Handwashing is never enough, bureaucrats have no spine: E. coli O157 from animals at Ekka edition

The EKKA, Queensland’s agricultural showpiece, concluded last week in Brisbane, about the same time an uncomfortable memory was finally published in the peer-reviewed cyber-sphere.

In Aug. 2013, 56 people became sick with E. coli O157 after contact with animals, or hanging out in the animal facility at the EKKA.

No child, or family, should have to go through grief and anguish because they took the kids to a petting zoo at the local fair.

Being repeatedly told they failed because they didn’t wash their hands is condescending. And ignores the science.

Handwashing is never enough.

At the time, a Biosecurity Australia dude said, “This highlights the importance of people practising sound hygiene measures following all contact with animals, their body fluids and excretions.”

How many want bureaucrats talking about body secretions?

As Anderson and Weese found in 2011 at a temporary petting zoo in Guelph (that’s in Canada) using video observation, 58 per cent of visitors performed some form of hand hygiene (either using water, soap and water, or hand sanitizer), and two interventions (improved signage while offering hand sanitizer, and verbal hand hygiene reminders by venue staff) were associated with increased hand hygiene compliance. U.K. health officials currently recommend handwashing stations with soap and water only (no wipes or sanitizers).

And while some studies suggest inadequate handwashing facilities may have contributed to enteric disease outbreaks or washing hands was protective against illness, others suggest relevant infectious agents may be aerosolized and inhaled.

In the fall of 2009, an E. coli O157:H7 outbreak at Godstone Petting Farm in the U.K resulted in 93 illnesses – primarily little kids.

The investigation into the Godstone outbreak identified evidence of environmental contamination outside the main barn, indicating acquisition of illness through both direct animal or fecal contact, and indirect environmental contact (e.g. contacting railings or soiled footwear).

Aerosolization of potential pathogens is also possible, as suggested in an E. coli O157:H7 outbreak at a county fair in Oregon, in which 60 people fell ill.

As part of the response to the Godstone outbreak, U.K. health types recommended handwashing stations with soap and water only (no wipes or sanitizers, because they don’t work that well under certain conditions).

Ihekweazu et al. subsequently concluded that in the Godstone outbreak, “handwashing conferred no demonstrable protective effect. …

“Moreover, from the findings of many previous published studies, it must be assumed that all petting or open farms are potentially high-risk environments for the acquisition of VTEC O157 infection (an STEC).”

This is what the Ekka folks had to say about the 2013 outbreak (which no one in Brisbane seems to know about).

The 2013 Ekka agricultural show displayed >10,000 animals and included sections where direct contact between visitors and animals could occur. The animal boulevard included a large animal nursery where visitors could pat and feed farm animals, including goats, lambs, calves, piglets, chicks, ducklings, donkeys, and turkeys. A milking demonstration took place in an area adjacent to the animal nursery and visitors were invited to milk a cow. Unpasteurized milk was not served. Visitors could also view the birth of lambs that took place in an enclosed booth. The birthed lambs were available for supervised petting after >24 h after veterinary clearance. Other animals displayed in the animal boulevard and other pavilions were less accessible to the public for direct contact. 

The number of visitors in the animal nursery was not restricted. Limited unsupervised handwashing facilities were available opposite the exit of the animal nursery. Hand sanitizers were available in other areas. Signs in animal contact areas encouraged visitors to wash their hands. Staff at the agricultural show regularly removed animal waste from animal contact areas. 

Stool samples from 56 of 57 case-patients showed identical virulence gene profiles, consisting of stx1, stx2, eaeA, and ehxA . The virulence gene profile of the remaining probable primary case-patient was only stx2 and ehxA. Twenty bovine, 4 ovine, and 2 caprine fecal samples were tested from animals traced to other properties after the show had ended. Serotype O157:H- was confirmed from 51 of the human cases, and also from ovine, caprine, and bovine feces, and the animal bedding sample. All O157:H- isolated from animal and environmental sources displayed the same MLVA profiles (6_8_2_9_4_7_8_2_3_8 and 11–7-13–4-5–6-4–9) (Technical Appendix Table 2), stx1a and stx2c subtypes, and sequence type ST11, and 2/51 of human isolates differed by 1 allele in 1 of the MLVA profiles. Although E. coli O157 has frequently been reported to belong to sequence type 11 (13), the MLVA profiles were novel to the Queensland collection of previously typed STEC isolates (n = 112). 

