FDA says 1 percent of US cucumbers carry Salmonella

One in a hundred cucumbers carries Salmonella, according to new data from the U.S. Food and Drug Administration — and for fresh hot peppers that number rises to three per hundred.

cucumber-spainmepBoth the vegetables were targeted by the agency’s proactive testing because of their role in previous outbreaks. Because cucumbers are often eaten raw, bacteria on them are more likely to make it into food; raw cucumbers have been blamed in five outbreaks of illness from 1996 to 2014.

Hot peppers, such as jalapeño and serrano peppers, on the other hand, are often cooked but can be a “stealth component” of multi-ingredient dishes, the FDA said. In 2008, hot peppers were implicated in an outbreak that caused 1,500 illnesses, 308 hospitalizations, and two deaths.

The FDA’s proactive sampling program began testing for disease-causing microbes in certain foods in 2014 to learn more about the prevalence of disease-causing bacteria and to help the agency identify patterns that may help predict and prevent future contamination.

The latest findings, released lastThursday, included results from 1,050 cucumber samples and 1,130 hot pepper samples. Eventually 1,600 of each will be sampled.

Of the cucumber samples, 15 tested positive for salmonella. None tested positive for E. coli. Of the hot pepper samples, 35 tested positive for salmonella, and one tested positive for a strain of Shiga toxin-producing E. coli that was determined to be incapable of causing severe illness.

The samples were collected at ports, packing houses, manufacturers, and distributors across the US.

The agency may take enforcement action, such as a recall, on foods that test positive.

“This testing is still underway and no conclusions can be drawn at this time,” according to the FDA.

 In 2014, the FDA started a sampling program for a variety of commodities to learn more about the prevalence of disease-causing bacteria on the commodities.

 The microbiological sampling assignments were designed to collect a statistically determined number of samples of certain commodities over 12 to 18 months and test them for certain types of bacteria that can cause foodborne illnesses.

Beware jailhouse nachos

The U.S. Centers for Disease Control reports on October 12, 2015, a county health department notified the Wyoming Department of Health of an outbreak of gastrointestinal illness among residents and staff members at a local correctional facility.

jail-nachos-2The majority of ill persons reported onset of symptoms within 1–3 hours after eating lunch served at the facility cafeteria at noon on October 11. Residents and staff members reported that tortilla chips served at the lunch tasted and smelled like chemicals. The Wyoming Department of Health and county health department personnel conducted case-control studies to identify the outbreak source.

Consuming lunch at the facility on October 11 was highly associated with illness; multivariate logistic regression analysis found that tortilla chips were the only food item associated with illness. Hexanal and peroxide, markers for rancidity, were detected in tortilla chips and composite food samples from the lunch. No infectious agent was detected in human stool specimens or food samples. Extensive testing of lunch items did not identify any unusual chemical. Epidemiologic and laboratory evidence implicated rancid tortilla chips as the most likely source of illness.

This outbreak serves as a reminder to consider alternative food testing methods during outbreaks of unusual gastrointestinal illness when typical foodborne pathogens are not identified. For interpretation of alternative food testing results, samples of each type of food not suspected to be contaminated are needed to serve as controls.

Gastrointestinal illness associated with rancid tortilla chips at a correctional facility — Wyoming, 2015


Tiffany Lupcho et al.


Blame the media: Crypto reporting in England

During August 2015, a boil water notice (BWN) was issued across parts of North West England following the detection of Cryptosporidium oocysts in the public water supply.

les_nessmanUsing prospective syndromic surveillance, we detected statistically significant increases in the presentation of cases of gastroenteritis and diarrhea to general practitioner services and related calls to the national health telephone advice service in those areas affected by the BWN.

In the affected areas, average in-hours general practitioner consultations for gastroenteritis increased by 24.8% (from 13.49 to 16.84) during the BWN period; average diarrhea consultations increased by 28.5% (from 8.33 to 10.71). Local public health investigations revealed no laboratory reported cases confirmed as being associated with the water supply. These findings suggest that the increases reported by syndromic surveillance of cases of gastroenteritis and diarrhea likely resulted from changes in healthcare seeking behaviour driven by the intense local and national media coverage of the potential health risks during the event.

 This study has further highlighted the potential for media-driven bias in syndromic surveillance, and the challenges in disentangling true increases in community infection from those driven by media reporting.

The potential impact of media reporting in syndromic surveillance: An example using a possible Cryptosporidium exposure in north west England, August to September 2015

Euro Surveill. 2016;21(41):pii=30368. DOI: http://dx.doi.org/10.2807/1560-7917.ES.2016.21.41.30368

AJ Elliot, HE Hughes, J Astbury, G Nixon, K Brierley, R Vivancos, T Inns, V Decraene, K Platt, I Lake, SJ O’Brien, GE Smith


Foodborne (1973-2013) and waterborne (1971-2013) disease outbreaks – United States

This isn’t the detailed overview, but the annual overall snapshot of food and waterborne illness in the U.S.

cdc-outbreak-data-2013My favorite part has always been the second figure. To avoid foodborne illness, move to Texas. That hasn’t changed since 1973.

