E. coli outbreak at childcare facility in mid-west Ireland

The Department of Public Health in the Mid-West is handling an E.coli outbreak at a childcare facility and is reminding the public of the danger this bacteria can pose. 

Verotoxigenic E. coli (VTec) is a powerful strain of E.coli bacterium that lives in the gut of healthy cattle and sheep and can cause serious illness in the elderly and in children aged under five. 

The Mid-West public health department said the outbreak was under control but the incidence highlights the importance of hand hygiene and proper water treatment. 

VTec can be a source of food poisoning and can cause bowel inflammation leading to bloody diarrhea and severe stomach cramps. 

A specialist in public health said Ireland had one of the highest incidence rates of VTec in Europe and that the Mid-West region has one of the highest reported rates in the country. 

It underpins the importance of hand hygiene before and after preparing food, after contact with farm animals and their environment, and effective treatment and rehabilitation of private wells. 

Best communication practices in communicating a drinking water-related public health emergency

I guess someone published this again, since the Walkerton outbreak of E. coli O157 which killed seven and sickened over 2,000 k in a town of 5,000 happened in May 2000.

I know it’s not the best writing, but I tried, and it was 20 years ago. I severed on an expert (I hate that word) committee and we wrote our report.

We live near the publicaly 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 Walkerton-resident friend and what he went through in the aftermath of the E. coli O157 outbreak in drinking water.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 E. coli O157:H7 waterborne outbreak in Walkerton, Ont., Canada, in May 2000, presented a clear and present danger of risk to citizens who consumed that water — at least in retrospect. More challenging though, is to know when a risk is severe enough to warrant extraordinary communications and how best to compel citizens to comply with health advisories.

Risk theory, involving assessment, management and communication, is important to underpin discussions of how regulators, industry and citizensincorporate and act on information about risks — such as the hazards posed by E. coli O157:H7 in drinking water. Today it is well accepted that the three components of risk analysis cannot be separated and are, in fact, integrated, and that communication involves the multi-directional flow of information.

Evidence from recent water-borne disease outbreaks illustrates the importance of timeliness in health related warnings.

Timeliness of message delivery is dependent on how quickly a problem is identified, and how the message is delivered. The public can passively receive information on health related risks  from the media or the utility, or actively seek out information from information sources such as the Internet, telephone hotlines or library services (Casman et al., 2000).

In determining when to go public with health advisories, health authoritiesreport that every outbreak of food- or water-borne illness must be examine dusing factors such as severity, potential impact and incubation time of the suspect pathogen. The health risk outcome of microbiological hazards to the public should be assessed, discussed and quantified among workers from diverse disciplines, including health officials, veterinarians, food processing experts, microbiologists, medical doctors, risk analysis experts, and consumer behavior experts.

Once sufficient evidence exists to issue a public health advisory, risk messages must be designed that accurately describe the risk to individuals and provide concrete steps that individuals can take to reduce the chances of risk exposure.

Further, the number of suspected or confirmed illnesses related to the particular outbreak should be included as a matter of course in any public communications. And once health advisories have been created, a variety ofmessage delivery techniques need to be employed, again depending on the severity of the hazard, the size of the impacted population and local circumstances.

For a severe and immediate hazard such as E. coli O157:H7 in drinking water, a mixture of low-to-high technology message delivery mechanisms should be employed, including door-to-door, the buddy system, the use of existing community networks such as Neighbourhood Watch, emergency hubsite information centers and even mobile megaphones, complimented by more broader mechanisms such as local media, posting information on a website, automated telephone messages, broadcast faxes, and electronic mail distribution.

However, the key to using any of these technologies effectively is to plan ahead and be prepared.  Effective planning will establish which techniques are best for the size of the community and the existing infrastucture.  No one technology can reach all members of the target audience, therefore combining delivery methods is essential.

The current state of risk management and communication research suggests that those responsible with food and water safety risk management must be actively seen to be reducing, mitigating or minimizing a particular risk. The components for managing the stigma associated with any food safety issue seem to involve all of the following factors:

  • effective and rapid surveillance systems;
  • effective communication about the nature of risk;
  • a credible, open and responsive regulatory system;
  • demonstrable efforts to reduce levels of uncertainty and risk; and,
  • evidence that actions match words.

