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

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

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

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

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

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

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

Focus on poop: NZ splash parks, AUS child cares, terrible people

A mystery pool pooper – or poopers – has struck again at an Invercargill, NZ swimming pool.

i.poop.youIt is the sixth Friday in a row someone has defecated in a swimming pool at the centre.

In the first instance a “smidgen” of faeces was discovered in the leisure pool at the Splash Palace Aquatic Centre about 4.30pm.

Aquatic Centre manager Pete Thompson said swimmers had been removed from the pool and extra chlorine had been added to the water but he believed this incident to be “an unfortunate coincidence”.

“The mode is dissimilar to anything else we have had. It was a very tiny 10 cent piece-size which suggests it probably came out of a baby’s togs,” he said.

He did not know if the poos were deliberate.

“How do you prove something is deliberate unless you catch them in the act?

“I hope whoever this person is, if it’s deliberate, ceases to behave in this manner. It’s disgusting.

In Australia, some childcare centres are sending kids home with their poo and undergarments in labelled plastic bags.

If a kid stocks the lake with brown trout (in their undies), it’s a health and safety issue. There is a chance of cross-contamination in sinks and fecal matter flicking up into a worker’s eyes. So instead of putting it in the teeny tiny toilets, the childcare workers just bag the undies up, log and all, name them and put them with the other packages of joy for the parents to deal with upon pick up.

We should also spare a thought for those who live in warmer climates. There would be some serious fermentation going on in those plastic bags.

And in Washington State an 8-year-old girl received a package of animal poop, perhaps an anonymous form of bullying.

caddyshack.pool.poop-1Oddly enough, there are some companies that specialize in these sort of deliveries.

When Jamie Villanueva’s daughter opened the package, she thought someone sent her chocolate ice cream.

“And when I saw it, my heart just sunk,” Villanueva said.

Her worst suspicious however, turned out to be true.

“So I opened it and inside it has feces,” Villanueva said. “A container of feces.”

The container came with a calling card from a company called “I Poop You.” According to its website it specializes in packaging and delivering animal waste as a joke.

“I get it. I have a sense of humor. I think it’s very clever of the company,” Villanueva said. “But it’s really inappropriate with children.”

There are several websites that offer poop delivery and there doesn’t seem to be any specific law against it.

Gettin’ shiggy wit it: There’s a lot of Shigella being shared at child care centers in Missouri

Unfortunately no one in the public knows exactly where though.

According to the Columbia Tribune reported cases of shigellosis is more than 4 times the expected rate in the Columbia area, and most illnesses are linked to child care settings.

The Columbia/Boone County Department of Public Health and Human Services reports 25 cases of shigellosis, also called shigella, occurring in the past two weeks. Spokeswoman Andrea Waner said the department has averaged six cases a year for the past five years.dirty-hands-medium-new

Waner said most of the cases involve children attending day care. The Missouri Code of State Regulations prohibits her from identifying the locations, she said.

Michelle Baumstark, spokeswoman for Columbia Public Schools, said the district had only one case, several weeks ago. The student was the sibling of a child who was in day care at a location where shigella was reported.

She said because school-age children are toilet trained there isn’t a big concern about the illness spreading in the schools.

A couple of years ago I collaborated with Clemson’s Angie Fraser on a set of USDA NIFA funded food safety and infection factsheets for childcare facilities including using exclusion of ill staff and children as an outbreak control measure. The sheets can be downloaded here and hereAngie just published a bunch of the observation work that led to the the factsheets in the American Journal of Infection Control (abstract below). The work provides some insight on how pathogens might move around a center.

An observational study of frequency of provider hand contacts in child care facilities in North Carolina and South Carolina

jan.15

American Journal of Infection Control 43 (2015) 107-11

Angela Fraser, Kelly Wohlgenant, Sheryl Cates, Xi Chen, Lee-Ann Jaykus, You Li, Benjamin Chapman

Background: Children enrolled in child care are 2.3-3.5 times more likely to experience acute gastrointestinal illness than children cared for in their own homes. The purpose of this study was to determine the frequency surfaces were touched by child care providers to identify surfaces that should be cleaned and sanitized.

