I love science: 28 sick from Salmonella in kratom

I go to group therapy most Fridays, because it keeps me humble.

Half are regulars, half are newbies, usually on some opioid path, of late.

The U.S. Centers for Disease Control along with public health and regulatory officials in several states, and the U.S. Food and Drug Administration (FDA) are investigating a multistate outbreak of Salmonella I 4,[5],12:b:- infections.

As of February 16, 2018, 28 people infected with the outbreak strain of Salmonella I 4,[5],12:b:- have been reported from 20 states. A list of the states and the number of cases in each can be found on the Case Count Map page. WGS performed on isolates from ill people were closely relatedly genetically. This means that people in this outbreak are more likely to share a common source of infection.

Illnesses started on dates ranging from October 13, 2017 to January 30, 2018. Ill people range in age from 6 to 67 years, with a median age of 41. Sixteen people are male. Eleven hospitalizations have been reported. No deaths have been reported.

WGS analysis did not identify any predicted antimicrobial resistance in isolates from five ill people. Testing of outbreak isolates using standard antibiotic susceptibility testing methods is currently underway in CDC’s National Antimicrobial Resistance Monitoring System (NARMS) laboratory.

Epidemiologic evidence indicates that kratom is a likely source of this multistate outbreak. Kratom is a plant consumed for its stimulant effects and as an opioid substitute. Kratom is also known as Thang, Kakuam, Thom, Ketom, and Biak.

In interviews, ill people answered questions about the foods they ate and other exposures in the months before they became ill. Eight (73%) of 11 people interviewed reported consuming kratom in pills, powder, or tea. No common brands or suppliers of kratom have been identified at this time.

At this time, CDC recommends that people not consume kratom in any form. The investigation indicates that kratom products could be contaminated with Salmonella and could make people sick. CDC’s recommendation may change as more information becomes available. This investigation is ongoing and we will provide updates as needed.

Multistate outbreak of salmonella I 4,[5],12:b- infections linked to Kratom

20.feb.18

CDC

https://www.cdc.gov/salmonella/kratom-02-18/index.html

Why we had don’t eat poop shirts in 4 languages: CDC Emergency partners and limited English proficiency

According to the U.S. Centers for Disease Control there are at least 350 languages spoken in U.S. homes (2009-2013 data).

People who have limited English proficiency can be found in all 50 states (2014 data).

About 65,00 people in the U.S. who have limited English proficiency speak Navajo or another native North American Language (2009-2013 data).

    Effective communication during an emergency can sometimes mean the difference between life and death. This is true whether communicating with those whose primary language is English or with people who have limited English proficiency. People who are limited English proficient (LEP) are those who “do not speak English as their primary language and who have a limited ability to read, speak, write, or understand English” (https://www.lep.gov/faqs/faqs.html#OneQ1).

People who are LEP can be found throughout the United States and when it comes to planning for, responding to, and recovering from disasters, considering their needs can help ensure a better emergency response. Below are some tips from our colleagues at the U.S. Department of Justice (DOJ) for reaching LEP communities in emergency preparedness, response, and recovery.

Establish policies and procedures that include language access in your emergency plan.

Identify the language groups in your area.

Ensure LEP individuals can access your programs and services.

Conduct outreach efforts.

Include LEP individuals and language access issues in training,

Provide notifications, warnings, and other information in the languages of the affected communities.

Plan for language access needs as part of survivor care.

Do not rely upon children as interpreters and translators.

For more information on how to carry out these recommendations and where to find tools to help take action, see Tips and Tools for Reaching Limited English Proficient Communities in Emergency Preparedness, Response, and Recovery.

Careful with that cow: 56 sick from Salmonella linked to contact with dairy

The U.S. Centers for Disease Control reports this outbreak investigation is over. Illnesses could continue because people may not know they could get a Salmonella infection from contact with dairy calves or other cattle.

CDC, several states, and the U.S. Department of Agriculture’s Animal and Plant Health Inspection Service (USDA-APHIS) investigated a multistate outbreak of multidrug-resistant Salmonella Heidelberg infections. Epidemiologic and laboratory evidence indicated that contact with dairy calves and other cattle was the likely source of this outbreak.

A total of 56 people infected with the outbreak strains of Salmonella Heidelberg were reported from 15 states.  Illnesses started on dates ranging from January 27, 2015 to November 25, 2017. Of those with available information:

35% of people were hospitalized. No deaths were reported.

35% of people in this outbreak are children younger than 5 years.

Epidemiologic, laboratory, and traceback investigations linked ill people in this outbreak to contact with calves, including dairy calves.

