Be the bug, easy to figure out: Charges laid over NZ gastro outbreak

In August, 2016, 5,200 people were sickened with Campylobactor  after the Havelock North, NZ, water supply was contaminated.

vomit-dontLast week, the Hawke’s Bay District Health Board’s public health unit followed up reports of a gastro illness circulating in the community.

On Nov. 18, 2016 Hawke’s Bay Regional Council laid charges against a party for alleged offences uncovered in the course of its investigation into the contamination of Havelock North drinking water.

The charges were laid after the council investigated the source of the contamination that resulted in more than 5000 people getting sick, and the condition of water supply bores in the area.

The council said its investigations had found evidence of a breach of the maintenance conditions of the party’s resource consent. If a breach was proved, the resource consent no longer permitted the taking of water.

The council has commenced a prosecution against the party, alleging the unlawful taking of water from the aquifer arising from the alleged failure to meet well head maintenance conditions.

Council chief executive Andrew Newman said the drinking water contamination has had a devastating effect on the Havelock North community with wider regional impacts and the council was “very keen to see the cause of the contamination identified and to ensure it does not happen again”.  

He said his council had more than 15 people working on its investigations.

These included council scientists, and Environmental Science Research (ESR) with expertise in the environment, land use, water and climate, as well as dye tracing experts.

He said their investigations had included surface and groundwater quality, the bore infrastructure, water pathways in the local environment and livestock in nearby paddocks.

5530 sick 39% of residents: Health board discloses full extent of Campy in NZ water outbreak

Forty-five people, mostly over 70 were admitted to hospital with campylobacter a Hawke’s Bay District Health Board update reveals.

poop-water-nz-nov-16The DHB has conducted four surveys since the event in August, the latest on September 27 and 28, the results of which they collated with the previous findings.

The surveys were conducted by telephone and the latest figures brought the estimated total number of residents affected by gastroenteritis to 5530 or 39 per cent of Havelock North’s population, 1072 of those confirmed cases.

Of those hospitalised, as of October 10, 27 were aged over 70, followed by four in the 60-69 year age group, four in the 40-49 age group and three in the 50-59 age group.

Four people under the age of 20 also ended up in hospital.

The total number of people who had developed the rare complication from campylobacter, Guillan Barre Syndrome, was reported to be three people. As the incubation time was up to four weeks, it was considered that any new cases now would not be linked to the original outbreak.

Of the estimated 5530 residents who were affected, 32 per cent had a recurrence of the bug, and as of September 28 four people were experiencing ongoing symptoms.

At the time an estimated 78 per cent of people who had symptoms took time off work or school.

Blocking Campy’s ability to latch on

A team at Griffith University in Queensland, Australia, has found a way to disable one sensor of Campylobacter jejuni, that stops it from being able to attach to its host and therefore cause gastroenteritis.

chickenThe findings were published in Nature Communications and show a wide range of possibilities for tackling various strands of gastro, lead researcher Professor Victoria Korolik said.

“We conducted the study in chickens by disabling this particular sensor (CcrG) and we found that it does reduce the level of colonisation,” she said.

“We found this sensor (CcrG) does not occur in all strains of this bacteria, only in about 10 or 11 per cent, but those strains tend to be those isolated from really sick people such as those that have meningitis as a consequence of gastro.”

Professor Korolik described the sensor as a type of “hand” that grabbed onto a specific molecule within the stomach of its host that could lead the bacteria to cells from which to colonise and cause gastroenteritis.

“This sensor grabs a molecule, it grabs it and holds it like you would a ball in your hand and that molecule tells the bacteria they are on the right track and moving towards the right cell,” she said.

“They also have a part that goes inside the cell and sends a signal – to go forward or turn around depending on what is happening.

“Because it can find the human cells efficiently and quickly, it can attack and cause disease.”

Professor Korolik said an antimicrobial drug that acted as a synthetic “ball” could block the sensor and prevent it from finding the cell.

“If you block the hand part of the receptor, the signal is stuck and the bacteria goes around in circle and can’t find its target,” she said.

“If we can design a ‘ball’ that is a better fit than the natural one then we can block the receptor – if the bacteria can’t find its direction because it doesn’t know what else is on the environment because it is blocked and it goes around and around and is eventually passed out.”

Professor Korolik said every bacteria has a variety of sensory structures that are separate from each other which allows one sensor of one bacteria to be targetted without impacting on existing gut flora.

Campylobacter jejuni bacteria is the most common cause of food poisoning in Australia and hospitalised more than 3200 people in 2014, according to Queensland Health.

