Things rarely happen until they do: 4136 sick from Norovirus in bottled water, Spain, 2016

In April 2016, an outbreak of gastrointestinal illness (4,136 cases) occurred in Catalonia, Spain. We detected high levels of norovirus genotypes I and II in office water coolers associated with the outbreak. Infectious viral tiiter estimates were 33–49 genome copies/L for genotype I and 327–660 genome copies/L for genotype II.

During April 11–25, 2016, a total of 4,136 cases of gastroenteritis were reported by the Public Health Agency of Catalonia (ASPCAT; Figure, panel A). A case-patient was defined as an exposed person who had vomiting or diarrhea (3 or more loose stools within 24 hours) and >2 of the following: nausea, abdominal pain, or fever (≥37.8°C). Six patients required hospitalization.

The epidemiologic investigation conducted by the ASPCAT pointed toward an association of the outbreak with drinking bottled spring water from office water coolers; the water had been bottled at a source in Andorra (M. Jané-Checa and A. Martínez-Mateo, Public Health Agency of Catalonia, pers. comm., 2016 Sep 1). Compared with other modes of transmission such as food or person to person, norovirus outbreaks associated with drinking water are rare in developed countries. On April 15, 2016, as a precautionary measure, the company producing the bottled water recalled >6,150 containers of water of suspected quality that had already been distributed to 925 companies. The water complied with all requirements of the European Commission directive on the exploitation and marketing of natural mineral waters, but these requirements do not include any virologic determination.

Norovirus in bottled water associated with gastroenteritis outbreak, Spain, 2016

Emerging Infectious Diseases, Volume 23, Number 9—September 2017

Albert Blanco, Susana Guix, Noemí Fuster, Cristina Fuentes, Rosa Bartolomé, Thais Cornejo, Rosa Maria Pintó, and Albert Bosch

https://wwwnc.cdc.gov/eid/article/23/9/16-1489_article

 

Probably noro: 252 sick from cafeteria at Spanish hospital

Ainhoa Iriberri of El Español reports (and something may be lost in translation) there are already 252 those affected by the outbreak of acute gastroenteritis that ravaged last week to the Hospital of Bellvitge, in L’Hospitalet de Llobregat. The Public Health Agency of Catalonia (ASPCAT) has reported the increase of victims, which last Friday had been set at 190, all workers at the health center.

In all cases the symptomatology has been mild so, despite the high number of affected, the outbreak has had no attendant consequences. That is to say, it has not had to reprogram surgeries nor close operating rooms, always according to the governmental organism.

This has also indicated that the analysis of samples is ongoing but that, so far, two of them have proved to be norovirus positive, reason why it is suspected that this pathogen is the cause of the massive infection.

Although the information is still preliminary, it seems also to confirm where the source of the infection would be that is not other than the snacks served in the cafeteria for hospital staff between Tuesday and Friday.

Or sick employees.

‘It’s a super-cool study’ Salmonella took down the Aztecs

Eye herpes is a real thing.

I got it in 1984.

Probably from my ex roomate’s towel.

I was so sick for two weeks, although I did manage to crawl out of bed for a Neil Young show in Toronto (part of the International Harvesters tour) but then felt so sick afterwards I went home to Brantford.

One of my parent’s neighbours was my evy doctor, so I was in for a regular check-up and he detected it immediately.

Put me on some Acyclovir, which had just come out, and I was cured in no time.

Or temporarily. Viruses don’t go away.

We’re all hosts on a viral planet.

Mine has come back, in the form of a cold sore, probably because of the stress of buying a new house in an over-heated real-estate market and not selling ours.
I went to the chemist, got some drugs that aren’t really working, but at least I had that option.

Imagine 600 years ago, when Cortez from Spain dances across the water to what is now Mexico and there’s no chemist down the road.

Ewen Callaway of Nature writes one of the worst epidemics in human history, a sixteenth-century pestilence that devastated Mexico’s native population, may have been caused by a deadly form of salmonella from Europe, a pair of studies suggest.

In one study, researchers say they have recovered DNA of the stomach bacterium from burials in Mexico linked to a 1540s epidemic that killed up to 80% of the country’s native inhabitants. The team reports its findings in a preprint posted on the bioRxiv server on 8 February.

This is potentially the first genetic evidence of the pathogen that caused the massive decline in native populations after European colonization, says Hannes Schroeder, an ancient-DNA researcher at the Natural History Museum of Denmark in Copenhagen who was not involved in the work. “It’s a super-cool study.”

