Cyclospora: Back to the future

During the summers of 2015 and 2016, the United Kingdom experienced large outbreaks of cyclosporiasis in travellers returning from Mexico. As the source of the outbreaks was not identified, there is the potential for a similar outbreak to occur in 2017; indeed 78 cases had already been reported as at 27 July 2017. Early communication and international collaboration is essential to provide a better understanding of the source and extent of this recurring situation.

Cyclosporiasis in travellers returning to the United Kingdom from Mexico in Summer 2017: Lessons from the recent past to inform the future

Eurosurveillance, vol. 22, issue 32, 10 August 2017, DFP Marques, CL Alexander, RM Chalmers, R Elson, J Freedman, G Hawkins, J Lo, G Robinson, K Russell, A Smith-Palmer, H Kirkbride, DOI: http://dx.doi.org/10.2807/1560-7917.ES.2017.22.32.30592

http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=22854

Going public fail 2-in-1 day: Tainted eggs were known about for months

I hate the phrase, food scare.

Hate is a strong word, but when it comes to food poisoning outbreaks that kill little kids and others, it’s not a scare, it’s real.

A scare implies former scream-queen Jamie-Lee Curtis flogging yoghurt that makes people poop.

That’s a food scare.

See how many times the N.Y. Times can use the word scare in its opening paragraphs:

The European Union on Monday notified the food safety authorities in Britain, France, Sweden and Switzerland to be on the lookout for contamination in eggs after a food scare in Belgium, Germany and the Netherlands.

Anna-Kaisa Itkonen, a European Commission spokeswoman, said, “We do not know if the eggs are contaminated or not, but because of these notifications, it’s now up to the national authorities to check.”

The scare over contaminated eggs, which began in Belgium, has led supermarkets there and in Germany and the Netherlands to clear shelves of the product as the crisis entered its third week.

The removal of eggs from shops was prompted by the discovery of the insecticide fipronil in some shipments. The contamination is thought to have been caused by the mixing of the insecticide with a cleaning agent used at chicken farms. The scare began July 19 when the government of Belgium said that fipronil had been found in eggs produced there.

Major supermarket chains in Belgium, including Delhaize and Colruyt, have stopped selling eggs from affected farms. In the Netherlands, one poultry producer declared bankruptcy on Friday as a result of the insecticide scare, according to an industry group.

 The Dutch consumer safety authority has published a guide on identifying the tainted eggs through a 10-digit serial number stamped on the shells. The country’s biggest supermarket chain, Albert Heijn, stopped selling many eggs last week, but the company said that eggs were back on sale as normal on Monday. In the Netherlands, an estimated nine million chickens from about 180 farms have been affected.

In Germany, the supermarket chain Aldi withdrew all eggs from sale after the authorities said that about three million eggs imported from the Netherlands had been affected. Since then, fipronil contamination has been found at four farms in the German state of Lower Saxony.

Fipronil is toxic in large quantities and can damage kidneys, liver and lymph glands. The Belgian and Dutch authorities are investigating how the contamination happened.

The Dutch poultry association said that farmers had no idea that cleaners were using the substance. Aalt den Herder, the group’s secretary, said the risk had been overstated.

“It was never an issue of human health, it was an issue of consumer confidence,” he said.

Yeah, except, as explained by the Irish Examiner:

Belgian authorities have now admitted they began investigating pesticide contamination in eggs in early June – several weeks before the public was made aware of a food safety scare affecting several European countries.

Kathy Brison, of the Belgian food safety agency, said on Sunday that a Belgian farm alerted authorities to a possible contamination in June, and they began investigating and alerted Belgian prosecutors.

German authorities are frustrated by the apparent delay in informing European neighbours.

German Agriculture Minister Christian Schmidt plans to speak to his Belgian counterpart about the issue on Monday.

And where would a risk communication failure be without the UK Food Standards Agency, who today reported, “We have no evidence that eggs laid in the UK are contaminated or that Fipronil has been used inappropriately in the UK. 85% of the eggs we consume in the UK are laid here.

“The number of eggs involved represents about 0.0001% of the eggs imported into the UK each year. Our risk assessment, based on all the information available, indicates that as part of a normal healthy diet this low level of potential exposure is unlikely to be a risk to public health and there is no need for consumers to be concerned. Our advice is that there is no need for people to change the way they consume or cook eggs or products containing eggs.”