All it means is, cowboys and girls don’t look too hard.

It’s just a little barfing – get over it

Foodborne Disease Outbreaks

During 1973–2013, the U.S. Centers for Disease Control (CDC) received reports of 30,251 foodborne disease outbreaks with 742,945 outbreak-associated illnesses from the 50 states, Puerto Rico, the District of Columbia, and freely associated states/territories. An average of 738 (range: 298–1,404) outbreaks were reported each year.

The average annual number of foodborne disease outbreaks reported to CDC increased in 1998 in comparison to previous years, coinciding with the transition to an electronic reporting system, and decreased in 2009 in comparison to 1998–2008 coinciding with the transition to reporting through NORS (FDOSS and WBDOSS share an enhanced reporting platform, the National Outbreak Reporting System (NORS) (http://www.cdc.gov/nors). NORS also collects information on disease outbreaks with modes of transmission other than food and water, including person-to-person contact, animal contact, and environmental contamination.)

In 2013, a total of 792 single-state exposure outbreaks were reported with 11,786 illnesses by 47 states and Puerto Rico (Table) (Figure 2); an additional 26 multistate outbreaks (i.e., exposure to the implicated food occurred in more than one state) with 1,530 associated illnesses also were reported. CDC periodically publishes more detailed annual summaries describing the implicated foods, etiologic agents, settings, and points of contamination associated with foodborne disease outbreaks (http://www.cdc.gov/foodsafety/fdoss/data/annual-summaries/index.html).

Waterborne Disease Outbreaks

During 1971–2013, CDC received reports of 1,957 waterborne disease outbreaks with 642,782 outbreak-associated illnesses from 50 states and six freely associated states/territories. An average of 46 waterborne outbreaks was reported each year (Figure 1). In 2013, a total of 55 outbreaks causing at least 2,824 illnesses occurred in 21 states. No multistate outbreaks were reported; waterborne disease outbreak data for 2013 are preliminary (Table) (Figure 3). CDC periodically publishes more detailed summaries of waterborne disease outbreaks associated with recreational water and of waterborne disease outbreaks associated with drinking water (http://www.cdc.gov/healthywater/surveillance/surveillance-reports.html).

cdc-outbreak-data-2013-stateReported outbreaks represent only a small fraction of all foodborne and waterborne illnesses that occur each year and the outbreak data reported here are subject to limitations. Outbreaks caused by certain pathogens or vehicles might be more likely to be recognized, investigated, or reported. Some illnesses reported as sporadic (i.e., not outbreak-associated) are likely not recognized as being part of a reported outbreak or might be part of an undetected outbreak. In addition, all outbreak-related illnesses might not be identified during an investigation, smaller outbreaks might not come to the attention of public health authorities, and some outbreaks might not be investigated or reported to CDC.

Reporting practices for foodborne and waterborne disease outbreaks vary among states and territories, which might have differing definitions or interpretations of which events are reportable and unique laws related to disease outbreak reporting. Thus, variations in reporting rates by state or territory might reflect variations in levels of effort and funding for foodborne and waterborne disease outbreak investigation, rather than true differences in outbreak incidence rates by state. NORS maintains a dynamic database; this report includes data available on May 1, 2015, for foodborne disease outbreaks and May 4, 2015, for waterborne disease outbreaks; data published in this Summary might differ from those published earlier or later.

Foodborne disease outbreaks are defined as two or more cases of a similar illness resulting from ingestion of a common food. Waterborne disease outbreaks are defined as two or more cases of a similar illness linked epidemiologically by time and location to exposure to water or water-associated chemicals volatized into the air.

Is there anybody out there? Physicians and handwashing

Our objectives were to evaluate the utility of electronic hand hygiene counting devices in outpatient settings and the impact of results feedback on physicians’ hand hygiene behaviors.

big-brother-1984We installed 130 electronic hand hygiene counting devices in our redesigned outpatient department. We remotely monitored physicians’ hand hygiene practices during outpatient examinations and calculated the adherence rate as follows: number of hand hygiene counts divided by the number of outpatients examined multiplied by 100. Physician individual adherence rates were also classified into 4 categories.


