Raw is risky: Ceviche source of V. cholera 01 in Minn

As we drove the five hours yesterday to Sawtell, NSW, for a week of (ice) hockey for Sorenne, and some R&R for me and Amy (mainly me), Amy was telling me about this one time, she went to Senegal (they speak French) in 2005, and the hosts offered her Tang but she didn’t want to drink it because she had been warned about the water.

Turns out there was an on-going cholera outbreak.

I was driving and thought, should I tell her that cholera is a member of the Vibrio genus?

I kept driving.

Today, while Sorenne is working it on the ice, I’m catching up and came across this report from friends at the Minnesota Department of Health (MDH) published by the U.S. Centers for Disease Control.

On August 20, 2016, the Minnesota Department of Health (MDH) was notified of a case of Vibrio cholerae infection. The isolate was identified as serogroup O1, serotype Inaba at MDH. CDC determined that the isolate was nontoxigenic. The patient was a previously healthy woman, aged 43 years, with history of gastric bypass surgery. On August 16, she experienced profuse watery diarrhea, vomiting, abdominal cramps, and headache. On August 18, she sought care and submitted the stool specimen that yielded the V. cholerae isolate. She reported no recent travel. However, she had consumed ceviche made with raw shrimp and raw oysters at restaurant A on August 14, 49 hours before illness onset. Her husband had a similar illness with a similar incubation period after eating the same foods at restaurant A.

On August 22, MDH sanitarians visited restaurant A and obtained tags and invoices for oyster and shrimp products; the oysters were a product of the United States, and the shrimp was a product of India. Sanitarians also gathered patron contact information and credit card receipts for August 12–14. Two additional patrons reported experiencing a gastrointestinal illness that met the case definition of three or more episodes of watery stool in a 24-hour period within 5 days of eating at restaurant A; one reported eating ceviche and oysters at restaurant A. Review of complaints to the MDH foodborne illness hotline revealed a previous complaint from two persons who reported experiencing watery diarrhea after eating raw shrimp ceviche (but no oysters) at restaurant A on August 2. These persons did not provide stool specimens, but their gastrointestinal illnesses met the case definition, resulting in a total of six cases, including one laboratory-confirmed case. No other V. cholerae O1 Inaba cases were reported in the United States during this outbreak.

The Minnesota Department of Agriculture facilitated sampling of shrimp at the distributor from the same lots served at restaurant A on August 14, and most likely during August 2–13, and sent them to the Food and Drug Administration for culture. Shrimp samples yielded V. cholerae non-O1, non-O139, but V. cholerae O1 was not isolated. In response to the outbreak results, restaurant A placed consumer warnings on their menus about the risks of consuming raw or undercooked food items and identified raw menu items for consumers. Restaurant A also focused on other actions that might facilitate reduction of V. cholerae, including appropriate freezing of food items, and allowing raw food items to soak in lime juice before being served, rather than serving the items immediately after adding lime juice (1,2).

V. cholera has over 150 serogroups and has been identified in a wide range of aquatic life, including seafood (3). Whereas multiple serogroups can cause vibriosis, only serogroups O1 and O139 that also contain the cholera toxin are classified as causes of cholera (4). Previous studies have documented the presence of nontoxigenic V. cholerae O1 from environmental and shrimp samples in India and Southeast Asia (5–7).

This outbreak of domestically acquired, nontoxigenic V. cholerae infections, likely from shrimp consumption, included the first V. cholerae O1 case identified in a nontraveler in Minnesota since active surveillance for Vibrio began in 1996. Since 1996, MDH has detected 26 V. cholerae infections, 21 (81%) of which were non-O1, non- O139, and five of which were O1. Among the four O1 type cases identified before the current outbreak, all patients had a recent travel history to Micronesia or India. This outbreak demonstrates the importance of investigating all seafood eaten by patients with vibriosis. In addition, investigators should include nontoxigenic V. cholerae as a possible etiology of domestic foodborne outbreaks, particularly when foods eaten include those from V. cholerae O1–endemic areas.