Methods: Observation data from a convenience sample of 37 child care facilities in North Carolina and South Carolina were analyzed. Trained data collectors used iPods (Apple, Cupertino, CA) to record hand touch events of 1 child care provider for 45 minutes in up to 2 classrooms in each facility.

Results: Across the 37 facilities, 10,134 hand contacts were observed in 51 classrooms. Most (4,536) were contacts with porous surfaces, with an average of 88.9 events per classroom observation. The most frequently touched porous surface was children’s clothing. The most frequently touched nonporous surface was food contact surfaces (18.6 contacts/observation). Surfaces commonly identified as high- touch surfaces (ie, light switches, handrails, doorknobs) were touched the least.

Conclusion: General cleaning and sanitizing guidelines should include detailed procedures for cleaning and sanitizing high-touch surfaces (ie, clothes, furniture, soft toys). Guidelines are available for nonporous surfaces but not for porous surfaces (eg, clothing, carpeting). Additional research is needed to inform the development of evidence-based practices to effectively treat porous surfaces.

Reason to use different colored bottles: 28 children accidentally drink bleach at N.J. day care

Twenty-eight children and two adults accidentally drank bleach at a day care center in Jersey City on Thursday, according to officials.

the_first_bleach_bottle_by_thebleachbottle-d5h2xeyThe children, aged 3 and 4, were evaluated and taken from the day care center, Growing Tree II, to Jersey City Medical Center-Barnabas Health. The children were in stable condition and expected to be released to their parents, officials said.

“We don’t think the amount they ingested is significant,” said hospital spokesman Mark Rabson.

Hospital officials were not clear how or why bleach was ingested by the children and staff.

Dr. Steven M. Marcus, the executive director of New Jersey Poison Information and Education System, said such accidents are fairly common. Hotels, restaurants and other food service outlets are required to regularly sanitize certain areas, and often use bleach and water as the solution. Despite warnings by the poison center against it, workers will often put the solution in a container — such as a brand-name water bottle or gallon jug — that can be mistaken for water.

Irish child care remains closed to assist E. coli cleaning

A childcare facility in Cavan remains closed for cleaning following an outbreak of E. coli over four weeks ago. In a statement to Northern Sound News, the HSE say there have been factors relating to the cleaning and the fabric of the crèche that have been outside of the control of the Health Executive and under the control of the crèche management.

daycare_children_pictures_242_op_800x533The HSE was notified of the latest case of E. coli at the childcare facility in Cavan over one month ago. It followed a confirmed case of a similar infection in another child in the same facility in April. The Health Service Executive says no source was identified for the infection in the previous case.

Irish childcare facility closed due to E. coli outbreak

A childcare facility in county Cavan will remain closed until the area is cleaned following an outbreak of verotoxigenic E. coli.

HSE-300x162The Health Service Executive says that they were notified of a case of E. coli in a child at the facility in county Cavan. It followed a confirmed case of a similar infection in another attendee at the same facility back in April. The HSE was notified of the latest case of E. coli in a child at this facility over three weeks ago. It followed a confirmed case of a similar infection in another attendee at the same childcare facility back in April. The Health Service Executive says no source was identified for the infection in the previous case.

10 sick, two hospitalized in UK E. coli day care outbreak

Two children are in hospital after a suspected E. coli outbreak at a nursery in Cheshire.

sorenne.nurseryPublic health officers said the children, who both go to the Chrysalis Day Nursery in Northwich, were being treated at Leighton Hospital due to “complications.”

In total, seven children and three family members had shown symptoms of the infection, the officers added.

Children and staff at the nursery are being screened as a precaution.

Regulations do not equal enforcement, and (partly) why the other parents hate me: reptile- and amphibian-associated Salmonellosis in childcare centers

Sorenne starts a new kindy at the end of Jan. 2013, which is the end of summer in Brisbane.

