33 sick: Outbreak of E. coli infections linked to ground bison

According to the U.S. Centers for Disease Control (CDC) an outbreak of Shiga toxin-producing Escherichia coli (STEC) — E. coli O103 and E. coli O121 — linked to ground bison appears to be over.

CDC, several states, the U.S. Food and Drug Administration, and the Canadian Food Inspection Agency investigated a multistate outbreak of infections.

On July 16, 2019, Northfork Bison Distributions, Inc., in Saint-Leonard, Quebec, Canada, recalled external icon ground bison produced between February 22, 2019, and April 30, 2019. Recalled ground bison was sold to distributors as ground bison and bison patties, referred to as Bison Burgers and/or Buffalo Burgers. Recalled ground bison was also sold to retailers in 4-ounce burger patties.

Do not eat, sell, or serve recalled Northfork Bison products.

As of September 13, 2019, this outbreak appears to be over.

A total of 33 people infected with the outbreak strain of STEC O103 and STEC O121 were reported from eight states.

Eighteen people were hospitalized. No cases of hemolytic uremic syndrome, a type of kidney failure, were reported. No deaths were reported.

When ordering at a restaurant, ask that ground bison burgers be cooked to an internal temperature of at least 160°F.

How a frozen meringue led Australian investigators to the source of a potent Salmonella outbreak

Jess Davis of ABC News reports a frozen meringue was key to identifying and outbreak of Salmonella enteritidis (SE), a bacteria that until last year was not found in Australia, that sickened almost 200 people.

People first started getting sick in May 2018 and by July a cluster of cases had appeared in New South Wales. That was when health authorities started investigating.

“Health, through their investigations, were able to look at a number of isolates of Salmonella enteritidis that came from humans, who unfortunately had been ill, and use a technology called whole genome sequencing,” said NSW Food Authority CEO Lisa Szabo.

“So it’s a genetic-based technology that helps us join the dots, shall I say. And this was the first time they could see a group of people with the same whole genome sequence.”

Anyone with a confirmed case of SE was interviewed by investigators and asked for a detailed account of what they’d eaten — to try to find what the different cases had in common.

A few weeks after being interviewed, one of those people remembered they had a frozen meringue cake in their freezer, leftover from a birthday party, around the time they got sick.

Officers went to that person’s home, collected the cake and had it tested.

“We were able to isolate the Salmonella enteritidis and it had that same whole genome sequence. At the same time we could see who manufactured that cake,” Ms Szabo said.

“We could go back to the manufacturer, have a look at their environment, look at how they handle food and where they get their ingredients from, and that’s where we saw the connection to the egg farm.”

It wasn’t until September that the frozen meringue led investigators to a farm on the outskirts of Sydney, but by then the bacteria had slowly started spreading across the industry.

“Once we detected salmonella enteritidis on this particular farm, we then commenced another round of investigations … more from the biosecurity and then the farm side of trying to understand … [whether the] farm had other connections to other properties around the state” Ms Szabo said.

But how the bacteria made its way into Australian eggs in the first place is likely to remain a mystery.

One property in Victoria and 13 in NSW have been affected so far and more than half-a-million birds have been culled at a cost of $10 million.

The spread of SE has been blamed largely on the interconnected nature of the egg industry, with all the infected farms connected in some way.

Egg farmers often trade produce with each other, and equipment and workers also regularly move from farm to farm.

Veterinarian Rod Jenner said SE was difficult to contain because it could survive and multiply without a host and could live in the environment for up to two years.

“It can survive in dust and dirt, in vehicles, and can travel in the wind. Rodents, wild birds, that sort of thing, can carry it on their skin or in their bodies as well,” he said.

“So it has actually been demonstrated to travel vast distances and be contaminated, be deposited on other farms that have previously been free.”

A farmer’s worst nightmareBede Burke’s egg farm at Tamworth in NSW was the 11th property to be infected, with a notification it had tested positive to SE during a routine check just over three months ago.

“Your whole world crashes down around you, you know,” Mr Burke said.

“We just didn’t sleep for a week and that first seven or eight days was really traumatic. We had to learn how to both decontaminate and disinfect the premises.”

When the notification came through on the eve of the federal election, Mr Burke had to withhold his eggs from sale and was faced with the prospect of culling entire flocks.

“But then you’ve got heap of eggs on your premises, you can’t not stop packing eggs, we were still going to pack 90,000 eggs a day,” he said.

“It’s just stress beyond all belief and then start planning for the worst.”