This report has been concerned with the second point, the ability to effectively communicate about the nature of risk. E. coli O157:H7 is not regular E. coli. It is a highly virulent and dangerous pathogen that sickens tens of thousands annually in North America and kills hundreds. Each year since the 1993 Jack-in-the-Box outbreak has brought a high profile and deadly outbreak of E. coli O157:H7 from some corner of the developed world; outbreaks that receive significant media coverage and provide new insights; Australia in 1994 (involving the related E. coli O111); Scotland and Japan in 1996; a waterpark in Atlanta, Ga in 1998. While many Canadians may be unfamiliar with such outbreaks — media coverage in Canada is superficial at best, frequently focused on the hypothetical risks posed by various food-related technologies while ignoring the carnage associated with food and water-borne pathogens

Any local efforts must be supported by a national culture of awarenessregarding a risk such as E. coli O157:H7, which has been known to cause outbreaks and severe illness, and sometimes death, for almost 20 years. When compared to outbreaks and response in the U.S., it is observed that outbreaks, particularly of E. coli O157:H7 bring a sustained policy response from the highest levels of government, including the Office of the President. While there have been many private-sector initiatives in Canada to enhance the safety of the food supply, these efforts are rarely communicated or discussed by government, short of admonitions to “cook hamburger thoroughly.

If I dance, it’s poorly, but I loved it.

Canadian boy permanently brain damaged after eating lettuce contaminated with E. coli

Tyana Grundig, Greg Sadler and Asha Tomlinson report for CBC’s Marketplace (see below) that the last decade has seen recall after recall of tainted romaine lettuce coming into Canada from the United States. At least seven people have died, and hundreds have been sickened or hospitalized in both countries.

Toddler Lucas Parker was one of them.

In the fall of 2018, his parents, Nathan Parker and Karla Terry of Richmond, B.C., took Lucas and his siblings to Disneyland, their first trip outside Canada. But what they couldn’t know at the time was that a few bites of romaine salad Lucas ate one night at a small California roadside restaurant would change their lives forever. 

Soon after that dinner, an outbreak of E. coli O157: H7 contamination spread across both Canada and the United States — eventually leaving 35 people hospitalized.

Like most people who get sick from this strain of E. coli, Lucas, then two years old, didn’t show symptoms right away. When he started feeling unwell, the family headed out for the long drive home. By the time he was in a Canadian hospital, the E. coli had shut down one of his kidneys and led to two brain injuries. There are no current treatments for E. coli that can help alleviate infections or prevent complications. 

Lucas can no longer walk, talk or see. 

“Lucas was just a beaming ray of light … he was a caring person … a cheeky boy, a loving brother,” said his father, Nathan Parker. “I remember him in the hospital waking up out of a coma and looking around, just lost, not talking, not walking, not moving much. Such a brain injury that his brain was so swollen that there was no comfort, there was nothing. It was just hell.”

Bill Marler, an American lawyer and food-safety advocate who has been fighting for food safety for almost 30 years, represents Lucas and his parents. Marler has filed suit on behalf of the family against the restaurant where they ate, as well as the farm and suppliers of the lettuce; the case is currently in the discovery phase in a court system slowed down because of the COVID-19 pandemic. 

Lucas, “is the most devastatingly injured human who has survived a food-borne illness outbreak — ever,” said Marler. “The fact that he survived at all and his parents care for him as gently and as caringly as they do is a testament to them.”

Young children and older adults are most at risk of developing serious complications from E. coli O157: H7 contamination. While most people simply experience an upset stomach, some develop life-threatening symptoms, including stroke, kidney failure and seizures — and some die. 

Between 2009 and 2018, the U.S. Food and Drug Administration (FDA) and Centers for Disease Control and Prevention (CDC) say they identified 40 food-borne outbreaks of infections from this strain of E. coli in the U.S. with a confirmed or suspected link to leafy greens.

Marler says he believes cows — and a society that values convenient, bagged lettuce — are to blame.

Sydney mum denies trying to poison son by putting feces in his hospital IV drip

Australia is a hard country with massive droughts, massive rainfalls every 10 years (like now) and quite weird behavior.

Stories like the following appear daily. The weird ones.

Heath Parkes-Hupton of The Australian writes a mum accused of putting feces in her son’s cannula as he writhed in pain at a Sydney hospital was heard being asked by her sick child “why are you doing this to me”, a court has heard.

