Later on Friday, Haukeland Hospital reported that it is campylobacter bacteria that cause intestinal infection, which has been detected in admitted from Askøy. Campylobacter is a bacterium that E-coli often finds along with.
Isbjørn Is has used the water in the municipality both in the products and for cleaning equipment. Kolseth explains that all the products in which it enters water are heat treated – so that no pathogenic bacteria can survive. However, they use lower temperature water for rinsing and cleaning parts and smaller equipment.
– This means that there can potentially be poor quality water on parts of our equipment when production starts. We have to have full control of this, says Kolseth.
MRT reports that a patient from a southern Norway island with contaminated water has died after being hospitalized with gastrointestinal symptoms, authorities said Thursday.
Erik Vigander of the regional hospital entity in southern Norway said the bacteria Campylobacter was found in the patient’s system. That’s the same bacteria identified in other people sickened since E. coli was found in a reservoir that supplied drinking water for the island of Askoey.
Vigander says the patient who died Wednesday also had “a very serious underlying” health disorder and an autopsy will be performed to determine “the ultimate cause of death.”
A 1-year-old child from the island died last week of an infection in the digestive tract, but it was not clear whether the death was linked to the water contamination.
About 2,000 people have fallen sick. Since June 6, 64 have been hospitalized.
Hospital tests have shown that Campylobacter was found in at least three dozen cases.
Local newspaper Askoeyvaeringen reported that there had been been safety issues with the waterworks in the Askoey municipality, and feces was recently found near a reservoir that supplied part of the area’s drinking water.
We live near the publicly-funded Princess Alexandria hospital in Brisbane.
A helicopter flies over our house a couple of times a day bringing some victim from the outback or the coast.
The state of Queensland is really, really big.
It reminds me of my friend, Jim, and what he went through in the aftermath of the E.coli O157 outbreak in drinking water that killed seven and sickened 2,500 in the town of Walkerton, population 5,000.
Jim knew that every helicopter was someone dead or dying being flown to the medical center in London, Ontario (that’s in Canada, like Walkerton).
I think of Jim and the victims every time a chopper goes past.
The U.S. Centers for Disease Control reports a center pivot irrigation system intended to pump livestock waste water onto adjacent farmland in Nebraska malfunctioned, allowing excessive run off to collect in a road ditch near two wells that fed a municipal water supply, sickening 39 persons who consumed untreated city water. The use of culture-independent diagnostic tests facilitated case identification allowing for rapid public health response.
Access to clean water sources continues to be an important public health issue, and public health professionals should consider exposure to untreated water sources as a potential cause for Campylobacter outbreaks.
In March 2017, the Nebraska Department of Health and Human Services (NDHHS) and the Southwest Nebraska Public Health Department were notified of an apparent cluster of Campylobacter jejuni infections in city A and initiated an investigation. Overall, 39 cases were investigated, including six confirmed and 33 probable. Untreated, unboiled city A tap water (i.e., well water) was the only exposure significantly associated with illness (odds ratio [OR] = 7.84; 95% confidence interval [CI] = 1.69–36.36). City A is served by four untreated wells and an interconnected distribution system. Onsite investigations identified that a center pivot irrigation system intended to pump livestock wastewater from a nearby concentrated animal feeding operation onto adjacent farmland had malfunctioned, allowing excessive runoff to collect in a road ditch near two wells that supplied water to the city. These wells were promptly removed from service, after which no subsequent cases occurred. This coordinated response rapidly identified an important risk to city A’s municipal water supply and provided the evidence needed to decommission the affected wells, with plans to build a new well to safely serve this community.
