Another Cyclospora outbreak IDed in Minnesota

The Minnesota Department of Health (MDH) is investigating an increase in Cyclospora infections within the last month. To date, state health officials have identified two outbreaks together involving at least three dozen Minnesotans.

One outbreak has been identified among people who ate at Sonora Grill in Minneapolis in mid-May. To date, 17 patrons have reported illness. The restaurant is fully cooperating with the investigation, and investigators say they do not have any indication that there is an ongoing risk to patrons.

To better identify the source of infection, MDH investigators want to speak with people who ate at Sonora Grill over the weekend of May 18-May 20, regardless of whether they became ill.

“Even if you have not been sick, your information can help us identify what may have caused these illnesses and prevent future illnesses,” said Trisha Robinson, an epidemiologist supervisor with MDH. “If you ate at Sonora Grill during that weekend of May 18-20, please contact the Minnesota Department of Health Waterborne Diseases Unit at 651-201-4891.”

Infection with Cyclospora, known as cyclosporiasis, is caused by the parasite Cyclospora and is spread through consumption of imported fresh produce; it is not spread person-to-person. Washing of imported produce, or routine chemical disinfection or sanitizing methods, are unlikely to kill Cyclospora. Symptoms typically include watery diarrhea, stomach cramps, nausea, loss of appetite and weight loss. People typically become ill about a week after exposure, but this period can range from 2-14 days. Diarrhea can last several weeks or longer if not treated.

A second outbreak has been linked to Del Monte vegetable trays purchased at Kwik Trip locations. To date, 20 cases have been identified among Minnesotans in this outbreak. Cases report purchasing the vegetable trays at various Kwik Trip locations around the state. Kwik Trip is cooperating with the investigation and voluntarily removed the vegetable trays from their shelves. Consumers should not eat the following products:

Del Monte Vegetable Tray, containing broccoli, cauliflower, carrots and dill dip, 6 oz.

Del Monte Vegetable Tray, containing broccoli, cauliflower, carrots and dill dip, 12 oz.

MDH investigators are working with the Minneapolis Health Department and the Minnesota Department of Agriculture (MDA) on the Sonora Grill outbreak and with MDA and other states on the Kwik Trip outbreak.

“We do not have any indication at this time that the two outbreaks are related,” Robinson said. “Besides these outbreak cases, there are other cases of cyclosporiasis that do not appear to be related to either of these outbreaks, which is not unexpected for this time of year. We typically see increases in Cyclospora infections from May through August.”

Money talks: Safety interventions in Dutch vegetable production

Surveys still suck, but the results of this one generally correlate to what we have found doing 20 years of on-farm food safety with fresh produce growers.

Outbreaks and crisis drive grower food safety concerns, prevention is a hard sell, but we’ve shown it can be done.

Understanding growers’ preferences regarding interventions to improve the microbiological safety of their produce could help to design more effective strategies for the adoption of such food safety measures by growers.

The objective of this survey study was to obtain insights for the design of interventions that could stimulate growers to increase the frequency of irrigation water sampling and water testing to reduce possible microbiological contamination of their fresh produce.

The results showed that price intervention, referring to making the intervention less costly by reducing the price via discounts, is the most effective strategy to change growers’ intentions to increase their frequency of irrigation water testing. Moreover, a sense of urgency affects their intentions to increase the frequency of irrigation water testing.

The findings of this survey support the hypothesis that, to date, safety is not perceived as a quality control issue under normal circumstances, but safety becomes an overriding attribute in a food crisis.

Understanding preferences for interventions to reduce microbiological contamination in Dutch vegetable production

June 2018, Journal of Food Protection vol. 81 no. 6

A. P. M. VAN ASSELDONK,1*L. MALAGUTI,2M. L. H. BREUKERS,1 and H. J. van der FELS-KLERX2,3

https://doi.org/10.4315/0362-028X.JFP-17-106

http://jfoodprotection.org/doi/abs/10.4315/0362-028X.JFP-17-106

Does chlorine make pathogens harder to detect in fresh produce?

The microbiological safety of fresh produce is monitored almost exclusively by culture-based detection methods. However, bacterial foodborne pathogens are known to enter a viable-but-nonculturable (VBNC) state in response to environmental stresses such as chlorine, which is commonly used for fresh produce decontamination.