In 1519, when forces led by Spanish conquistador Hernando Cortés arrived in Mexico, the native population was estimated at about 25 million. A century later, after a Spanish victory and a series of epidemics, numbers had plunged to around 1 million.

The largest of these disease outbreaks were known as cocoliztli (from the word for ‘pestilence’ in Nahuatl, the Aztec language). Two major cocoliztli, beginning in 1545 and 1576, killed an estimated 7 million to 18 million people living in Mexico’s highland regions.

“In the cities and large towns, big ditches were dug, and from morning to sunset the priests did nothing else but carry the dead bodies and throw them into the ditches,” noted a Franciscan historian who witnessed the 1576 outbreak.

There has been little consensus on the cause of cocoliztli — although measles, smallpox and typhus have all been mooted. In 2002, researchers at the National Autonomous University of Mexico (UNAM) in Mexico City proposed that a viral haemorrhagic fever, exacerbated by a catastrophic drought, was behind the carnage2. They compared the magnitude of the 1545 outbreak to that of the Black Death in fourteenth-century Europe. 

In an attempt to settle the question, a team led by evolutionary geneticist Johannes Krause at the Max Planck Institute for the Science of Human History in Jena, Germany, extracted and sequenced DNA from the teeth of 29 people buried in the Oaxacan highlands of southern Mexico. All but five were linked to a cocoliztli that researchers think ran from 1545 to 1550.

Ancient bacterial DNA recovered from several of the people matched that of Salmonella, based on comparisons with a database of more than 2,700 modern bacterial genomes.

Further sequencing of short, damaged DNA fragments from the remains allowed the team to reconstruct two genomes of a Salmonella enterica strain known as Paratyphi C. Today, this bacterium causes enteric fever, a typhus-like illness, that occurs mostly in developing countries. If left untreated, it kills 10–15% of infected people.

It’s perfectly reasonable that the bacterium could have caused this epidemic, says Schroeder. “They make a really good case.” But María Ávila-Arcos, an evolutionary geneticist at UNAM, isn’t convinced. She notes that some people suggest that a virus caused the cocoliztli, and that wouldn’t have been picked up by the team’s method.

Krause and his colleagues’ proposal is helped by another study posted on bioRxiv last week, which raises the possibility that Salmonella Paratyphi C arrived in Mexico from Europe.

A team led by Mark Achtman, a microbiologist at the University of Warwick in Coventry, UK, collected and sequenced the genome of the bacterial strain from the remains of a young woman buried around 1200 in a cemetery in Trondheim, Norway. It is the earliest evidence for the now-rare Salmonella strain, and proof that it was circulating in Europe, according to the study. (Both teams declined to comment on their research because their papers have been submitted to a peer-reviewed journal – good for them, dp).

“Really, what we’d like to do is look at both strains together,” says Hendrik Poinar, an evolutionary biologist at McMaster University in Hamilton, Canada. And if more ancient genomes can be collected from Europe and the Americas, it should be possible to find out more conclusively whether deadly pathogens such as Salmonella arrived in the New World from Europe.

We’re all hosts on a viral planet virome edition

The X-files movie was on the other night – the 1998 one – featuring bad dialogue, overwrought music, mysterious scientists and a mutated virus originally delivered by extraterrestrials.

bacteriophageAt the same time I was reading how scientists at the Catalan Institute for Water Research (ICRA) in Spain have carried out a comprehensive analysis of several viromes from different habitats to explore whether bacteriophages (viruses that infect bacteria) harbor antibiotic resistance genes.

The team demonstrated that while human-associated viromes do not or rarely carry resistance genes, viromes from non-human sources (e.g., pig feces, raw sewage, and freshwater and marine environments) contain a large reservoir of resistance genes. Their work is described in the journal Environmental Pollution (1).

“These findings suggest that phages may play a more significant role in the acquisition and mobilization of antibiotic resistance genes than previously expected”, says Dr. Jose L. Balcazar, a Ramon y Cajal research scientist and senior author of the study.

Of course they do: We’re all hosts on a viral planet.

