Again, 11 sick: Blame the consumer Hong Kong edition

The Centre for Health Protection (CHP) of the Department of Health is today (January 19) investigating an outbreak of food poisoning affecting 11 persons, and reminded the public to maintain personal, food and environmental hygiene to prevent food-borne diseases.

The patients, comprising one man and 10 women aged 63 to 76, developed abdominal pain, nausea, vomiting, diarrhoea and fever about 12 to 26 hours after having lunch at a restaurant at Lau Fau Shan in Yuen Long on January 7.

Five of them sought medical attention, of whom one required hospitalisation but was discharged upon treatment. The stool specimen of that patient tested positive for Vibrio parahaemolyticus. All affected persons are now in stable condition.

Cilantro has a history of shits: Produce risk modelling in India

This study estimates illness (diarrhea) risks from fecal pathogens that can be transmitted via fecal-contaminated fresh produce. To do this, a quantitative microbial risk assessment (QMRA) framework was developed in National Capital Region, India based on bacterial indicator and pathogen data from fresh produce wash samples collected at local markets.

Produce wash samples were analyzed for fecal indicator bacteria (Escherichia coli, total Bacteroidales) and pathogens (Salmonella, Shiga-toxin producing E. coli (STEC), enterohemorrhagic E. coli (EHEC)). Based on the E. coli data and on literature values for Cryptosporidium and norovirus, the annual mean diarrhea risk posed by ingestion of fresh produce ranged from 18% in cucumbers to 59% in cilantro for E. coli O157:H7, and was <0.0001% for Cryptosporidium; for norovirus the risk was 11% for cucumbers and up to 46% for cilantro. The risks were drastically reduced, from 59% to 4% for E. coli O157:H7, and from 46% to 2% for norovirus for cilantro in post-harvest washing and disinfection scenario.

The present QMRA study revealed the potential hazards of eating raw produce and how post-harvest practices can reduce the risk of illness. The results may lead to better food safety surveillance systems and use of hygienic practices pre- and post-harvest.

Quantitative microbial risk assessment to estimate the risk of diarrheal diseases from fresh produce consumption in India

Food Microbiology, January 2018

Arti Kundu, Stefan Wuertz, Woutrina Smith

DOI: 10.1016/j.fm.2018.01.017 

http://www.x-mol.com/paper/530702

Eating sushi can be risky

I dry heaved when I read this…..

Michelle Robertson of SF Gate reports

A Fresno man with a daily sushi habit had a 5.5-foot tapeworm lodged in his intestines. He pulled it out himself, wrapped it around a cardboard toilet paper tube and carried the creature into Fresno’s Community Regional Medical Center.
Kenny Bahn was the lucky doc on shift at the time. He recounted his experience on a recent episode of the podcast “This Won’t Hurt A Bit.”
Bahn said the patient complained of “bloody diarrhea” and expressed a desire to get treated for tapeworms.
“I get asked this a lot,” the doctor said. “Truthfully, a lot of times I don’t think they have it.”
This man had it, which he proved to Bahn by opening a plastic grocery bag and pulling out the worm-wrapped toilet paper tube.
Bahn then asked some questions, starting with: “That came out of your bottom?”
“Yes.” 
According to the doctor’s retelling, the patient was using the restroom when he noticed what looked like a piece of intestine hanging out of his body.
Doctors in Taiwan extracted an 8-and-a-half foot tapeworm from a girl’s intestine and believe she contracted the parasite through raw, contaminated fish.
“He grabs it, and he pulls on it, and it keeps coming out,” Bahn recounted. He then picks the thing up, “looks at it, and what does it do? It starts moving.” (Note: At this point in the podcast, the hosts audibly gasp.)
That’s when the man realized he had a tapeworm stuck in his insides. He headed to the emergency room shortly thereafter, where Bahn treated him with an anthelmintic, a single-treatment deworming medication used on humans and dogs alike.
Bahn also took it upon himself to measure the specimen on the floor of the hospital. It stretched a whopping 5 feet, 6 inches — “my height,” noted the doctor.
Tapeworms can be contracted in a variety of ways, but Bahn said his patient hadn’t traveled out of the country or engaged in any out-of-the-ordinary behavior. The man also professed his love of sushi, specifically raw salmon sashimi, which he confessed to eating daily.
Fresno is located an ample 150 miles from coastline and is not exactly famed for its sushi. The Centers for Disease Control and Prevention warned last February that the rise in popularity of raw fish consumption has likely spurred a recent increase of tapeworm infections.

