Bambi poops in water, 4 kids get sick with E. coli O157, 2016

In May 2016, an outbreak of Shiga toxin–producing Escherichia coli O157 infections occurred among children who had played in a stream flowing through a park. Analysis of E. coli isolates from the patients, stream water, and deer and coyote scat showed that feces from deer were the most likely source of contamination.

In the United States, recreational water is a relatively uncommon source of Shiga toxin–producing Escherichia coli (STEC) O157 outbreaks (1). We describe an outbreak of STEC O157 infections among children exposed to a contaminated stream in northern California, USA, and provide laboratory evidence establishing wildlife as the source of water contamination.

In May 2016, four cases of Shiga toxin (Stx) 1– and 2–producing E. coli O157 infection were reported to a local health department in northern California; investigation revealed a common source of exposure. The case-patients, ranging in age from 1 to 3 years, had played in a stream adjacent to a children’s playground within a city park. Exposure of the case-patients to the stream occurred on 3 separate days spanning a 2-week period. Two case-patients are known to have ingested water while playing in the stream. Two case-patients were siblings. All case-patients had diarrhea and abdominal cramps; bloody diarrhea was reported for 3. One case-patient was hospitalized with hemolytic uremic syndrome.

The stream is a second-order waterway located in a northern California community of ≈7,500 residents. At the time of exposures, stream flow was <30 ft3/s. The land upstream is not used for agricultural activities such as livestock production. The community is serviced by a public sewer system; inspection of sewer lines indicated no breach to the system.

Water samples were collected from the exposure site 7 days after the last case-patient was exposed and weekly thereafter for 17 weeks; samples were tested quantitatively for fecal indicator organisms. Throughout the study period, all water samples exceeded recreational water quality limits for E. coli and enterococci levels (2). Water samples were also cultured for STEC isolation and PCR detection of stx1 and stx2 (3). Stx1- and Stx2-producing E. coli O157 were isolated from stream water each week for the first 4 weeks. Additionally, an Stx2-producing E. coli non-O157 strain was isolated from the stream in the first week of sampling. Enrichment broth cultures of water samples were also positive by PCR for stx1 and stx2 for the first 4 weeks of sampling. Thereafter, both stx1 and stx2, or stx2 only, were intermittently detected in enrichment broth cultures for 9 additional weeks.

In the absence of an obvious source (e.g., upstream agricultural operation or sewer leak), wildlife was considered as a possible contributor to water contamination. Thirteen fresh wildlife scat specimens were collected along the stream for STEC culture and PCR. Of the 13 scat specimens, 8 originated from deer, 2 from raccoon, and 1 each from coyote, turkey, and river otter. Six scat specimens (4 deer, 1 coyote, 1 river otter) were positive for stx1 and stx2 or for stx2 by PCR (Technical Appendix[PDF – 16 KB – 1 page]). Stx1- and Stx2-producing E. coli O157 were isolated from deer scat and coyote scat. An Stx2-producing E. coli non-O157 strain was isolated from a deer scat specimen. The animal origin of the coyote and river otter scat specimens were definitively identified by partial DNA sequencing of mitochondrial cytochrome b (4).

To assess strain relatedness, we compared STEC O157 isolates from the case-patients, water, deer scat, and coyote scat by using pulsed-field gel electrophoresis (PFGE) and multilocus variable-number tandem-repeat analysis (MLVA) (5). PFGE patterns for XbaI-digested genomic DNA were highly similar among all isolates; only slight variations were found in the lower-sized bands (Figure). PFGE patterns for genomic DNA samples digested with BlnI also demonstrated a high degree of similarity (data not shown). Furthermore, MLVA profiles were identical for the case-patient, water, and deer scat isolates; only the coyote scat isolate differed from the main profile by 2 repeats at a single locus (VNTR_3).

This study provides laboratory evidence linking STEC O157 infections with the ingestion of recreational water that was probably contaminated by wildlife scat. Wild ruminants, including deer and elk, are known carriers of STEC and have been connected to outbreaks of human infections (69). We detected STEC in 50% of deer scat specimens collected from the stream bank. One of these specimens, found 1.5 miles upstream of the exposure site, contained an E. coli O157 isolate that was highly similar by molecular subtyping to case-patient and water isolates. These findings support the likelihood that feces from deer carrying STEC were the source of water contamination or, at the very least, contributed to the persistence of STEC in the water. It is unknown whether the STEC detected in coyote and river otter scat represents carriage or transitory colonization within these animals.