Notes from the field: Vibrio cholerae Serogroup O1, Serotype Inaba — Minnesota, August 2016

CDC MMWR

Victoria Hall, Carlota Medus, George Wahl, Alida Sorenson, Melanie Orth, Monica Santovenia, Erin Burdette, Kirk Smith

https://www.cdc.gov/mmwr/volumes/66/wr/mm6636a6.htm?s_cid=mm6636a6_e

 

E. coli O157 claims sister; brother remains critical in Minn.

Two siblings, Kade and Kallan Maresh from Maple Lake, Minnesota, were stricken with E. coli O157, possibly after visiting a petting zoo.

The family’s Caring Bridge site broke the sad news on Sunday when it reported that Kallan lost her battle with the deadly strain.

Bill Hudson of CBS Minnesota reports she died one week after shiga toxin-producing E. coli O157 raced through her young body.

“It’s very serious, potentially fatal,” says George Canas, M.D., with Kidney Specialists of Minnesota.’

The state Health Department is investigating where the E. coli exposure was. Possibly, something as simple as a trip to a petting zoo and transferring the bacteria onto the child’s hands and their mouth. It’s also common to acquire an exposure by eating unsanitary meat, produce or dairy.

The severe case eventually claimed Kallan’s life just a week after she was rushed to Masonic Children’s Hospital. Fortunately, her older brother, Kade, continues his fight, although his situation remains extremely serious.

Petting zoo: Minnesota 10-year-old awarded $7.55 million in E. coli settlement

Maury Glover of Fo 9 reports a jury awarded $7.5 million to a Rosemount, Minnesota family after a young girl contracted E. coli from a petting zoo at Dehn’s Pumpkins in Dayton.

emma-rosemount-girl-e-coli_1479962267763_2325612_ver1-0_640_360In 2013, Emma Heidish spent a month overcoming a potentially deadly form of kidney disease which cause her kidneys to shut down and required surgery and near constant dialysis.

On Tuesday, a Hennepin County jury found the owners of the farm where she got E. coli, Dehn’s Pumpkins in Dayton, negligent for not taking steps to prevent their animals from transmitting diseases and awarded Emma $7.5 million.

Emma was one of seven people sickened in an October 2013 E. coli O157:H7 outbreak linked by the Minnesota Department of Health to cows in the animal attraction  at Dehn’s Pumpkins, LLC, a business located in Dayton, MN.

The bulk of the money is for future medical bills and pain and suffering.

“It is one of the largest verdicts in the country for an E. coli outbreak for a condition like this one and its one of the largest involving a petting zoo case,” Emma’s attorney, Fred Pritzker, said. “The people who run the pumpkin patch are decent people. It’s not that they were mean spirited. But, what they didn’t know caused a great deal of pain and suffering for my clients.”

Since the outbreak, the popular pumpkin patch no longer operates a petting zoo, but Pritzker sais animal attractions like it are not regulated or inspected.

His firm will push for a new law, named after Emma, requiring petting zoos to follow safety precautions, like having hand washing stations nearby to help prevent the spread of the disease.

“There have been 150 to 200 cases of outbreaks involving animals in public settings in the last 15 years, Pritzker said

Pritzker says Emma probably won’t see all the money because the farm’s insurance doesn’t have that much coverage.

A table of petting zoo outbreaks (which needs to be updatd) is available at http://barfblog.com/wp-content/uploads/2014/04/Petting-Zoo-Outbreaks-Table-4-8-14.xlsx

Minneapolis sees rise in foodborne illness from nororvirus, Vibrio in oysters

When I think Minnesota, I think raw oysters.

No, I never think that about anywhere.

raw.oysters.minnJeremy Olson of the Star Tribune reports that city health inspectors in Minneapolis are investigating a summer increase in foodborne illnesses related to norovirus and Vibrio, a bacteria found in raw oysters.

The increases were highlighted in the city’s “food establishment” newsletter, released Thursday.

“The reason for the spike in norovirus outbreaks is not known,” the advisory stated. “The Vibrio outbreaks are due to higher concentrations of bacteria in some oyster beds during the summer.”