In interviews, ill people answered questions about contact with animals and foods eaten in the week before becoming ill. Of the 54 people interviewed, 34 (63%) reported contact with dairy calves or other cattle. Some of the ill people interviewed reported that they became sick after their calves became sick or died.

Surveillance in veterinary diagnostic laboratories showed that calves in several states were infected with the outbreak strains of multidrug-resistant Salmonella Heidelberg

Information collected earlier in the outbreak indicated that most of the calves came from Wisconsin. Regulatory officials in several states attempted to trace the origin of calves linked to more recent illnesses. A specific source of cattle linked to newer illnesses was not identified.

Antibiotic resistance testing conducted by CDC on clinical isolates from ill people shows that the isolates were resistant to multiple antibiotics.

Antibiotic resistance may be associated with increased risk of hospitalization, development of a bloodstream infection, or treatment failure in patients.

Whole genome sequencing analysis identified predicted antibiotic resistance in outbreak-associated isolates from 48 ill people, in 88 isolates from cattle, and in 13 isolates from animal environments.

These findings match results from standard antibiotic resistance testing methods used by CDC’s National Antimicrobial Resistance Monitoring System (NARMS) laboratory on 10 isolates from 9 ill people and 1 animal. All 10 isolates were resistant to amoxicillin-clavulanic acid, ampicillin, cefoxitin, ceftriaxone, streptomycin, sulfisoxazole, and tetracycline. In addition, nine had reduced susceptibility to ciprofloxacin, nine were  resistant to trimethoprim-sulfamethoxazole, six were resistant to nalidixic acid, four were resistant to chloramphenicol, and one was resistant to gentamicin. All 10 isolates tested were susceptible to azithromycin and meropenem.

Follow these steps to prevent illness when working with any livestock:

Always wash your hands thoroughly with soap and water right after touching livestock, equipment, or anything in the area where animals live and roam. Use dedicated clothes, shoes, and work gloves when working with livestock. Keep and store these items outside of your home.

It is especially important to follow these steps if there are children younger than 5 years in your household. Young children are more likely to get a Salmonella infection because their immune systems are still developing.

Work with your veterinarian to keep your animals healthy and prevent diseases.

It is important to remember that cattle can carry Salmonella and not appear sick. However, in this outbreak, some people did notice illness in their cattle, especially among calves. Livestock handlers should watch for sicknesses in dairy calves and consult their veterinarian if needed.

60 days don’t mean shit: 1 dead, 28 sick from E. coli O157:H7 in raw milk cheese, Canada, 2013

Between 12 July and 29 September 2013, 29 individuals in five Canadian provinces became ill following infection with the same strain of Escherichia coli O157:H7 as defined by molecular typing results. Five case patients were hospitalized, and one died.

Twenty-six case patients (90%) reported eating Gouda cheese originating from a dairy plant in British Columbia. All of the 22 case patients with sufficient product details available reported consuming Gouda cheese made with raw milk; this cheese had been produced between March and July 2013 and was aged for a minimum of 60 days. The outbreak strain was isolated from the implicated Gouda cheese, including one core sample obtained from an intact cheese wheel 83 days after production.

The findings indicate that raw milk was the primary source of the E. coli O157:H7, which persisted through production and the minimum 60-day aging period. This outbreak is the third caused by E. coli O157:H7 traced to Gouda cheese made with raw milk in North America.

These findings provide further evidence that a 60-day ripening period cannot ensure die-off of pathogens that might be present in raw milk Gouda cheese after production and have triggered an evaluation of processing conditions, physicochemical parameters, and options to mitigate the risk of E. coli O157:H7 infection associated with raw milk Gouda cheese produced in Canada.

Outbreak of Escherichia coli O157:H7 infections linked to aged raw milk gouda cheese, Canada, 2013

Andrea Currie, Eleni Galanis, Pedro Chacon, Regan Murray, Lynn Wilcott, Paul Kirkby, Lance Honish, Kristyn Franklin, Jeff Farber, Rob Parker, Sion Shyng, Davendra Sharma, Lorelee Tschetter, Linda Hoang, Linda Chui, Ana Pacagnella, Julie Wong, Jane Pritchard, Ashley Kerr, Marsha Taylor, Victor Mah, and James Flint

Journal of Food Protection, vol. 81, No. 2, 2018, pg. 325-331

doi:10.4315/0362-028X.JFP-17-283

https://www.ncbi.nlm.nih.gov/pubmed/29369688

PR before publication still a bad idea: Food safety on TV doesn’t go out of style

If you were deserted on a desert island, what would be the top 5 records/CDs/cassettes/8-tracks you would bring?

Stones, Beggar’s Banquet

Stones, Let it Bleed

Tragically Hip, Up to Here

Blue Rodeo, 5 Days in May

Old and in the Way

Just a suggestion.