Because it’s now the beginning of summer (google schoolies and Gold Coast), I went to an information meeting last night for new parents, which was also the annual general meeting and incredibly dull.

My neighbors already refer to me as grumpy, but this was over the top; and I had an engineer friend to share our collective quinquagenarian grumpiness.

We were the only two 50-somethings in the crowd; the other parents probably thought we were the grandparents of our respective 4-year-olds (and that’s apparently going to happen soon enough).

I haven’t heard such nonsense about sustainability since I had to debate self-proclaimed environmentalist types about genetically engineered foods 12 years ago.

(I was told by a current child care type this morning that every center is working sustainability into everything to comply with government funding requirements; yet they still require vast amounts of paperwork because e-mail is somewhat baffling, and that paper has to be protected in a plastic enclosure; my friend said they must go through a lot of toner.)

We heard about all the things the kids did in the past year, like plant a garden and harvest and eat their own produce, the beehive they established, how they had potlucks with exotic foods, and all the reptiles they got to pet over the year.

But when the nice lady talked about how they had a nude food policy – food without packaging, and encouraged healthy foods, but that refrigeration was only offered for lunches — I dutifully raised my hand.

“My daughter arrives at 8 a.m., and you want healthy snacks, like produce, but afternoon tea isn’t until around 2ish so that’s six hours at room temperature. Isn’t there a health risk there?”

Three parents immediately chimed in and said, don’t be dumb, just put it in a little cooler.

I’d like to see the verification studies of microbial growth on cut produce in one of those coolers and six hours of temperature abuse (it gets a little hot here in the summer; and spring; and fall).

I didn’t pursue the issue any further, but earned the wrath and derision of a bunch of use-stereotype-here-like-hippie-yuppie-earthtone parents who will hate me next year.

I love my work.

And this report from Emerging Infectious Diseases will get passed on to the kindy.

Salmonella spp. infection represents a major public health problem in the United States; nearly 1.4 million human cases and 600 associated deaths are reported each year (1). Reptile and amphibian exposures might cause >70,000 of these cases annually (2). Furthermore, children are at increased risk of acquiring Salmonella spp. and experiencing severe manifestations of disease (3,4). Given the increasing popularity of reptiles and amphibians as pets, reptile- and amphibian-associated salmonellosis is a substantial public health concern (5).

The public has a generally low level of awareness that Salmonella spp. can be acquired from reptiles and amphibians (6); a poll conducted by the US Centers for Disease Control and Prevention (CDC) during 2003 showed that as few as 4 of 49 states require pet stores to provide information about salmonellosis to persons purchasing reptiles (4). A Food and Drug Administration ban, activated in 1975, on the sale of small turtles subsequently prevented an estimated 100,000 cases of salmonellosis in children each year (7). To further reduce the risk of reptile- and amphibian-associated salmonellosis, the CDC has issued recommendations advising that children <5 years of age avoid contact with reptiles and amphibians and that these animals not be kept in childcare centers. The CDC also recommends that all persons wash their hands after handling reptiles and amphibians (8).

We reviewed the regulations as of December 2011 for childcare centers in all US states aimed at preventing reptile- and amphibian-associated salmonellosis. To gather these data, we searched the websites for each state’s public health department or the state’s equivalent of an early childhood learning agency. When searches on the Internet did not yield the desired information, the appropriate state agencies were contacted by phone or email. In some instances, we corresponded with the designated State Public Health Veterinarian.

Overall, only 50% of states had regulations that required staff and/or children to wash their hands after touching any animals in childcare centers. Twelve states banned reptiles from childcare centers; 3 of these 12 states also banned amphibians, and these were the only states we found to have banned amphibians from childcare centers. While some states did not allow potentially dangerous or harmful animals in childcare centers, a minority of these states went further to expressly ban reptiles as well (of the 23 states that banned potentially dangerous or harmful animals, 8 states also banned reptiles). One state (Colorado) explicitly banned reptiles, amphibians, and potentially dangerous or harmful animals from childcare centers and also required staff and children in the center to wash their hands after touching animals.