More than 500 cases have been reported in Queensland in the past month, with the gastrointestinal disease impacting 16,436 across Australia this year so far, according to the national department of health.

Campy in organic and conventional layer chickens

Poultry is a major source of Campylobacter, which can cause foodborne bacterial gastroenteritis in humans. Additionally, poultry-associated Campylobacter can develop resistance to important antimicrobials, which increases the risk to public health. While broiler chickens have been the focus of many studies, the emergence of antimicrobial-resistant Campylobacter on layer farms has not received equal attention. However, the growing popularity of cage-free and organic layer farming necessitates a closer assessment of (1) the impact of these farming practices on the emergence of antimicrobial-resistant Campylobacter and (2) layers as a potential source for the transmission of these pathogens.

chicken-thermHere, we showed that the prevalence of Campylobacter on organic and conventional layer farms was statistically similar (p > 0.05). However, the average number of Campylobacter jejuni-positive organically grown hens was lower (p < 0.05) in comparison to conventionally grown hens. Campylobacter isolated from both production systems carried antimicrobial resistance genes. The tet(O) and cmeB were the most frequently detected genes, while the occurrence of aph-3-1 and blaOXA-61 was significantly lower (p < 0.05). Farming practices appeared to have an effect on the antimicrobial resistance phenotype, because the isolates from organically grown hens on two farms (OF-2 and OF-3) exhibited significantly lower resistance (p < 0.05) to ciprofloxacin, erythromycin, and tylosin. However, on one of the sampled organic farms (OF-1), a relatively high number of antimicrobial-resistant Campylobacter were isolated.

We conclude that organic farming can potentially impact the emergence of antimicrobial-resistant Campylobacter. Nevertheless, this impact should be regularly monitored to avoid potential relapses.

Antimicrobial-resistant Campylobacter in organically and conventionally raised layer chickens

Foodborne Pathogens and Disease. September 2016, ahead of print. doi:10.1089/fpd.2016.2161.

Kassem Issmat I., Kehinde Olugbenga, Kumar Anand, and Rajashekara Gireesh

http://online.liebertpub.com/doi/abs/10.1089/fpd.2016.2161

Gross: Raw chicken sashimi: Japan’s health types urge

Takahiro Takenouchi of The Asahi Shimbun reports that chicken sashimi and “tataki” (seared chicken breasts and livers) are a common menu item in yakitori bars and restaurants across Japan.

chicken-sashimiHowever, eating undercooked or raw chicken can cause food poisoning via the campylobacter bacteria, which can cause severe stomach pain and diarrhea.

Raw beef liver and raw pork are banned, but no such restrictions have been imposed on raw chicken, despite many cases of food poisoning caused by eating tainted bird meat.

“It is not fatty, and I love it. I never worry about food poisoning,” said a 39-year-old company employee enjoying a plate of chicken sashimi at a yakitori bar in Tokyo.

The owner of the yakitori bar added, “Chicken sashimi and tataki have been some of our popular dishes since we opened (50 years ago). I am careful about campylobacter.”

The owner said she purchases chickens freshly butchered in the morning for sashimi, and the meat is boiled in hot water until the surface turns white. No cases of food poisoning have ever been reported related to her restaurant.

In June this year, the Ministry of Health, Labor and Welfare finally took action and advised regional public health centers to take steps to implement preventative measures to reduce food poisoning from raw chicken.

Although the advisory is not legally binding, the ministry printed fliers asking restaurants to change their practices.

“Re-evaluate raw and half-raw chicken menus,” the flier reads, urging restaurants to heat the meat at 75 degrees at its core for one minute.

More than 800 people complained about stomachaches or diarrhea in Tokyo and Fukuoka in April and May after eating chicken breast sashimi and chicken sushi rolls at events made by the same company.

chicken-sashimi-2The mass food poisoning in the span of two months prompted the ministry to issue its advisory.

According to ministry preliminary statistics, there were 56 cases with 395 people treated at the hospital for food poisoning from campylobacter from June to August. More than half of the identified causes were due to consuming chicken.

Another ministry report says that 67 percent of chicken meat processed for consumption tested positive for the bacteria, and freshness does not always mean safe.

 “There is a certain demand for raw chicken eating, and it is part of our food culture,” a health ministry official said.

The ministry plans to estimate the number of campylobacter infection cases that go unreported to gauge the extent of the food poisoning as it only causes minor diarrhea in some cases. In addition, the ministry seeks to implement sterilizing methods, such as rapid freezing technology or food disinfectants.

