Animal poop is everywhere in Bangladesh, and fecal indicator bacteria sorta suck

Fecal-oral pathogens are transmitted through complex, environmentally mediated pathways. Sanitation interventions that isolate human feces from the environment may reduce transmission but have shown limited impact on environmental contamination.

We conducted a study in rural Bangladesh to (1) quantify domestic fecal contamination in settings with high on-site sanitation coverage; (2) determine how domestic animals affect fecal contamination; and (3) assess how each environmental pathway affects others. We collected water, hand rinse, food, soil and fly samples from 608 households. We analyzed samples with IDEXX Quantitray for the most probable number (MPN) of E. coli.

We detected E. coli in source water (25%), stored water (77%), child hands (43%), food (58%), flies (50%), ponds (97%) and soil (95%). Soil had >120,000 mean MPN E. coli per gram. In compounds with vs. without animals, E. coli was higher by 0.54 log10 in soil, 0.40 log10 in stored water and 0.61 log10 in food (p<0.05). E. coli in stored water and food increased with increasing E. coli in soil, ponds, source water and hands.

We provide empirical evidence of fecal transmission in the domestic environment despite on-site sanitation. Animal feces contribute to fecal contamination, and fecal indicator bacteria do not strictly indicate human fecal contamination when animals are present.

Animal feces contribute to domestic fecal contamination: Evidence from E. coli measured in water, hands, food, flies, and soil in Bangladesh

Environmental Science and Technology, July 2017, Ayse Ercumen, Amy Janel Pickering, Laura H. Kwong, Benjamin Arnold, Sarker Masud Parvez, Mahfuja Alam, Debashis Sen, Sharmin Islam, Craig Kullmann, Claire Chase, Rokeya Ahmed, Leanne Unicomb, Stephen Luby, and John M. Colford, DOI: 10.1021/acs.est.7b01710

http://pubs.acs.org/doi/abs/10.1021/acs.est.7b01710?journalCode=esthag

 

Handwashing is never enough: Texas family says sons infected with E. coli at petting zoo

An Azle family wants to warn others after both their young boys were hospitalized with E. coli earlier this year.

“It’s awful. You can’t do anything but just sit there and watch your child hurt,” Emily Miller told WFAA.

Miller’s sons Brayden, 7, and Dylan, 5, were both diagnosed with an E. coli infection, and Dylan’s case impacted his kidneys. Miller said he required dialysis, and he was hospitalized for 27 days, including several nights in the ICU.

“It’s such a crazy thought that this could happen,” Miller said.

She was surprised by the intensity of the illness, but also by where her boys may have come into contact with E. coli. She said doctors believe they were likely contaminated while the family was visiting a petting zoo.

“I wasn’t aware that you could get it from animals and livestock,” Miller said.

She took the boys to the petting zoo back in January, and four days later her oldest was in the hospital.

Both brothers are now doing well, though Dylan is still on blood pressure medicine due to the illness, Miller said.

The Centers for Disease Control says petting zoos do pose risks, as livestock can carry E. coli bacteria. The CDC’s advice is to wash hands with soap and water immediately after being near animals, whether you touch them or not.

The CDC also says that soap and water is more effective than instant hand sanitizers, and if sanitizers are the only option, go ahead and use them but follow up with soap and water as soon as possible.

A table of petting zoo outbreaks is available at http://barfblog.com/wp-content/uploads/2014/04/Petting-Zoo-Outbreaks-Table-4-8-14.xlsx.