On March 10, 2017, NDHHS was notified of five reports of campylobacteriosis in the Southwest Nebraska Public Health Department jurisdiction. Two positive culture reports and three positive culture-independent diagnostic tests, specifically a gastrointestinal polymerase chain reaction (PCR) panel, were received from persons not living together. Campylobacteriosis is a reportable condition in Nebraska, and this number of cases was higher than expected; during 2006–2016, an average of one Campylobacter case was reported in a city A resident every 3 years. Initial questioning of ill persons did not include an assessment of exposure to untreated drinking water and suggested ground beef consumption as a possible shared exposure. The Nebraska Department of Agriculture Food Safety and Consumer Protection obtained distribution records for poultry and ground beef for two local restaurants and one local grocery store. The distribution of poultry and ground beef was evaluated by reviewing the routing records of these products to their source, and no evidence of a shared poultry source was identified. The ground beef was not ground in-house at the grocery store, and the distributors that supplied ground beef to the grocery store and each of the two local restaurants were not shared. Through interviews of city A residents and business owners, investigators were made aware of a report of standing water that “smelled of cattle manure” in a roadside ditch near two municipal water wells.
A collaborative on-site investigation revealed that during the pumping of a large volume of livestock wastewater from a concentrated animal feeding operation through a center pivot irrigation system, the system malfunctioned at an undetermined time. The wastewater was intended to be placed on adjacent farmland. This malfunction allowed excessive runoff to flood a road ditch approximately 15 feet (4.6 m) from two municipal water well houses (3 and 4) that had been operating 6 days before the onset of illness in the first patient. The presence of this standing water was confirmed by city A water operators, who reported seeing water in the ditch for 4 days (February 22–25) (Figure). Pump records indicated that during February 22–27, well 3 was in use, and during February 28–March 7, well 4 was in use (Table 1). During both periods, another well (well 2) was also operating. Wells are rotated in and out of service by city operators as part of regular operations. Water is distributed through the well system without any disinfection or filtration. Routine total coliform and Escherichia coli testing of water from the distribution system was performed on March 8; however, only wells 2 and 5 were operating on that date. As part of the investigation, additional coliform and E. coli testing was performed again on March 16 on direct samples from wells 2, 3, 4, and 5; bacterial culture specifically for Campylobacter was performed on March 20 (wells 4 and 5) and 27 (wells 2 and 3). All samples were negative for coliforms and Campylobacter. No additional pump or testing records were reviewed.
On March 16, Nebraska Department of Environmental Quality and the Department of Agriculture conducted an additional investigation of two concentrated animal feeding operation–certified waste lagoons (a manufactured basin that collects livestock waste and water in an oxygen-deprived setting to promote anaerobic conditions as a way to manage refuse)* and associated use of three pivot irrigation systems. The investigation team observed that water from the waste lagoons had been pumped through a pivot onto an adjacent field, which is a common farming practice for fertilizing farm ground or watering crops. City operators confirmed that on February 24 they had observed flow of livestock wastewater into the road ditch near well 4. They followed the wastewater up the road ditch and reported that it came out of the farmland upstream from the wells. Investigators also obtained details of total well depths, static water levels, and pumping water levels (measured during active pumping). Wells 4 and 3 were relatively shallow, with static water levels of 21 and 22 feet, pumping levels of 25 and 26 feet, and total well depths of 43 and 46 feet, respectively; both began service in the 1930s, similar to the other wells in the system, which were also older.
While details around this event were being clarified and environmental testing was pending, an Internet-based questionnaire was designed to aid case-finding and assess potential exposures. A probable case was defined as a diarrheal illness of ≥2 days’ duration with one or more additional signs or symptoms (nausea, vomiting, fever, chills, or headache) in a city A resident, with onset during February 28–March 23, 2017. A confirmed case was defined as a person meeting the probable case definition with either stool culture or PCR-positive results for Campylobacter, or a laboratory-confirmed probable illness in a nonresident who worked, dined, or shopped for groceries in city A. Among approximately 600 city A residents, 94 (16%) completed a questionnaire to report food consumption history, drinking water source, animal exposures, and symptoms. Among questionnaire respondents, 39 (41%) campylobacteriosis cases (six confirmed and 33 probable) were identified, with illness onset from February 28–March 21 (Figure); 25 (64%) cases occurred in females and 14 (36%) in males. The median age was 34.5 years (range = 1.5–85 years). Twelve (31%) patients sought medical care, and three (8%) were hospitalized; no deaths were reported.