Here, complete VBNC induction of green fluorescent protein-tagged Listeria monocytogenes and Salmonella enterica serovar Thompson was achieved by exposure to 12 and 3 ppm chlorine, respectively. The pathogens were subjected to chlorine washing following incubation on spinach leaves. Culture data revealed that total viable L. monocytogenes and Salmonella Thompson populations became VBNC by 50 and 100 ppm chlorine, respectively, while enumeration by direct viable counting found that chlorine caused a <1-log reduction in viability. The pathogenicity of chlorine-induced VBNC L. monocytogenes and Salmonella Thompson was assessed by using Caenorhabditis elegans. Ingestion of VBNC pathogens by C. elegans resulted in a significant life span reduction (P = 0.0064 and P < 0.0001), and no significant difference between the life span reductions caused by the VBNC and culturable L. monocytogenes treatments was observed. L. monocytogenes was visualized beyond the nematode intestinal lumen, indicating resuscitation and cell invasion. These data emphasize the risk that VBNC food-borne pathogens could pose to public health should they continue to go undetected.

IMPORTANCE Many bacteria are known to enter a viable-but-nonculturable (VBNC) state in response to environmental stresses. VBNC cells cannot be detected by standard laboratory culture techniques, presenting a problem for the food industry, which uses these techniques to detect pathogen contaminants. This study found that chlorine, a sanitizer commonly used for fresh produce, induces a VBNC state in the foodborne pathogens Listeria monocytogenes and Salmonella enterica. It was also found that chlorine is ineffective at killing total populations of the pathogens. A life span reduction was observed in Caenorhabditis elegans that ingested these VBNC pathogens, with VBNC L. monocytogenes as infectious as its culturable counterpart. These data show that VBNC foodborne pathogens can both be generated and avoid detection by industrial practices while potentially retaining the ability to cause disease.

Viable-but-nonculturable listeria monocytogenes and Salmonella enterica serovar Thompson induced by chlorine stress remain infectious

17 April 2018

American Society for Microbiology, vol. 9 no. 2

Callum J. HighmoreaJennifer C. Warnera*Steve D. Rothwellb, Sandra A. Wilksa, C. William Keevila

doi: 10.1128/mBio.00540-18

http://mbio.asm.org/content/9/2/e00540-18

Wasn’t there a Food Safety Authority before this? NZ food safety for a foodie nation

I used to go there a lot, but probably won’t get invited anytime soon.

I get it that politicians have a short life-span, that things change, but New Zealand used to have the New Zealand Food Safety Authority, and then it got sucked into the Ministry of Primary Industries, and now you’re creating New Zealand Food Safety.

The printers of business cards will be pleased with the work.

Food Safety Minister Damien O’Connor says the establishment of New Zealand Food Safety will help raise the profile of food safety for all New Zealanders.

It is one of four new business units created within the Ministry for Primary Industries to create a stronger focus on keys areas of work, along with Biosecurity New Zealand, Fisheries New Zealand and Forestry New Zealand.

“In the spirit of manaakitanga, our food safety system cares for the people producing and processing food, as well as those consuming it. It protects consumers at home and abroad by ensuring that food grown, harvested, imported, processed, transported, stored, exported and sold is safe to eat,” Damien O’Connor says.

“The integrity of the food safety system is particularly important to New Zealand because we are a nation of food producers and exporters, and we are trusted across the globe.

“New Zealand Food Safety brings together about 390 people from MPI’s food standard setting, verification and assurance teams into one strong and visible business unit.

‘A kinder gentler machine gun hand’ Food safety realities in the biz

Chapman has always been the kinder, gentler version of me.

But sometimes, ya gotta get stuff done.

I’m proud of everything he has accomplished but then thought, I was applying for about the 200th job in Australia, and I always put Dr. Chapman down as a reference.

“Ben, has anyone ever called or e-mailed you about my job application?”

Nope.

That’s some harsh reality, but puts food safety where it is usually treated: An afterthought, and only if someone gets caught.

That’s why we’re gonna do our own thing: 2 weeks, 2 books, Australia, 2018.

Drinking E. coli for science

There’s just not enough grad students willing to go deep and shield professors from abusive partners, bail their professors out of jail, coach girls hockey or drink E. coli for the sake of science.