The common risk factor among the case-patients in this STEC O157 outbreak was exposure to a natural stream within a city park. After the outbreak was recognized, signs warning of bacterial contamination were posted along the stream. No further STEC O157 infections attributed to stream water exposure were reported.

Dr. Probert is the assistant director for the Napa-Solano-Yolo-Marin County Public Health Laboratory. His research interests focus on the development of molecular diagnostic tools for the detection of infectious agents.

Acknowledgment

We thank Frank Reyes, Keith Snipes, and Nailah Souder for their technical assistance; the County of Marin Health and Human Services and Environmental Health Services for information about the epidemiologic and environmental investigation; and the Microbial Diseases Laboratory Branch of the California Department of Public Health and the Santa Clara County Public Health Laboratory for the molecular subtyping data.

References

Heiman KE, Mody RK, Johnson SD, Griffin PM, Gould LH. Escherichia coli O157 outbreaks in the United States, 2003–2012. Emerg Infect Dis. 2015;21:1293–301. DOIPubMed

United States Environmental Protection Agency. 2012. Recreational water quality criteria. Office of Water 820-F-12–058 [cited 2017 Apr 13]. https://www.epa.gov/sites/production/files/2015-10/documents/rwqc2012.pdf

Probert WS, McQuaid C, Schrader K. Isolation and identification of an Enterobacter cloacae strain producing a novel subtype of Shiga toxin type 1. J Clin Microbiol. 2014;52:2346–51. DOIPubMed

Parson W, Pegoraro K, Niederstätter H, Föger M, Steinlechner M. Species identification by means of the cytochrome b gene. Int J Legal Med. 2000;114:23–8. DOIPubMed

Hyytia-Trees E, Lafon P, Vauterin P, Ribot EM. Multilaboratory validation study of standardized multiple-locus variable-number tandem repeat analysis protocol for Shiga toxin–producing Escherichia coli O157: a novel approach to normalize fragment size data between capillary electrophoresis platforms. Foodborne Pathog Dis. 2010;7:129–36. DOIPubMed

Fischer JR, Zhao T, Doyle MP, Goldberg MR, Brown CA, Sewell CT, et al. Experimental and field studies of Escherichia coli O157:H7 in white-tailed deer. Appl Environ Microbiol. 2001;67:1218–24. DOIPubMed

Keene WE, Sazie E, Kok J, Rice DH, Hancock DD, Balan VK, et al. An outbreak of Escherichia coli O157:H7 infections traced to jerky made from deer meat. JAMA. 1997;277:1229–31. DOIPubMed

Rounds JM, Rigdon CE, Muhl LJ, Forstner M, Danzeisen GT, Koziol BS, et al. Non-O157 Shiga toxin–producing Escherichia coli associated with venison. Emerg Infect Dis. 2012;18:279–82. DOIPubMed

Laidler MR, Tourdjman M, Buser GL, Hostetler T, Repp KK, Leman R, et al. Escherichia coli O157:H7 infections associated with consumption of locally grown strawberries contaminated by deer. Clin Infect Dis. 2013;57:1129–34. DOIPubMed

 Contaminated stream water as source for Escherichia coli O157 illness in children

05.may.17

William S. Probert, Glen M. Miller, and Katya E. Ledin

Emerging Infectious Diseases, vol. 23, no. 7, July 2017

https://wwwnc.cdc.gov/eid/article/23/7/17-0226_article

Listeria and leafy greens

Internalin A is an essential virulence gene involved in the uptake of the foodborne pathogen Listeria monocytogenes into host cells. It is intact in clinical strains and often truncated due to Premature Stop Codons (PMSCs) in isolates from processed foods and processing facilities. Less information is known about environmental isolates.