But he was lucky the contamination was picked up early and while a swab of dirt and dust had tested positive, it hadn’t yet spread to his egg or birds.

There have been no confirmed cases of SE since June and the industry hopes that will be the end of it.

But the outbreak has raised serious questions about how biosecurity is managed. Despite the disease becoming a national problem, its enforcement and regulation is state-based.

Philip Szepe, who runs an egg farm at Kinglake in Victoria, tests for all strains of salmonella every three months.

But he’s concerned that not all farmers are as diligent and said biosecurity was too reliant on self-regulation.

“Government’s really good at responding to crisis. It’d be great if the Government had a bit more engagement with the industry around monitoring, surveillance and compliance,” he said.

Arrest after NZ man escaped from Auckland police by pretending to vomit

Police have made an arrest after a man escaped from police custody last Tuesday.

Melanie Earley of Stuff reports 28-year-old Michael Luke Robertson allegedly fled from Avondale Police station on Tuesday morning by pretending he was about to vomit.

On Tuesday, Auckland City district commander Superintendent Karyn Malthus said officers were called to an incident where an unknown man was sleeping in a person’s vehicle.

He was taken back to the Avondale Police Station but fled while being taken from the police car into the station.

“Police gave chase however were unable to catch him and he was last seen running down a driveway on Great North Rd,” Malthus said.

On Thursday, police said a man was arrested about midday in connection to the incident.

Salted clams culprit behind hepatitis A rise

Salted clams from China and Korea appear to be the common factor in a spate of hepatitis A cases in various countries.

According to the Korea Biomedical Review, the Korea Centers for Disease Control and Prevention (KCDC) said that it has confirmed that contaminated fermented shellfish was the main culprit behind the hepatitis A outbreak this summer.

The KCDC came to the conclusions after conducting an in-depth epidemiological investigation.

The agency randomly sampled 270 of the 2,178 hepatitis A patients, diagnosed between July 28 and August 24, and surveyed whether they consumed fermented shellfish this summer. It found that 42 percent of the patients had eaten fermented shellfish during the incubation period.

KCDC also found that 80.7 percent of the 26 patients diagnosed with hepatitis A in August also ate fermented shellfish, while discovering Hepatitis A virus genes in 11 batches out of the 18 batches collected after the outbreak.

Notably, five of these genes found in the research showed close relations with the virus detected in hepatitis A patients.

As of now, the disease control agency has confirmed 10 products that have tested positive to the hepatitis A virus. Nine of them were imported from China, and one was made in Korea.

“Out of the total 10 products, weighing 37,094kg, 31,764kg has already been sold to the markets, while the remaining 5,330 kg were recovered and disposed of,” the agency said.

Yesterday, the Australian NSW Food Authority advised that Byul Mi Kim Chi is conducting a recall of Salted clams, due to a possible microbial (Hepatitis A virus) contamination. Further, Koryo Food Co. is conducting a recall of Pickled clams, due to a possible microbial (Hepatitis A virus) contamination.

NSW Food Authority CEO, Lisa Szabo said testing was underway on a number of products but full results may take a number of weeks.

“Although a contamination has not yet been confirmed, we have advised the companies of a potential link to 8 cases of hepatitis A in NSW, and they have both undertaken a recall of the product,” Dr Szabo said.

E. coli O26 and (O121) loves flour

I wrote this in May, and it’s still relevant:

I used to be a lick-the-batter-off-the-spoon kind of guy. I stopped doing that a few years ago. I don’t eat raw cookie dough, or let my kids eat it. I’m probably not the most fun dad, but outbreaks recalls like what is going on right now is why.

General Mills announced today a voluntary national recall of five-pound bags of its Gold Medal Unbleached All Purpose Flour with a better if used by date of September 6, 2020. The recall is being issued for the potential presence of E. coli O26 which was discovered during sampling of the five-pound bag product. This recall is being issued out of an abundance of care as General Mills has not received any direct consumer reports of confirmed illnesses related to this product.

This recall only affects this one date code of Gold Medal Unbleached All Purpose Flour five-pound bags. All other types of Gold Medal Flour are not affected by this recall.

Guidance from the Food and Drug Administration (FDA) and the Centers for Disease Control (CDC) continues to warn that consumers should refrain from consuming any raw products made with flour. E. coli O26 is killed by heat through baking, frying, sautéing or boiling products made with flour. All surfaces, hands and utensils should be properly cleaned after contact with flour or dough.