A table of petting zoo outbreaks is available at http://www.barfblog.com/wp-content/uploads/2017/08/Petting-Zoo-Outbreaks-Table-7-26-17.xlsx

Mild illness during outbreak of shiga toxin-producing Escherichia coli O157 infections associated with agricultural show, Australia

Emerging Infectious Diseases, vol. 23, no 10, October 2017, Bhakti R. Vasant, Russell J. Stafford, Amy V. Jennison, Sonya M. Bennett, Robert J. Bell, Christine J. Doyle, Jeannette R. Young, Susan A. Vlack, Paul Titmus, Debra El Saadi, Kari A.J. Jarvinen, Patricia Coward, Janine Barrett, Megan Staples, Rikki M.A. Graham, Helen V. Smith, and Stephen B. Lambert

https://wwwnc.cdc.gov/eid/article/23/10/16-1836_article

During a large outbreak of Shiga toxin−producing Escherichia coli illness associated with an agricultural show in Australia, we used whole-genome sequencing to detect an IS1203v insertion in the Shiga toxin 2c subunit A gene of Shiga toxin−producing E. coli. Our study showed that clinical illness was mild, and hemolytic uremic syndrome was not detected.

Erdozain G, Kukanich K, Chapman B, Powell D. 2012. Observation of public health risk behaviours, risk communication and hand hygiene at Kansas and Missouri petting zoos – 2010-2011. Zoonoses Public Health. 2012

Outbreaks of human illness have been linked to visiting settings with animal contact throughout developed countries. This paper details an observational study of hand hygiene tool availability and recommendations; frequency of risky behavior; and, handwashing attempts by visitors in Kansas (9) and Missouri (4), U.S., petting zoos. Handwashing signs and hand hygiene stations were available at the exit of animal-contact areas in 10/13 and 8/13 petting zoos respectively. Risky behaviors were observed being performed at all petting zoos by at least one visitor. Frequently observed behaviors were: children (10/13 petting zoos) and adults (9/13 petting zoos) touching hands to face within animal-contact areas; animals licking children’s and adults’ hands (7/13 and 4/13 petting zoos, respectively); and children and adults drinking within animal-contact areas (5/13 petting zoos each). Of 574 visitors observed for hand hygiene when exiting animal-contact areas, 37% (n=214) of individuals attempted some type of hand hygiene, with male adults, female adults, and children attempting at similar rates (32%, 40%, and 37% respectively). Visitors were 4.8x more likely to wash their hands when a staff member was present within or at the exit to the animal-contact area (136/231, 59%) than when no staff member was present (78/343, 23%; p<0.001, OR=4.863, 95% C.I.=3.380-6.998). Visitors at zoos with a fence as a partial barrier to human-animal contact were 2.3x more likely to wash their hands (188/460, 40.9%) than visitors allowed to enter the animals’ yard for contact (26/114, 22.8%; p<0.001, OR= 2.339, 95% CI= 1.454-3.763). Inconsistencies existed in tool availability, signage, and supervision of animal-contact. Risk communication was poor, with few petting zoos outlining risks associated with animal-contact, or providing recommendations for precautions to be taken to reduce these risks.

Cyclosporiasis – France ex Mexico

This case of cyclospora may have no relation to the Canadian outbreak; or may.

A 64-year-old French [female] with type 2 diabetes mellitus was referred to our department on [Mon 3 Jul 2017] because she was suffering from protracted diarrhea.