Cases of norovirus, a highly contagious bug that causes severe vomiting and diarrhea, are not required to be reported to the Minnesota Department of Health, but the state agency has received reports of a slight uptick that is unusual for this time of year.

Sanitation sucks: Federal court orders Minnesota sprout and noodle company to cease operations

On July 15, 2016, the U.S. District Court for the District of Minnesota entered a consent decree of permanent injunction between the United States and Kwong Tung Foods, Inc., doing business as Canton Foods; its president and owner, Vieta “Victor” C. Wang; and its vice-president, Juney H. Wang, for significant and ongoing violations of the Federal Food, Drug, and Cosmetic Act (FD&C Act) and its implementing regulations. The business, located in Minneapolis, Minnesota, sells rice and wheat noodles, and mung bean and soy bean sprouts.

Canton 2The U.S. Department of Justice brought the action on behalf of the FDA. The complaint that accompanied the consent decree alleges that Kwong Tung Foods, Inc. has an extensive history of operating under unsanitary conditions in violation of current Good Manufacturing Practice (cGMP) regulations and the FD&C Act. The FDA conducted multiple inspections, most recently in 2014 and 2015, and the FDA investigators observed repeated unsanitary conditions, including, rodent excreta pellets too numerous to count, improper cleaning, mold-like substances on equipment, failure to prevent cross-contamination from allergens and improper employee sanitation practices. Despite receiving a Warning Letter and participating in regulatory meetings with the FDA, Kwong Tung Foods, Inc., and Victor and Juney Wang failed to take adequate corrective actions to ensure the safety of their food. Additionally, the FDA worked with the Minnesota Department of Agriculture (MDA) to resolve this matter.

“The FDA expects food companies to follow cGMP regulations, and when a company does not address violations and sanitary protocols are being neglected, it poses potentially hazardous conditions,” said Melinda K. Plaisier, the FDA’s associate commissioner for regulatory affairs. “The FDA is taking the necessary actions to protect consumers and the U.S. food supply.”

Food, especially produce, is vulnerable to contamination with pathogenic microorganisms if exposed to unsanitary conditions during growing, harvesting, packing, holding or manufacturing, processing or transportation. Rodents in a facility are an additional cause for concern as they can sometimes carry and transfer bacteria and pathogenic microorganisms, like Salmonella, onto food. Salmonella can cause serious and sometimes fatal infections in young children, frail or elderly people, and others with weakened immune systems.

As a result of this action, Kwong Tung Foods, Inc. is prohibited from directly or indirectly receiving, processing, manufacturing, preparing, packing, holding, and/or distributing any article of food at or from its facility. If Kwong Tung Foods Inc. intends to resume operations, the company must notify the FDA, and, among other requirements, retain an independent food safety expert to ensure Kwong Tung Foods, Inc. has and implements, to the FDA’s satisfaction, an appropriate written Sanitation Control Program. If it resumes operations, Kwong Tung Foods, Inc. must also retain an independent laboratory to conduct analyses of its food processing environment and food products, and provide employee training on sanitation and appropriate food handling techniques.

Although no illnesses have been reported in connection with Kwong Tung Foods Inc., consumers with complaints about any FDA-regulated products can report problemsto their district office consumer complaint coordinator.

The FDA, an agency within the U.S. Department of Health and Human Services, protects the public health by assuring the safety, effectiveness, and security of human and veterinary drugs, vaccines and other biological products for human use, and medical devices. The agency also is responsible for the safety and security of our nation’s food supply, cosmetics, dietary supplements, products that give off electronic radiation, and for regulating tobacco products.

Stop playing with Just Bare chicken: In-house tampering behind need to recall 27 tons

In-house tampering is being blamed for GNP Co. of central Minnesota recalling more than 27 tons of chicken over the weekend after contaminants were detected in some of the product that was distributed primarily to food service and institutional outlets.