I think they mean cleaned and sanitized.

There’s something about O26 and O121 and flour that we’re all gonna have to figure out.

Here’s the outbreak from May 2019. Here’s a Canadian outbreak from 2017. Oh, here’s another outbreak from 2016.

Boy, 10, dies eight years after he was paralysed by contaminated Lidl beefburger

Nolan Moittie was 23-months-old when he became one of 15 children in the Hauts-de-France region to fall ill having eaten beef contaminated with E. coli.

The boy was left paralysed for life, unable to walk, talk or eat.

Yesterday he was rushed to intensive care when his heart stopped beating.

He died shortly afterwards, despite medics’ efforts to revive him, Le Parisien reported.

The other children suffer from conditions that will affect their kidneys for the rest of their lives.

The lawyer of Nolan’s family, Florence Rault, said the boy had suffered a ‘real ordeal since the accident’.

Bosses at Seb-Cerf, who marketed frozen steaks under the Steak Country brand, were tried at Douai Criminal Court in northern France in 2017.

Former boss Guy Lamorlette, 78, was sentenced to three years in prison for failing to carry out checks on the meat.

He was also banned from any industrial or commercial activity and ordered to pay damages to the victims.

At a February hearing Lamorlette tried to blame Laurent Appere, the company’s former quality manager who died just before the trial began.

Lamorlette is said to be considering an appeal.

Nolan’s family lawyer, Florence Rault, told Le Parisien: “I hope that the person responsible for this tragedy will have the decency to withdraw his appeal on points of law.

“At the first trial, he did not even want to watch Nolan, now he must serve his sentence and Nolan’s parents must be able to be compensated and mourn.”

Botulism is the worst, avoid the old soup – Lost in translation edition

While most of the time the symptoms are identified and the illness diagnosed, I still think that botulism would be a terrible way to go. Paralysis, ventilator, life long impacts.

Florian Garcia of Le Parisien reports (and this has been translated, poorly) that outdated soup was to blame for a French woman’s botulism. I’m guessing there was some temperature control issues (like it came in a tetra pack and wasn’t refrigerated – or there was a processing failure) at the root of this, not the date thing.

soup, via wikipedia

“She is almost totally paralyzed, blows a friend of the family. And with very little hope of recovery. “A week and a half after a first malaise occurred late August, the health of this resident of Essonne has deteriorated significantly. After several days of hospitalization, the doctors of Pitié-Salpêtrière in Paris diagnosed her case of botulism . A very rare disease, which she contracted by ingesting an outdated vegetable soup.

For the family, who does not want to express themselves, a vegetable soup is at the origin of the disease. In the fridge of the victim, several products call the investigators of the repression of frauds. Among them, a soup with a deadline of consumption (DLC) August 4 … outdated for three weeks.

“We took this information very seriously and immediately put ourselves at the disposal of the authorities, details the brand of soup incriminated. No problem was reported on the 630 bottles of the lot that have been sold and consumed since. “

According to her, the negligence was therefore committed by the consumer. “Given the incubation period, three days according to the National Health Security Agency (ANSES), the date of hospitalization of the patient, end of August, and the deadline for consumption of the product, August 4 , it turned out that the sick person has consumed an expired product, “says the company.

Given the severity of the disease, the company’s production method was scrutinized. “We were able to demonstrate that all the manufacturing operations were done in the state of the art,” added the spokesperson. It is a pasteurized soup and like all products of this type, it is heated above 80 ° C. This guarantees pasteurization but not sterilization. It must therefore be kept cool and consumed within a maximum of 30 days. Beyond this DLC, the freshness of a product of this type can not be guaranteed. “

UK still insists on steaming (rather than piping) hot to reduce Campy in chicken; scientists do a Picard face palm

The UK Food Standards Agency reports the top nine retailers across the UK have published their latest testing results on campylobacter contamination in UK-produced fresh whole chickens (covering samples tested from April to June 2019).

The latest figures show that on average, across the major retailers, 3.6% of chickens tested positive for the highest level of contamination. These are the chickens carrying more than 1,000 colony forming units per gram (cfu/g) of campylobacter. 

Results

The sampling and analyses are carried out in accordance with protocols laid down by the FSA and agreed by Industry.