Erdozain G, Kukanich K, Chapman B, Powell D. 2012. Observation of public health risk behaviours, risk communication and hand hygiene at Kansas and Missouri petting zoos – 2010-2011. Zoonoses Public Health. 2012 Jul 30. doi: 10.1111/j.1863-2378.2012.01531.x. [Epub ahead of print]

Abstract below:

Observation of public health risk behaviors, risk communication and hand hygiene at Kansas and Missouri petting zoos – 2010-2011Outbreaks of human illness have been linked to visiting settings with animal contact throughout developed countries. This paper details an observational study of hand hygiene tool availability and recommendations; frequency of risky behavior; and, handwashing attempts by visitors in Kansas (9) and Missouri (4), U.S., petting zoos. Handwashing signs and hand hygiene stations were available at the exit of animal-contact areas in 10/13 and 8/13 petting zoos respectively. Risky behaviors were observed being performed at all petting zoos by at least one visitor. Frequently observed behaviors were: children (10/13 petting zoos) and adults (9/13 petting zoos) touching hands to face within animal-contact areas; animals licking children’s and adults’ hands (7/13 and 4/13 petting zoos, respectively); and children and adults drinking within animal-contact areas (5/13 petting zoos each). Of 574 visitors observed for hand hygiene when exiting animal-contact areas, 37% (n=214) of individuals attempted some type of hand hygiene, with male adults, female adults, and children attempting at similar rates (32%, 40%, and 37% respectively). Visitors were 4.8x more likely to wash their hands when a staff member was present within or at the exit to the animal-contact area (136/231, 59%) than when no staff member was present (78/343, 23%; p<0.001, OR=4.863, 95% C.I.=3.380-6.998). Visitors at zoos with a fence as a partial barrier to human-animal contact were 2.3x more likely to wash their hands (188/460, 40.9%) than visitors allowed to enter the animals’ yard for contact (26/114, 22.8%; p<0.001, OR= 2.339, 95% CI= 1.454-3.763). Inconsistencies existed in tool availability, signage, and supervision of animal-contact. Risk communication was poor, with few petting zoos outlining risks associated with animal-contact, or providing recommendations for precautions to be taken to reduce these risks.

Best practices for planning events encouraging human-animal interactions

Zoonoses and Public Health 62:90-99, 2015

G. Erdozain , K. KuKanich , B. Chapman  and D. Powell

http://onlinelibrary.wiley.com/doi/10.1111/zph.12117/abstract?deniedAccess

Educational events encouraging human–animal interaction include the risk of zoonotic disease transmission. It is estimated that 14% of all disease in the US caused by Campylobacter spp., Cryptosporidium spp., Shiga toxin-producing Escherichia coli (STEC) O157, non-O157 STECs, Listeria monocytogenes, nontyphoidal Salmonella enterica and Yersinia enterocolitica were attributable to animal contact. This article reviews best practices for organizing events where human–animal interactions are encouraged, with the objective of lowering the risk of zoonotic disease transmission.

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2-year-old on life support in Texas after contracting E. coli

An Ennis family says the CDC is investigating after their 2-year-old was exposed to a dangerous strain of E.coli.

Landon Huston is now on life support at Children’s Medical Center Dallas.

“He’s usually up, rambunctious, running around,” said his mother, Lindsey Montgomery. “I’m ready for my little boy to be back.”

The family took a trip to Oklahoma two weeks ago, cooling down in a hotel pool and at a natural spring.

“I’d never heard of people swimming and get E. oli,” said his father, John Huston.

Unfortunately, many, many people have been identified as getting sick with Shiga-toxin producing E. coli from swimming, water parks, or water supplies.

“Three, four days later, Landon’s got fever, diarrhea, really sick,” said Montgomery.

But by the time a test confirmed E.coli, his kidneys were shutting down. Montgomery said the CDC interviewed her trying to determine the source of the infection.

“They asked me where he had been, what food he had ate, any restaurants,” she said.

Dr. Jeffrey Kahn, Children’s Health Chief of Pediatric Infections Diseases, said it’s normal for a case like this to trigger a public health investigation.

“That suggests that there’s some contamination somewhere. It’s usually water or food and typically that means it’s not just one individual who’s been exposed,” he said.

Brisbane’s idea of a water warning

Fucking hopeless at communication.

Walkerton Water Tower

The Courier Mail reports that residents north of Brisbane (we’re southsiders) are being advised to boil all their tap water before drinking it following fears the water supply has been compromised.

Unitywater says the advise applies to 3,500 residents in Petrie and Old Petrie Town.