Just-Bare-Chicken-1The recall involving the Gold’n Plump and Just Bare brands by the Upper Midwest’s leading chicken manufacturer follows the company disclosing the discovery of sand and black soil in the chicken. GNP is the parent of the popular Gold’n Plump brand.

“Our own inspections turned it up,” said Lexann Reischl, a GNP spokeswoman, “and two food service customers called and told us they found the same material.”

In a statement issued Sunday afternoon, the company said, “Extraneous foreign matter … is linked to an isolated product tampering incident that occurred at the company’s Cold Spring processing plant the week of June 6.”

An employee, who has since been fired, is believed to be behind the contamination, Reischl said.

Cold Spring Police Sgt. Jason Blum said Sunday “there is a known suspect” being investigated, but an arrest has not been made.

We never had a problem: 10 sick with crypto linked to Minn. farm visit

The Litchfield Independent Review reports the Minnesota Department of Health is investigating an outbreak of diarrheal illness possibly linked to school students visiting Nelson Farm southwest of Litchfield.

girl with rabbitMore than 10 cases of diarrheal illness, including three confirmed cases of Cryptosporidium infection, have been reported from five different schools. In all cases, individuals had taken field trips to Nelson Farm, according to a health advisory issued by the agency May 26.

On the morning of May 26, Department of Health officials visited the farm to tour its facilities, according to Nelson Farm owner Don Nelson.

“Right now we don’t even know if it came from our farm,” he said. “We won’t know until next week (when the test results come back).”

Outbreaks associated with farm animal contact may include multiple pathogens including Salmonella, Campylobacter, Shiga toxin-producing E. coli (STEC), and Cryptosporidium, the health advisory states. The incubation period for these illnesses range from 12 hours to as long as 14 days.

Don said he was informed the evening of May 25 of the possible outbreak, which came as a surprise to both himself and his wife, Sonja.

“We’ve done this for 30 years, and we have never ever have been called on this before,” Sonja said.

“We won’t deny that there is chance we wouldn’t have anything because everything has bacteria,” she added, but emphasized that the Department of Health has not confirmed whether Nelson Farm caused the outbreak.

topleftDon said Department of Health officials were impressed with the overall state of the farm, noting that they had positive comments on the farm’s hand washing areas and where visitors eat.

“I’m very, very concerned because we want to make it a healthy experience on the farm,” Don said. “That’s our goal.”

Since being notified by the state, Don has called all the schools that visited Nelson Farm since May 9 to see if children have gotten sick, one of which was the School of St. Philip.

Nearly 20 kindergarten, first-grade and second-grade students at the School of St. Philip visited the farm May 23 for their annual spring field trip.

“At this point we have not heard of any instances associated with that outbreak,” Principal Michelle Kramer said.

While on the farm, students toured an old barn, visited animals, played in the hay barn and had lunch at the farm.

“I’m sure we’ll be back at Nelson Farm next year. These things happen, and we have to take every precaution that we can, but we’re not going to cut them out of our school schedule because they have a very great deal to add to our programming here,” Kramer said.

For Don and Sonja, the investigation has become a teaching opportunity in how to prevent the transmission of illnesses.

“Thirty years ago it was our goal to get close to the animals to give the best possible learning experience,” Don said.

Many of the students who are visiting the farm are now more susceptible to diseases than 30 years ago, he explained.

“Our young students don’t play in the dirt as much, not around as many farm animals, generally live in cleaner environments such as schools, homes, businesses, therefore immunity and resistance to diseases is lower today,” Don said.

Another time for Don’s version of the hygiene hypothesis. For now, focus on the kids.

A table of petting zoo outbreaks is available at http://barfblog.com/wp-content/uploads/2016/05/Petting-Zoo-Outbreaks-Table-5-5-16.xlsx

Best practices for planning events encouraging human-animal interations

Zoonoses and Public Health 62:90-99

Erdozain , K. KuKanich , B. Chapman and  D. Powell, 2015

http://onlinelibrary.wiley.com/doi/10.1111/zph.12117/abstract?deniedAccess

Educational events encouraging human–animal interaction include the risk of zoonotic disease transmission. ‘It is estimated that 14% of all disease in the USA caused by Campylobacter spp., Cryptosporidium spp., Shiga toxin-producing Escherichia coli (STEC) O157, non-O157 STECs, Listeria monocytogenes, nontyphoidal Salmonella enterica and Yersinia enterocolitica were attributable to animal contact. This article reviews best practices for organizing events where human–animal interactions are encouraged, with the objective of lowering the risk of zoonotic disease transmission.