Sounds good if they’re all getting “laid here.”

Once again:

Going public: Early disclosure of food risks for the benefit of public health

Mar.17

NEHA, Volume 79.7, Pages 8-14

Benjamin Chapman, Maria Sol Erdozaim, Douglas Powell

http://www.neha.org/node/58904

Often during an outbreak of foodborne illness, there are health officials who have data indicating that there is a risk prior to notifying the public. During the lag period between the first public health signal and some release of public information, there are decision makers who are weighing evidence with the impacts of going public.

Multiple agencies and analysts have lamented that there is not a common playbook or decision tree for how public health agencies determine what information to release and when. Regularly, health authorities suggest that how and when public information is released is evaluated on a case-by-case basis without sharing the steps and criteria used to make decisions. Information provision on its own is not enough.

Risk communication, to be effective and grounded in behavior theory, should provide control measure options for risk management decisions.

There is no indication in the literature that consumers benefit from paternalistic protection decisions to guard against information overload. A review of the risk communication literature related to outbreaks, as well as case studies of actual incidents, are explored and a blueprint for health authorities to follow is provided.

Going public fail: 14 sick with E. coli linked to raw milk in Virginia, 2016

The general public didn’t have access to the suspect food, so there was no point in unnecessarily alarming the public.

I’ve heard that paternalistic crap for 30 years now, and it never turns out well.

Coral Beach of Food Safety News reports that Virginia officials did not alert the general public to an E. coli outbreak in March 2016 that sickened at least 14 people — a dozen of them children.

This week, 17 months after the outbreak, public health officials expect to complete their report on the incident, according to a spokesman for the Virginia Department of Health. The implicated milk was from Golden Valley Guernseys (free samples delivered for $4) dairy, which sent a letter to members of its herd-share operation alerting them to the illnesses at the time.

Of the 14 confirmed E. coli victims, half had symptoms so severe that they required hospitalization. Three developed hemolytic uremic syndrome.

The state health department’s Rappahannock-Rapidan Health District office did not make a public announcement about the outbreak at the time because the general public did not have access to the milk, District Director Dr. Wade Kartchner told Food Safety News.

“Consideration was given to putting out a broad public notice, but the nature of the herd-share programs are such that we were confident that we would be able to effectively reach those who were truly at risk of illness,” Kartchner said. “… it is not quite the same situation as a restaurant outbreak where the public at large may be exposed.”

This is so wrong.

Others, even mere mortals, learn from outbreaks: How did this happen? How dangerous was the outbreak? And what kind of foods to avoid, like raw fucking milk.

In the absence of public announcements, it also makes it harder for mere scientists to make a case that a certain food may be risky.

Going public is the new normal for foodborne outbreaks, and some day, admin-types may catch up.

Facebook, tweets, calls to lawyers like Marler, going public is any agency’s best defense.

And it’s the right thing to do.

We’ve published about this before, and as I said at the time, I’ve had different versions of this paper running through my head for 25 years.

It started as a rebel-without-a-clue teenager, and led to questions about mad cow disease in 1995 (or earlier) when the UK government knew there were human victims but said nothing until March 1996.

Yet the job of public health, no matter how many political assholes, no matter how many impediments, and no matter how many dog bites you have to investigate, is to protect public health.

If people are barfing, it’s time to go public.

That doesn’t always happen.

Anyone can search barfblog.com under the phrase “going public” and find hundreds of incidents of people acting like shits.

But this is important shit, because credibility depends on transparency and trust and truthiness (at least in my idyllic world-view).

Public health is under siege.

The science is there, the outbreaks are there. Go public.

Or at least explain the process so the rest of us can understand.

Going public: Early disclosure of food risks for the benefit of public health

Mar.17

NEHA, Volume 79.7, Pages 8-14

Benjamin Chapman, Maria Sol Erdozaim, Douglas Powell

http://www.neha.org/node/58904

Often during an outbreak of foodborne illness, there are health officials who have data indicating that there is a risk prior to notifying the public. During the lag period between the first public health signal and some release of public information, there are decision makers who are weighing evidence with the impacts of going public.