In a statement, Unitywater said residents should boil water for the next 24 hours, or until the water quality has returned to normal.

Residents have been advised to use cool boiled water or bottled water when brushing their teeth, drinking, washing and preparing food beverages, making ice, bathing infants or preparing baby formula.

“This is a rare event and Unitywater is working closely with Queensland Health to resolve the situation as quickly as possible,” the statement said.

Unitywater is currently flushing the mains in the area and supplying water from an alternative reservoir.

“We are also taking regular samples to monitor the water quality.”

Losing my religion: Vibrio death following Jesus tattoo

Ben Tinker of CNN reports a 31-year-old Texas man went to get a tattoo on his right leg. Beneath an illustration of a cross and hands in prayer, the words “Jesus is my life” were written in cursive.

As tattoo artists will tell you, there are some critically important rules to follow in the hours and days after getting inked. Most important: keeping your new body art clean and covered while the skin has a heightened susceptibility to bacterial infection.

Every time a tattoo gun pierces your skin, the needle is opening a wound — and another pathway by which germs can enter your body. The larger the tattoo, the more you increase your risk of possible infection.

A report published last week in BMJ Case Reports, a prominent peer-reviewed medical journal, reveals only that the subject was a Latino man living in Texas.

Five days after getting his tattoo, the man decided to go for a swim in the Gulf of Mexico. Just three days after that, he was admitted to Parkland Memorial Hospital in Dallas with severe pain in both of his legs and feet. His symptoms included a fever, chills and redness around his tattoo and elsewhere on his legs.

“A lot of our patients, when they come to our institution, come in sick — and he was certainly among the sicker of the patients that we’ve had come in,” said Dr. Nicholas Hendren, an internal medicine resident at University of Texas Southwestern Medical Center and lead author of the report. “He said he had a lot of pain in [his right leg]. That, of course, drew our attention right away.

“Within a few hours, things had progressed pretty quickly,” he said. “There’s darkening skin changes, more bruising, more discoloration, what we call bullae — or mounds of fluid that were starting to collect in his legs — which, of course, is very alarming to anyone, as it was to us.

“He was already in the early stages of septic shock, and his kidneys had already had some injury,” Hendren said. “Very quickly, his septic shock progressed from … early stages to severe stages very rapidly, within 12 hours or so, which is typical for this type of infection.”

To make matters worse, the man had chronic liver disease from drinking six 12-ounce beers a day. He was immediately placed on a ventilator to help him breathe and given potent antibiotics.

The man tested positive for Vibrio vulnificus, a bacterium commonly found in coastal ocean water. The CDC estimates that this infection, called vibriosis, causes 80,000 illnesses and 100 deaths every year in the United States. The strongest risk factors are liver disease, cancer, diabetes, HIV and thalassemia, a rare blood disorder.

“In the USA, most serious infections appear to occur with the ingestion of raw oysters along the Gulf Coast, as nearly all oysters are reported to harbor V. vulnificus during the summer months and 95% of cases were related to raw

Most of the time, the only symptoms someone will experience are vomiting and diarrhea, according to Hendren. Most healthy people don’t end up in the hospital, he said, because their immune system is strong enough to fight the infection.

But “Infections can also occur with exposure of open wounds to contaminated salt or brackish water; however, this represents an uncommon mechanism of infection,” according to the report.

Hendren never got the opportunity to ask the patient directly whether he was aware of the advice against swimming soon after getting a tattoo but said the man and his family were unaware of how a serious infection can progress so quickly.

For the next few weeks, the man was kept largely sedated. After initial pessimism about the man’s prognosis, Hendren and his colleagues became cautiously optimistic. The patient was removed from the breathing machine 18 days after being admitted to the hospital and began “aggressive rehabilitation.”

Over the next month, however, the man’s condition slowly began to worsen. About two months after he was first admitted to the hospital, he died of septic shock.

“For patients who are healthy, this organism very rarely infects people,” Hendren said. “If they are infected, most people do fine and essentially never present to the hospital. But in patients who do have liver disease, they’re susceptible to much more infection.”