 

Raw is risky: Oysters strike down victims in Louisiana, Hong Kong

A Texas woman who spent a day along the Louisiana coast crabbing with friends and enjoying oysters found herself fighting for her life just 36 hours later, KLFY-TV reported.

Jeanette LeBlanc contracted a deadly flesh-eating bacteria called Vibrio that day, resulting in her death a few weeks later.

LeBlanc’s symptoms started out similar to an allergic reaction. In fact, that’s what she suspected it was before doctors told her otherwise. She had red patches of a rash on her legs and experienced respiratory issues before the symptoms worsened, KLFY reported.

The Centers for Disease Control and Prevention said the bacteria that causes Vibriosis creates 80,000 cases of illness in the United States each year and 100 deaths. The Vibrio bacteria live in coastal waters, those where oysters also live. The oysters contract the bacteria by filtering water to feed and the bacteria ends up in the tissues of the oyster, then when someone like LeBlanc eats it raw, they also contract the bacteria.

In Hong Kong, the Centre for Health Protection (CHP) of the Department of Health today (December 29) reported its investigations into three food poisoning outbreaks suspected to be related to the consumption of raw oysters in three different restaurants.

They involve:

  1. One man and two women, aged from 25 to 39, who have developed abdominal pain, diarrhea and vomiting about 11 to 50 hours after having lunch (including raw oysters) in a restaurant in Yau Ma Tei on December 17. All sought medical attention;

2.Two women, aged from 36 to 37, who have developed similar symptoms about 30 to 33 hours after having dinner (including raw oysters) in a restaurant in Kowloon Bay on December 19. Both sought medical attention; and

  1. One man and three women, aged from 22 to 24, who have developed similar symptoms about 16 to 59 hours after having dinner (including raw oysters) in a restaurant in Tsim Sha Tsui on December 25.

One sought medical attention.

Raw water: It’s a thing

In Australia, communities at the suburb level have the power to decide whether to fluoridate water or not.

Every time I go to the dentist, he tells me the same story: I can tell where you’re from by your teeth, no fluoride means more business for me.

In an America dominated by indulgence, privilege and the nonsensical, raw water is a thing.

Nellie Bowles of the New York Times writes at Rainbow Grocery, a cooperative in Culver, Oregon, one brand of water is so popular that it’s often out of stock. But one recent evening, there was a glittering rack of it: glass orbs containing 2.5 gallons of what is billed as “raw water” — unfiltered, untreated, unsterilized spring water, $36.99 each and $14.99 per refill, bottled and marketed by a small company called Live Water.

“It has a vaguely mild sweetness, a nice smooth mouth feel, nothing that overwhelms the flavor profile,” said Kevin Freeman, a shift manager at the store. “Bottled water’s controversial. We’ve curtailed our water selection. But this is totally outside that whole realm.”

Here on the West Coast and in other pockets around the country, many people are looking to get off the water grid.

Start-ups like Live Water in Oregon and Tourmaline Spring in Maine have emerged in the last few years to deliver untreated water on demand. An Arizona company, Zero Mass Water, which installs systems allowing people to collect water directly from the atmosphere around their homes, began taking orders in November from across the United States. It has raised $24 million in venture capital.