Background information

Contamination levels         July-September 2018          October-December 2018    January-March 2019           April-June 2019

cfu/g less than 10   58.8% 63.1% 55.4% 59%

cfu/g 10-99   26.7% 22.3% 25.3% 25.3%

cfu/g 100-1000         11%    11.4% 15.8% 12.1%

cfu/g over 1000       3.5%   3.1%   3.5%   3.6%

We have been testing chickens for campylobacter since February 2014 and publishing the results as part of a campaign to bring together the whole food chain to tackle the problem. Campylobacter is the most common cause of food poisoning in the UK.

In September 2017 we announced changes to the survey, with major retailers carrying out their own sampling and publishing their results under robust protocols laid down by the FSA. We are continuing to sample fresh whole chickens sold at retail, however, the focus is now on the smaller retailers and the independent market.

Chicken is safe if consumers follow good kitchen practice:

Cover and chill raw chicken – cover raw chicken and store at the bottom of the fridge so juices cannot drip onto other foods and contaminate them with food poisoning bacteria such as campylobacter

Don’t wash raw chicken – thorough cooking will kill any bacteria present, including campylobacter, while washing chicken can spread germs by splashing

Wash used utensils – thoroughly wash and clean all utensils, chopping boards and surfaces used to prepare raw chicken

Wash hands thoroughly with soap and warm water, after handling raw chicken – this helps stop the spread of campylobacter by avoiding cross-contamination

Cook chicken thoroughly – make sure chicken is steaming hot all the way through before serving. Cut into the thickest part of the meat and check that it is steaming hot with no pink meat and that the juices run clear.

It’s a scientific embarrassment.

Sweden: Mouse pies on fallow sausage in school kitchen—high levels of E. coli

One morning when today’s school lunch was to be cooked at the Torskolan in Torsås, the staff discovered that the falu sausage that would have been cooked was covered with musbajs.

The school called me and told me that something similar to rodent spilling was found on the fallow basket. We then contacted the company from which we buy the sausage, which immediately withdrew it, says Gustaf Nilsson, environmental inspector at Torsås Municipality.

The planned sausage lunch was quickly replaced with soup and a detective work has been underway to find out where the mice have come in.

“I don’t know where they managed to get in, but before it came to school, the sausage was both at a factory and at a transhipment center. However, it is unlikely that it happened at school. The staff has detailed their routines there.

Gustaf Nilsson says he has not been to anything like it before.

“After all, the routines have failed and it is very unfortunate that this has happened. However, the staff at Torskolan did everything right to discover the pellet before starting to cook.”

Samples taken on the sausage show high levels of E. coli, ie some form of stool. The suspicion is that it comes from forest mice.

We’re all hosts on a viral planet and vaccines still work: Hep A outbreaks related to drinking water

The U.S. Centers for Disease Control reports that waterborne hepatitis A outbreaks have been reported to CDC. Person-to-person transmission of hepatitis A has increased in recent years.

Reported drinking water–associated hepatitis A outbreaks have declined since introduction of universal childhood vaccination recommendations and public drinking water regulations. However, unvaccinated persons who use water from untreated private wells remain at risk.

Public health officials should raise awareness of risks associated with untreated ground water among users of private wells and of options for private well testing and treatment. Water testing and treatment are important considerations to protect persons who use these unregulated systems from HAV infection.

Hepatitis A virus (HAV) is an RNA virus primarily transmitted via the fecal-oral route and, in rare cases, causes liver failure and death in infected persons. Although drinking water–associated hepatitis A outbreaks in the United States are rarely reported (1), HAV was the most commonly reported etiology for outbreaks associated with untreated ground water during 1971–2008 (2), and HAV can remain infectious in water for months (3). This report analyzes drinking water–associated hepatitis A outbreaks reported to the Waterborne Disease and Outbreak Surveillance System (WBDOSS) during 1971–2017. During that period, 32 outbreaks resulting in 857 cases were reported, all before 2010. Untreated ground water was associated with 23 (72%) outbreaks, resulting in 585 (68.3%) reported cases. Reported outbreaks significantly decreased after introduction of Advisory Committee on Immunization Practices (ACIP) hepatitis A vaccination recommendations* and U.S. Environmental Protection Agency’s (USEPA) public ground water system regulations.† Individual water systems, which are not required to meet national drinking water standards,§ were the only contaminated drinking water systems to cause the last four reported hepatitis A outbreaks during 1995–2009. No waterborne outbreaks were reported during 2009–2017. Water testing and treatment are important considerations to protect persons who use these unregulated systems from HAV infection.