In this study, several viromes (community of viruses) from humans, animals, and different environments worldwide were screened for sequences similar to those associated with antibiotic resistance genes. The results showed that genes encoding major facilitator superfamily transporters and beta-lactamases were found in all analysed viromes regardless their origin. The presence of these resistance genes in bacteriophages is of particular concern, because these genes may eventually be transferred to bacteria, making them resistant to antibiotics. Considering that bacteriophages have the potential to transfer genetic material between bacteria, they play an important role in the evolution and ecology of bacterial species. However, the contribution of bacteriophages to the acquisition and spread of antibiotic resistance has been partially explored in environmental settings. So these findings suggest that the role of bacteriophages should be taken into account in the development of strategies for tackling antibiotic resistance. This work was funded by the first joint call of the Water Joint Programming Initiative (JPI) and the Spanish Ministry of Economy and Competitiveness.

Published articles

Lekunberri I., Subirats J., Borrego C.M., Balcazar J.L. (2016) “Exploring the contribution of bacteriophages to antibiotic resistance”. Environmental Pollution. DOI: 10.1016/j.envpol.2016.11.059

 “Wastewater treatment plant discharges can promote the development of antibiotic resistance in streams” [PDF]. Science for Environment Policy of the European Commission DG Environment News Alert Service.

Everyone’s got a camera Spanish bakery edition: Rats tucking into sandwiches at popular chain

Customers at a Madrid bakery witnessed a rather unexpected – and stomach churning – sight on Friday: four rats tucking into sandwiches in the bakery’s display case. 

rat-granier-bakeryThe rodents were spotted by two men passing by a branch of the Granier bakery chain and were caught on camera helping themselves to food that was left in a glass-fronted display case.  

The men can be heard joking “how cute” as they film the two large rats scampering over the fresh food in a video published on social media.

Police confirmed they were called to the bakery at around 1.30pm on Friday and had closed the establishment pending health and safety checks. 

Granier, a Spanish chain, has 350 bakeries across Spain as well as in Portugal, Italy and London. 

The company confirmed that the bakery, located in the Pueblo Nuevo neighbourhood of Madrid, “was closed and would stay closed”, in a statement released on Friday. 

“The company has put itself at the disposal of the appropriate authorities and has opened an internal investigation into these events,” the company said, adding that food safety protocol had been “strictly adhered to” in the establishment. 

Granier said that the bakery underwent quarterly inspections, the last having taken place on October 26, when, according to documents released by the company, the branch in question was fumigated. 

It was, the company claimed, “an isolated event” and “the 350 Granier establishments in Spain and abroad comply strictly with all food health regulations.”

3 sick with botulism in Spain and Germany linked to dried salted fish

Two cases of botulism in the province of Alicante and another in Germany linked to a brand of dried salted fish produced in The Netherlands has led to it being withdrawn from sale in various parts of Spain.

dried-roach-fish-salted-hanged-log-wall-drying-50980748Salted roach (rutilus rutilus, known in Spanish and branded as such in supermarkets asrutilo), stocked in refrigeration cabinets and bearing the identification number NL-6114-EG, distributed by Monolith Alimentos España Sur (in Valencia) and Norte (in Catalunya) has been taken off the shelves after two consumers in the province of Alicante reported having been apparently affected by the bug.

Both showed ‘very similar symptoms’, although it has yet to be confirmed whether they caught botulism from eating dried roach.

All supermarkets and delicatessens in the towns of Dénia, Altea, La Nucia, Torrevieja, Benidorm, Orihuela and Alicante city have taken it off the shelves, as have those in the province of Castellón, Gandia (Valencia province) and Valencia city.

In Catalunya, shops in Barcelona, Badalona and Sabadell (Barcelona province), Salou (Tarragona province) and Lleida have withdrawn it from sale.

The Spanish Consumer, Food Safety and Nutrition Agency (AECOSAN), part of the ministry of health, says it has received a European alert after a case of botulism in Germany thought to have been caused by the same product.

16 sickened with trichinellosis in Belgium from imported wild boar meat

Trichinellosis is a rare parasitic zoonosis caused by Trichinella following ingestion of raw or undercooked meat containing Trichinella larvae. In the past five years, there has been a sharp decrease in human trichinellosis incidence rates in the European Union due to better practices in rearing domestic animals and control measures in slaughterhouses.

wild-boar-recipes-and-uses_homemediumIn November 2014, a large outbreak of trichinellosis occurred in Belgium, related to the consumption of imported wild boar meat. After a swift local public health response, 16 cases were identified and diagnosed with trichinellosis. Of the 16 cases, six were female. The diagnosis was confirmed by serology or the presence of larvae in the patients’ muscle biopsies by histology and/or PCR. The ensuing investigation traced the wild boar meat back to Spain. Several batches of imported wild boar meat were recalled but tested negative.