Symptoms began on [Sat 10 Jun 2017] as she was just returning from a touristic trip in Cancun (Quintana Roo State, Mexico) where she stayed from [Mon 29 May to Fri 9 Jun 2017] with her husband.

She acknowledged having moderate watery diarrhea with abdominal discomfort, bloating, transient vomiting, 5 kg weight [approx. 11.02 pounds] loss and fatigue. Empiric therapy with oral Metronidazole 500 mg 3 times a day for 7 days she received previously failed to improve her symptoms. Of note, a 1st microscopic stool examination failed to identify parasites and no enteropathogenic bacteria was found by culture on selective media.

Up to 3 extra stool specimens where sent to the laboratory of clinical parasitology in our hospital.

Oocysts of Cyclospora cayetanensis where evidenced by autofluorescence after Bailenger concentration technique.

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.

32,000 hospitalized over contaminated water in Turkey

The number of people hospitalized due to contaminated water in the Elbistan district of the Mediterranean province of Kahramanmaraş has risen from 5,000 to some 32,000, while a group of officials announced a norovirus infection in caisson wells within the water supply network from Ceyhan River was the cause of the contamination. 

norovirus-2“We needed to find what the microorganism causing diarrhea was and the source of it. In light of the samples we took from the patients, we determined that what caused their diarrhea was a norovirus, which means bacteria and viruses together,” Health Ministry Health Services Department General Manager İrfan Şencan told journalists at a press briefing on Aug. 29, adding it can spread very easily.

“It’s a type of virus that can cause stomach ache, nausea, vomiting, fever and diarrhea. It can spread very easily and affects a lot of people. I need to stress that in addition to the infection occurring through drinking water directly, one can be infected through several other ways including kissing, washing hands, preparing meals, shaking hands and so on,” he added. 

Şencan noted there was no issue concerning the chemical quality of the water.

 

Stomach bug outbreak at Fort McMurray wildfire evacuation centres declared over

After 307 cases of gastro-intestinal illnesses were reported at evacuation centres between May 6 and June 1, health officials declared the outbreak over Rescue-Me-Season-Monday.

Alberta Health Services said it was no longer seeing a spike in stomach illness connected to any evacuation or reception area related to the Fort McMurray wildfire.

Not everything is wrong in Kansas (just most things): FDA takes action against food manufacturer for Listeria violations

The U.S. District Court for the District of Kansas entered a consent decree of permanent injunction today between the United States and Native American Enterprises, LLC, located in Wichita, Kansas; its part-owner, William N. McGreevy; and its production manager, Robert C. Conner.

Native American Enterprises.beansThe U.S. Department of Justice brought the action on behalf of the U.S. Food and Drug Administration for significant and ongoing violations of federal food safety laws and regulations. The complaint alleges that the company’s ready-to-eat (RTE) refried beans and sauces are adulterated in that they have been prepared, packed and/or held under unsanitary conditions whereby the food may have become contaminated with filth or have been rendered injurious to health.  

Native American Enterprises, LLC is a manufacturer and distributor of a variety of food, including RTE refried beans and sauces falling under FDA jurisdiction. The consent decree prevents the company from selling FDA-regulated products until it comes into compliance with the Federal Food, Drug, and Cosmetic Act (the Act).

The FDA issued a letter to Native American Enterprises, LLC in August 2013 warning the company to promptly correct its violations or potentially face legal action. The FDA conducted several follow-up inspections of the company’s food processing facility and continued to observe unsanitary conditions at the facility, including unsanitary employee practices and persistent strains of Listeria Monocytogenes(L. mono), a dangerous human pathogen that can cause listeriosis, a life-threatening illness. People with compromised immune systems, the elderly, pregnant women, and developing fetuses are particularly susceptible to listeriosis.

The FDA used Whole Genome Sequencing (WGS) to identify persistent strains of L. mono at Native American Enterprises, LLC. WGS technology can show the relationship among isolates of bacterial pathogens found in the environment, a food source, or a person who became ill from consuming contaminated food.