Data analysis indicated a significant association between ill persons and consumption of untreated, unboiled municipal tap water (OR = 7.84; 95% CI = 1.69–36.36) (Table 2). Other exposures were assessed, including unpasteurized milk, animal contact, raw poultry, and ground beef, but none demonstrated a significant association with illness. Notably, no cases were reported among the approximately 28 residents of city A’s only nursing home, which used city water but treated it with a reverse osmosis system.
Public Health Response
Wells 3 and 4 were both permanently removed from service on March 16, and no additional illnesses were reported with onset after March 21. On April 25, NDHHS reclassified these wells to Emergency Status, meaning the well can only be pumped during a case of emergency (e.g., fire, drought, etc.) for nonpotable purposes. Furthermore, meetings were held with area stakeholders to present these findings as evidence to support the award of a planning grant to city A to explore options for a new, higher-volume well to be dug to an acceptable depth in a different location.
This investigation implicates Campylobacter jejuni as the cause of this outbreak, most likely from a municipal water system contaminated by wastewater runoff from an adjacent concentrated animal feeding operation (1). In addition to environmental and statistical findings, this conclusion is consistent with prior investigations that demonstrate Campylobacter outbreaks of similar size are historically associated with contaminated water (2–7). Although laboratory testing of the water in this investigation did not yield any positive results, samples were not taken until long after the contamination event, and test results might have been affected by switches among wells supplying the system over time. These findings also suggest that routine coliform testing might not be a good indicator of the presence of Campylobacter species (8). Further, it is possible that Campylobacter in particular might be viable but not necessarily detectable by culture in water systems (9,10). The use of both culture and culture-independent diagnostic tests (PCR) were needed to detect the initial cluster of cases and early recognition of this outbreak. If culture alone had been used, only two cases would have been reported, one of which did not occur in a city A resident. Of those two culture-confirmed cases, one patient refused the interview and the other had typical Campylobacter exposures, such as live poultry, which might not have prompted such a rapid response. This investigation demonstrates the importance of considering exposure to untreated water sources as a potential cause for Campylobacter outbreaks. Including this risk factor in initial questioning could help to expedite outbreak investigations. Ultimately, early recognition and a coordinated response by several state and local agencies greatly facilitated this successful public health intervention.
Campylobacteriosis outbreak associated with contaminated municipal water supply-Nebraska, 2017
The roles of environmental reservoirs, including wild birds, in the molecular epidemiology of Campylobacter jejuni have not been assessed in depth.
Our results showed that game birds may pose a risk for acquiring campylobacteriosis, because they had C. jejuni genomotypes highly similar to human isolates detected previously. Therefore, hygienic measures during slaughter and meat handling warrant special attention. On the contrary, a unique phylogeny was revealed for the western jackdaw (right) isolates, and certain genomic characteristics identified among these isolates are hypothesized to affect their host specificity and virulence.
Comparative genomics within sequence types (STs), using whole-genome multilocus sequence typing (wgMLST), and phylogenomics are efficient methods to analyze the genomic relationships of C. jejuni isolates.
Population Genetics and Characterization of Campylobacter jejuni Isolates from Western Jackdaws and Game Birds in Finland Sara Kovanen, Mirko Rossi, Mari Pohja-Mykrä, Timo Nieminen, Mirja Raunio-Saarnisto, Mikaela Sauvala, Maria Fredriksson-Ahomaa, Marja-Liisa Hänninen and Rauni Kivistö
Appl. Environ. Microbiol. February 2019 85:e02365-18; Accepted manuscript posted online 14 December 2018, doi:10.1128/AEM.02365-18
Campylobacter as an inhabitant of the poultry gastrointestinal tract has proven to be difficult to reduce with most feed additives. The use of in-feed antibiotics have been taken out of poultry diets due to the negative reactions of consumer along with concerns regarding the generation of antibiotic resistant bacteria. Consequently, interest in alternative feed amendments to antibiotics has grown.