Two hundred and eighty physicians from 28 clinical departments were monitored for 3 months. The overall hand hygiene adherence rate was 10.7% at baseline, which improved significantly after feedback to 18.2% in the third month. Of the clinical departments, 78.6% demonstrated significant improvement in hand hygiene compliance. The change in the percentage of physicians in each category before and after feedback were as follows: very low (84.3% to 72.1%), low (8.6% to 14.3%), moderate (2.9% to 8.9%), and high (4.3% to 4.6%), from the first to third month, respectively. Based on category assessment, 17.1% of physicians were classified as responders.


Physicians’ adherence to hand hygiene practices during outpatient examinations was successfully monitored remotely using electronic counting devices. Audit and feedback of adherence data may have a positive impact on physicians’ hand hygiene compliance.

Utility of electronic hand hygiene counting devices for measuring physicians’ handwashing

American Journal of Infection Control, DOI: http://dx.doi.org/10.1016/j.ajic.2016.08.002

A Arai, M Tanabe, A Nakamura, D Yamasaki, Y Muraki, T Kaneko, A Kadowaki, M Ito



Whole genome sequencing, Campylobacter and what makes people barf

High-throughput whole-genome sequencing (WGS) is a revolutionary tool in public health microbiology and is gradually substituting classical typing methods in surveillance of infectious diseases. In combination with epidemiological methods, WGS is able to identify both sources and transmission-pathways during disease outbreak investigations.

barfblog-tshirt-frontThis review provides the current state of knowledge on the application of WGS in the epidemiology of Campylobacter jejuni, the leading cause of bacterial gastroenteritis in the European Union.

We describe how WGS has improved surveillance and outbreak detection of C. jejuni infections and how WGS has increased our understanding of the evolutionary and epidemiological dynamics of this pathogen. However, the full implementation of this methodology in real-time is still hampered by a few hurdles. The limited insight into the genetic diversity of different lineages of C. jejuni impedes the validity of assumed genetic relationships. Furthermore, efforts are needed to reach a consensus on which analytic pipeline to use and how to define the strains cut-off value for epidemiological association while taking the needs and realities of public health microbiology in consideration.

Even so, we claim that ample evidence is available to support the benefit of integrating WGS in the monitoring of C. jejuni infections and outbreak investigations.

Use of whole-genome sequencing in the epidemiology of Campylobacter jejuni infections: state-of-knowledge

Ahead of print, doi: http://dx.doi.org/10.1101/078550

Ann-Katrin Llarena, Mirko Rossi


Salmonella in seafood in Kochi

A survey carried out by a team of scientists of the Microbiology, Fermentation and Biotechnology Division of Central Institute of Fisheries Technology (CIFT) Kochi, found Salmonella in 29 per cent of seafood samples.

seafood-kochiDuring the screening process, the researchers collected as many as 150 fresh seafood samples including popular varieties like sardine, mackerel, prawns and crabs from the markets in and around Kochi.

The study was conducted by a team of scientists including S.S. Greeshma, M.M. Prasad, K.V. Lalitha, Toms C. Joseph, and V. Murugadas.

The presence of salmonella in seafood indicates contamination with human and animal excreta. Fishes and shellfish normally do not harbour micro-organisms like salmonella but can get contaminated with through the use of contaminated ice, water, containers and poor hygienic handling practices, explained Dr. Greeshma.

Samples were collected over a period of nine months. Once salmonella reaches soil and aquatic environments, it can survive there for long periods.

While cooking kills the micro-organism, there exists the risk of cross-contamination with other food items that are consumed raw when handled along with seafood contaminated with salmonella.

Humans who come into direct contact with salmonella-contaminated seafoods face health risk, she explained.

The study underscores the need to hygienic handling of fish in the markets, said C.N. Ravishankar, Director of the Institute in a communication.

The researchers are planning a source study to identify the routes and points of possible contamination of the fish.

Toxoplasma at high levels in pigs from tropical Mexico

Background: Toxoplasmosis is caused by the protozoon Toxoplasma gondii, which is one of the most widespread parasites that infect animals and humans worldwide. One of the main routes of infection for humans is through the consumption of infected meat containing bradyzoites in tissue cysts. Pork is one of the foremost meat types associated with outbreaks of acute toxoplasmosis in humans.

pig-mexicoMaterials and Methods: Sixty blood samples were collected from finished pigs at slaughter and their sera was evaluated by an indirect-IgG ELISA. Matched muscle samples were obtained from the tongue and loin. Whole blood and tissue samples were evaluated to search for T. gondii DNA using a nested-polymerase chain reaction.

Results: Seroprevalence of T. gondii was 96.6% (58/60) of sampled pigs. Meanwhile, T. gondii DNA was present in 23.21% of tongue tissue samples (13/56), 7% of loin tissues (4/57), and 0% in blood samples (0/44), respectively. Two pigs were serologically indeterminate.