Rachael Rettner of Live Science reports that in a new studdy, volunteers downed a cup of E. coli, for science.

Their fortitude paid off. Scientists were able to study an important question: whether a person’s blood type affects the severity of an “Enterotoxigenic E. coli” infection, the leading cause of traveler’s diarrhea.

It turns out, there was a difference in severity by blood type: Those with blood type A got sick sooner, and experienced more severe symptoms, than those with blood type B or O, the researchers said. [Top 7 Germs in Food that Make You Sick]

What’s more, the study uncovered an explanation for these findings: It appears that the bacteria release a protein that attaches to intestinal cells in people with blood type A, but not in people with other blood types.

The new finding might one day lead to the development of a vaccine that could reduce disease severity in people with type A blood. “A vaccine targeting this protein would potentially protect the individuals at highest risk for severe disease,” study senior author Dr. James Fleckenstein, an associate professor of medicine and molecular microbiology at Washington University School of Medicine in St. Louis, said in a statement.

The study was published online (May 17) in The Journal of Clinical Investigation.

Original article on Live Science.

Playing in water, is it making you barf?

The U.S. Centers for Disease Control reports that outbreaks associated with treated recreational water can be caused by pathogens or chemicals.

During 2000–2014, 493 outbreaks associated with treated recreational water caused at least 27,219 cases and eight deaths. Outbreaks caused by Cryptosporidium increased 25% per year during 2000–2006; however, no significant trend occurred after 2007. The number of outbreaks caused by Legionella increased 14% per year.

The aquatics sector, public health officials, bathers, and parents of young bathers can take steps to minimize risk for outbreaks. The halting of the increase in outbreaks caused by Cryptosporidium might be attributable to Healthy and Safe Swimming Week campaigns.

Outbreaks associated with treated recreational water — United States, 2000–2014

18.may.18

Centers for Disease Control and Prevention

Michele C. Hlavsa, MPH; Bryanna L. Cikesh, MPH; Virginia A. Roberts, MSPH; Amy M. Kahler, MS; Marissa Vigar, MPH; Elizabeth D. Hilborn, DVM; Timothy J. Wade, PhD; Dawn M. Roellig, PhD; Jennifer L. Murphy, PhD; Lihua Xiao, DVM, PhD; Kirsten M. Yates, MPH; Jasen M. Kunz, MPH; Matthew J. Arduino, DrPH; Sujan C. Reddy, MD; Kathleen E. Fullerton, MPH; Laura A. Cooley, MD; Michael J. Beach, PhD; Vincent R. Hill, PhD; Jonathan S. Yoder, MPH

https://www.cdc.gov/mmwr/volumes/67/wr/mm6719a3.htm

The silence from the leafy greens lobby is deafening: A tale of two women with E. coli

A listing of 78 outbreaks linked to leafy greens since 1995 is posted here.

Maggie Menditto, the executive administrator of the McDowell Foundation for social justice, writes in the New York Times that before my illness, I was a healthy 22-year-old just out of college. But at some point, my doctors speculated, I must have eaten leafy greens contaminated by E. coli bacteria.

My mother had driven me to my local emergency room in the middle of the night after several days of unbearable abdominal cramps and a startling amount of blood coming out of new and terrifying places. The doctor on call thought it was probably just a bad case of colitis.

As the sun began to rise, I was asked if I’d like to go home and take Imodium or if I’d like to stay in the hospital. Given the severity of my pain, I was surprised that I was even given a choice. I allowed myself to be wheeled upstairs with a needle in my vein administering a steady stream of antibiotics, a common treatment for colitis.

But that weekend, I took a turn for the worse, throwing up every hour until there was nothing left in my system but sticky green bile. An infectious disease doctor was called in, my stool sample tested, and I was finally given a diagnosis of E. coli infection.

Doctors don’t know for sure how I became infected with E. coli — at the time, last October, the outbreak tied to romaine lettuce was still several months in the future — but we do have some clues. I’m a vegetarian, so we know it didn’t come from eating meat. Although none of my family members got sick, my father also tested positive for E. coli. The only food we remembered sharing was a batch of arugula from a local farmers’ market about five days before I became ill, making it the most likely culprit.