“We never expect the public to consume chickens raw,” said Teruaki Oshima with the Japan Chicken Association, which is made up of meat producers and food processing companies. “If consumers choose to eat raw chicken, they should carefully consider the risks, and the level of hygiene and credibility of the restaurant.”

Whole genome sequencing, Campylobacter and what makes people barf

High-throughput whole-genome sequencing (WGS) is a revolutionary tool in public health microbiology and is gradually substituting classical typing methods in surveillance of infectious diseases. In combination with epidemiological methods, WGS is able to identify both sources and transmission-pathways during disease outbreak investigations.

barfblog-tshirt-frontThis review provides the current state of knowledge on the application of WGS in the epidemiology of Campylobacter jejuni, the leading cause of bacterial gastroenteritis in the European Union.

We describe how WGS has improved surveillance and outbreak detection of C. jejuni infections and how WGS has increased our understanding of the evolutionary and epidemiological dynamics of this pathogen. However, the full implementation of this methodology in real-time is still hampered by a few hurdles. The limited insight into the genetic diversity of different lineages of C. jejuni impedes the validity of assumed genetic relationships. Furthermore, efforts are needed to reach a consensus on which analytic pipeline to use and how to define the strains cut-off value for epidemiological association while taking the needs and realities of public health microbiology in consideration.

Even so, we claim that ample evidence is available to support the benefit of integrating WGS in the monitoring of C. jejuni infections and outbreak investigations.

Use of whole-genome sequencing in the epidemiology of Campylobacter jejuni infections: state-of-knowledge

Ahead of print, doi: http://dx.doi.org/10.1101/078550

Ann-Katrin Llarena, Mirko Rossi

http://biorxiv.org/content/early/2016/10/01/078550

20 sick with campy linked to raw milk in Colorado

Jakob Rodgers of The Gazette reports that up to 20 people have been sickened from raw milk supplied by a ranch in Pueblo County, leading health officials to warn against drinking unpasteurized milk from the farm.

santa-barf_sprout_raw_milk7The outbreak of campylobacteriosis – an infection causing nausea and diarrhea – stems from raw milk distributed by Larga Vista Ranch, which is about 20 miles east of Pueblo, according to El Paso and Pueblo county health officials.

The infections highlight the dangers of drinking raw, unpasteurized milk, said Dr. Christine Nevin-Woods, El Paso County Public Health’s medical director.

“Sometimes people think that raw foods of all kinds are healthier,” she said. “But in this case, raw milk is very dangerous to be drinking.”

Since Aug. 1, health officials have confirmed 12 such cases and eight probable cases, according to the El Paso and Pueblo county health departments. Of those 20 people, half live in El Paso County, and half live in Pueblo County.

The infections stem from milk supplied by a herdshare program, which allows people to purchase stakes in livestock, such as cows or goats, and to receive a portion of each animal’s milk or meat.

Some of the people sickened were not part of the herdshare program. They received the milk from people who were part of it, which is now allowed, health officials said.

An after-hours call to the ranch by The Gazette was not returned.

Chlorine is your friend, but chlorinating water in Christchurch’s northwest is off the table

As the third case of Guillain-Barre Syndrome has been linked to the Campylobacter contamination of Havelock North’s water supply, New Zealand, chlorinating water in Christchurch’s northwest is off the table, for now.

eight_col_1m1a9865The Christchurch City Council went against its own staff advice and unanimously decided on Thursday not to consider temporarily chlorinating the water from eight shallow wells that feed into three pump stations, serving about 20,000 residents.

The council instead decided to accelerate a $16 million programme to replace 22 shallow bores, supplying 80,000 northwest households.

The work was originally due to be finished by June 30, 2018, but most of the wells would now be decommissioned by March 2017. Fourteen of the most vulnerable shallow wells have already either been decommissioned or shut down.

Accelerating the work would cost an additional $480,000.

The council would also embark on a programme to raise community awareness of the risks of drinking untreated water from the shallow bores.

Canterbury’s medical officer of health, Alistair Humphrey, last month asked the council to explain why its continued use of the shallow wells did not present “an untenable risk”. Humphrey’s request was prompted by a gastro outbreak caused by campylobacter in the water supplying the town of Havelock North in Hawke’s Bay.

Staff will now talk to Humphrey to see if he was satisfied with the council’s response, without chlorinating the water. They will report back to the council in November.

Water from the bores was tested for E.coli daily, but it took at least 24 hours to get the results, so there was always a 24-hour period where contamination could go undetected, council three waters and waste boss John Mackie said.

He said the council complied with the water standards, but his professional advice to the council was to chlorinate the water, which would eliminate the risk.

