Two stricken with Giardia in Norway

Many thanks to our Norwegian correspondent who reports that two people admitted to Haukeland Hospital have been diagnosed with Giardia infection.

“We have two confirmed cases, but it is possibly a third too. It is too early to say anything about the source of infection,” says Surveillance Authority in Bergen municipality Kari Stidal Øystese.

Bergen is sensitive to Giardia outbreaks because in autumn 2004, the drinking water was infected by the Giardia parasite and approximately 5,000 people from Bergen became sick, and many have suffered after-effects for years.

In 2006, a SINTEF report commissioned drainage systems related to the buildings at Knatten, Starefossen and Tarlebøveien, triggered the epidemic. Local authority Torgeir Landvik would blame the dog owners for the fact that thousands of mountain people were infected by Giardia in the fall of 2004. But in 2015, an expert group picked up the dog-kit theory. “Based on available knowledge, Giardia infection from humans is still the most likely cause of the outbreak of disease and long-term strokes,” said the group’s conclusion.

A large community outbreak of waterborne giardiasis- delayed detection in a non-endemic urban area

BMC Public Health, 2006, 6:141,   Karin Nygård, Barbara Schimmer, Øystein Søbstad, Anna Walde, Ingvar Tveit, Nina Langeland, Trygve Hausken and Preben Aavitsland, https://doi.org/10.1186/1471-2458-6-141

https://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-6-141

Background

Giardia is not endemic in Norway, and more than 90% of reported cases acquire the infection abroad. In late October 2004, an increase in laboratory confirmed cases of giardiasis was reported in the city of Bergen. An investigation was started to determine the source and extent of the outbreak in order to implement control measures.

Methods

Cases were identified through the laboratory conducting giardia diagnostics in the area. All laboratory-confirmed cases were mapped based on address of residence, and attack rates and relative risks were calculated for each water supply zone. A case control study was conducted among people living in the central area of Bergen using age- and sex matched controls randomly selected from the population register.

Results

The outbreak investigation showed that the outbreak started in late August and peaked in early October. A total of 1300 laboratory-confirmed cases were reported. Data from the Norwegian Prescription Database gave an estimate of 2500 cases treated for giardiasis probably linked to the outbreak. There was a predominance of women aged 20–29 years, with few children or elderly. The risk of infection for persons receiving water from the water supply serving Bergen city centre was significantly higher than for those receiving water from other supplies. Leaking sewage pipes combined with insufficient water treatment was the likely cause of the outbreak.

Conclusion

Late detection contributed to the large public health impact of this outbreak. Passive surveillance of laboratory-confirmed cases is not sufficient for timely detection of outbreaks with non-endemic infections.

Hare fever in Norway

(Something may be lost in translation.)

The veterinary institute has recently diagnosed hare fever (tularemia) with many hares and one dog – all from southern Norway. This indicates that the disease is relatively widespread in this area and people should be aware of it.

Harane with hare fever has been submitted from Agder, northern part of Buskerud and Inner Sogn during the last weeks. Tularemia (harepest) obsessed infection with the bacterium Francisella tularensis.

The bacterium can infect humans and many different animal species. The hare is particularly sensitive to infection and dying usually by blood poisoning few days after he has been infected. Dogs can be infected by catching or by eating smokers. Commonly, they develop transient disease.

Harepest (tularemia) is a disease that can be transmitted from animals to humans. Often it happens via drinking water, for example if dead mice or lem infect wells, streams and other water sources.

The danger of being infected with tularemia or other waterborne disease will always be present. After a lean year, the following year there may be dead animals still infectious. We therefore recommend that you follow the advice and measures for drinking water listed below for safety. It will prevent hare fever and other diseases from drinking water, especially the drinking water that is extracted from wells and other sources in nature.

‘Many sick’ from crypto in Norway

Thanks to our Norwegian correspondent, we now know the Norwegian Food Safety Authority was notified on September 26, 2017, of a Cryptosporidium outbreak, and after talking to the sick, they could narrow the time of infection to 14-16. September,

The Food Safety Authority believes the people were infected at the Taqueros Taco & Tequila restaurant (because when I think Norway, I think tacos and tequila, not schnapps and raw fish).

The restaurant decided to shut one day to wash the premises when they heard about the outbreak and that the infection came from them.

The source of the infection was not found, but the Norwegian Food Safety Authority emphasizes that they do not discourage people from eating at the restaurant.

Specialist warden Erik Wahl in Mattilsynet in Trondheim and surroundings said, “We have reason to believe that the infection is now gone, as no people who have become ill after September 16 have not been reported. We have no reason to discourage people to eat at this restaurant.”