And Liquid Eden, a water store that opened in San Diego three years ago, offers a variety of options, including fluoride-free, chlorine-free and a “mineral electrolyte alkaline” drinking water that goes for $2.50 a gallon.

What adherents share is a wariness of tap water, particularly the fluoride added to it and the lead pipes that some of it passes through. They contend that the wrong kind of filtration removes beneficial minerals. Even traditional bottled spring water is treated with ultraviolet light or ozone gas and passed through filters to remove algae. That, they say, kills healthful bacteria — “probiotics” in raw-water parlance.

The quest for pure water is hardly new; people have been drinking from natural springs and collecting rainwater from time immemorial. The crusade against adding fluoride to public water began in the 1950s among Americans who saw danger in the protective measures that had been adopted over decades to protect the populace from disease and contamination.

But the off-grid water movement has become more than the fringe phenomenon it once was, with sophisticated marketing, cultural cachet, millions of dollars in funding and influential supporters from Silicon Valley.

Food safety in hospitals: Chemotherapy patients may be ill because they aren’t aware of the food poisoning risks (and neither are the food service types)

It’s no secret I have my share of demons, but I’ve always shared them publicly, (whether you wanted to know or not; if you don’t, go start your own blog and stop reading mine).

Every Friday, on average, I am fortunate enough to go to a place called Damascus at the Brisbane Private Hospital, where a group of 10-15 of us sit and tell stories and get better.

Some people have been sober for 10 years.

Some are straight out of the detox ward upstairs.

I’m somewhere in between.

But I value this community of lawyers, doctors, vets – both the military and animal kind – financial planners and people who just got lost along the way.

When Bill Leiss asked me to write a second edition of my first book, Mad Cows and Mothers Milk, I quoted a Neil Young line: “Heart of Gold put me in the middle of the road. Traveling there soon became a bore so I headed for the ditch.”

The ditch trilogy stands up strong 45 years later, and was featured during Neil’s solo show in Omemee, Ontario (that’s in Canada) a few weeks ago.

To add insult to injury, his next studio recording was the harrowing “Tonight’s The Night”, though with a perversity that was becoming typical of him the latter wasn’t released until after the subsequently-cut “On The Beach”. Both albums stand up strongly to this day. Both use the rock format as a means of redemption and rejuvenation, the very act of recording (no overdubs) serving as therapy. “Tonight’s The Night” and “On The Beach” were pretty free records,” Young pondered, lighting another unfiltered Pall Mall. 

“I was pretty down I guess at the time, but I just did what I wanted to do, at that time. I think if everybody looks back at their own lives they’ll realise that they went through something like that. There’s periods of depression, periods of elation, optimism and scepticism, the whole thing is…. it just keeps coming in waves. 

You go down to the beach and watch the same thing, just imagine every wave is a different set of emotions coming in. Just keep coming. As long as you don’t ignore it, it’ll still be there. If you start shutting yourself off and not letting yourself live through the things that are coming through you, I think that’s when people start getting old really fast, that’s when they really age. 

‘Cause they decide that, they’re happy to be what they were at a certain time in their lives when they were the happiest, and they say ‘that’s where I’m gonna be for the rest of my life’. From that minute on they’re dead, y’know, just walking around. I try to avoid that.”

I can’t swim, but the quote above encapsulates why I like being near the beach.

I’m no Neil Young, but I do have my passions, like safe food, so when Brisbane Private Hospital keeps serving funeral home sandwiches loaded with raw sprouts, I say something.

No change, though the hospital is serving an immunocompromised population.

As Ellen W. Evans, junior research fellow, Cardiff Metropolitan University, writes in The Conversation, chemotherapy treatment can reduce immune function and the body’s ability to defend against opportunistic pathogens. It is well documented that people undergoing chemotherapy are at an increased risk of infection, including those transmitted via food.

This is not just about suffering through a tummy bug. People who are already undergoing the gruelling side effects of chemotherapy can be made seriously ill simply because the food they are eating isn’t being handled properly at home. Added to that is the fact that foodborne infection could cause delays in treatment, and potentially increase patient mortality.