listeria4We sequenced the inlA alleles and did Multi Locus Variable Number Tandem Repeat Analysis (MLVA) on 112 L. monocytogenes isolates from a 3-year period from naturally contaminated watersheds near a leafy green growing area in Central California. The collection contained 14 serotype 1/2a, 12 serotype 1/2b, and 86 serotype 4b strains. Twenty-seven different inlA alleles were found. Twenty-three of the alleles are predicted to encode intact copies of InlA, while three contain PMSCs. Another allele has a 9-nucleotide deletion, previously described for a clinical strain, indicating that it is still functional. Intact inlA genes were found in 101 isolates, and 8 isolates contained the allele predicted to contain the 3-amino acid deletion. Both allele types were found throughout the 3-year sampling period. Three strains contained inlA alleles with PMSCs, and these were found only during the first 3 months of the study. SNP analysis of the intact alleles indicated clustering of alleles based on serotype and lineage with serotypes 1/2b and 4b (lineage I strains) clustering together, and serotype 1/2a (lineage II strains) clustering separately. The combination of serotype, MLVA types, and inlA allele types indicate that the 112 isolates reflect at least 49 different strains of L. monocytogenes. The finding that 90% of environmental L. monocytogenes isolates contain intact inlA alleles varies significantly from isolates found in processing plants.

This information is important to public health labs and growers as to the varieties of L. monocytogenes that could potentially contaminate fresh produce in the field by various means.

The majority of genotypes of the virulence gene inlA are intact among natural watershed isolates of Listeria monocytogenes from Central California Coast

PLoS ONE 11(12): e0167566. doi:10.1371/journal.pone.0167566

http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0167566

 

Food poisoning grounds Blue Angels at California airshow

Sam Stanton of The Sacramento Bee writes the Blue Angels flight team abruptly canceled its performance Saturday afternoon at the California Capital Airshow at Mather Airport after the squadron’s commanding officer came down with a form of food poisoning.

blueangelsformationpdAir show officials announced the cancellation after determining that Cmdr. Ryan Bernacchi “contracted a foodborne ailment and is under the medical supervision of the team’s flight surgeon.”

“Cmdr. Bernacchi will be re-evaluated regularly, as the team is hopeful he will be ready to fly for the final day of the air show,” a statement from organizers stated. “At this time, the Blue Angels are scheduled to perform on Sunday as planned.”

Organizers said people who attended Saturday’s show can have their tickets honored for general admission for Sunday’s show, and parking passes will be honored with proof of purchase from Saturday or a parking stub.

The Blue Angels are the U.S. Navy’s flight demonstration squadron and stars of the two-day event at Mather, which last year drew more than 109,000 attendees to the event at the former Mather Air Force Base.

Members of the squadron were among Capital Airshow performers who participated in a Friday night “block party” in midtown where fans were able to meet air show pilots, the Sacramento Kings Dancers and take part in other entertainment.

Up until about 3 p.m. Saturday, there were no indications of problems. Before noon, the Blue Angels’ Twitter account indicated all systems were go: “Happy October, Fans! Today, we turned up and inspected the jets, making sure they were good to go for today’s California Capital Airshow.”

But word that illness had grounded the team led to fans expressing their disappointment on social media, and to a number of suppositions about the origins.

“No more gas station sushi!” one follower tweeted.

Officials investigate link between 3 children with shiga-toxin E. coli and Fairfax Creek in Calif.

Richard Halstead of the Marin Independent Journal writes two young children, one a 2-year-old Fairfax resident, have been diagnosed with a toxin-producing form of E. coli, and Marin public health officials are investigating the possibility that the source of the bacteria was a creek that runs through Peri Park in downtown Fairfax.

periparkA third child, a 3-year-old San Anselmo resident, has also displayed symptoms consistent with a diagnosis of E. coli, but tests results are still pending. The second confirmed E. coli case is a 3-year-old resident of Truckee. All three children played in Peri Park’s Fairfax Creek not long before becoming ill.

“We have not yet confirmed that water contamination is the source,” said Dr. Lisa Santora, Marin County’s deputy public health officer.

Rebecca Ng, deputy director of Marin County’s environmental health department, said, “We took water samples this morning.”

Test results from those samples weren’t available Thursday; but Santora said they will show only whether there is coliform bacteria in the creek, not whether the type of E. coli that caused these illnesses is present there. Coliform bacteria is found in the intestinal tract of humans and other animals.

Fairfax Town Manager Garrett Toy said the creek is polluted from storm drain runoff and could contain feces from dogs, deer or other animals.

“It’s a creek; there is always going to be bacteria in the creek,” Toy said. “You really shouldn’t be consuming water from the creek even if it is by accident.”

Santora said the Truckee child was the first to become ill and was hospitalized May 8-9 at Marin General Hospital. The Fairfax child became ill on May 15, and the San Anselmo child became ill on May 21.

Neither of the Marin County children have been hospitalized. Santora said she didn’t have current information on the medical condition of any of the children.