Since most infections are the result of eating raw oysters, Hendren stressed the only way to kill the bacteria is by cooking them. People with liver disease or iron disorders should never eat raw oysters because they’re at such high risk for these infections, he said.

Hendren said the message isn’t that people shouldn’t get tattoos.

“It’s if you choose to get a tattoo, do it safely, do it through a licensed place, and make sure you take care of the wound and treat it like any other wound,” he said. “That’s important.”

 

It’s only water safety but I like it: Chlorine is a friend, multiple failings in NZ campy-in-water outbreak that sickened 5500 and killed 3

On Sunday, May 21, 2000, at 1:30 p.m., the Bruce Grey Owen Sound Health Unit in Ontario (that’s in Canada) posted a notice to hospitals and physicians on their web site to make them aware of a boil water advisory for Walkerton, and that a suspected agent in the increase of diarrheal cases was E. coli O157:H7.

Walkerton Water Tower

Not a lot of people were using RSS feeds, and I don’t know if the health unit web site had must-visit status in 2000. But Walkerton, a town of 5,000, was already rife with rumors that something was making residents sick, and many suspected

the water supply. The first public announcement was also the Sunday of the Victoria Day or May 24 long weekend and received scant media coverage.

It wasn’t until Monday evening that local television and radio began reporting illnesses, stating that at least 300 people in Walkerton were ill.

At 11:00 a.m., on Tuesday May 23, the Walkerton hospital jointly held a media conference with the health unit to inform the public of outbreak, make the public aware of the potential complications of the E. coli O157:H7 infection, and to tell the public to take necessary precautions. This generated a print report in the local paper the next day, which was picked up by the national wire service Tuesday evening, and subsequently appeared in papers across Canada on May 24.

The E. coli was thought to originate on a farm owned by a veterinarian and his family at the edge of town, a cow-calf operation that was the poster farm for Environmental Farm Plans. Heavy rains washed cattle manure into a long discarded well-head which was apparently still connected to the municipal system. The brothers in charge of the municipal water system for Walkerton were found to add chlorine based on smell rather than something like test strips, and were criminally convicted.

Ultimately, 2,300 people were sickened and seven died. All the gory details and mistakes and steps for improvement were outlined in the report of the Walkerton inquiry, available at http://www.attorneygeneral.jus.gov.on.ca/english/about/pubs/walkerton/.

In Aug. 2016, some 5,500 people in a New Zealand town of 14,000 were sickened with Campylobacter linked to the water supply and three died.

Didn’t chlorinate.

Just like Walkerton, where a drunk employee was found to adjust chlorine levels based on smell, Hawke’s Bay, New Zealand also had some lax procedures.

A panel looking into last year’s outbreak made the first stage of its findings public at Hastings District Court on Wednesday.

It identified several failings by the Hastings District Council, Hawke’s Bay Regional Council and drinking water assessors.

The outbreak in August last year made some 5500 of the town’s 14,000 residents ill with campylobacteriosis. It put 45 in hospital and was linked to three deaths.

The contamination was later found to have entered the town’s drinking water bores. Panel chair Lyn Stevens QC said the outbreak “shook public confidence” in this fundamental service of providing safe drinking water and it raised “serious questions” about the safety and security of New Zealand’s drinking water.

The district and regional councils did not directly cause the outbreak, but their “dysfunctional relationship” and their lack of co-operation resulted in a number of missed opportunities that may have prevented it from occurring.

Knowledge and awareness of aquifer and contamination risks near Brookvale Rd fell below “required standards” and it failed to take effective steps to assess the risk, including the management of the many uncapped or disused bores in the vicinity, and the monitoring of the district council’s resource consent to take the water.

Walkerton redux.

The district council “failed to embrace or implement the high standard of care required of a public drinking-water supplier,” particularly in light of a similar outbreak in the district in 1998, from which it appeared to have learned nothing.

The council’s mid-level managers especially failed, Stevens said. They delegated tasks but did not adequately supervise or ensure implementation of requirements. This led to unacceptable delays in developing the council’s water safety plan which would have been “fundamental in addressing the risks of the outbreak.”