One of these alternatives, prebiotics has been examined as a potential animal and poultry feed additive. Prebiotics are non-digestible ingredients that enhance growth of indigenous gastrointestinal bacteria that elicit metabolic characteristics which are considered beneficial to the host. In addition, these compounds support microbial activities in the gastrointestinal tract that are antagonistic to the establishment of pathogens. There are several carbohydrate polymers that qualify as prebiotics and have been fed to poultry. These include mannoligosaccharides and fructooligosaccharides as the most common ones marketed commercially that have been used as feed supplements in poultry.
More recently several non-digestible oligosaccharides have also been identified as possessing prebiotic properties when implemented as feed supplements. While prebiotics appear to be generally effective in poultry and limit establishment of foodborne pathogens such as Salmonella in the gastrointestinal tract, less is known about their impact on Campylobacter.
This review will focus on the potential of prebiotics to limit establishment of Campylobacter in the poultry gastrointestinal tract and future research directions.
Potential for prebiotics as feed additives to limit foodborne campylobacter establishment in the poultry gastrointestinal tract
Frontiers in Microbiology
Sun A. Kim, Min J. Jang, Seo Y. Kim, Yichao Yang, Hilary O. Pavlidis, and Steven C. Ricke
A Petland store in Michigan is facing its third lawsuit this year after a man said he was hospitalized after buying a puppy later found to be sick from the store.
Doug Rose said he became infected with Campylobacter — a multi-drug resistant infection — after he and his wife Dawn purchased Thor, a beagle-pug mix puppy that the couple said was infected with parasites, suffered from coccidia and giardia, and had an upper respiratory infection, The Oakland Press reported.
The couple said the same veterinary clinic that gave the dog a clean bill of health through the Petland in Novi also diagnosed the puppy with a number of ailments.
Symptoms of Campylobacter infections can include abdominal pain, diarrhea, headache, fever, nausea and vomiting.
The couple is seeking monetary compensation after Doug Rose said he required multiple weeks of medical treatment.
Randy Horowitz, who owns the Petland in the Detroit suburb, told the newspaper the case would be resolved to “reflect the facts.”
A lawsuit filed by 17 plaintiffs against Horowitz was dismissed earlier this year. The lawsuit alleged that Horowitz knowingly sold puppies suffered from genetic defects.
A lawsuit was filed in April by nine families alleging that puppies they purchased suffered from a number of medical issues.
In January, the Centers for Disease Control and Prevention released results of a multi-state investigation that showed 113 cases of Campylobacter across 17 states linked to pet stores. A majority of people reported becoming sick after coming in contact with a puppy purchased from a Petland store or after coming in contact with another human who had recently purchased a dog from a Petland store.
A matched case–control study in Quebec, Canada, evaluated consumption of veal liver as a risk factor for campylobacteriosis. Campylobacter was identified in 28 of 97 veal livers collected concurrently from slaughterhouses and retailers. Veal liver was associated with human Campylobacter infection, particularly when consumed undercooked.
Recent investigations conducted in Quebec, Canada, after an increased number of sporadic campylobacteriosis illnesses suggested that consumption of veal liver may be a risk factor for campylobacteriosis. Many of the persons infected reported eating veal liver, and many of those had eaten it pink or undercooked. The association between campylobacteriosis and the consumption of meat products, including chicken liver and offal from different animal species, has been previously described (1–5). We designed an epidemiologic study to examine the relationship between veal liver consumption and campylobacteriosis.
We conducted a matched case–control study to examine a potential association between veal liver consumption and campylobacteriosis, using salmonellosis cases as controls. The study began in September 2016 and continued for 9 months. Salmonellosis and campylobacteriosis cases are reportable in Quebec; we selected all subjects from the provincial reportable disease registry. We used a systematic sampling method to select every fifth reported campylobacteriosis case-patient >45 years of age. We paired each campylobacteriosis case-patient with 1 salmonellosis case-patient by age group (45–64 and >65 y) and sex; both infections were confirmed by fecal culture. We matched case-patients if the salmonellosis sample was collected within a window of 7 days before to 60 days after the campylobacteriosis sample was collected. Inclusion criteria for cases and controls were infection that was sporadic and domestically acquired. Exclusion criteria were co-infection with another pathogen, being part of a recognized outbreak, or contact with a gastroenteritis case-patient <10 days before illness.