But the problem is not down to patients’ laziness. In our newly published research, we have found that they are not being given consistent information, nor do they recognise the serious risks that food can pose.

In our study, we investigated the availability and adequacy of food safety information available to UK cancer patients. We looked at online food-related resources, and conducted in-depth interviews with patients and their families on their food experiences during chemotherapy treatment.

Although some food safety information exists for chemotherapy patients, their access to it is limited. In total, we found just 45 resources online that related to food safety. These included 35 from the 154 NHS chemotherapy providers in England, Scotland and Wales, the Department of Health, and three from 184 identified UK cancer charities.

Looking at the content, 67% of the food-related information resources we identified included food safety advice – for example, “ensure eggs are thoroughly cooked”. Guidance on hand decontamination routines, such as hand washing, was most frequently included (49%). But information on how to reduce the risk of listeriosis, or safe alternatives to particular foods – such as unpasteurised dairy products, and raw or under-cooked meat – were lacking.

Most worryingly, we found that some of the online advice actually promoted potentially unsafe practices. For example, some suggested eating lukewarm food, when this temperature range can encourage bacteria growth.

The most comprehensive food safety resources that we found were tailored to the needs of neutropenic patients – those that have very low levels of white blood cells – but these are unlikely to be given to, or accessed by, all people undergoing chemotherapy.

An assessment of food safety information provision for UK chemotherapy patients to reduce the risk od foodborne infection

Public Health, December 2017, vol. 153, pg 25-35, E.W. Evans, E.C. Redmond, DOI: http://dx.doi.org/10.1016/j.puhe.2017.06.017

http://www.publichealthjrnl.com/article/S0033-3506(17)30220-2/fulltext

Objectives

Given the increased risk of foodborne infection to cancer patients receiving chemotherapy treatment, and the risk of listeriosis reportedly five-times greater to this immunocompromised patient group, there is a need to ensure the implementation of domestic food safety practices among chemotherapy patients and their family caregivers. However, information regarding the adequacy of resources to inform and enable patients to implement domestic food safety practices to reduce the risk of foodborne infection is limited. Consequently, this study aimed to evaluate the provision of food safety information available to UK chemotherapy patients.

Study design

In-depth semi-structured interviews and content analysis of online patient information resources.

Methods

Interviews with patients and family caregivers (n = 15) were conducted to explore food-related experiences during chemotherapy treatment. Online food-related information resources for chemotherapy patients (n = 45) were obtained from 35 of 154 National Health Service chemotherapy providers in England, Scotland, and Wales, the Department of Health (DoH) and three of 184 identified UK cancer charities. Identified food-related information resources were reviewed using a content-analysis approach to assess the inclusion of food safety information for chemotherapy patients.

Results

In-depth interviews established that many patients indicated awareness of immunosuppression during treatment. Although patients reported practicing caution to reduce the risk of communicable diseases by avoiding crowded spaces/public transport, food safety was reported to be of minimal concern during treatment and the risk of foodborne infection was often underestimated. The review of online food-related patient information resources established that many resources failed to highlight the increased risk of foodborne infection and emphasize the importance of food safety for patients during chemotherapy treatment. Considerable information gaps exist, particularly in relation to listeriosis prevention practices. Cumulatively, information was inconsistent, insufficient, and varied between resources.

Conclusion

The study has identified the need for an effective, standardized food safety resource specifically targeting chemotherapy patients and family caregivers. Such intervention is essential to assist efforts in reducing the risks associated with foodborne infection among chemotherapy patients.

Neil Young – 2017-12-01 Coronation Hall, Omemee, Ontario, Canada [720p] from JoeRay Skrha on Vimeo.

 

 

Steam with your melons? If it makes produce safer, why not

Abstract

The purpose of this study was evaluation of the effectiveness of superheated steam (SHS) on inactivation of foodborne pathogens on cantaloupes and watermelons.

