.’ I can’t dispute that what they say.

But the patrons aren’t the only ones saying it. So are scientists at the Monroe County Department of Health who investigate the source of foodborne illness. They say at last year’s Thanksgiving buffet Golden Ponds served up turkey with a side dish of Clostridium perfringens – a dangerous bacteria that inspectors say was likely in gravy held at unsafe temperatures. Two hundred and sixty people suffered serious symptoms from bloody diarrhea to cramping resulting in hospitalizations for some.

“The most difficult case we had a woman who had her colon removed and is going to spend the rest of her life with a colostomy bag,” said Paul Nunes, an attorney for dozens of plaintiffs suing the restaurant.

In his lawsuits, Nunes points to the Monroe County Health Department’s inspection reports which lists mold on the floor of the walk-in refrigerator, heavily rusted shelving in that same refrigerator, a walk-in freezer that didn’t close tightly, mouse droppings, and a kitchen area that inspectors said was quote “in very poor sanitary condition.”

“If you’re sloppy in one thing, you’re sloppy in another thing,” said Nunes. “It’s a modus operandi. This is how they ran the restaurant.”

That’s an allegation Rinaudo denied during News10NBC’s tour of the now closed Golden Ponds. Everything is now for sale from the stove to the ovens still marked with the signs of heavy use. Asked if the auction would get him out of debt he said, “No, no, nothing. Selling this building wouldn’t get me out of debt.”

Nacho cheese botulism was likely linked to retail practices

Lots of folks must like to eat gas station food; even the nacho cheese and nacho combos. I figure they are good sellers since so much retail space is dedicated to the snack. Earlier this year, according to a memo from the California Department of Public Health, ten people became ill with botulism after eating nacho cheese from Valley Oak Food and Fuel gas station in Walnut Grove, CA.

The memo highlights three notable things that came out of the investigation:

  • The 5 pound bag of nacho cheese collected at the retail location on May 5, 2017 was being used past the “Best By” date.
  • Records were not being maintained by the gas station employees indicating when the bag of nacho cheese was originally added to the warming unit.
  • The plastic tool designed to open the bags of cheese (provided with the nacho cheese warming and dispensing unit) was not being used by employees.

So the cheese was in the dispenser for a while, no one knows how long, and folks were using some other means to open the bag. Maybe some utensil with some soil ended up inserting bot spores deep into the anaerobic cheese bag.

 

19 sickened: Temperatures matter; C. perfringens outbreak at a catered lunch Connecticut, 2016

The U.S. Centers for Disease Control reports in September 2016, the Connecticut Department of Public Health was notified of a cluster of gastrointestinal illnesses among persons who shared a catered lunch.

The Connecticut Department of Public Health worked with the local health department to investigate the outbreak and recommend control measures. Information about symptoms and foods eaten was gathered using an online survey. A case was defined as the onset of abdominal pain or diarrhea in a lunch attendee <24 hours after the lunch. Risk ratios (RRs), 95% confidence intervals (CIs), and Fisher’s exact p-values were calculated for all food and beverages consumed. Associations of food exposures with illness were considered statistically significant at p<0.05. Among approximately 50 attendees, 30 (60%) completed the survey; 19 (63%) respondents met the case definition. The majority of commonly reported symptoms included diarrhea (17 of 18), abdominal pain (15 of 16), and headache (7 of 15).

The median interval from lunch to illness onset was 5.3 hours (range = 0.4–15.5 hours) for any symptom and 7 hours (range = 2.5–13 hours) for diarrhea. Analysis of food exposures reported by 16 ill and 10 well respondents (four respondents did not provide food exposure information) found illness to be associated with the beef dish (RR = undefined; CI = 1.06–∞; p = 0.046) (Table). All 16 ill respondents reported eating the beef. Coffee was also associated with illness; however, all 13 coffee drinkers who became ill also ate the beef. Eating cake approached significance (p = 0.051); all 10 cake eaters who became ill also ate the beef.The caterer had begun preparing all dishes the day before the lunch. Meats were partially cooked and then marinated in the refrigerator overnight. In the morning, they were sautéed 2 hours before lunch. Inspection of the facility found the limited refrigerator space to be full of stacked containers that were completely filled with cooked food, disposable gloves that appeared to have been washed for reuse, and a porous wooden chopping block.

The caterer’s four food workers reported no recent illness. Stool specimens from the food workers and from four ill attendees all tested negative for norovirus, Campylobacter, Escherichia coli O157, Salmonella, and Shigella at the Connecticut State Public Health Laboratory. All eight specimens were sent to the Minnesota Department of Health Public Health Laboratory, where additional testing was available. Two specimens from food workers were positive for enterotoxigenic Escherichia coli by polymerase chain reaction, but no enterotoxigenic E. coli colonies were isolated. Seven specimens (four from food workers and three from attendees) were culture-positive for Clostridium perfringens, and specimens from all attendees contained C. perfringens enterotoxin. Pulsed-field gel electrophoresis of 29 C. perfringens isolates from the culture-positive specimens found no matches among attendee isolates, but demonstrated a single matching pattern between two food worker specimens. No leftover food items were available for testing.

C. perfringens, a gram-positive, rod-shaped bacterium, forms spores allowing survival at normal cooking temperatures and germination during slow cooling or storage at ambient temperature (1). Diarrhea and other gastrointestinal symptoms are caused by C. perfringens enterotoxin production in the intestines. Vomiting is rare and illness is usually self-limited, although type C strains can cause necrotizing enteritis (1).

Symptoms reported were consistent with C. perfringens infection, with a predominance of diarrhea, and median diarrhea onset time was at the lower end of the typical C. perfringens incubation period (6–24 hours) (1). C. perfringens enterotoxin detection in the stool of two or more ill persons confirms C. perfringens as the outbreak etiology (2). Both C. perfringens and enterotoxigenic E. coli can colonize asymptomatic persons (3,4), which might explain the presence of these pathogens in the stools of asymptomatic food workers. Pulsed-field gel electrophoresis did not identify the C. perfringens strain responsible for the outbreak, but findings add to the evidence for a wide variety of C. perfringens strains, not all producing C. perfringens enterotoxin (5).

C. perfringens outbreaks are typically associated with improper cooling or inadequate reheating of contaminated meats (1), which might have occurred with the beef dish. The restaurant was advised about the need for adequate refrigeration and best practices for cooling foods, including using stainless steel rather than plastic containers, avoiding filling containers to depths exceeding two inches, avoiding stacking containers, and ventilating hot food. Upon follow-up inspection, staff members discarded disposable gloves after one use, used only food-grade cutting boards, and maintained proper food temperatures for hot holding, cold holding, cooling, and reheating, as outlined in the Food and Drug Administration Food Code.

An estimated 1 million illnesses in the United States each year are attributable to C. perfringens, but fewer than 1,200 illnesses are reported annually with C. perfringens outbreaks (6). C. perfringens testing is not routine for foodborne outbreaks; even if testing is unavailable, C. perfringens should be considered when improper cooling, inadequate reheating, and improper temperature maintenance of meat are identified.