We administered a structured questionnaire by telephone to collect information on exposures in the 7 days before illness onset. Exposures were consumption of meat and unpasteurized milk products, contact with animals, drinking and recreational water exposures, and occupational exposures. In particular, we investigated consumption of a variety of livers and the degree to which they were cooked. We conducted matched univariate and multivariate analysis to estimate odds ratios (OR) for each exposure.
In addition, we collected samples of veal, chicken, pork, and beef livers from slaughterhouses and retail stores in Quebec between October 2014 and March 2017. We tested each liver specimen for the presence of Campylobacter, Salmonella, and Escherichia coli O157:H7 by using standardized methods (6,7).
We matched a total of 112 campylobacteriosis cases to salmonellosis cases. We found no significant statistical difference in the age or sex distribution of retained cases or controls and the excluded patients. The species of Campylobacter were C. jejuni (79.5%), C. jejuni/coli undifferentiated (3.6%), C. coli (0.9%), other (1.8%), and not identified (14.3%). Among campylobacteriosis case-patients, 42 (37.5%) consumed veal liver and 29 (69.0%) ate it undercooked.
Only the consumption of veal liver and having contact with farm animals were statistically significantly associated with campylobacteriosis (Table 1). After applying the Bonferroni correction to adjust for multiple comparisons (0.05 level of significance divided by 45 variables tested yields α = 0.001), only veal liver consumption remained as a statistically significant exposure (matched OR 9.50, 95% CI 3.39–26.62; p = 0.000001).
Among veal liver consumers, adequate cooking (e.g., well-cooked vs. pink or rare, on the basis of the participant’s subjective observation) was protective. Specifically, 13 (30.2%) of 43 case-patients versus 6 (85.7%) of 7 controls ate their veal liver well-cooked (unmatched OR 0.07, 95% CI 0.002–0.72; p = 0.02). Multivariate analysis using logistic regression confirmed that a statistically significant association between the consumption of veal liver and campylobacteriosis remained when all other exposures were included as covariates. Although we conducted this study among persons ≥45 years of age, it is reasonable to assume that eating veal liver, especially undercooked, would also carry risk for younger persons.
We sampled 339 veal, pork, chicken, and beef livers collected from 138 retailers and 16 slaughterhouses. When we evaluated all livers collected at both locations, we detected Campylobacter in 28.0% of veal livers, 22.2% of pork livers, 36.8% of chicken livers, and 19.1% of beef livers (Table 2). We detected Salmonella more frequently in chicken livers (22.1%) and pork livers (19.1%) than in veal livers (3.1%); we did not detect Salmonella in beef livers. We rarely identified E. coli O157:H7 in livers of any kind. The proportion of contaminated livers differed between animal species and also with respect to location of sampling. A higher proportion of veal livers (35.7%) collected from retailers were contaminated by Campylobacter, compared with veal livers collected from slaughterhouses (16.2%). We observed the reverse for chicken and pork livers. The reason for these variations is unclear at this time, but this finding may be an artifact resulting from the relatively small number of samples taken at each location.
Cattle are a well-known reservoir for a variety of Campylobacter species, such as C. jejuni, C. coli, and C. fetus (8,9). Campylobacter species have been isolated from beef intestinal contents and also from beef bile, bile ducts, gallbladder, and liver (10–14). The gallbladder and bile contain substances that have a chemoattractant effect on C. jejuni, which explains the presence of Campylobacter within the biliary tract (10,15). Liver contamination varies between animal species (10–14). Chicken liver, for example, can be contaminated by Campylobacter and Salmonella and has been the source of several outbreaks (3,4,11,13). Because few case-patients consumed livers from other animal species during our study, we were not able to identify any substantial risks associated with those exposures.