I’m spit-balling here.

Repetition is the norm. Karl Popper had something to say about that.

In 2004, my laboratory reported (and by reported I mean published in a peer-reviewed journal) that, based on 60 hours of detailed viewing of television cooking shows, an unsafe food handling practice occurred about every four minutes, and that for every safe food handling practice observed, we observed 13 unsafe practices. The most common errors were inadequate hand washing and cross-contamination between raw and ready-to-eat foods.

Once the paper was published, it made headlines around the globe.

And then it started getting replicated. Texas, Europe, a few other places, and Massachusetts.

Now Germany.

BfR is presenting a research project on the topic of TV kitchen hygiene at International Green Week.

I’ve e-mail the folks at BfR who published this stuff and asked them whether it was peer-reviewed or not.

That was last week.

No answer.

Maybe something was lost in translation.

There were errors on average every 50 seconds, with the most common being dirty hands wiped on a tea towel and chopping boards being reused without first being cleaned.

They then tested two groups of participants making chicken salad with home-made mayonnaise based on a cooking video – one of which showed a chef who followed recommendations and another which showed a cook with poor hygiene. 

Those shown the video with the exemplary kitchen hygiene complied with the recommended measures more frequently when cooking the dish by themselves.

Prof Hensel added: “The results show that the kitchen hygiene presented in cooking shows may have an influence on the hygiene behaviour of the viewers.

“TV cooking shows can therefore take on a role model function by sharpening awareness of kitchen hygiene instead of neglecting it.”

Keep on spit-balling.

Mathiasen, L.A., Chapman, B.J., Lacroix, B.J. and Powell, D.A. 2004. Spot the mistake: Television cooking shows as a source of food safety information, Food Protection Trends 24(5): 328-334.

Consumers receive information on food preparation from a variety of sources. Numerous studies conducted over the past six years demonstrate that television is one of the primary sources for North Americans. This research reports on an examination and categorization of messages that television food and cooking programs provide to viewers about preparing food safely. During June 2002 and 2003, television food and cooking programs were recorded and reviewed, using a defined list of food safety practices based on criteria established by Food Safety Network researchers. Most surveyed programs were shown on Food Network Canada, a specialty cable channel. On average, 30 percent of the programs viewed were produced in Canada, with the remainder produced in the United States or United Kingdom. Sixty hours of content analysis revealed that the programs contained a total of 916 poor food-handling incidents. When negative food handling behaviors were compared to positive food handling behaviors, it was found that for each positive food handling behavior observed, 13 negative behaviors were observed. Common food safety errors included a lack of hand washing, cross-contamination and time-temperature violations. While television food and cooking programs are an entertainment source, there is an opportunity to improve their content so as to promote safe food handling.

17 sick from hepA in Denmark linked to dates

Since the end of January, the State Serum Institute has investigated a disease outbreak of contagious hepatitis caused by hepatitis A virus infections. This indicates that the source of infection may be dates, and the case is further investigated in collaboration with the Danish Veterinary and Food Administration and the DTU Food Institute. The outbreak is the second national food-borne outbreak of hepatitis A in Denmark.

The outbreak thus includes 17 patients, nine women and eight men aged 17 years. Patients have become ill from December 2017 onwards. Patients are resident throughout the country and 16 have been hospitalized. Virus from seven of the patients has been type-approved for type 3A, and for the time being, genetic studies have shown that four of these are identical, which supports the suspicion of a common source of infection. It is still expected that more patients will come, as about four weeks from eating the contaminated dates until you get sick with hepatitis A.

To investigate the source of infection for the outbreak, the State Serum Institute has conducted extensive interviews with patients and made a so-called case-control study. During the initial interviews, dates, as several of the patients indicated to have eaten, were suspected. The correlation between dates and disease risk was then investigated in the case-control study. Here you compare how often patients have eaten a number of specific foods with similar information from a comparable group of healthy Danes. 

The results have shown that the source of infection was most likely to have been dates since patients had far more eaten this food than the comparable group of healthy Danes. The dates are described by most patients as soft dark stones with stones purchased in Rema1000. The results were handed over to the Danish Veterinary and Food Administration, The importer and Rema1000 chose to withdraw the dates on 6 February .

The likelihood of infectious hepatitis infection caused by infection with Hepatitis A virus by eating dates from Rema1000 is considered very small. Therefore, there is no need to consult a doctor if you have no symptoms of hepatitis A infection.

If you have eaten Rema1000 dadels after 1 December 2017 and develop symptoms of hepatitis such as nausea, madness, abdominal pain, vomiting, diarrhea or fever without any other obvious causes or yellowing of the skin and the whites of the eyes, light colored dye and / or dark , porter-colored urine, consult your own doctor. 