 

4 stricken with E. coli O157 in Norway

Since August 2017, the Norwegian Institute of Public Health has found the same variant of the bacterium E. coli O157: H7 in 4 persons.

The Norwegian Institute of Public Health was informed in mid-August 2017 of a child with E. coli O157: H7 infection that developed hemolytic uremic syndrome (HUS) and was a resident of Møre og Romsdal. In addition, the Norwegian Institute of Public Health has detected the same bacterial strain in 3 adults with diarrhea symptoms living in Hedmark, Buskerud and Hordaland.

“We have good procedures on how we monitor infection with EHEC infection,” says Director General Line Vold at the Institute of Public Health. We collaborate with the Norwegian Food Safety Authority, the municipal authorities and the Veterinary Institute. Depending on the need, interviews are conducted by the sick, as well as possible sampling in relevant foods and close contacts. Since the patients reside in different counties, the investigation of the outbreak is coordinated by the National Institute of Public Health.

“None of the investigations around these cases have so far revealed any common source of infection. This work takes time and is complicated. It is not always possible to find the source of infection, ” says Line Vold.

Norway: 7 infected with rare Salmonella

Ida Louise Rostad of NRK Finnmark reports seven people in Norway have been stricken with a rare form of Salmonella.

The samples of the patients were taken at the end of August, and all are thought to be infected in Norway. Bacteria with similar DNA profiles have been detected in all seven people, says senior adviser Heidi Lange at the Public Health Institute in a press release.

The people who are infected are between 19 and 60 years old. Two people live in Finnmark, but also people from Møre og Romsdal, Sogn og Fjordane, Akershus and Oslo are infected.

The DNA profile of the bacterium has never been seen before in Norway, either in humans, animals or in foods.

“There are no symptoms beyond what we usually see, such as diarrhea, fever and abdominal pain. So it does not look like this is more serious,” says Director of the Department of Public Health Institute, Line Violence to NRK.

“Now we are working on common routines for outbreaks. We have a little work to do to get out and we know this is work that can take time, “she says.

Now the institute cooperates with the municipal health service, the Norwegian Food Safety Authority and the Veterinary Institute to investigate whether patients can have a common source of infection.

The bacterium is a rare variant of the bacterium Salmonella Typhimurium.

The Norwegian Institute of Public Health does not want to provide information on whether patients are in hospital or have been with the GP to detect infection.

10 students hospitalized after drinking vinegar in Norway uni hazing

A man in his 20s was seriously injured after drinking vinegar during a student party at the Norwegian University of Science and Technology (NTNU) on Tuesday.

Fourteen students were transported to St. Olavs Hospital in Trondheim after the hazing incident at NTNU.

This still goes on?

Marit Kvikne, communication director at St. Olavs Hospital says the students “have taken a mixture of vinegar and water, and have had an eternal damage in the oral cavity. There are 14 patients who have come to the emergency room, 10 of which were sent to the hospital. Three are for observation and one receives intensive care.”

Shiga toxin producing E coli in raw milk products in Norway

The Norwegian Food Safety Authority has detected Shiga toxin producing E. coli (STEC) in four unpasteurized milk products.

Mattilsynet said 82 unpasteurized milk products were examined and STEC was isolated from three products from Norwegian companies and a French cheese. Stx genes were also detected in 20 samples.

E. coli O-, stx2a was found in a Norwegian-produced soft red cheese of cow’s milk and rømme (a type of blue cheese) and E. coli O26, Stx1 and eae was in fresh cheese from goat milk. E. coli O113, stx2d was detected in French chèvre.

Joe Whitworth of Food Quality News reports Mattilsynet took 714 samples of pasteurized and unpasteurized dairy products – mainly cheeses – as part of a monitoring program from 2010 to 2016 – including 184 samples last year.

Samples in 2016 consisted of 102 produced from pasteurized milk and 82 of unpasteurized milk from stores, importers and manufacturers.

These products consisted of cow’s milk (139), goat (33), sheep (11) and a mixture of these (1).

The monitoring program was done to acquire knowledge on hygiene of dairy products on the Norwegian market.

Tough mudders and cyclists, beware the agri-land: Outbreaks amongst participants in Norway, Scotland

NRK reports that some 50 of 300 participants became sick with Campylobacter in a cycling event in Norway.

Competitors at the start of the 2015 Tough Mudder Scotland at Drumlanrig Castle, Dumfries and Galloway

Earlier, several people were stricken by E. coli O157 in a tough mudder event which was held at Drumlanrig Castle in Scotland on June 17 and 18.

These outbreaks follow previous, numerous outbreaks involved with playing in mud.

In Norway, the reason why the cyclists have become so bad is because animal wreckage resolved after a heavy rainfall and remained in the road. This has again sprung up on the cyclists.

