Hong Kong fairytales: More Vibrio: Suspected food poisoning outbreak in tour group

The Centre for Health Protection (CHP) of the Department of Health is investigating a suspected outbreak of food poisoning in a tour group, and hence urged the public to maintain good personal, food and environmental hygiene to prevent food-borne diseases.

Because all foodborne illness is caused by poor personal hygiene, and not contaminated product.

Not

The outbreak affected six members of the tour group, comprising two men and four women aged from 44 to 80, who developed abdominal pain, diarrhoea and vomiting 14 to 40 hours after their lunch buffet in a restaurant in a hotel in Macau on August 13 arranged by a travel agent in Hong Kong.

Among them, three sought medical attention in Hong Kong and required no hospitalisation. All affected persons have been in stable condition.

The stool specimen of one patient tested positive for Vibrio parahaemolyticus upon laboratory testing.

 

Dozens of guests at Ibiza hotel struck down by gastroenteritis amid fears dirty rainwater seeped into water tanks

One of my fondest childhood memories was the rain barrels my grandparents used to collect water.

I have no idea why, other than a foreshadowing of somewhat of a career in microbiology, but the memories remain vivid.

Now we live in Australia, which has 10 years of drought followed by a 1-in-500-year downpour, so we have these bloody big rain water collection tanks that look nothing like my grandparents.’

Around 50 guests at an Ibiza hotel popular with British holidaymakers have fallen ill with suspected gastroenteritis.

A pregnant woman needed hospital treatment and doctors were made available for 49 other guests following the outbreak at the four-star Hotel Algarb in Playa d’en Bossa,

A probe is now underway to establish the cause, although it has been initially linked to rainwater from midweek storms on the island filtering into hotel water tanks and ending up being used to make ice.

The mum-to-be who was hospitalised with “light gastroenteritis” has now been discharged.

14 sick, 4 with HUS from E. coli in Calif. lake

An E. coli-contaminated lake in Nevada County, Calif., linked to the illnesses of 14 people will remain closed until at least Aug. 23, county officials announced Wednesday.

Hannah Knowles of the Sacramento Bee reports authorities closed all of Lake Wildwood’s public beaches last week after water testing confirmed reports linking E. coli infections to the lake’s Main Beach, also called Commodore Park. The county also advised against any swimming in the lake.

As of Wednesday, 14 people – 11 children and three adults – are believed to have contracted E. coli after visiting the Main Beach and, in many cases, ingesting lake water, according to the Nevada County Public Health Department. Lab results so far confirm 11 of those 14 cases are connected to the lake’s bacteria.

By Tuesday, nine people had been hospitalized in connection with the outbreak, county Public Health Coordinator Patti Carter said. Six had been discharged by Wednesday evening.

Four sickened children developed a serious condition called hemolytic uremic syndrome, which can lead to potentially fatal kidney failure and anemia.

Careful with that Italian water fountain: An entire orchestra is rushed to hospital

Norman Lebrecht of Slippedisc reports all 80 members of the European Spirit of Youth Orchestra were rushed to the Santa Chiara Emergency Room in Trento, Italy, suffering from dehydration after an outbreak of vomiting and diarrhea.

About 20 young musicians received prolonged treatment and two were detained in hospital overnight.

The problem was traced to a picturesque fountain in the small town of Belluno, where the orchestra had stopped for a drink of water. Officials say this was due to current repairs to the aqueduct.

The orchestra aims to continue its tour with conductor Igor Coretti-Kuret.

 

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

 

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.”