This survey has several limitations. Given the ambiguity in the language used in some regulations and that the language was not standardized between states, we might have misinterpreted some of the documents we reviewed. Furthermore, we might have unintentionally overlooked regulations that were already in place during our investigation, and hence our findings might underestimate the true number of states that have such policies. In some cases, cities and counties have regulations that provide increased protection beyond those implemented at the state level.

In summary, we found great variation between state regulations for childcare centers aimed at reducing transmission of Salmonella spp. from reptiles and amphibians to humans. The discrepancy in the regulations of states that banned potentially dangerous or harmful animals from childcare centers but that did not also specifically ban reptiles and amphibians was paradoxical, considering the well-recognized risk that these animals pose for transmitting Salmonella spp. We do not know how many childcare centers across the United States currently house reptiles or amphibians. However, our data suggest that there is room for revision of the regulations in many states which could in turn augment efforts to prevent Salmonella spp. transmission from reptiles and amphibians. We believe that the recommendations issued by the CDC for the prevention of salmonellosis from reptiles and amphibians (4) could serve as a practical guide as state regulations are updated. Our own experience has indicated that greater collaboration between public health organizations and the agencies responsible for setting regulations for childcare centers can be informative and productive. Similarly, state agencies can work with the pet industry and childcare centers to develop approaches that are mutually beneficial.

Although pets provide many benefits to humans, particularly during the early years of life (9), any exposure that children have to animals must pose minimal risk to the children’s health. Ultimately, keeping reptiles and amphibians out of childcare centers and requiring that staff and children wash their hands after touching animals offers a simple way to better safeguard the health of children while having a minimal effect on practices of childcare centers.

Neil M. Vora , Kristine M. Smith, Catherine C. Machalaba, and William B. Karesh

Author affiliations: Author affiliations: Columbia University, New York, New York, USA (N.M. Vora);EcoHealth Alliance, New York (N.M. Vora, K.M. Smith, C.C. Machalaba, W.B. Karesh)

Acknowledgments

We thank Casey Barton Behravesh, Carina Blackmore, Bryan Cherry, John Dunn, Karl Musgrave, Joni Scheftel, Sally Slavinski, Faye Sorhage, and Carl Williams for their clarification on state and national regulations aimed at reducing the risks of salmonellosis and their advice on conducting this survey. We also thank members and staff of the National Association of State Public Health Veterinarians and the National Resource Center for Health and Safety in Child Care and Early Education for their assistance.

This survey was generously funded by the Mars Foundation and New York Community Trust.

References

Mead PS, Slutsker L, Dietz V, McCaig LF, Bresee JS, Shapiro C, Food-related illness and death in the United States. Emerg Infect Dis. 1999;5:607–25. DOIPubMed

Mermin J, Hutwagner L, Vugia D, Shallow S, Daily P, Bender J, Reptiles, amphibians, and human Salmonella infection: a population-based, case-control study. Clin Infect Dis.2004;38(Suppl 3):S253–61. DOIPubMed

Mermin J, Hoar B, Angulo FJ. Iguanas and Salmonella Marina infection in children: a reflection of the increasing incidence of reptile-associated salmonellosis in the United States. Pediatrics.1997;99:399–402. DOIPubMed

Centers for Disease Control and Prevention. Reptile-associated salmonellosis—selected states, 1998–2002. MMWR Morb Mortal Wkly Rep. 2003;52:1206–9 .PubMed

Pickering LK, Marano N, Bocchini JA, Angulo FJ. Exposure to nontraditional pets at home and to animals in public settings: risks to children. Pediatrics. 2008;122:876–86. DOIPubMed

Centers for Disease Control and Prevention. Multistate outbreak of human SalmonellaTyphimurium infections associated with aquatic frogs—United States, 2009. MMWR Morb Mortal Wkly Rep. 2010;58:1433–6 .PubMed