The public health investigation allowed us to identify clustered undiagnosed cases. Early warning alerts and a coordinated response remain indispensable at a European level.

Outbreak of Trichinellosis related to eating imported wild boar meat, Belgium, 2014

Eurosurveillance, Volume 21, Issue 37, 15 September 2016, DOI: http://dx.doi.org/10.2807/1560-7917.ES.2016.21.37.30341

P Messiaen, A Forier, S Vanderschueren, C Theunissen, J Nijs, M Van Esbroeck, E Bottieau, K De Schrijver, IC Gyssens, R Cartuyvels, P Dorny, J van der Hilst, D Blockmans

http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=22581

Norovirus? Look to the barf

We investigated an outbreak of norovirus that affected students and teachers of a high school in Lleida, Spain through various transmission mechanisms.

norovirus-2A case-control epidemiological study of the risk of disease and the relative importance of each mode of transmission was carried out. Cases and controls were selected from a systematic sample of students and teachers present at the school on 28 January. Fecal samples were taken from three food handlers and 16 cases. The influence of each factor was studied using the adjusted odds ratio (aOR) and the estimated population attributable risk (ePAR) with 95% confidence intervals (CI). We interviewed 210 people (42 cases, 168 controls). The proportion of symptoms in these individuals was nausea 78·6%, vomiting 59·5%, diarrhoea 45·2%, and fever 19·0%. The epidemic curve showed transmission for at least 4 days. The risk of disease was associated with exposure to food (aOR 5·8) in 66·1% of cases and vomit (aOR 4·7) in 24·8% of cases. aecal samples from 11 patients and two food handlers were positive for norovirus GII.12 g.

Vomit may co-exist with other modes of transmission in norovirus outbreaks and could explain a large number of cases.

Norovirus gastroenteritis outbreak transmitted by food and vomit in a high school

Epidemiology and Infection / Volume 144 / Issue 09 / July 2016, pp 1951-1958Copyright © Cambridge University Press 2016  DOI: http://dx.doi.org/10.1017/S0950268815003283 (About DOI), Published online: 13 January 2016

Godoy, M. Alsedà, R. Bartolomé, D. Clavería, I. Módol, P. Bach, G. Mirada And À. Domínguez

http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=10346522&utm_source=Issue_Alert&utm_medium=RSS&utm_campaign=HYG

How did the noro get into the bottled water?

Over 4000 illnesses linked to bottled water in Spain and there are a few theories how the virus got into the hundreds of coolers and fridges across the country. Maybe someone puked in the bottling plant, spreading virus particles all over. My money goes on the source.

Whatever the cause, it’s likely little comfort to those who were barfing as a result.

Live Science reports that the thousands of ill folks consumed water cooler water in early April.

It’s possible that norovirus contaminated the water at its source where it was bottled, said Benjamin Chapman, an associate professor and food safety specialist at North Carolina State University, who was not involved in the investigation. In this case, the spring water was bottled in Andorra, a small country located in the Pyrenees mountains between Spain and France.amd-water-cooler-jpg

Norovirus is spread through fecal matter, and in past outbreaks, drinking water became contaminated when sewage leaked into the water source, Chapman said. Given that the recent outbreak in Spain was so large, with hundreds of bottles affected, “it’s more likely that it would be source contamination,” as opposed to contamination at some later point in the bottling process, Chapman said.

Still, it’s also possible that the water was contaminated at the manufacturing facility. Norovirus is a very hardy virus, Chapman said, and if someone with the illness vomited at a bottling facility, this could contaminate equipment used for bottling the water, Chapman said.

We just distribute the poop: 3166 sick – probably noro — in Spain linked to bottled water

Gastroenteritis caused by bottled water has affected 3,166 people in Catalonia, according to the regional health department.

05_eden LOGOThe origin of the intoxication is a norovirus that was discovered in bottles distributed throughout Barcelona and Tarragona on April 7, 8, 11, 12 and 13.

The water was drawn from a natural spring called Arinsal, in the principality of Andorra between Spain and France. It was distributed in Catalonia by a company named Eden.

Eden notes that it receives the sealed bottles from Andorra and merely distributes them.

Health authorities are calling all businesses that sold the product in a bid to tally a final number of affected customers. Because the gastroenteritis had mild effects, not all patients went to the doctor, department sources said.

The first tests conducted on patient samples show the presence of a norovirus, a microorganism that is responsible for half of all common gastroenteritis. It is present in animal droppings, which can contaminate the water.