Going public: Kale sucks and sickened 6 with Salmonella in Minn. in April

Posting a product recall (alert) notice on a company website, and then quickly removing it, is like putting down sugar to ward off ants. For the few remaining investigative journalists, such actions are akin to painting a bullseye on the company for further questioning.

spongebob.oil.colbert.may3.10And it shouldn’t be that way.

There is a scientific, public health and moral reason to make outbreaks known, whether product is still on the shelves or not. It’s how the rest of us mere mortals learn, it’s how to make things better, it’s the right thing to do.

Anyone who hides behind legalese is not worthy of trust – especially the consumer faith and trust that goes into every food purchase — because industry government, and academia rationalize a Chomsky-esque form of self-censorship that is barf-inducing to watch, and made worse by the Salmonella.

Coral Beach, formerly of The Packer and now with Bill Marler’s Food Safety News, reports that government and corporate entities failed to reveal in April that they were investigating a cluster of Salmonella illnesses in which at least five out of six victims reported eating Taylor Farms Organic Kale Medley Power Greens Mix purchased at various Sam’s Club locations.

After a notice on another company’s website — Pacific Coast Fruit Co. of Portland — brought the situation to light, Taylor Farms’ chairman and CEO Bruce Taylor confirmed that Minnesota officials had notified him about the investigation. However, it is not clear to whom Taylor issued his May 6 statement, which was still not available on the Taylor Farms website as of May 15.

Taylor’s statement, provided to Food Safety News on May 14, says:

organic.kale.screen.shot“On Thursday, May 5th, Taylor Farms was informed by the Minnesota Department of Health (MDH) and Minnesota Department of Agriculture (MDA) of an investigation of reported foodborne illness.

“In April, six people with Salmonella Enteritidis infections, with the same rare DNA fingerprint pattern, were reported to the MDH. All of those infected are from the state of Minnesota. All are recovering.

“The FDA is not requiring any action from Taylor Farms and we are not issuing any formal recalls. We will continue to work with the MDH and MDA regarding this issue.

“The safety and health of the consumers who buy our products has always and will always be the highest priority for us. We will continue to strive to deliver the industry highest quality, safest produce in the industry.”

Pleeeeassse.

Although Taylor did not reference a specific product or where it was distributed, the Pacific Coast Fruit Co. notice named Sam’s Club and said the retailer pulled Taylor Farms Organic Kale Medley Power Greens Mix from shelves nationwide on April 4.

The Pacific Coast Fruit notice, dated May 6, was available on the company’s website May 14, but has since been removed. The notice carried the headline “Taylor Farms-Organic Kale Medley Recall” and was addressed to “our customers and the Pacific Coast Fruit Team.”

Minnesota officials did not respond to weekend requests for comment on the situation. Similarly, no one from Pacific Coast Fruit or Sam’s Club responded this weekend to requests for comment.

The Pacific Coast Fruit notice said six people with Salmonella enteritidis infections, all with the same rare DNA fingerprint pattern, were reported to MDH in April. The victims ranged in age from 7 to 69 and their illnesses began between April 3 and April 26. One person was hospitalized, and all are recovering, according to Pacific Coast Fruit.

“Five of the ill people in Minnesota reported eating Taylor Farms Organic Kale Medley purchased at several Sam’s Club locations, and the source of the sixth person’s illness is under investigation,” Pacific Coast Fruit’s notice said.

An external communications spokesman for Taylor Farms said May 15 that the Salinas, CA, company did not need to issue a recall.

“No recall was needed because the issue being investigated was from back in late March early April. So, independent of the findings of the investigation, the product is no longer in the market place due to shelf-life limitations,” the Taylor Farms spokesman said.