The antibiotics were immediately stopped, as they have been linked to an increased likelihood of developing dangerous complications from the bacterial infection. But by then the signs were already beginning to show. My platelet count was dropping at a dangerous rate, my kidney function had begun to falter. I had developed hemolytic uremic syndrome, a life-threatening complication of E. coli infection.

I was treated to the first ambulance ride of my life to transfer to Georgetown University Hospital, where I would remain hospitalized for the next 33 days.

In the critical care unit, I was strapped into several machines that would monitor my vitals. The next morning, a doctor came in and inserted a temporary access catheter into the right side of my neck. I was wheeled down to a lower level of the hospital for the first of my six plasmapheresis treatments, a particularly draining experience in which blood was removed, cleaned and then returned to my body via a large tube in my neck.

A team of hematologists, nephrologists, infectious disease specialists and a general physician visited every morning. They’d ask, “How are you feeling, Frances?”

Everyone knows me as Maggie, but in an annoying quirk of my hospitalization, my medical records and wristband all bear my legal name, Frances. “One name for each grandmother,” my mom reasoned when my parents decided to christen me Frances Margaret. An unintended consequence of their thoughtfulness is that I have spent much of my life correcting people who called me Frances. “It’s Maggie, short for Margaret, my middle name,” I said.

But in the hospital, it helped to have a second persona. Frances put on a brave face during the hours of treatment in sterilized facilities, while Maggie drew inward, refusing books and music or anything else that reminded me of who I was outside the hospital walls. From where I sat, pinned to machines by the needles in my veins, in a body I hardly recognized, and with a label on my wrist displaying a name that wasn’t mine, I couldn’t be sure that it was me this was really happening to. I listened patiently as doctors and nurses and technicians came into my room to offer Frances their well wishes, draw blood, or discuss what medications she should take or what procedures might make her body strong once more.

During my first week of hospitalization, the kidney doctors debated whether to begin the dialysis process, sticking to the typical “wait-and-see” approach. But by the end of the week there was no question. I had gained 30 pounds from all the excess fluid and could hardly stand up and walk on my own. I began my first of many three-hour-long dialysis treatments, where they siphoned off the liquid, doing the work of my kidneys that I had so long taken for granted.

I had mostly avoided social media since getting sick, but one day, I logged onto Facebook to see that across the country, people I knew and people I didn’t — a pair of girls I once babysat for, a football team in Rhode Island — were praying for Maggie, hoping Maggie pulled through. The more people that worried about me, the sicker I must be, I thought.

The dialysis continued for three weeks with tiny but measurable results. My platelet counts began to climb, and I started to pee again. But it wasn’t enough to impress the nephrologists, who decided to surgically place a catheter in my chest, to both drain and administer fluids.

Doctors began discussing a kidney transplant and temporary home-care dialysis training. I was sent home for a weekend to rest up before my first training for an eventual dialysis machine to be brought to my parents’ house, but we didn’t get that far. I went to bed after dinner and woke up in an ambulance racing back to the hospital I had just left. My blood pressure had begun a dangerous rise as my kidneys began to start working again, and I had the first of three seizures that night.

The next few days are mostly lost from memory, but some hazy images survive. Waking up in a tube to discover I was getting an M.R.I. A nurse delicately pulling glue from my hair from where the technicians had inserted sensors. My hospital bed being wheeled out of the operating room after the catheter was removed from inside my chest. The sharp lines of the white hallway walls, every corner offering a shadowy descent into someone else’s hospital story.

Through my half-closed lids, I see a rare pocket of sunlight at the end of the corridor. Briefly I feel the warmth of its gaze as we trek on through the seemingly endless maze of the hospital’s hallways and locked doors. The dryness in my mouth is the first clue that I’m back in my body, that my kidneys have begun to heal themselves at an admirable pace.

My mom finds me soon after, as I’m attempting to drink water from a clear plastic straw. She reaches out and holds it in place. The nurse comes in to tell us that it all went well, that Frances’s vitals look good, that we’ll be ready to transfer her back upstairs soon.

“She goes by Maggie,” my mom says.

“Oh, I’m sorry,” the nurse says, glancing down at her chart before stepping back into the hall, “Maggie.”

I turn to smile at my mom. It doesn’t matter what they call me anymore. She holds my hand as we’re guided back upstairs to my hospital room for the last time.