Cohen ML, Potter M, Pollard R, Feldman RA. Turtle-associated salmonellosis in the United States. Effect of Public Health Action, 1970 to 1976. JAMA. 1980;243:1247–9. DOIPubMed

Centers for Disease Control and Prevention. Turtle-associated salmonellosis in humans—United States, 2006–2007. MMWR Morb Mortal Wkly Rep. 2007;56:649–52 .PubMed

National Association of State Public Health Veterinarians, Inc. Compendium of measures to prevent disease associated with animals in public settings, 2011: National Association of State Public Health Veterinarians, Inc. MMWR Recomm Rep. 2011;60(RR-04):1–24.

Gotta keep ’em separated: cohorting can be effective in limiting spread in childcare facilities

Jack made it through his first child care season without much disease excitement —  just a little bit of pink eye and a couple of runny noses.  Child care facilities are notorious illness-spreading sites; children and care providers pass around pathogens like rotavirus, norovirus, Shigella and E. coli. As hand hygiene usually isn’t the best in these facilities, outbreaks are often started by or extended by ill people (staff included) showing up while shedding. Cohorting (separating the already sick from the healthy) can be an effective way to limit spread.

Except sick kids aren’t always kept home and staff don’t always stay away.

In an early-release article in Pediatric Infectious Disease, investigators of an outbreak of E. coli O26:H11 linked to a Colorado child care center say that it could have been worse had health authorities hadn’t pushed for cohorting. Part of the strategy was to test every staff member and child for STEC – those who were carrying the bug were separated from those who weren’t. Sixty percent of the kids and staff at the center were carrying the outbreak strain (41 ill – 4 asymptomatically) and health authorities aggressively kept sick folks away until they stopped shedding.

Some gems for child care providers from the abstract:

– The median duration of shedding among symptomatic confirmed cases was 30.5 days.

– The risk of being a case as in children <36 months was twice the risk among children 36-47 months.

– Nearly half (49%) of the household contacts of confirmed cases developed a diarrheal illness.

Outbreak of Shiga toxin-producing Escherichia coli serotype O26: H11 infection at a child care center in Colorado
20.dec.11
Pediatric Infectious Disease Journal
Brown, Jennifer A. DVM, MPH; Hite, Donna S. BS; Gillim-Ross, Laura A. PHD; Maguire, Hugh F. PHD; Bennett, Janine K. MS; Patterson, Julia J. BA; Comstock, Nicole A. MSPH; Watkins, Anita K. MPH; Ghosh, Tista S. MD, MPH; Vogt, Richard L. MD
Background: Shiga toxin-producing Escherichia coli (STEC) O26:H11 is an emerging cause of disease with serious potential consequences in children. The epidemiology and clinical spectrum of O26:H11 are incompletely understood. We investigated an outbreak of O26:H11 infection among children younger than 48 months of age and employees at a child care center.
Methods: Every employee at the center (n=20) and every child <48 months (n=55) were tested for STEC and administered a questionnaire. Thirty environmental health inspections and site visits were conducted. A cohorting strategy for disease control was implemented.
Results: Eighteen confirmed and 27 suspect cases were detected. There were no hospitalizations. The illness rate was 60% for children and for employees. The risk of being a case as in children <36 months was twice the risk among children 36-47 months (risk ratio: 2.10; 95% confidence interval: 1.00, 4.42). The median duration of shedding among symptomatic confirmed cases was 30.5 days (range: 14-52 days). Four (22%) confirmed cases were asymptomatic and 3 (17%) shed intermittently. Nearly half (49%) of the household contacts of confirmed cases developed a diarrheal illness. The outbreak was propagated by person-to-person transmission; cohorting was an effective disease control strategy.
Conclusions: This was the largest reported outbreak of O26:H11 infection in the United States and the largest reported non-O157 STEC outbreak in a U.S. child care center. Non-O157 STEC infection is a differential diagnosis for outbreaks of diarrhea in child care settings. Aggressive disease control measures were effective, but should be evaluated for outbreaks in other settings.