Mayor Lianne Dalziel asked Mackie if the risk from the shallow bores had changed in the last few years. He said no.

She said it was only the perception of risk that had been heightened since the Havelock North contamination.

 

Campy in Canada: Pets and raw milk underestimated

To inform source attribution efforts, a comparative exposure assessment was developed to estimate the relative exposure to Campylobacter, the leading bacterial gastrointestinal disease in Canada, for 13 different transmission routes within Ontario, Canada, during the summer.

sadie-dog-powellExposure was quantified with stochastic models at the population level, which incorporated measures of frequency, quantity ingested, prevalence, and concentration, using data from FoodNet Canada surveillance, the peer-reviewed and gray literature, other Ontario data, and data that were specifically collected for this study. Models were run with @Risk software using Monte Carlo simulations.

The mean number of cells of Campylobacter ingested per Ontarian per day during the summer, ranked from highest to lowest is as follows: household pets, chicken, living on a farm, raw milk, visiting a farm, recreational water, beef, drinking water, pork, vegetables, seafood, petting zoos, and fruits.

The study results identify knowledge gaps for some transmission routes, and indicate that some transmission routes for Campylobacter are underestimated in the current literature, such as household pets and raw milk. Many data gaps were identified for future data collection consideration, especially for the concentration of Campylobacter in all transmission routes.

A comparative exposure assessment of Campylobacter in Ontario, Canada

Risk Analysis, 18 Sept 2016, DOI: 10.1111/risa.126553

http://onlinelibrary.wiley.com/doi/10.1111/risa.12653/abstract

Inquiry into NZ water contamination under way

An independent inquiry into the contamination of Havelock North’s water supply will begin its work this week, the Government has announced, as a woman sickened with Campylobacter was diagnosed with symptoms confirmed as Guillain-Barre syndrome.

wellington-waterAttorney-General Chris Finlayson has also revealed the members of the inquiry, who have to report back with their findings by March next year.

Last month, the Government announced an inquiry into the Havelock North campylobacter outbreak, which has affected thousands of residents and been linked to the deaths of two elderly people.

Finlayson said the inquiry would be chaired by retired Court of Appeal judge Lyn Stevens QC.

“The members of the inquiry panel have the extensive legal, public health, local government and water management expertise required to conduct an inquiry of this nature,” Finlayson said.

The inquiry would start this week, but had until March 31 next year to report back.

It would focus on how the Havelock North water supply became contaminated and how it was dealt with, how local and central government agencies responded to the public health outbreak, and how to reduce the risk of a similar outbreak happening in future.

The latest outbreak made 5200 people sick and hospitalised 22. Two elderly women who died were found to have contracted campylobacter, but both had other health issues.

An investigation is under way to find how the bug made its way into the water. Evidence to date indicates it came from sheep or cattle and may have originated from near the bores.

So how is Wellington’s water made safe: chlorinated, fluoridated, then delivered to your glass.

Rachel Thomas of The Dominion reports that Kaitoke and Wainuiomata are home to Wellington’s two river-based water sources.

Greater Wellington Regional Council chairman Chris Laidlaw says the catchments of both the river sources in Kaitoke and Wainuiomata are in protected forest parks where there is virtually no human activity. 

“There’s no agriculture up there and very little intrusions with the water. It’s pure water we get from the hills.”

That said, all water sourced from rivers is at permanent risk of contamination from faecal or other organic matter.

That is why it is chlorinated, says Lower Hutt Deputy Mayor David Bassett, who is also chairman of Wellington Water’s governance committee.

“It’s better to err on the side of caution, and we are very risk averse when it comes to Wellington’s river water supply.”

Most of the residents in Lower Hutt, Upper Hutt, Porirua and Wellington get either chlorinated river water, or a mix of chlorinated river water and aquifer water.

The region’s confined aquifer can be found at Waiwhetu in Lower Hutt. It is the only source of unchlorinated, unfluoridated water in the region, and supplies drinking water to more than 70,000 Hutt City residents.

Water from the aquifer is free of bacteria and other contaminants, Bassett says.

That is because it is at least a year old and goes through a natural filtration process as it makes its way through the aquifer layers.

“It doesn’t need to be chlorinated, and so long as the network [of pipes] is secure, it is safe to drink at the tap – and we test the water throughout the network to make sure that it remains safe.”

Over the past year, there have been four positive E.coli tests at reservoirs in the unchlorinated network, Bassett says.

When that happens, Wellington Water notifies regional health authorities, shuts off the system, chlorinates the relevant reservoir, and re-tests the water until it is all-clear.