Multiple agencies and analysts have lamented that there is not a common playbook or decision tree for how public health agencies determine what information to release and when. Regularly, health authorities suggest that how and when public information is released is evaluated on a case-by-case basis without sharing the steps and criteria used to make decisions. Information provision on its own is not enough.

Risk communication, to be effective and grounded in behavior theory, should provide control measure options for risk management decisions.

There is no indication in the literature that consumers benefit from paternalistic protection decisions to guard against information overload. A review of the risk communication literature related to outbreaks, as well as case studies of actual incidents, are explored and a blueprint for health authorities to follow is provided.

Science is my faith; the arena is my church: Hucksters, buskers and Kato Kaelin

It was a visit to the Wizard of Oz museum in Kansas that solidified my belief in the hucksters and buskers ruining the dream of America.

I was willingly living in Kansas with a girl I fell in love with – still am — and two of my Canadian daughters were visiting in 2007, so we decided to travel down the road from Manhattan, Kansas, to Wamego, KS, home of the Wizard of Oz museum.

If there’s genius in David Lynch, it’s predicting things before they happen – the elevated hairdo in Eraserhead made popular by Lyle Lovett, the Dr. Amp personified by radio-talk shrill Alan Jones.

Even John Oliver has had a go at Dr. Group, the unfortunately-named chiropractor and Kato-Kaelin–lookalike who shrills science with the veracity of a Kardashian.

Which reminds me, I gotta tell Chapman to shorten his bio.

In academia, when starting as an assistant professor, most  feel a need to put everything they farted out that passed peer review into their bio, including boy scout leader, and hockey coach.

As time goes on, the bio becomes shorter, because you’ve earned that full prof title, and even you don’t give a shit about repeating everything you’ve toiled over for the past 40 years – you also correctly reason that no one else gives a shit either, and if they do, google it.

Check out the degrees behind Dr. Group.

The struggle to confirm who is legitimate and why, continues, and is often laid bare in the fanciest of university-type institutions.

Do these people really care about learning, or are they just there, to make a paycheck, get their retirement and go through the motions.

I won’t go into the latest details about Gwenyth preaching that livers and kidneys can be detoxed by handstands, why Canada’s Dr. Jen Gunter has taken on debunking her Gwenythness, or why a top uni in Spain scraped homeopathy — because it’s nonsense.

Instead I give you the wisdom of John Oliver.

Seafood safety, roses and writing

Chapman is a shitty writer.

How he got a staff member named Katrina Levine, who can write, is beyond my grasp.

But, I’m content to be amazed at the world, not think too much about it, and be grateful for the beauty in a rose or an MPH who can put a couple of sentences together.

Katrina (whom I’ve never met) writes:

I’ve never been one who likes attention, but I’ll admit that during the 15 minutes of fame that came with the publication of Evaluating Food Safety Messages in Popular Cookbooks in the British Food Journal, I got a little excited every time someone wanted to interview me. Terrified, but excited.

During the 2 week media buzz that followed the press release, I did approximately 6 interviews, one of which was for Consumer Reports. Unlike most of the interviews, which were focused on our row with Gwyneth Paltrow or how her cookbook could give you food poisoning, the nice journalist I spoke with wanted my professional opinion on how to choose and prepare seafood safely.

As I said before in an earlier barfblog post, the media attention from this paper gave us an opportunity to share what we know about safe food handling while people were listening. So when this journalist asked me to talk about seafood food safety, share I did – for about 45 minutes.

The messages I shared ranged from safe thawing methods, such as running raw seafood under cold running water, to determining doneness using a thermometer or opacity. Sari Hararr of Consumer Reports writes:

In a hurry? For safe seafood, thaw frozen fish and shellfish under cold running water in a sealed plastic bag, then cook it right afterward, says Katrina Levine, M.P.H., a registered dietitian and an extension associate in food safety and nutrition at North Carolina State University in Raleigh

For thicker fish such as a salmon steak, you can slip the thermometer into a side of the fillet, Levine says. But because it’s almost impossible to use a thermometer on shellfish or a delicate fillet of sole, the USDA notes that it’s also considered safe to cook fish until the flesh is opaque and separates or flakes easily with a fork. Cook crabs, lobster, and shrimp until the flesh is opaque and pearly; clams, mussels, and oysters until their shells open; and scallops until they are milky white or firm and opaque.