OrganicKaleMedley-1web-216x300The failure of public health officials and corporate entities to announce the spike in Salmonella cases and the subsequent investigation is the latest incident in what one food safety professional says is a disturbing, decade-long trend.

After the deadly E. coli outbreak in 2006 that was linked to bagged fresh spinach, companies have increasingly demanded governmental agencies provide confirmation results from time-consuming follow-up laboratory tests before issuing voluntary product recalls, said Douglas Powell, former professor at Kansas State University’s Department of Diagnostic Medicine/Pathobiology.

Powell, who now lives in Australia, is publisher of barfblog.com, which has been monitoring and publicizing foodborne illness outbreaks since 2006 (1993, when Food Safety Network started), coined the phrase “leafy green cone of silence” to describe the lack of transparency on the part of government and industry in the decade since the spinach outbreak.

“This situation fits the pattern,” Powell told Food Safety News May 15. “It’s part of a bigger picture about the question of when to go public about outbreak investigations.

“There’s a question of public health. I don’t care that the product’s not on the shelves any more. The public has a right and a need to know about these incidents.”

do.the.right.thingBill Marler, partner at the Seattle law firm Marler Clark LLP, had similar concerns. Marler has been representing victims of foodborne illnesses since the 1993 E. coli outbreak traced to undercooked hamburgers served by the Jack in The Box chain. He provided testimony to Congress during the drafting of the Food Safety Modernization Act.

“My main concern is the lack of transparency, and that’s not just a comment on Taylor Farms, it’s a comment on FDA, the Minnesota departments of health and agriculture and a comment on the CDC,” Marler said May 15. “I think that anytime, especially when there are illnesses involved, I think the public has an absolute right to know what’s going on.

“My assumption is that someone’s determined that the product is no longer in the marketplace because it’s a perishable product and the public’s no longer at risk. While I appreciate that, it’s not a reason to not let consumers know.

“In order for the free market to work, in order for consumers to know what products are safe or safer, the companies and the government have a responsibility to educate the consumer.

“When they withhold that kind of information, for whatever justifiable reason they think they have, it doesn’t give (consumers) the information to know how to protect themselves and their families and also calls into question public health’s commitment to the public’s health.”

 

Why Minnesota doesn’t post restaurant inspection reports

Hawaii has joined other states in providing restaurant inspection data online, New Yorkers are debating whether inspections and reviews of Chinese and other ethnic restaurants are racist, and Canada is once again lauding Toronto’s red-yellow-green system of disclosure.

larry.the_.cable_.guy_.health.inspector-213x300-213x3001-213x300Strangely absent in such debate is the state of Minnesota, which is often praised for its skill and speed investigating outbreaks of foodborne illness.

According to Eric Roper of the Star Tribune, Minnesota is one of the least transparent states in the nation with regard to restaurant inspections.

A local developer posted Minneapolis restaurant inspections to the Web several years ago, but ultimately took the site down after trouble getting up-to-date data from the city. The city’s health department said it hopes to have this data live in 2016, though it had similar goals in 2013.

With regard to letter grades in particular, the city’s Environmental Health Manager Dan Huff is not a fan.

“What we have found is that jurisdictions that do have grades, more resources go into fighting over the grade than actually improving food safety,” Huff said.

He believes it would be detrimental to the inspection process. “It creates a more adversarial relationship with the inspector,” Huff said. “Because you’re like ‘Come on! I just need one point so I’m an A. Give me a break man.’”

Council Member Andrew Johnson, meanwhile, has asked staff to explore the idea further.

“Making it so people can go out to the website and look up restaurants is … a great step,” Johnson said. “But it also would be even better to have higher visibility that incentivizes businesses to put safety first and health first.”

Professor Craig Hedberg, a foodborne illness expert at the University of Minnesota, said there has not been much research into the effectiveness of various grading systems.