The illnesses have caused a flurry of postings on the social media site Nextdoor. According to one posting, the Truckee child was transferred to the University of California at Davis Medical Center in Sacramento after his kidneys began to fail and is responding well to intravenous therapy and blood transfusions.

Pasteurization works, and Salmonella is not a magical ingredient of raw milk

My version of the 90-10 rule: 90 per cent of time is spent on 10 per cent of participants, whether it’s hockey parents, graduate students, or public health.

napoleon.raw.milkSo once again, raw milk and cream produced by a Fresno County-based dairy company were recalled Monday due to salmonella, the California Department of Food and Agriculture said.

Salmonella was detected by the CDFA in Organic Pastures Dairy’s Raw Heavy Cream, Raw Whole Milk and Raw Skim Milk with the “USE BY” date of June 1, 2016.

The dairy products should be immediately pulled from retail shelves and consumers are urged to throw out any products in their homes, the CDFA said.

The salmonella bacteria was found during a follow-up test to an earlier recall. On May 9, Organic Pastures Dairy’s products with “USE BY” date May 18, 2016, were recalled also due to salmonella.

Red-yellow-green for Calif.’s Contra Costa restaurants

Starting with the 20 on-site inspections completed laws week, Contra Costa’’s Environmental Health Department is now giving the 4,000-some restaurants, grocery stores, delis, conveniencemarts and gas station heat-lamp operations physical placards showing whether that establishment fully passes (green) or is on “conditional” status (yellow).

placard-types-400x455If major problems like vermin infestations, lack of hot water or improper storage temperatures result in an order to close, such establishments can be assigned a red placard until the problems are solved.

For Contra Costa Environmental Health Department Director Marilyn Underwood, it’s largely a matter of consistency. Alameda County, with the exception of the city of Berkeley, has since July 2012 used a color-coded placard system much like the one Contra Costa has adopted with green (pass), yellow (conditional pass) and red (closed) given to the county’s 6,000 restaurants, grocery stores and other places food is sold.

In 2014, Santa Clara County adopted a similar system showing inspection results for its 8,000 vendors. The only Bay Area county that doesn’t do this or something similar, Underwood said, is San Francisco.

“People here live in one area and commute to other areas, and we wanted a consistent look to what people see,” she said.

Also, having a vendor’s rating posted publicly should encourage them to clean up their acts, literally, and may result in more clients reporting problems they see.

To see more about the Contra Costa placard program, go to http://cchealth.org/eh/retail-food/placard.php

More information on the Alameda County program is available at www.acgov.org/aceh/food/grading.htm

Details on Santa Clara County’s placard program can be found at www.sccgov.org/sites/cpd/programs/fsp/Pages/Placarding.aspx

Going public: 10 sick with E. coli O157 linked to raw milk in California

Apparently I wasn’t imagining when I wrote the Spongebob cone of silence – usually reserved for leafy greens, cantaloupes and sometimes tomatoes — had finally been lifted on an E. coli O157 outbreak involving raw milk in California.

spongebob.oil_.colbert.may3_.10Organic Pastures Dairy in Fresno County voluntarily recalled its raw milk in Jan. 2016 after internal tests found evidence of E. coli. The tainted milk caused at least 10 illnesses, with six of those victims reporting they drank Organic Pastures raw milk, said California Department of Public Health officials on Mar. 1, 2016.

The victims all had closely related strains of E. coli O157, the health department said.

Dairy owner Mark McAfee said that in early January the company voluntarily recalled the milk within 36 hours of determining the presence of E. coli.

At the time of the last announcement, CDPH types told Healthy Magician the state health department is continuing to investigate the outbreak, but will not provide specific details.

“The environmental investigation is ongoing. CDPH has collected a large number of samples including feces, water and raw milk, which are still undergoing evaluation at the department’s Food and Drug Laboratory Branch,” the CDPH spokesman said via email.

When they are available, the department will not release them until the investigation is finished, the CDPH spokesman said last Tuesday.

The department has not published any statements about the outbreak or investigation.

“CDPH does not routinely post in-process updates on its active investigations,” the department’s spokesman said via email. “If the public needs to be alerted about an adulterated food, CDPH will issue a Health Advisory warning consumers of the food that should be avoided.

colbert.raw_.milk_“In this case, the outbreak was identified and the voluntary recall issued by the firm after the shelf-life of the product had expired. Since no product was believed to remain in the marketplace, no health alert was issued.”