Although seafood does not need to reach an internal temperature as high as some foods like ground beef – 145°F compared to 160°F for ground beef and 165°F for poultry – it’s not any less risky. Outbreaks of norovirus and Vibrio have been linked to raw or undercooked seafood.

We know that using a thermometer to check internal temperatures is the best practice for knowing when food is done. Yet, people are even less likely to use a thermometer on fish than on meat or poultry, and cookbook recipes are also less likely to include safe endpoint temperatures for fish. While raw or undercooked seafood may be trendy (sushi and raw oyster lovers – you know who you are), getting foodborne illness isn’t.

These sponges go to 14

Friend of barfblog, and frequent contributor (and modeler extraordinaire), Don Schaffner writes,

I’m always interested in the way microbiology is perceived in the popular culture. When peer reviewed research articles get wide pick up, I’m especially interested. This happened recently with an article on kitchen sponges. Rob Mancini has already blogged about this right here on barfblog, but I’d like to share my thoughts and perspectives.

The fact the kitchen sponges can be massively contaminated by high levels of microorganisms is not news. This has been shown repeatedly in the peer reviewed literature.

What was apparently new in this latest article was the application of “454–pyrosequencing of 16S rRNA genes and fluorescence in situ hybridization coupled with confocal laser scanning microscopy (FISH–CLSM)”. And I get it. Molecular-based methods are all the rage, and the ability to visualize the presence of microorganisms is very important.

But we shouldn’t lose sight of the fact that experimental design, and proper experimental controls are important no matter what sort of science you’re doing. When I dug a little deeper into the above article I was shocked to learn that all of their conclusions were based on a sample of 14 sponges. That’s right, 14 sponges. Furthermore, the authors make claims that “sponge sanitation methods appear not sufficient to efectively reduce the bacterial load in kitchen sponges”. How did they know this? Well when they were collecting those 14 sponges they asked the sponge owners “to specify whether they regularly apply special measures to clean their sponge. The procedures mentioned were: heating in a microwave and rinsing with hot, soapy water”. Of the 14 sponges collected, in five cases the sponge owners reported applying special measures, although the authors do not which of the five used microwaving and which used rinsing with hot, soapy water.

What’s my take away message from this? By all means, go out there and use the hot new technology. But please don’t forget that sample size is very important, and while surveying people for their opinion about what they do might be convenient, it’s no substitute for actually investigating. And if I had to predict the effect of washing sponges with hot soapy water? Probably no different than washing in cold soapy water.

And if anybody out there has access to “454–pyrosequencing of 16S rRNA genes and fluorescence in situ hybridization coupled with confocal laser scanning microscopy (FISH–CLSM)“ and wants to collaborate, I am available.

Shock and shame: Science behind getting people to wash their hands

Gimmie shelter from the ravages of time.

I’d largely forgotten about my lab’s handwashing phase, probably because I was leaving the safety (shurley not) of Kansas and heading to Australia.

But was reminded from this excerpt in The New Yorker from Nate Dern’s “Not Quite a Genius,” to be published by Simon & Schuster:

Employees must wash hands.

Employees must wash their own hands.

Employees must wash their own hands after they use the restroom.

Employees of this restaurant must wash their own hands after they use the restroom.

Employees of this restaurant must wash their own hands (literally, not metaphorically) after they use the restroom.

Employees of this restaurant must wash their own hands (literally, not metaphorically) after they use the restroom, or else they are in violation of the health code.

Employees of this restaurant must wash their own hands (literally, not metaphorically) after they use the restroom, or else they are in violation of the health code, and, no, there is no practical way to regulate or enforce this rule.

Employees of this restaurant must wash their own hands (literally, not metaphorically) after they use the restroom, or else they are in violation of the health code, and, no, there is no practical way to regulate or enforce this rule, but, yes, we still ask, and trust that you will comply.

Employees of this restaurant must wash their own hands (literally, not metaphorically) after they use the restroom, or else they are in violation of the health code, and, no, there is no practical way to regulate or enforce this rule, but, yes, we still ask, and trust that you will comply, and, O.K., we apologize for the condescending tone of the posting of this rule, which seems to imply that without such a sign we would assume that our employees are disgusting children with no regard for their own hygiene.