Raw is risky, for pets and humans

I have never fed any of my dogs or cats raw pet food.

They may eat each other’s poop, but I control what I can control.

The U.S. Food and Drug Administration is alerting pet owners to a history of four recalls of and multiple complaints associated with Darwin’s Natural and ZooLogics pet foods, manufactured by Arrow Reliance Inc., dba Darwin’s Natural Pet Products, over the period from October 17, 2016 to February 10, 2018. In each instance, the company recalled these products after being alerted to positive findings of Salmonella and/or Listeria monocytogenes in samples of their raw pet food products.

In its most recent recall, on February 10, 2018, Arrow Reliance/Darwin’s Natural recalled ZooLogics Duck with Vegetable Meals for Dogs (Lot #41957) and ZooLogics Chicken with Vegetable Meals for Dogs (Lot #41567) because the products may be contaminated with Salmonella and therefore have the potential to cause salmonellosis in humans and animals. The company states that it only sells its products online through direct-to-consumer sales.

The FDA has investigated six complaints of illness and death in animals that have eaten the recalled products.

Arrow Reliance/Darwin’s Natural has notified its customers directly of the recalls, but has so far not issued any public notification announcing this or any of the previous recalls.

This issue is of particular public health importance because Salmonella can make both people and animals sick.

As part of an ongoing investigation into complaints associated with products manufactured by Arrow Reliance/Darwin’s Natural of Tukwila, WA, the FDA has confirmed that new samples of Darwin’s Natural Pet Products raw pet foods have tested positive for Salmonella. These raw pet foods include ZooLogics Duck with Vegetable Meals for Dogs Lot #41957 and ZooLogics Chicken with Vegetable Meals for Dogs Lot #41567.

The latest recall was triggered by a complaint of an adult dog that had recurring diarrhea over a nine-month period. The dog tested positive for Salmonella from initial testing by the veterinarian and by follow-up testing by the FDA’s Veterinary Laboratory Investigation and Response Network (Vet-LIRN). The Darwin’s Natural raw pet food that the dog had been fed was also positive for Salmonella.

Arrow Reliance/Darwin’s Natural is aware of the dog’s illness and the positive results and initiated a recall on February 10, 2018 by directly notifying its customers via email. The firm has not issued a public recall notice.

Since October 2016, Arrow Reliance/Darwin’s Natural has initiated four recalls and had six reported complaints (some referring to more than one animal) associated with their raw pet food products, including the death of one kitten from a severe systemic Salmonella infection. The Salmonella isolated from the kitten was analyzed using whole genome sequencing and found to be indistinguishable from the Salmonella isolated from a closed package from the same lot of Darwin’s Natural cat food that the kitten ate.

In addition to reports of illnesses associated with Salmonella contamination in the products, the FDA is aware of complaints of at least three animals who were reportedly injured by bone shards in the Darwin’s Natural raw pet food products.

‘Multiple illnesses’ Salmonella cases in Iowa linked to Fareway chicken salad

The Iowa Department of Public Safety (IDPH) and Iowa Department of Inspections and Appeals issued a consumer advisory Tuesday for chicken salad sold at Fareway stores.

The chicken salad, which is produced and packaged by a third party for Fareway, is implicated in multiple cases of salmonella illness across Iowa. Preliminary test results from the State Hygienic Laboratory (SHL) at the University of Iowa indicate the presence of salmonella in this product.

Fareway voluntarily stopped the sale of the product and pulled the chicken salad from its shelves after being contacted by DIA. “The company has been very cooperative and is working with IDPH and DIA in the investigation of the reported illnesses,” said DIA Food and Consumer Safety Bureau Chief Steven Mandernach, who noted that no chicken salad has been sold to the consuming public since last Friday evening (2/9/18).

IDPH is investigating multiple cases of possible illness associated with the chicken salad. “The bottom line is that no one should eat this product,” said IDPH Medical Director, Dr. Patricia Quinlisk. “If you have it in your refrigerator, you should throw it away.”

But what does gastro mean? Outbreak hits University of Queensland students

I don’t know what it is about Australians, whether it’s some pseudo-inherited British culture of hierarchy, or just dumbness, but lately, any outbreak of barfing and pooping is called a gastro outbreak.

As in gastroenteritis.

There are microbiology labs in Australia, so figure it out, and let people know.

Janelle Miles of The Courier Mail reports 20 students at two University of Queensland residential colleges have fallen ill with gastroenteritis in the middle of orientation week.

The students are residents of King’s College and Grace College at UQ’s St Lucia campus in Brisbane’s west.

They have been quarantined separated from other students to avoid the infection spreading.

Was it foodborne? Are there any epidemiologists in Australia? Is anyone investigating?