That’s a polite way of saying, people care more about their retirement than others, and often fuck up.

Drinking Water Assessors were also at fault, with Stevens finding they were “too hands off” in applying the drinking water standards.

Sounds like food safety auditors.

They should have been stricter in requiring the district council to comply with responsibilities with its water safety plan, he said.

“They failed to address the [council] sufficiently about the lack of risk assessment and the link between the bores and the nearby pond.”

Nicki Harper of Hawkes Bay Today wrote a high number of positive E. coli readings in the Havelock North and Hastings water supplies over the years, dating back to a 1998 water contamination event similar to last year’s Havelock North campylobacter outbreak, caused bureau-types to do, nothing.

It was confirmed yesterday that the most likely source of the contamination was sheep feces that ran off a paddock following heavy rain on August 5 and 6 into the Mangateretere pond near Brookvale Bore 1.

Water from the pond then entered into the aquifer and flowed across to Bore 1 where it was pumped into the reticulation, Mr Stevens said.

The son of an elderly woman who died shortly after contracting Campylobacter during the Havelock North gastro crisis says she had “good innings” despite her death.

Jean Sparksman, 89, was one of three elderly people whose deaths were linked to the outbreak and had been living in the Mary Doyle retirement village at the time of the crisis.

Speaking from the Whangaparaoa Peninsula in Auckland yesterday, Mrs Sparksman’s son, Keith, said her death shouldn’t have happened the way it did.

“She contracted this bug but there were no steps taken to help. That’s probably why she died in the first place.”

The failures are all too familiar: space shuttle Challenger, Bhopal, BP in the Gulf, Listeria in Maple Leaf cold cuts, Walkerton: the tests said things were not good. But a human condition kicked in: Nothing bad happened yesterday so there is a greater chance of nothing bad happening today.

All these people fucked up, and others got sick.

Yet government, industry and academia will trod along, piling up retirement savings, until the next shitfest comes along.

So just watch this stupid Stones video with Keith out of his mind.

Nothing bad will really happen.

Crypto hits NSW pools

As we chill (sweat) in the sleepy haven of South Golden Beach in New South Wales for a brief Christmas break, health authorities report Cryptosporidium has sickened at least 200 people in December and are warning people with diarrhea to stay out of shared pools.

sorenne-south-golden-beach-16The Sydney Morning Herald reports almost half of the cases were in children under 10-years-old. 

Health authorities have issued the warning urging people to stay out of shared swimming pools and water parks.

The biggest outbreak of cryptosporidiois was recorded in Sydney in 1998, when there were more than 1,000 confirmed cases.

Sydney was forced to boil its drinking water because it was found to be infected with the pathogens cryptosporidium and giardia.

Chlorine works, focus on public health: NZ campy-in-water inquiry wraps up with 16 draft recommendations

I served on one of those water inquires, back in Canada after the 2000 outbreak of E. coli O157:H7 that killed seven and sickened 2,300 residents in Walkerton, Ontario, Canada, a town of about 5,000.

Walkerton Water Tower

Walkerton Water Tower

It was decent work, but what surprised me most was the actions taken by various social actors in the aftermath of the outbreak: protect themselves, public health be damned.

The number of higher-ups who wanted to meet with me to express why they did what they did, in a private chat, had absolutely no influence on my conclusions, and was sorta repulsive.

Maybe I was naïve.

Still am (I’m the full professor from Kansas State University who got fired for bad attendance with  — nothing, except my family, and that makes a good Hollywood tale).

In August, 2016, about 5,530 or 39 per cent of Havelock North, New Zealand’s population reported gastroenteritis from Camplylobacter in the water supply, 1,072 of those confirmed cases.

Nicki Harper of the New Zealand Herald reports a government inquiry into contamination of a Hawke’s Bay water supply has made 16 draft recommendations.

The inquiry into the Hastings District Council’s request to re-activate a Brookvale Road bore to augment Havelock North’s peak summer water supply retired today with a set of draft recommendations.