Employees must wash hands. Greg has been fired.

Filion, K., KuKanich, K.S., Chapman, B., Hardigree, M.K., and Powell, D.A. 2011. Observation-based evaluation of hand hygiene practices and the effects of an intervention at a public hospital cafeteria. American Journal of Infection Control 39(6): 464-470.

Background

Hand hygiene is important before meals, especially in a hospital cafeteria where patrons may have had recent contact with infectious agents. Few interventions to improve hand hygiene have had measureable success. This study was designed to use a poster intervention to encourage hand hygiene among health care workers (HCWs) and hospital visitors (HVs) upon entry to a hospital cafeteria.

Methods

Over a 5-week period, a poster intervention with an accessible hand sanitizer unit was deployed to improve hand hygiene in a hospital cafeteria. The dependent variable observed was hand hygiene attempts. Study phases included a baseline, intervention, and follow-up phase, with each consisting of 3 randomized days of observation for 3 hours during lunch.

Results

During the 27 hours of observation, 5,551 participants were observed, and overall hand hygiene frequency was 4.79%. Hygiene attempts occurred more frequently by HCWs than HVs (P = .0008) and females than males (P = .0281). Hygiene attempts occurred more frequently after poster introduction than baseline (P = .0050), and this improvement was because of an increase in frequency of HV hand hygiene rather than HCW hand hygiene.

Conclusion

The poster intervention tool with easily accessible hand sanitizer can improve overall hand hygiene performance in a US hospital cafeteria.

Wilson, S.M., Jacob, C.J. and Powell, D.A. 2011. Behavior-change interventions to improve hand hygiene practice: A review. Critical Public Health 21: 119-127.

http://www.informaworld.com/smpp/content~content=a934338802~db=all~jumptype=rss

Despite the role of hand hygiene in preventing infectious disease, compliance remains low. Education and training are often cited as essential to developing and maintaining hand-hygiene compliance, but generally have not produced sustained improvements. Consequently, this literature review was conducted to identify alternative interventions for compelling change in hand-hygiene behavior. Of those, interventions employing social pressures have demonstrated varying influence on an individual’s behavior, while interventions that focus on organizational culture have demonstrated positive results. However, recent research indicates that handwashing is a ritualized behavior mainly performed for self-protection. Therefore, interventions that provoke emotive sensations (e.g., discomfort, disgust) or use social marketing may be the most effective.

Food fraud: Mexican alcohol edition

To my four Canadian daughters: Pay attention.

Tourists to all-inclusive resorts in Mexico suspect they were given tainted alcohol.

Raquel Rutledge of the Milwaukee Journal Sentinel writes the scene at the swim-up bar at the Mexican resort where Abbey Conner was pulled listless from the pool in January was full of young tourists last month when an attorney hired by Conner’s family showed up.

It wasn’t surprising. It was a typical scene at an all-inclusive five-star resort where foreigners from both sides of the equator flock to escape their cold winters.

But as he watched, the attorney noticed something disturbing.

“They serve alcoholic drinks with alcohol of bad quality and in great amounts, mixing different types of drinks,” he wrote in his native Spanish.

That single paragraph, buried near the end of a four-page report summarizing how 20-year-old Conner drowned within a couple hours of arriving at the Iberostar Hotel & Resorts’ Paraiso del Mar, offers a possible lead in the investigation into her death.

And it could shed light on the circumstances surrounding numerous reports from others who have told the Milwaukee Journal Sentinel they experienced sickness, blackouts and injuries after drinking at Iberostar and other resorts around Cancun and Playa del Carmen in recent months.

A Pewaukee family traveled to an all-inclusive resort in Playa del Carmen in January. Their two college kids wound up unconscious, face down in the pool within two hours. Twenty-year-old Abbey died.

They told the Journal Sentinel they believe they were drugged or the alcohol may have been tainted. They questioned how they could fall into a stupor so quickly. And whether they had been targeted.

I can’t make this shit up: Chipotle taps Wu-Tang Clan for marketing buzz

I can’t make this shit up: here’s a company with billions invested in it, and Chipotle decides to reach out to the Wu-Tang Clan.

