Most of us are taught from a very early age that hand-washing is an easy, essential way of keeping ourselves clean and healthy. But residents of Flint, Michigan and surrounding areas have been forgoing this common practice out of fear of the water’s toxicity. Genesee county, of which Flint is a the largest city, and the adjacent county of Saginaw combined have experienced an outbreak of 131 cases of Shigellosis (named after the bacteria that causes it, Shigella). It’s a bloody diarrheal disease transmitted via tiny amounts of contaminated fecal matter. It typically lasts about a week, but can also cause patients to feel like they have to go to the bathroom even when they have no more waste in their systems. Additionally, the US Centers for Disease Control (CDC) also notes that “may be several months before [patients] bowel habits are entirely normal.”
In 2013, there were just under five cases reported per every 100,000 people in America. The outbreak in Michigan far exceeds that number, and it’s likely because residents in the area are afraid to use their tap water, which was found to have toxic levels of lead, a heavy metal that can cause neurological problems when it builds up in the body, in 2015. Even though the water was deemed safe for consumption with a proper filter, people in the area are still scared to wash their hands at all, according to the Washington Post.
Instead, they’re cleaning themselves using baby wipes—aren’t nearly as effective as disinfectant as good old-fashioned scrubbing—which should take about 20 seconds to ensure that any potential pathogens are washed down the drain.
“Some people have mentioned that they’re not going to expose their children to the water again,” Jim Henry, Genesee County’s environmental health supervisor, told CNN.
In 2015, 17 cases of Shigellosis were reported in the region. Since the beginning of 2016, 14 cases have been reported. The infectious disease has been reported in Blaine, Minidoka, Twin Falls and Jerome counties.
“Many people are unfamiliar with Shigella and what causes it,” said Tanis Maxwell, SCPHD Epidemiologist, in a news release. “Shigella is a bacteria present in the fecal matter of an infected individual. The symptoms of Shigella are watery or bloody diarrhea, abdominal pain, and fever.”
There’s a lot of amateur epidemiology going on this week. The latest comes from the owner of San Jose’s Mariscos San Juan #3, which reopened yesterday after being linked to 182 illnesses including 12 hospitalizations.
“This is first time this happened in my store, I opened my store in 2000,” said Segio Cruz, the restaurant owner.
Cruz owns three restaurants. He says since the shigella outbreak, business has dropped off 70 percent. He says even more damaging is the negative reputation generated by the incident, which he feels his restaurant does not deserve. “You can get sick in your house, your office, anywhere,” insists Cruz.
Cruz said homeless people often use the bathroom inside his restaurant and that perhaps could be another contributing factor. But again, there is still no definitive answers as to what caused this massive, and now mysterious, outbreak.
If his theory is correct, how did the Shigella get from the restroom to the food?
Marisco’s San Juan #3 restaurant linked to 200 cases of shigellosis is due to be open for business tomorrow according to KCRA. Although a source of the outbreak wasn’t confirmed, the working theory is that an infected food handler was to blame.
The Department of Environmental Health reinspected Marisco’s San Juan #3, which has been closed since Oct. 18, and approved it for reopening after finding it no longer poses a risk to public health from shigella bacteria, officials said.
County officials said the restaurant’s owners voluntarily discarded all food products on site, cleaned and sanitized the facility and retrained all employees in proper food handling methods. Employees who tested negative for shigella are being allowed to return to work.
Health officials determined that an outbreak of illness connected with the restaurant at 205 N. Fourth St. that caused 190 people to become sick was caused by shigella, a contagious diarrhoeal illness.
The source was most likely from an infected food handler at the restaurant who contaminated the entrees with their hands, officials said. But the exact source of the outbreak has not been determined, and officials have said it might never be identified.
A majority of the sick ate food last weekend from Marisco’s #3 Mexican Sea Food restaurant, located at 205 N. 4th Street in San Jose and public health officials say they expect to see more secondary cases, in which people had contact with someone who ate the restaurant.
Doug Powell, a former professor of food safety at Kansas State University who now lives in Australia and writes for barfblog.com, regards Yelp and social media as potentially useful tools for public-health investigators.
“But it doesn’t replace boots on the street, the epidemiological work that people have to do,” he said. “All these things have to be taken with a grain of salt, because Yelp is a business.”
“PLEASE DO NOT EAT HERE!!!!” Pauline A. wrote in her Oct. 18 review of the Mariscos San Juan #3 restaurant. “My sister in and brother-in-law along with his parents ate here Friday night and all four of them ended up in the hospital with food poisoning!!!”
That same day, the Santa Clara County Public Health Department shut down the restaurant. Two days later, officials announced that more than 80 people who had eaten there had become acutely ill, with many requiring hospitalization. Twelve diners went to intensive care units.
Some health researchers and public health professionals believe consumer review sites like Yelp might just help them identify and investigate food poisoning outbreaks similar to this one. It’s not unlike using Google searches to track potential flu and Dengue outbreaks.