However, legal eagle Bill Marler got his hands on a summary of the investigation dated March 3, 2013. The report concludes:

Evidence collected to date, indicates that cattle in the OPDC milking herd were shedding E. coli O157 that matched PFGE patterns associated with ten illnesses in January 2016. In early January 2016, Cow 149 produced milk contaminated with E. coli O157 which may have been bottled and shipped to the public. Feces, soil, and water collected from OPDC on February 8, 2016 tested positive for E. coli O157:H7, and PFGE patterns for those isolates also matched those patterns associated with the illnesses. The collection of environmental samples from OPDC on February 8, 2016 focused on feces likely deposited on February 6, 7, and 8. It is unlikely that the positive findings from February 8, 2016 represent conditions linked entirely to Co 149. The isolation of E. coli O157:H7 and non-O157 Shiga toxin-producing E. coli from cattle used to produce raw milk for human consumption is concerning and could result in additional illness to raw milk consumers in the future if not addressed at the dairy.

Faith-based food safety: Slaughterhouse owner sentenced for selling meat from sick cattle

A California slaughterhouse owner who admitted ordering the sale of meat from ailing and uninspected cattle — leading to a nationwide recall of 8.7 million pounds of beef and veal products in 2014 — was sentenced Wednesday to a year in federal prison.

Rancho-Feeding-CorpJesse Amaral, 78, of Petaluma, former president of Rancho Feeding Corp., pleaded guilty a year ago to conspiracy to distribute adulterated and misbranded meat. Robert Singleton, owner of Rancho Veal Corp., which purchased cattle for the Petaluma slaughterhouse, and two slaughterhouse employees have also pleaded guilty and await sentencing in March.

Amaral admitted ordering employees between 2012 and January 2014 to process cattle that had been condemned by a government veterinarian — meaning they were unfit for human consumption — and to avoid full inspection of cattle suffering from epitherlioma, or eye cancer.

Prosecutors said he told the employees to deceive inspectors by putting the heads of cows that had been healthy next to the carcasses of decapitated cows that had eye cancer. He also directed employees to use carvers to remove “condemned” stamps from cattle carcasses, prosecutors said. Amaral also admitted sending fraudulent invoices to cattle farmers telling them their cattle had died or had been condemned rather than slaughtered and sold.

Why a neurotoxin is closing crab season in California

State officials have closed both recreational and commercial fishing for Dungeness and rock crab on the California coast north of Santa Barbara to the Oregon border, due to a large algae bloom that’s making the crab unsafe for consumption.

California's Dungeness crabsThe bloom, created by an organism called Pseudo-nitzschia, produces a neurotoxin called domoic acid that can build up in marine life. It causes vomiting, diarrhea and cramping in humans — and even death, in severe cases.

California’s Dungeness crabs are shipped across the U.S. and internationally, and the $60 million fishery is considered vital to the region’s small fishermen. Both the commercial and recreational fishery will open as soon as test samples show the crab is safe.

Clarissa Anderson, a research scientist at the Institute of Marine Sciences at the University of California, Santa Cruz, told NPR this bloom has been unprecedented in its extent and its persistence. It started in May and continued on to September.

The warm temperatures all along the North Pacific and off the West Coast are contributing to the persistence of this bloom and are allowing it to stay in the surface waters. We’re now starting to see that subside a little bit as we go into fall.

We know from weekly sampling that domoic acid levels, at least in the surface waters, have been coming down for the last two months. And they’re pretty low now.

The issue with the crabs is that toxin can persist in the sediments. And those crabs are feeding on all kinds of crustaceans and shrimp along the bottom. And so the crabs are bio-accumulating it in their flesh.

Campy in raw organic milk in Calif.

The California Food and Drug Administration has ordered a state-wide recall of raw milk produced by milk Organic Pastures Dairy of Fresno.

colbert.raw.milkThat recall follows a quarantine order after Campylobacter was discovered in some of the company’s milk. The CDFA reported on Friday that no illnesses have been reported from people drinking the affected milk.

Under the recall order, Organic Pastures Dairy’s grade-A, raw milk with a code date of “OCT 24” on the containers must be pulled from store helves, and consumers are urged to dispose of any of this milk remaining in their refrigerators.

The bacteria was discovered during normal testing by the CDFA of the company’s milk, the agency reports.