A company that sucks bonding with a band that sucks and hoping that two negatives make a positive?

In April, 2017, Chipotle tapped hey-now Hank Kinsley and some other actors for some spots about how real Chipotle’s food was.

Guess that hasn’t gone so well.

Now, the aptly-named Mark Crumpacker, Chipotle’s chief marketing officer and convicted cokehead, told Bloomberg that Chipotle Mexican Grill Inc., has enlisted rapper RZA from the Wu-Tang Clan to unveil a new website that spotlights Chipotle’s ingredients. The company’s so-called clean menu — free of artificial preservatives and other additives — was a major selling point before a 2015 food-safety crisis sickened hundreds of customers and sent its shares plummeting.

Yup, real hardcore reaching out to the Wu-Tang Clan.

RZA, whose real name is Robert Diggs, helped design Chipotle’s new Savor.Wavs site. The rapper created 51 snippets of music, one for each ingredient on the menu, that lets people hear a audio interpretation of their typical Chipotle order. The new site doesn’t let customers order food, but it’s meant to drive home the simplicity of the chain’s menu.

“That might be lost on some, but people who are into the music will appreciate it,” said Crumpacker.

Crumpacker touted Chipotle’s simple menu at a party in Manhattan on Tuesday that featured a performance by RZA. He noted that fast-food hamburgers can have as many as 47 ingredients.

While the company declined to say how much it spent on the RZA campaign, Chipotle indicated it was less than the $5 million that a Super Bowl ad would have cost.

Chipotle’s stock, which hit a closing high of $757.77 in August 2015, has been battered by the food-safety concerns. The shares had been up for the year until Tuesday, when reports surfaced that customers had been sickened after eating a restaurant in Virginia. That location, which was closed on Monday, was slated to be reopened on Wednesday.

The stock is now trading around $368, about half its peak.

‘It felt as if my heart had been ripped out’ 3-day-old Australian baby dies of

A mother from Queensland has shared the heartbreaking moment she was told she’d contracted Listeria and passed it to her unborn baby.

Jeanya Rush, 20, from Brisbane, was six months pregnant with her second child – a baby boy – when she started to experience ‘excruciating headaches and high fevers’.

The young mum told Katherine Davison of the Daily Mail Australia that she later discovered she had contracted Listeria – from either a pre-cut fruit salad, cream cheese or an ice-cream she had eaten – and had passed the foodborne illness on to her baby boy, who she and her partner Levi had named Zephaniah.

Doctors told her the infection had left her son ‘severely disabled’ and she and Levi faced the agonising decision whether to let him go.

‘I had tested positive for Listeria. It had infected my uterus and also reached Zephaniah’s brain,’ Ms Rush wrote in a heartrending Facebook post.

‘He [the doctor] told us that Zephaniah could not live without the machines that aid him and if he were to survive he would be severely disabled for the rest of his life. 

‘He would show no emotion or understanding he would be basically be in a comatose state. And worst of all, it was our choice whether or not to let him go. Levi and I were broken. Nothing could ever describe the pain we felt in that moment.’

Ms Rush said it was the hardest decision they had ever had to make. 

‘It took a long time to decide. As Zephaniah stayed on life support, we were by his side and it made everything that much harder,’ she wrote.

‘But we both knew what we had to do and eventually Levi and I came to a decision and it was the hardest one we have ever had to make. We chose to let Zephaniah go and relieve him of his pain and suffering.’

Ms Rush had tested positive for listeria – leading their baby to be severely disabled – and the young couple made the devastating decision to let him go.

‘The midwives and doctors arranged everything. We had our loved ones come in to say good bye to our boy, Zephaniah was blessed by the Elders of Levi’s church, and it was one very long emotional day preparing to send our boy off,’ Ms Rush wrote.

‘When the time came, Levi and I were taken to a private room with Zephaniah, accompanied by 2 lovely midwives. 

‘They took out his breathing tubes and we held Zephaniah for approximately an hour until his final breath. 

‘When he turned cold in my arms it felt as if my heart had been ripped out of my chest. 

‘We held him for a little while longer before the midwives took him away. We returned to our room and sat in silence. I will never forget the pure pain of that moment.’