Not all cities are convinced by letter grades. Baltimore ditched a proposal last year to adopt them, over concerns that it would negatively impact restaurants.

barf.o.meter_.dec_.12-216x300-216x3001-216x300Peter Oshiro, manager of Hawaii’s food safety inspection program, said “We’re taking transparency to an entirely new level,” adding that, “Information from the inspection reports empowers consumers and informs their choices. … This should be a great catalyst for the industry to improve their food safety practices and make internal quality control a priority before our inspections.”

 

Filion, K. and Powell, D.A. 2009.

The use of restaurant inspection disclosure systems as a means of communicating food safety information.

Journal of Foodservice 20: 287-297.

The World Health Organization estimates that up to 30% of individuals in developed countries become ill from food or water each year. Up to 70% of these illnesses are estimated to be linked to food prepared at foodservice establishments. Consumer confidence in the safety of food prepared in restaurants is fragile, varying significantly from year to year, with many consumers attributing foodborne illness to foodservice. One of the key drivers of restaurant choice is consumer perception of the hygiene of a restaurant. Restaurant hygiene information is something consumers desire, and when available, may use to make dining decisions.

Filion, K. and Powell, D.A. 2011. Designing a national restaurant inspection disclosure system for New Zealand. Journal of Food Protection 74(11): 1869-1874
.

The World Health Organization estimates that up to 30% of individuals in developed countries become ill from contaminated food or water each year, and up to 70% of these illnesses are estimated to be linked to food service facilities. The aim of restaurant inspections is to reduce foodborne outbreaks and enhance consumer confidence in food service. Inspection disclosure systems have been developed as tools for consumers and incentives for food service operators. Disclosure systems are common in developed countries but are inconsistently used, possibly because previous research has not determined the best format for disclosing inspection results. This study was conducted to develop a consistent, compelling, and trusted inspection disclosure system for New Zealand. Existing international and national disclosure systems were evaluated. Two cards, a letter grade (A, B, C, or F) and a gauge (speedometer style), were designed to represent a restaurant’s inspection result and were provided to 371 premises in six districts for 3 months. Operators (n = 269) and consumers (n = 991) were interviewed to determine which card design best communicated inspection results. Less than half of the consumers noticed cards before entering the premises; these data indicated that the letter attracted more initial attention (78%) than the gauge (45%). Fifty-eight percent (38) of the operators with the gauge preferred the letter; and 79% (47) of the operators with letter preferred the letter. Eighty-eight percent (133) of the consumers in gauge districts preferred the letter, and 72% (161) of those in letter districts preferring the letter. Based on these data, the letter method was recommended for a national disclosure system for New Zealand.

Minnesota infant survives brush with botulism

The 3-month-old daughter of Wesley and Sarah Hendrickson of Brainerd, Della, was diagnosed earlier this month with infant botulism.

botulism microAfter another hospital stay at Essentia Health-St. Joseph’s Medical Center in Brainerd the next day, the Hendrickson family was airlifted to the St. Paul campus of Children’s Hospitals and Clinics later that evening. One of the doctors there had coincidentally treated two cases of infant botulism in his career beforehand and recognized the symptoms.

The doctors called a facility in California and requested them to ship a single antitoxin dose to Minnesota. That dose alone cost more than $45,000—but Della’s parents knew it could shorten her hospital stay from months to weeks.

After the dose was administered early March 13, the Hendricksons began to see a gradual improvement in Della’s condition—a breathing tube taken out one day, her ability to smile coming back another. Eventually, they moved out of the intensive care unit, to a regular hospital wing, and since then they’ve been working with rehabilitative therapists to improve Della’s functions.

Doctors project that Della will make a full recovery with no limitations, Wesley said. They might be able go home as soon as Saturday.

They can’t pin down a source for the spores. It could have been from neighbors clearing debris from the July 12 storm—or it could have been construction, or logging.

Infants can contract botulism through spores because their digestive systems produce less acid than adults—acid which would otherwise kill the toxin-producing botulism bacteria.

So far in 2016, Della has been one of two total cases of infant botulism. The other case was an infant in the metro area.

Botulism can sometimes be contracted when infants eat contaminated honey.