Sometimes now, in my apartment, on the train, while walking down a crowded street, I like to run my fingers over the fresh scars lining my collarbone. Now that the toxins have left my system, now that my body has built itself back up, I have only the scars to remind me that Frances was tested, that Maggie survived. That it really happened to me.

Altoona, Penn. Area High School student Mia Zlupko was shocked when doctors told her some scary news.

“All the doctors came in, and it was kind of like a big surprise like ‘It’s E. coli,'” Mia said.

The 16-year-old is a dancer who enjoys eating healthy. It’s not uncommon for her to grab a salad from the store, which is exactly what she did earlier this month. However, after eating it she became sick and was throwing up with abdominal pain.

“It was a scary process and I wouldn’t want to go through it again,” she said. “I know everyone else wouldn’t want to go through it.”

After four days in the hospital no one could figure out what exactly was wrong.

Just as Mia was heading home she learned her diagnosis. A relief for her mom Tina.

“Had we not gone back to the doctor and then gone to the emergency room, she could have gotten much sicker very quickly,” Tina Zlupko explained.

Now the teen is hoping to share an important message with others so no one else has to go through what she did.

“I’m definitely more aware and I want other people to be aware about it,” Mia said.

The CDC advisory now includes chopped and bagged romaine lettuce, as well as whole heads and hearts of romaine lettuce.

So far at least 64 people have been infected in 16 states. Pennsylvania is one place that has been hit the hardest with at least 12 people infected.

Officials think the outbreak is coming from Yuma, Arizona. They warn people not to eat any romaine lettuce unless you know where it’s from.

Always use a thermometer: 244 sickened by shiga toxin-producing E. coli at US Marine training base

In Nov. 2017, over 200 U.S. Marines-in-training were sickened by shiga-toxin producing E. coli at Marine Corps Recruit Depot San Diego and Camp Pendleton.

That outbreak was blamed on undercooked beef prepared by a civilian contractor, according to the results of an investigation.

First rule of public health (substitute military or any other organization): make public health look good.

According to Healio, the outbreak occurred in October and November among newly enlisted men at Marine Corps Recruit Depot, San Diego, and Camp Pendleton, a nearby base where recruits conduct weapons and field training, according to Amelia A. Keaton, MD, MS, EIS officer in the CDC’s Outbreak Response and Prevention Branch.

The outbreak involved Shiga toxin-producing E coli (STEC) — a major cause of foodborne illness in the United States each year and the pathogen responsible for the current multistate outbreak of E. coli linked to romaine lettuce. In all, 244 male recruits are suspected of being sickened, including 15 who developed a life-threatening complication of STEC infections called hemolytic uremic syndrome (HUS). Among those who developed HUS, six were deemed critically ill but none died, Keaton told Infectious Disease News during the CDC’s annual EIS conference.

She said the outbreak presented several challenges for investigators and highlighted some unique risk factors among military trainees living in close quarters.

“Nobody on our team had a military background, so we first wanted to understand what their training environment is like,” Keaton said. “Do they have any unique exposures that people in the general public don’t have? We wanted to get a sense of what day-to-day life was like for these guys and what risk factors for infection they were exposed to.”

Keaton and colleagues interviewed 43 case patients and 135 healthy controls, plus Marine officers, food workers and staff. They observed food preparation practices and studied recruit sleeping quarters, bathroom facilities and cafeterias where meals were served to around 2,000 to 3,000 recruits at a time, Keaton said.

Although they were unable to directly test any meat, through interviews investigators found that ill recruits were 2.4 times likelier to report consuming undercooked beef than healthy controls. Moreover, Keaton said investigators directly observed beef being undercooked.

According to Keaton, most dining facilities on military bases are run by civilian contractors, including the facilities involved in this outbreak, which offered the same menu prepared by the same company. The Navy is in charge of inspecting such facilities once a month, she said.

“A lot of people reported eating meals that were visibly undercooked,” Keaton said. “When we observed food preparation, we saw that food workers were cooking a large number of hamburger patties and a large number of meals. Because such a large number of meals are being prepared, they’re only able to check foods intermittently with a meat thermometer. In some instances, we saw there were temperature abuses where they weren’t necessarily cooking to temperatures recommended by California state law.”