Conclusion: This is the first report of the presence of T. gondii DNA in tissue samples obtained from finalized pigs. Results from the present study suggest a high exposure to T. gondii in pigs intended for human consumption from the tropical region of Mexico. Thus, the consumption of some undercooked pork meat meals typical from the southern region of Mexico could represent a significant risk for acquiring infection for the human population.

Presence of Toxoplasma gondii in pork intended for human consumption in tropical southern of Mexico

Foodborne Pathogens and Disease. September 2016, ahead of print. doi:10.1089/fpd.2016.2165.

IB Hernández-Cortazar, KY Acosta-Viana, E Guzmán-Marin, A Ortega-Pacheco, JF de Jesus Torres-Acosta, M Jimenez-Coello


Mt Kisco Smokehouse recalls smoked salmon because of possible health risk

Mt Kisco Smokehouse of Mt Kisco, NY, is voluntarily recalling two types of smoked salmon because it has the potential to be contaminated with Listeria monocytogenes.

listeria-mt-kisco-smokehouse-salmonProduct was distributed in New York and Connecticut through retail stores and restaurants between 9/6/2016 to 9/16/2016.

The whole product is packed in an unlabeled paper box and delivered to restaurants.  The sliced product is sold in a clear plastic package and labeled on the back with lot and use by date.

No illnesses have been reported to date in connection with this problem.

The potential for contamination was noted after routine testing by the FDA inspection revealed the presence of Listeria monocytogenes in floor drains and cracks in the floor.

Stop kissing cats (and stop touching yourself)

I went through an extremely brief Ted Nugent phase when I was 16.

I was driving my then-girlfriend and her mom somewhere, and thought it’d be cool to put Wango Tango on the 8-track (a prehistoric device used to play music).

cat-scratch-fever-04What an asshole (me and Ted).

Erin Ross of NPR reports that cat-scratch disease, as the name suggests, is spread by cats. It’s long been considered a mild illness, but a study finds that people are getting more serious complications, which can be fatal.

And kissing kittens increases the risk of being infected.

“The scope and impact of the disease is a little bit larger than we thought,” says Dr. Christina Nelson, a medical epidemiologist with the Centers for Disease Control and Prevention and lead author on the study. It’s the first large-scale evaluation of the illness in the United States in over 15 years.

While the total number of people infected with the disease has gone down, the number of people becoming seriously ill has increased. Symptoms typically involve fatigue, fever and swollen lymph nodes. But in a small number of cases, cat-scratch disease can cause the brain to swell or infect the heart. Infections like those can be fatal if they aren’t properly treated.

“Most of the people who get seriously sick from cat-scratch are immunocompromised. The classic example is patients with HIV,” says Dr. Aaron Glatt, chairman of medicine and hospital epidemiology of South Nassau Community Hospital in New York. Glatt was not involved in the study

The fact that there are more people with suppressed immune systems today may be why a larger number of patients are getting dangerously ill, Glatt says. But Nelson thinks that severe cases of cat-scratch disease may have been misdiagnosed in the past. Either way, she says, this study, which was published Wednesday in Emerging Infectious Diseases, is a good first step.

“Cat-scratch is preventable,” Nelson says. “If we can identify the populations at risk and the patterns of disease, we can focus the prevention efforts.”

It’s preventable because you need direct contact with a cat to get it. The disease is caused by bacteria, usually Bartonella henselae, and passed between cats by fleas. The bacteria are also present in flea dirt — the official name for flea feces — which build up in the cats’ fur. It gets on their paws and in their mouths when they groom themselves. If a person is scratched by contaminated claws, they’re at risk of getting the disease.

The study combed health insurance claims from 2005 to 2013, and charted when and where cat-scratch disease is most likely to strike. It found that about 12,000 people will be diagnosed with cat-scratch disease each year, and 500 of them will be sick enough to be hospitalized.

Many of those infected will be children, probably because of the ways kids play with cats. And most of the infections will occur in the South, where heat-and-moisture-loving fleas are more common.

If you want to avoid cat-scratch disease altogether, says Nelson, go somewhere arid —like Colorado or Utah.

But moving to the Rockies isn’t an option for everyone. If you’re stuck in the South, how can you skip cat-scratch?

“Stay away from cats,” says Glass, although he acknowledges that in a country full of cat-lovers, this isn’t really realistic.

“Use adequate flea control and keep your cats indoors,” suggests Nelson. The bacteria can also enter your body through your nose, eyes or mouth, so the CDC recommends washing your hands after touching a cat. Kissing their flea dirt-filled fur probably isn’t a good idea, either. Neither is letting them lick you if you have any scrapes, scabs or open wounds.

Oh. And avoid kittens.

“Younger cats are more likely to have bacteria in their blood,” explains Nelson. Kittens aren’t immune to cat-scratch, so they’re an easy target for the bacteria.

So try to keep from kissing Felix … at least until he’s flea-free.