U.S. states and territories have voluntarily reported waterborne disease outbreaks to WBDOSS since 1971.¶ Waterborne hepatitis A outbreaks (1971–2017) reported as of March 13, 2018, were reviewed. An outbreak of hepatitis A was defined as two or more cases of HAV infection epidemiologically linked by time and location of water exposure. To compare occurrence with other waterborne exposure pathways, outbreaks reviewed included those caused by drinking, recreational, environmental (i.e., nondrinking, nonrecreational water), or undetermined water exposures.** As described previously (1), data reviewed included location; date of first illness; estimated number of primary cases, hospitalizations, and deaths; water system type according to USEPA Safe Drinking Water Act definitions (i.e., community, noncommunity, and individual); setting of exposure; drinking water sources (i.e., ground water, surface water, and unknown); and water system characteristics.†† Community and noncommunity water systems are public water systems that have 15 or more service connections or serve an average of 25 or more residents for ≥60 days per year.§§ A community water system serves year-round residents of a community, subdivision, or mobile home park. A noncommunity water system serves an institution, industry, camp, park, hotel, or business. Individual water systems are small systems (e.g., private wells and springs) not owned or operated by a water utility that have fewer than 15 connections or serve fewer than 25 persons. The number of outbreaks before and after public health interventions were compared; chi-squared tests were used to identify significant (p-value<0.05) differences. Data were analyzed using SAS software (version 9.4; SAS Institute) and visualized in ArcGIS (version 10.6.1; Environmental Systems Research Institute).

Thirty-two drinking water–associated hepatitis A outbreaks were reported to CDC during 1971–2017; the last one occurred in 2009 (Table). These drinking water–associated outbreaks accounted for 857 cases (range = 2–50), with no reported deaths. Data on number of deaths were unavailable for three outbreaks. Data on hospitalizations were unavailable for all outbreaks. Outbreaks occurred in 18 states, all in the lower continental United States (Figure 1). One environmental outbreak (1975) and one recreational water outbreak (1989) were reported during this period, but were excluded from this analysis.

The most commonly reported water system type associated with an outbreak was individual, accounting for 13 of 32 (41%) outbreaks and 257 of 857 (30.0%) cases, followed by community (10 [31%] outbreaks; 241 [28.1%] cases) and noncommunity (9 [28%] outbreaks; 359 [41.9%] cases). All individual water systems with outbreaks were supplied by private wells or springs. The majority of all drinking water outbreaks and cases were associated with systems supplied by ground water (30 [94%] outbreaks; 804 [93.8%] cases) and with an absence of water treatment (23 [72%] outbreaks; 585 [68.3%] cases).

The incidence of reported drinking water–associated hepatitis A outbreaks significantly decreased after introduction of the 1989 USEPA Total Coliform and Surface Water Treatment Rules (77% decline from 1971–1989 [24 outbreaks] to 1990–2017 [eight]; p = 0.003), the 1996 ACIP hepatitis A vaccination recommendations (87% decline from 1971–1996 [29] to 1997–2017 [three]; p<0.001), and the 2006 Ground Water Rule and expanded ACIP vaccine recommendations (78% decline from 1971–2006 [30] to 2007–2017 [two]; p = 0.038) (Figure 2). From 1995 through 2009, all four hepatitis A drinking water–associated outbreaks, resulting in 35 cases, were attributed to individual water systems using untreated ground water sources. No water-associated hepatitis A outbreaks have been reported since July 2009.

Top

Discussion

Reported drinking water–associated hepatitis A outbreaks have declined since reporting began in 1971, and none have been reported since 2009, mirroring the overall decline in U.S. cases (4,5). Vaccination for hepatitis A, combined with USEPA regulations that require testing and, where necessary, corrective actions or treatment for drinking water supplies, likely played a role in reducing reported hepatitis A drinking water–associated outbreaks.

Vaccination efforts have led to significant changes in hepatitis A epidemiology (4,6,7). HAV infection rates in the United States have decreased since the introduction of hepatitis A vaccine in 1995 (4,5). Vaccine recommendations were originally targeted to children in communities with high rates of hepatitis A infections west of the Mississippi and other groups at risk (e.g., international travelers, men who have sex with men, illicit drug users, persons with clotting factor disorders, and persons with occupational risk). By 2006, routine hepatitis A vaccination was recommended for all children aged ≥l year regardless of geographic area of residence (5). Although vaccination was never recommended for users of individual ground water systems, this group likely benefited from the recommendations targeting children and other groups at risk. Incidence of HAV infection is now lowest among persons aged 0–19 years (4). However, the proportion of HAV-associated hospitalizations steadily increased during 1999–2011, likely because of more severe disease in older adults, with persons aged ≥80 years experiencing the highest rates of infection (6). The number of hepatitis A cases in the United States reported to CDC increased by 294% during 2016–2018, compared with the period 2013–2015 (8), primarily because of community-wide outbreaks in persons reporting homelessness or drug use (7). ACIP recommends vaccination to persons who use drugs and recently expanded recommendations to persons experiencing homelessness.¶¶