The boy’s mother is facing a special hearing at Downing Centre District Court for allegedly poisoning her then nine-year-old son through his cannula while he was a patient at The Children’s Hospital at Westmead in September 2014.

The woman, a mother of four who can’t be named, denies infecting the boy and has pleaded not guilty to using poison to endanger a life.

His blood culture later tested positive to the bacteria E. coli.

The mother’s barrister Pauline David told the court on Thursday there were a number of possibilities that could explain how the boy became infected.

Crown witness and nurse Lindie Brown, who was working at a unit manager at the ward where the boy was a patient, told the court he became “very unwell” during one of her shifts.

The court heard the boy had a temperature of 40C and began experiencing rigors – or shaking.

He was also complaining of pains in his back, stomach and head and asked for medicine to “take the pain away”, the court heard.

Ms Brown told the court she then heard the boy ask his mother “why she was doing this to him”.

He then said words to the effect of “you could have put something in my cannula when I was asleep”, Ms Brown said.

The hearing before Judge Justin Smith continues.

Romaine recalls: Why our salads can make us sick

CBC’s Marketplace (that’s a TV show in Canada) notes that Canada has been hit by a number of romaine lettuce recalls. We set out to the U.S., where the majority of our leafy greens come from, to dig up why E. coli outbreaks continue to plague our food supply. We meet one B.C. family whose lives have been forever changed by a contaminated salad (thanks to Bill Marler for posting on this).

STEC on dairy farms

One of my best friends used to be a dairy farmer, and he would always say, I’m not eating at McDonald’s, could be one of my former cows.

Shiga toxin-producing Escherichia coli (STEC) are foodborne bacterial pathogens, with cattle a significant reservoir for human infection. This study evaluated environmental reservoirs, intermediate hosts and key pathways that could drive the presence of Top 7 STEC (O157:H7, O26, O45, O103, O111, O121 and O145) on pasture-based dairy herds, using molecular and culture-based methods.

A total of 235 composite environmental samples (including soil, bedding, pasture, stock drinking water, bird droppings and flies and faecal samples of dairy animals) were collected from two dairy farms, with four sampling events on each farm. Molecular detection revealed O26, O45, O103 and O121 as the most common O-serogroups, with the greatest occurrence in dairy animal faeces (> 91%), environments freshly contaminated with faeces (> 73%) and birds and flies (> 71%). STEC (79 isolates) were a minor population within the target O-serogroups in all sample types but were widespread in the farm environment in the summer samplings.

Phylogenetic analysis of whole genome sequence data targeting single nucleotide polymorphisms revealed the presence of several clonal strains on a farm; a single STEC clonal strain could be found in several sample types concurrently, indicating the existence of more than one possible route for transmission to dairy animals and a high rate of transmission of STEC between dairy animals and wildlife.

Overall, the findings improved the understanding of the ecology of the Top 7 STEC in open farm environments, which is required to develop on-farm intervention strategies controlling these zoonoses.

Investigation of on-farm transmission routes for contamination of dairy cows with top 7 Escherichia coli O-serogroups

Environmental Microbiology

Rapp & C. M. Ross & P. Maclean & V. M. Cave & G. Brightwell

https://link.springer.com/article/10.1007/s00248-020-01542-5

FDA, California agricultural stakeholders launch multi-year study to enhance food safety

This is a few months old, but if Frank’s in it, I’ll run it, late but not never.

The following quote is attributed to Frank Yiannas, FDA Deputy Commissioner for Food Policy and Response:

The FDA is committed to providing innovative food safety approaches that build on past learnings and leverage the use of new information and data. Today we’re announcing a partnership with the California Department of Food and Agriculture (CDFA), the University of California, Davis, Western Center for Food Safety (WCFS), and agricultural stakeholders in the Central Coast of California to launch a multi-year longitudinal study to improve food safety through enhanced understanding of the ecology of human pathogens in the environment that may cause foodborne illness outbreaks.”