Saturated steam (SS) treatment was performed at 100 °C and that of SHS at 150 and 200 °C. Escherichia coli O157:H7, Salmonella Typhimurium and Listeria monocytogenes-inoculated cantaloupes and watermelons were exposed for a maximum of 30 s and 10 s, respectively. Populations of the three pathogens on cantaloupes and watermelons were reduced by more than 5 log after 200 °C steam treatment for 30 s and 10 s, respectively. After SHS treatment of cantaloupes and watermelons for each maximum treatment time, color and maximum load values were not significantly different from those of untreated controls. By using a noncontact 3D surface profiler, we found that surface characteristics, especially surface roughness, is the main reason for differences in microbial inactivation between cantaloupes and watermelons. The results of this study suggest that SHS treatment can be used as an antimicrobial intervention for cantaloupes and watermelons without inducing quality deterioration.

Comparison of the effect of saturated and superheated steam on the inactivation of Escherichia coli O157:H7, Salmonella Typhimurium and Listeria monocytogenes on cantaloupe and watermelon surfaces, Korea, April 2017 to October 2017, Food Microbiology, Volume 72

Sun-Ah Kwon, Won-Jae Song, Dong-Hyun Kang

http://www.sciencedirect.com/science/article/pii/S0740002017303805?_rdoc=1&_fmt=high&_origin=gateway&_docanchor=&md5=b8429449ccfc9c30159a5f9aeaa92ffb&ccp=y

Raw camel milk in US

Whenever someone writes, “frozen in Kansas” I think, that could have been me.

Ice storms and stuff.

And being a professor.

Making lots of money, going with the flow, and checking my brain at the door – on the few days I showed up.

So I decided to support my wife – although I’ve been a bit of a dick about it for the last 6 years – and move to Australia, eventually ending my career.

Although I do have a new job with the least amount of responsibility possible.

I’m having my American Beauty moment (but not chasing after younger girls, quite happy, and she noted it’s been 12 years since we first met).

So when raw milk advocate David Gumpert writes about raw camel milk and how the U.S. Food and Drug is asking the federal court to allow it to seize more than $70,000 worth of raw camel milk, some of it frozen, in storage in Kansas, and there’s some government conspiracy, I cast aspersions.

The agency had warned the owner of a small Missouri farm, which accounts for the bulk of raw camel milk production in the U.S., — of course it is in Missouri — to refrain from shipping it outside that state. The owner had reportedly agreed to the FDA’s order.

Now, a number of media are reporting that the FDA is asking a federal court to allow it to seize raw camel milk from the farm, known as Hump-Back Dairys, along with that of a national distributor of camel milk, Desert Farms.

Waste of time. Move on.Keep moving on.

Fancy food ain’t safe food: New York edition

One of New York’s most expensive restaurants is in some trouble with the Food and Drug Administration over its fresh fish.

John Tozzi of Bloomberg writes that Masa, which earned three Michelin stars for its $595 tasting menu (before drinks and tax), received a warning letter from the FDA dated Oct. 16 alleging violations of federal rules that govern seafood imports. “Your fresh trevally and fresh Katsuwonus pelamis (Katsuo), also known as skipjack tuna or bonito,” the agency wrote in a letter published online this week, “have been prepared, packed, or held under insanitary conditions whereby they may have been rendered injurious to health.”

“We take FDA regulations very seriously and, of course, food safety is always a priority. We are working closely with our purveyors in Japan to get this resolved quickly,” said Tina Clabbers, a representative for Masa, in an email.

While the the FDA doesn’t typically regulate individual restaurants, the agency has jurisdiction over seafood importers. Inspectors visited Masa on June 22, according to the letter, which redacted the name of the restaurant’s fish supplier.

The letter doesn’t specify the precise nature of the violation, and a spokesperson in the FDA’s New York district office was not available for comment.

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