“When a company repeatedly violates food safety laws and procedures they are putting the public at serious risk,” said Melinda K. Plaisier, the FDA’s associate commissioner for regulatory affairs. “The FDA took action against Native American Enterprises, LLC to protect public health, and as a result, the company’s adulterated food products are prevented from entering the marketplace.”

Native American EnterprisesUnder the consent decree, the company cannot prepare, process, manufacture, pack, and/or label FDA-regulated food products until it demonstrates that its facility and processing equipment are suitable to prevent contamination. Native American Enterprises, LLC must, among other things, retain an independent laboratory to collect and analyze samples for the presence of L. mono, retain an independent sanitation expert and develop a program to control L. mono and to eliminate unsanitary conditions at its facility. Should the company be permitted to resume operations in the future, the FDA maintains oversight over such operations under this consent decree and may order the company to take corrective actions if the agency discovers further food safety violations.

To date, no illnesses have been reported from Native American Enterprises, LLC’s products. Individuals who have eaten products purchased from the company should contact a health care professional if they experience any symptoms of listeriosis.  In addition, consumers are encouraged to contact the FDA to report problems with FDA-regulated products.

The company also manufactures meat and poultry products, which fall under U.S. Department of Agriculture (USDA) Food Safety and Inspection Service (FSIS) regulations. While the consent decree does not apply to USDA-regulated products, the FDA and USDA FSIS have and will continue to work closely together. USDA FSIS recently performed an investigation at the establishment and the company is currently operating under an FSIS enforcement verification plan when producing USDA-regulated products.

Aldi recalls smoked trout on Listeria concerns

Supermarket chain Aldi issued a recall on smoked trout products made by H. van Wijnen B.V. after Listeria was found in the product. 

forelfiletbeeld2In certain quantities (actually, U.S. has a zero tolerance) Listeria can be dangerous to a person’s health, especially to pregnant women, elderly people and those with a weakened immune system.

The smoked trout products involved are all from producer H. van Wijnen B.V. It involves 125 gram packages of smoked trout in the flavors natural, garlic and pepper.

Customers who bought these products are warned not to eat it, but to return it to any Aldi store for a refund.

Science and blogs: Gelman vs. Case-Deaton

Case and Deaton, welcome to the blogs.

french knightsProminent academics are often astonished at the rapidity with which the blogosphere occasionally pounces on and dissects their research findings. In this case, it happened to Case and Deaton, authors of a recent much-publicized study entitled “Rising morbidity and mortality in midlife among white non-Hispanic Americans in the 21st century.” The pounce was done by Phil Cohen, and – most prominently – by Andrew Gelman. 

The TL;DR version is that rising mortality in some of the subgroups spotlighted by Case and Deaton was increased by a composition effect – the average age within the subgroups increased over the observation period, which pushed up death rates for the aggregated subgroups. If you remove the composition effect, the mortality increase among these groups was considerably less.

Anne Case responded with the consternation typical of researchers first encountering blog attacks:

Case said that she didn’t buy this argument. “We spent a year working on this paper, sweating out every number, sweating out over what we were doing, and then to see people blogging about it in real time — that’s not the way science really gets done,” she said. “And so it’s a little hard for us to respond to all of the blog posts that are coming out.”

Academics are used to the cozy, staid world of academia. Responses are slow, polite, and vetted by third parties. Arguments happen in seminars, in office discussions, and at dinners. Disputes are resolved over a matter of years – when they are resolved at all. And never do intellectual adversaries take their case to the general public!

But academics are going to have to get used to blogs. The technological advances of the web have simply made it easier for crowds of outsiders to evaluate research in real time. How often that process produces the “wisdom of crowds”, and how often it merely adds unhelpful noise, remains to be seen. Certainly we’ve seen the internet do both of those things at different times. But blog criticism of research looks like something that’s here to stay, and academics whose work appears in the popular press will have to get used to it!

Blog discourse has some distinct advantages – above all, the speed of responses and the diversity of people who get involved in discussions. How often do you see two economists arguing with a sociologist and a political scientist/statistician? That’s pretty cool! There is, however, a tendency for blog debates to become too antagonistic. 