Public health workers in New York, aided by Columbia University researchers, scanned thousands of Yelp reviews in 2012 and 2013 to find previously undetected food-borne illness, unearthing nearly 900 cases that were worthy of further investigation by epidemiologists. Ultimately, the researchers found three previously unreported restaurant-related outbreaks linked to 16 illnesses that would have merited a public health investigation if officials had known of them at the time. Follow-up inspections of the restaurants found food-handling violations.
In another study, researchers from Boston Children’s Hospital analyzed more than 5,800 Yelp reviews of food services businesses near 29 colleges in 15 states, concluding that reviews describing food poisoning tracked closely with food-borne illness data maintained by the U.S. Centers for Disease Control and Prevention. The timeliness and often-graphic details of the reviews could prove useful for public health agencies investigating food poisoning outbreaks, the researchers concluded.
Researchers also have examined Twitter and Facebook as possible food-borne illness surveillance tools, and Chicago’s public health agency automatically sends information about its Foodborne Chicago reporting site to local Twitter users who complain of food poisoning.
But Yelp’s usefulness for epidemiologists is going to depend a lot on how it handles food poisoning complaints down the road.
The company has been accused of approaching restaurants to remove negative reviews in exchange for advertising dollars, although a class action lawsuit on those grounds was dismissed.
On Tuesday, the company placed an “Active Cleanup Alert” notice on Mariscos San Juan #3’s review page noting that because the business “recently made waves in the news,” Yelp would “remove both positive and negative posts that appear to be motivated more by the news coverage itself than the reviewer’s personal consumer experience with the business.”
While some reviews were easily visible, others were segregated into Yelp’s “not currently recommended” category, which requires readers to click to see them and do not figure in the establishment’s overall rating.
Fox 4 KC, citing newly released numbers from the Kansas City Health Department on Friday, reports the city usually sees 10 cases of Shigella per year, but so far in 2015 there have already been 150 reported cases. From Jan. 1 to July 1, there were only 16 cases, but in the last two months there have been 134 additional cases. The outbreak is 15-times the annual average.
Unfortunately no one in the public knows exactly where though.
According to the Columbia Tribune reported cases of shigellosis is more than 4 times the expected rate in the Columbia area, and most illnesses are linked to child care settings.
The Columbia/Boone County Department of Public Health and Human Services reports 25 cases of shigellosis, also called shigella, occurring in the past two weeks. Spokeswoman Andrea Waner said the department has averaged six cases a year for the past five years.
Waner said most of the cases involve children attending day care. The Missouri Code of State Regulations prohibits her from identifying the locations, she said.
Michelle Baumstark, spokeswoman for Columbia Public Schools, said the district had only one case, several weeks ago. The student was the sibling of a child who was in day care at a location where shigella was reported.
She said because school-age children are toilet trained there isn’t a big concern about the illness spreading in the schools.
A couple of years ago I collaborated with Clemson’s Angie Fraser on a set of USDA NIFA funded food safety and infection factsheets for childcare facilities including using exclusion of ill staff and children as an outbreak control measure. The sheets can be downloaded here and here. Angie just published a bunch of the observation work that led to the the factsheets in the American Journal of Infection Control (abstract below). The work provides some insight on how pathogens might move around a center.
An observational study of frequency of provider hand contacts in child care facilities in North Carolina and South Carolina
American Journal of Infection Control 43 (2015) 107-11
Angela Fraser, Kelly Wohlgenant, Sheryl Cates, Xi Chen, Lee-Ann Jaykus, You Li, Benjamin Chapman
Background: Children enrolled in child care are 2.3-3.5 times more likely to experience acute gastrointestinal illness than children cared for in their own homes. The purpose of this study was to determine the frequency surfaces were touched by child care providers to identify surfaces that should be cleaned and sanitized.
Methods: Observation data from a convenience sample of 37 child care facilities in North Carolina and South Carolina were analyzed. Trained data collectors used iPods (Apple, Cupertino, CA) to record hand touch events of 1 child care provider for 45 minutes in up to 2 classrooms in each facility.
Results: Across the 37 facilities, 10,134 hand contacts were observed in 51 classrooms. Most (4,536) were contacts with porous surfaces, with an average of 88.9 events per classroom observation. The most frequently touched porous surface was children’s clothing. The most frequently touched nonporous surface was food contact surfaces (18.6 contacts/observation). Surfaces commonly identified as high- touch surfaces (ie, light switches, handrails, doorknobs) were touched the least.
Conclusion: General cleaning and sanitizing guidelines should include detailed procedures for cleaning and sanitizing high-touch surfaces (ie, clothes, furniture, soft toys). Guidelines are available for nonporous surfaces but not for porous surfaces (eg, clothing, carpeting). Additional research is needed to inform the development of evidence-based practices to effectively treat porous surfaces.