Because livers may be collected from several animals and stored together, they may be contaminated during the evisceration process or by cross-contamination (11). Both the external and internal tissue of a liver may be contaminated with Campylobacter, and inadequate cooking may not fully inactivate Campylobacter and Salmonella (10,11), which is a cause for concern because ≈70% of the patients with campylobacteriosis who consumed veal liver in our study reported eating it undercooked. We did not examine possible cross-contamination of foods and surfaces and the host-related factors that may increase the risk for enteric diseases.
Our study identified a strong and statistically significant association between the consumption of veal liver and sporadic, domestically acquired campylobacteriosis among persons >45 years of age in Quebec. We found that adequate cooking of veal liver mitigates the risk of infection. We detected Campylobacter in almost one third of veal livers we sampled from slaughterhouses and retail stores, which supports our finding that veal liver consumption is a risk factor for campylobacteriosis. In light of these results, we recommend the dissemination of safe food handling practices for veal liver and other offal for retailers, food establishments, slaughterhouses, and the general public.
Dr. Gaulin is a physician epidemiologist who works in public health at the Protection Branch of the Ministry of Health in Quebec, Canada. She works in infectious diseases on enteric and nonenteric disease surveillance and also coordinates provincial outbreak investigations.
Veal Liver as Food Vehicle for Human Campylobacter Infections
Gaulin C, Ramsay D, Réjean Dion R, Simard M, Gariépy C, Levac É, et al. Veal liver as food vehicle for human Campylobacter infections. Emerg Infect Dis. 2018 Jun [date cited]. https://doi.org/10.3201/eid2406.171900
But the so-called experts undermine their case by not advocating the use of a tip-sensitive digital thermometer and instead relying on the woefully unreliable color test (‘chicken must be fully cooked through until juices run clear) for safety.
A new University of Otago, Wellington study, published last week in the international journal BMC Public Health found an overwhelming majority of consumers were not aware of the widespread Campylobacter contamination.
A University of Otago study found only 15 per cent of consumers were aware that 60 to 90 per cent of fresh chicken meat for sale in New Zealand is contaminated with campylobacter.
“This study has identified some clear gaps in campylobacteriosis prevention in New Zealand,” University of Otago infectious diseases researcher Professor Michael Baker said.
“Fresh chicken is heavily contaminated with campylobacter and causes an estimated 30,000 New Zealanders to get sick each year. “
Fresh chicken was also spreading antibiotic resistant bacteria and was “New Zealand’s number one food safety problem”, Baker said.
Speaking on Mike Hosking Breakfast today, he said people were still getting sick as a result of not carrying out best practice when preparing fresh chicken – including not adequately cleaning bench surfaces or sinks that have come in contact with it.
Baker said a label would need good information to help a consumer, but would need to be tested.
He said labels to should read something like: “This food should be treated with care.”
The study was based on interviews with 401 shoppers over 16 who were recruited outside 12 supermarkets and six butcheries in the Wellington Region
“New Zealand has one of the highest rates of campylobacteriosis in the world and at least half of cases can be attributed to contaminated chicken,” Philip Allan, a medical student and researcher at the Department of Public Health, University of Otago Wellington (UOW), said.
“Our study showed that many consumers are not aware of the risks, and that retailers should do much more to inform shoppers.”
The study also assessed the quality of current chicken labelling in supermarkets and butcheries and identified major deficiencies in the safety information provided to consumers.
Butchery labels in particular were lacking in chicken preparation information.
More than half wanted the levels of campylobacter contamination reported, the study found.
“Most participants thought a large, brightly coloured warning label containing safety information would be the most effective for communicating safe chicken preparation information.”
The study’s researchers said the most effective way to reduce campylobacteriosis rates is for Ministry for Primary Industries to mandate lower contamination levels of fresh poultry.
“This measure has been highly effective in the past, halving the rate of campylobacteriosis in New Zealand when implemented in 2007. “While improved labelling is important, it is no substitute for cleaning up our poultry,” Baker said.