I think Andrew Gelman’s latest salvo against Case and Deaton falls into this category a bit. He is put out that Case and Deaton have, so far, refused to issue a public mea culpa about what he sees as a major gotcha. Gelman writes up what he thinks such a mea culpa should say, and includes these bits of snark:

Had it not been for bloggers, we’d still be in the awkward situation of people trying to trying to explain an increase in death rates which isn’t actually happening…We count ourselves lucky to live in an era in which mistakes can be corrected rapidly[.]

Gelman is dramatically overstating the importance of what he found! To say that the increase in death rates “isn’t actually happening”, first of all, is not quite right – Gelman’s rough-and-ready composition adjustment removes all of the increase, but more careful examination shows that some portion of the increase remains.

Second, Gelman is kind of assuming that zero is the important benchmark for what constitutes an “increase”. He makes sure to point out that the paper’s main finding – that American white mortality increased a lot relative to various comparison groups – is not changed by the composition adjustment. But when he claims that the increase “didn’t really happen”, Gelman is saying that “increase” is an absolute rather than a relative term.

Andrew, you’re a stats guy. You know full well that people analyzing time-series data detrend stuff all the time. Measuring increases relative to a trend is totally standard practice! 

So like many blog debates, this one ends up making a mountain out of a molehill. The composition effect was a useful and instructive observation, but it doesn’t really change anything about the paper’s result. And publicly demanding that the authors engage in an equally public mea culpa over such a non-issue is a little unrealistic. If it leads to rancor in the long term, that will be a shame.

I like what blogs have done for research, but I think we should work to make those discussions less about point-scoring and more about a cooperative, crowdsourced search for truth.

Salmonella spurs peanut butter recall in Philippines

The Philippines Food and Drug Administration (FDA) has announced the recall of several batches of Arrowhead Mills Peanut Butter products over possible contamination from Salmonella.

salm.arrowhead.mills.peanut.butter.14Based on FDA Advisory 2014-079, specific batches of Arrowhead Mills Creamy Organic Peanut Butter (16oz.) and Arrowhead Mills Crunchy Organic Peanut Butter (16oz.) are being recalled by its distributors One Stop Distribution Inc. and Healthy Options Corporation.

“A voluntary recall has been initiated on the specific batches of Arrowhead Mills products due to potential Salmonella contamination,” said the FDA.

Included in the recall order are Arrowhead Mills Creamy Organic Peanut Butter (16oz.) with Product Code AM47052 and Unit Bar Code 074333470328 with Expiry Dates February 4, 2015; December 31, 2014; and May 14, 2015.

Also being recalled are Arrowhead Mills Crunchy Organic Peanut Butter (16oz.) with Product Code AM47032 and Unit Bar Code 074333470526 with Expiry Dates December 31, 2014; and May 14, 2015.

“The recall involves only the specified batch under the mentioned product codes and no other Arrowhead Mills peanut butter variants and sizes are affected,” said the FDA.

Consumers that are in possession of the concerned products are being advised by the FDA to contact One Stop Distribution – Merchandising Department at 527-5555 local 4757. (Sunnex)

Chili’s restaurant cook fired for shirtless kitchen selfies in Florida

One of my favorite food writers, Tina Nguyen, reports for Mediate, that a Chili’s line cook in Florida was fired this week after photos emerged of him taking shirtless photos in a restaurant, and no, we didn’t make this story up by pulling “Dumb American Stereotypes” out of a hat.

hey.now.hankThe photos went viral after Justin Speekz (actually his real name) decided to put them on Facebook, in which he poses next to a grill and lying down on a food prep surface, in an album called “Sexy Cooks of Chili’s”.

“Chili’s clearly does not encourage this type of behavior in our restaurants. We maintain very high standards of food quality, safety and cleanliness and took immediate steps to ensure the restaurant continues to follow these requirements,” Chili’s said in a statement to ABC Action News.