“Especially if the stool is fresh and there are large amounts of water, it can sprinkle on drinking bottles and hands so you get it when you drink,” said Tor Halvor Bjørnstad-Tuveng, to NRK (something may be lost in translation).

“We have been in dialogue with the management of the race, and we have some concrete measures that we will look at. We have been very unlucky with the rides of the year, but we must definitely look at what we can do to prevent it happening again, “says Bjørnstad-Tuveng.

Per Stubban was one of those who had to go to the hospital for intravenous nutrition.

“Now I’m on my way, but there have been some tough days. Next time I will not use a handheld drink bottle, but a drinking bag, and if there is as much rain as it was now, I would probably be skeptical to start, “he said.

Participants in an endurance event at a Scottish castle have been warned to look out for symptoms of E. coli O157 after it was identified among those who took part.

NHS Dumfries and Galloway said “a small number of cases” of the bacteria have been found in those involved in the Tough Mudder event at Drumlanrig Castle last month.

It has advised anyone associated with the event who experiences symptoms to seek medical advice.

A spokesman for the health board said: “NHS Dumfries and Galloway can confirm that we are aware of a small number of cases of E.coli O157 across Scotland that appear to be associated with participation in the Tough Mudder event which was held at Drumlanrig Castle on June 17 and 18.

“Any activity undertaken on agricultural land inevitably involves a small risk of gastrointestinal infection.”

A spokesman for the event said: “The safety of Tough Mudder participants, spectators, volunteers and staff is our number one priority.

Uh-huh.

Where’s Thor or Loki (having fun in Brisbane) 300 reindeer killed by lightning in Norway

Friday was a bad time to be a reindeer navigating the barren Hardangervidda plateau in Central Norway.

reindeer.lightening.norway323 reindeer were killed by lightning strikes, in one fell swoop. Norway’s Environment Agency is at a loss as to how the massacre could have happened. Agency spokesman Kjartan Knutsen told the Associated Press that while it’s not uncommon for reindeer or other animals to be struck by lightning, the sheer scale of this massacre is singular.

The agency now faces the bizarre dilemma of what, if anything, to do with 300+ lightning-struck reindeer corpses. Usually, they would simply let the animals decay naturally, but the volume of dead reindeer presents a disturbing conundrum.

We’re looking to some sky-dwelling deity — possibly Odin, or Thor, or one of the other Norse gods with dominion over lighting (perhaps Loki?) — to address this tragedy.

133 sickened in Norway: ‘Improvements required in production processing of fresh salad products’

In May 2014, a cluster of Yersinia enterocolitica (YE) O9 infections was reported from a military base in northern Norway. Concurrently, an increase in YE infections in civilians was observed in the Norwegian Surveillance System for Communicable Diseases. We investigated to ascertain the extent of the outbreak and identify the source in order to implement control measures.

radicchioA case was defined as a person with laboratory-confirmed YE O9 infection with the outbreak multilocus variable-number tandem repeat analysis (MLVA)-profile (5-6-9-8-9-9). We conducted a case–control study in the military setting and calculated odds ratios (OR) using logistic regression. Traceback investigations were conducted to identify common suppliers and products in commercial kitchens frequented by cases. By 28 May, we identified 133 cases, of which 117 were linked to four military bases and 16 were civilians from geographically dispersed counties. Among foods consumed by cases, multivariable analysis pointed to mixed salad as a potential source of illness (OR 10.26; 95% confidence interval (CI): 0.85–123.57). The four military bases and cafeterias visited by 14/16 civilian cases received iceberg lettuce or radicchio rosso from the same supplier. Secondary transmission cannot be eliminated as a source of infection in the military camps.

The most likely source of the outbreak was salad mix containing imported radicchio rosso, due to its long shelf life. This outbreak is a reminder that fresh produce should not be discounted as a vehicle in prolonged outbreaks and that improvements are still required in the production and processing of fresh salad products.

National outbreak of Yersinia enterocolitica infections in military and civilian populations associated with consumption of mixed salad, Norway, 2014

Eurosurveillance, Volume 21, Issue 34, 25 August 2016, DOI: http://dx.doi.org/10.2807/1560-7917.ES.2016.21.34.30321

E MacDonald, M Einöder-Moreno, K Borgen, L Thorstensen Brandal, L Diab, Ø Fossli, B Guzman Herrador, AA Hassan, GS Johannessen, EJ Johansen, R Jørgensen Kimo, T Lier, BL Paulsen, R Popescu, C Tokle Schytte, K Sæbø Pattersen, L Vold, Ø Ørmen, AL Wester, M Wiklund, K Nygård

http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=22561