Reported drinking water–associated hepatitis A outbreaks were most commonly linked to individual water systems that used wells with untreated ground water. Recreational and environmental outbreaks were only reported twice, suggesting that drinking water is a more common waterborne exposure pathway for hepatitis A. Nearly 43 million U.S. residents, or 13% of the population, are served by individual water systems, primarily from ground water sources (https://pubs.er.usgs.gov/publication/cir1441external icon). Untreated ground water sources were associated with 30% of all drinking water–associated outbreaks reported to CDC during 1971–2008 (1). The USEPA Total Coliform and Surface Water Treatment Rules of 1989 and Ground Water Rule of 2006 provide enhanced safety measures for public water systems using ground water sources and might have contributed to the absence of reported hepatitis A outbreaks linked to community water sources since 1990. However, federal regulations do not apply to individual water systems, which often have inadequate or no water treatment (9). Private wells or springs were the only contaminated drinking water systems to cause the last four reported hepatitis A outbreaks during 1995–2009. CDC recommends that owners of private wells test their water annually for indicators of fecal contamination (https://www.cdc.gov/healthywater/drinking/private/wells/testing.html). Factors contributing to fecal contamination of ground water include nearby septic systems or sewage, weather patterns (e.g., heavy rainfall), improper well construction and maintenance, surface water seepage, and hydrogeologic formations (e.g., karst limestone) that allow for rapid pathogen transport (2,9).

The findings in this report are subject to at least three limitations. First, waterborne hepatitis A outbreak reporting is through a passive, voluntary surveillance system; health departments have varying capacity to detect, investigate, and report outbreaks, which might result in incomplete data on outbreak occurrence and characteristics within and across jurisdictions. Thus, outbreak surveillance data might underestimate the actual number of drinking water–associated hepatitis A outbreaks and might underreport information regarding health outcomes such as cases of illness. Second, attributing the source of an outbreak to individual water systems can be particularly difficult because hepatitis A can also be spread through person-to-person transmission within a household. Finally, outbreak data before 2009 did not include case-specific information; thus, demographic factors, including age, could not be assessed.

Drinking water–associated hepatitis A outbreaks have declined and essentially stopped, likely in large part because of the introduction of an efficacious vaccine as part of the routine childhood immunization program and microbial drinking water regulations for public water systems. The degree to which these interventions have contributed to the decline in outbreaks is uncertain. However, waterborne outbreak surveillance data is not yet finalized for 2018, and the recent increase in person-to-person transmission of hepatitis A (7,8) has the potential to cause a resurgence in waterborne outbreaks through increased fecal HAV contamination of private ground water supplies. Outbreak data suggest that individual water systems, primarily those systems drawing untreated ground water from wells, pose the highest risk for causing drinking water–associated hepatitis A outbreaks. These systems are not regulated by USEPA; CDC recommends that owners evaluate their well water quality at least yearly. If indicators of fecal contamination are detected, remediation and treatment of private well water is recommended. Guidance on private well testing and treatment solutions for microbial contamination is provided by USEPA (https://www.epa.gov/privatewells/protect-your-homes-waterexternal icon) and CDC (https://www.cdc.gov/healthywater/drinking/private/wells/index.html). Although the current nationwide outbreak of hepatitis A is not water-associated, considering ground water as a possible transmission route is warranted during community-wide outbreaks of hepatitis A. Ground water can be contaminated with HAV during community transmission of hepatitis A, increasing the risk for persons using untreated water. Public health education about the risks associated with drinking untreated ground water from individual systems, as well as relevant safety measures (i.e., water testing, water treatment, and vaccination), is needed to prevent future drinking water–associated hepatitis A outbreaks.

US: Impact of public health interventions on drinking water-associated outbreaks of hepatitis A-United States, 1971-2017

6.sep.19

CDC

Catherine E. Barrett, Bryn J. Pape, et al

https://www.cdc.gov/mmwr/volumes/68/wr/mm6835a4.htm?s_cid=mm6835a4_e&deliveryName=USCDC_921-DM8344