“The launch of this longitudinal study follows a series of E. coli O157:H7 outbreaks in recent years linked to California’s leafy greens production regions, particularly three outbreaks that occurred in Fall 2019. Due to the recurring nature of outbreaks associated with leafy greens, the FDA developed a commodity-specific action plan to advance work in three areas: prevention, response, and addressing knowledge gaps. We’ve already made great strides executing our 2020 Leafy Greens Shiga toxin-producing E. coli (STEC) Action Plan by engaging with state partners to implement new strategies for preventing outbreaks before they occur, collaborating with industry partners to assess and augment response efforts when an outbreak occurs, and analyzing past leafy greens outbreaks to identify areas of improvement important to enhance leafy greens safety.”

“In alignment with the FDA’s New Era of Smarter Food Safety initiative, the findings from this longitudinal study will contribute new knowledge on how various environmental factors may influence bacterial persistence and distribution in the region, and how those factors may impact the contamination of leafy greens.”

The California longitudinal multi-year study will examine how pathogens survive, move through the environment and possibly contaminate produce, through work with water quality, food safety, and agricultural experts from CDFA, the WCFS, representatives from various agriculture industries, and members of the leafy greens industry.

Petting zoos in Switzerland as public health problem

Animal petting zoos and farm fairs provide the opportunity for children and adults to interact with animals, but contact with animals carries a risk of exposure to zoonotic pathogens and antimicrobial‐resistant bacteria.

The aim of this study was to assess the occurrence of Shiga toxin‐producing Escherichia coli (STEC), Salmonella, extended‐spectrum β‐lactamase (ESBL)‐producing Enterobacteriaceae and methicillin‐resistant Staphylococcus aureus (MRSA) in animal faeces from six animal petting zoos and one farm fair in Switzerland. Furthermore, hygiene facilities on the venues were evaluated.

Of 163 faecal samples, 75 contained stx1, stx2 or stx1/stx2 genes, indicating the presence of STEC. Samples included faeces from sika deer (100%), sheep (92%), goats (88%), mouflons (80%), camels (62%), llamas (50%), yaks (50%), pigs (29%) and donkeys (6%), whereas no stx genes were isolated from faeces of calves, guinea pigs, hens, ostriches, ponies, zebras or zebus. Salmonella enterica subsp. enterica serovar Stourbridge (S. Stourbridge) was detected in faecal samples from camels. A total of four ESBL‐producing E. coli strains were isolated from faeces of goats, camels and pigs. PCR and sequencing identified the presence of blaCTXM15 in three and blaCTXM65 in one E. coli. Antimicrobial resistance profiling using the disk diffusion method revealed two multidrug‐resistant (MDR) E. coli with resistance to ciprofloxacin, gentamicin and azithromycin, all of which are critically important drugs for human medicine. Multilocus sequence typing identified E. coli ST162, E. coli ST2179, extraintestinal high‐risk E. coli ST410 and E. coli ST4553, which belongs to the emerging extraintestinal clonal complex (CC) 648. No MRSA was detected.

On all animal petting venues, there were inadequacies with regard to access to hygiene information and handwashing hygiene facilities. This study provides data that underscore the importance of hygiene measures to minimize the risk of transmission of zoonotic pathogens and MDR, ESBL‐producing E. coli to visitors of animal petting venues.

Animal petting zoos as sources of shiga toxin-producing Escherichia coli, salmonella and extended-spectrum Beta-lactamase (EXBL)-producing Enterobacteriaceae

Zoonosis and Public Health

Meret Isler, Ramona Wissmann, Marina Morach, Katrin Zurfluh, Roger Stephan, Magdalena Nüesch‐Inderbinen

https://doi.org/10.1111/zph.12798

https://onlinelibrary.wiley.com/doi/abs/10.1111/zph.12798

Produce and on-farm risk management

Produce-associated foodborne disease outbreaks have increased worldwide highlighting the importance of proper implementation of risk management practices (RMP). We determined the relationship between environmental characteristics (i.e., physical resources) of produce farms and implementation of RMP.

Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses principles, we identified 36 studies to include in our analysis. Most study data were collected through surveys administered to growers in developed countries. Quality assessment results showed that studies on this topic should be more rigorously conducted (e.g., powering sample sizes and training data collectors) to yield better quality evidence. Agricultural waters were the most common environmental characteristic assessed, with many farms using unsafe water sources. Hygiene aids (e.g., accessible handwashing facilities), were lacking across many farms. Animal intrusion RMP were the least commonly assessed environmental characteristic. Only one study tested the relationship between on-farm environmental characteristics and RMP implementation reporting a positive relationship between accessible handwashing and worker hygiene practices.