Before wrapping up proceedings, inquiry panel chair Lyn Stevens QC thanked the Hawke’s Bay Regional Council (HBRC) and Hastings District Council (HDC) for the efforts they made that resulted in the regional council dropping its prosecution of the Hastings council.

This agreement came after the first day of hearings on Monday, when pressure was applied by the panel to re-consider the charges.

After extensive questioning on Monday, the regional council agreed to withdraw the charges relating to breaches of the Hastings District Council’s resource consent conditions for taking water from Brookvale bores 1 and 2 – opting to instead consider issuing infringement notices.

Mr Stevens said, “The panel has noted a level of defensiveness in some of the evidence filed to date.

“I’m not being critical of any organisation or witness but wish to emphasise the overriding interest with this inquiry is the public interest, while we look to fulfil the terms of reference to determine the possible causes of contamination.”

A set of 16 draft recommendations were issued and Mr Stevens said the joint working group would be an important conduit to implement them.

The aim was to have the bore re-opened at the end of January before Havelock North water use reached peak demand in February.

Among the recommendations was a directive that the working group – comprising representation from HDC, HBRC, the DHB and drinking water assessors – meet regularly and share information of any potential drinking water safety risk.

For at least 12 months from December 12, the bore would receive cartridge filtration, UV and chlorine treatment, and a regime of regular montioring be implemented.

It was also recommended that the HDC draft an Emergency Response Plan before Bore 3 was brought on line.

Know thy water: If it’s dry, I’m gonna water rather than lose a crop

Foodborne disease outbreaks associated with fresh produce irrigated with contaminated water are a constant threat to consumer health. In this study, the impact of irrigation water on product safety from different food production systems (commercial to small-scale faming and homestead gardens) was assessed.

drip-irrigation-carrots-jun-16Hygiene indicators (total coliforms, Escherichia coli), and selected foodborne pathogens (Salmonella spp., Listeria monocytogenes, and Escherichia coli O157:H7) of water and leafy green vegetables were analyzed. Microbiological parameters of all irrigation water (except borehole) exceeded maximum limits set by the Department of Water Affairs for safe irrigation water. Microbial parameters for leafy greens ranged from 2.94 to 4.31 log CFU/g (aerobic plate counts) and 1 to 5.27 log MPN/100g (total coliforms and E. coli). Salmonella and E. coli O157:H7 were not detected in all samples tested but L. monocytogenes was present in irrigation water (commercial and small-scale farm, and homestead gardens).

This study highlights the potential riskiness of using polluted water for crop production in different agricultural settings.

Assessment of irrigation water quality and microbiological safety of leafy greens in different production systems

Journal of Food Safety, 2 November 2016, DOI: 10.1111/jfs.12324

http://onlinelibrary.wiley.com/doi/10.1111/jfs.12324/abstract;jsessionid=883317B2001984CC39815B1792B68759.f04t01

5530 sick 39% of residents: Health board discloses full extent of Campy in NZ water outbreak

Forty-five people, mostly over 70 were admitted to hospital with campylobacter a Hawke’s Bay District Health Board update reveals.

poop-water-nz-nov-16The DHB has conducted four surveys since the event in August, the latest on September 27 and 28, the results of which they collated with the previous findings.

The surveys were conducted by telephone and the latest figures brought the estimated total number of residents affected by gastroenteritis to 5530 or 39 per cent of Havelock North’s population, 1072 of those confirmed cases.

Of those hospitalised, as of October 10, 27 were aged over 70, followed by four in the 60-69 year age group, four in the 40-49 age group and three in the 50-59 age group.

Four people under the age of 20 also ended up in hospital.

The total number of people who had developed the rare complication from campylobacter, Guillan Barre Syndrome, was reported to be three people. As the incubation time was up to four weeks, it was considered that any new cases now would not be linked to the original outbreak.

Of the estimated 5530 residents who were affected, 32 per cent had a recurrence of the bug, and as of September 28 four people were experiencing ongoing symptoms.

At the time an estimated 78 per cent of people who had symptoms took time off work or school.