Grower knowledge and perception of RMP combined with cost and ease in carrying out RMP might influence the availability of physical resources for proper RMP implementation. These results can inform practical interventions aimed to increase adoption of RMP on produce farms.

The relationship between environmental characteristics and risk management practices on produce farms: A systematic literature review

Agriculture

Dilhani Nisansala Jayawardhana 1 , Loan Thi Thanh Cao 2 , Thomas A. Yeargin 3 , Kristen E. Gibson 3 and Angela M. Fraser 1,*

http://scholar.google.com/scholar_url?url=http://131.220.45.179/ojs/index.php/fsd/article/download/69/997&hl=en&sa=X&d=18011325979091000715&ei=tuDCX4itNMeQmgGTyImoAQ&scisig=AAGBfm27ulzPEdzdGJcb8pYgpudYPZZCbA&nossl=1&oi=scholaralrt&hist=5kxqCikAAAAJ:5428478285509672052:AAGBfm0um7xNxqfVpArKOWnp4NG6xAm5og&html=&cited-by=

Raw is risky: Beware fresh produce and E. coli

Technology Networks reports that E. coli food poisoning is one of the worst food poisonings, causing bloody diarrhea and kidney damage. But all the carnage might be just an unintended side effect, researchers from UConn Health report in the 27 November issue of Science Immunology. Their findings might lead to more effective treatments for this potentially deadly disease.

Escherichia coli are a diverse group of bacteria that often live in animal guts. Many types of E. coli never make us sick; other varieties can cause traveler’s diarrhea. But swallowing even a few cells of the type of E. coli that makes Shiga toxin can make us very, very ill. Shiga toxin damages blood vessels in the intestines, causing bloody diarrhea. If Shiga toxin gets into the bloodstream it can cause kidney failure.

“This is especially common in children; about 15% of kids with Shiga toxin-producing E. coli infections get kidney disease, and some can suffer long term kidney damage,” says UConn Health immunologist Sivapriya Vanaja.

A group of Shiga toxin-producing E. coli called enterohemorrhagic E. coli, or EHEC, are especially common in the United States. When you hear that a batch of romaine lettuce is being recalled because of a dangerous outbreak of food poisoning, it’s almost certainly due to EHEC.

EHEC normally live in cattle without making them sick. It used to be relatively common to have EHEC outbreaks coming from unhygienically prepared ground meat, but stringent regulations on slaughterhouses have made this less common. Now it’s more likely for EHEC to appear on vegetables grown in fields adjacent to cattle or manure runoff.

But no matter where it comes from, once EHEC bacteria get inside a human, the infection is hard to treat. Antibiotics tend to make it worse—when the bacteria feel themselves dying, they make more Shiga toxin. And EHEC are very good at inhibiting the part of the immune system that normally responds early to this kind of infection, allowing them to grow unchecked in the human gut.

In a study led by Morena Havira, a postdoctoral fellow in Vanaja’s lab, the team wanted to know how EHEC suppresses the immune system. The body normally responds to early stages of E. coli infections by activating an enzyme that kicks off an alarm inside cells. The cell bursts open to release a cloud of warning molecules that call other parts of the immune system to come and fight the bacteria.

But EHEC squashes that early response. To figure out how it does that, Vanaja and her colleagues decided to see which individual gene in EHEC was responsible. They took many different varieties of EHEC from a bacterial mutant library, and infected immune cells with them.

The team found that cells infected with EHEC that was missing the gene for Shiga toxin mustered a higher immune response compared to normal EHEC.

It was surprising. Shiga toxin is very well-studied for its toxic activity; it wasn’t known that it had another function,” Dr. Vanaja says. So Shiga toxin’s stealthy suppression of the immune system may have a link to all the bloody drama that ensues. Spurred on by this exciting observation, they conducted a series of detailed molecular studies, which revealed that Shiga toxin blocks a protein from bursting open the infected cell and alerting the body of infection.

Now that Vanaja and her colleagues know the specific molecular step Shiga toxin interferes with inside the immune cells, they are trying to figure out how, exactly, it blocks it. Once they know that, they may be able to find medicines that prevent toxin from interfering with immune responses.
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