Are they judging jams? Blue-ribbon panel on the prevention of foodborne Cyclospora outbreaks

When someone says a blue-ribbon panel summarized results on the prevention of foodborne Cyclospora outbreaks, I think blue-ribbons is talking about jams or Holsteins at county fairs.

My aunt got sick from Cyclospora in some basil-based thingy in Florida (and sometimes there is for hockey for Sorenne last Sat).

She was sick for weeks.

On June 12, 1996, Ontario’s chief medical officer, Dr. Richard Schabas, issued a public health advisory on the presumed link between consumption of California strawberries and an outbreak of diarrheal illness among some 40 people in the Metro Toronto area. The announcement followed a similar statement from the Department of Health and Human Services in Houston, Texas, who were investigating a cluster of 18 cases of Cyclospora illness among oil executives.

Dr. Schabas advised consumers to wash California berries “very carefully” before eating them, and recommended that people with compromised immune systems avoid them entirely. He also stated that Ontario strawberries, which were just beginning to be harvested, were safe for consumption. Almost immediately, people in Ontario stopped buying strawberries. Two supermarket chains took California berries off their shelves, in response to pressure from consumers. The market collapsed so thoroughly that newspapers reported truck drivers headed for Toronto with loads of berries being directed, by telephone, to other markets.

However, by June 20, 1996, discrepancies began to appear in the link between California strawberries and illness caused by the parasite, Cyclospora, even though the number of reported illnesses continued to increase across North America. Texas health officials strengthened their assertion that California strawberries were the cause of the outbreak, while scientists at the U.S. Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA) said there were not yet ready to identify a food vehicle for the outbreak. On June 27, 1996, the New York City Health Department became the first in North America to publicly state that raspberries were also suspected in the outbreak of Cyclospora.

By July 18, 1996, the CDC declared that raspberries from Guatemala — which had been sprayed with pesticides mixed with water that could have been contaminated with human sewage containing Cyclospora — were the likely source of the Cyclospora outbreak, which ultimately sickened about 1,000 people across North America. Guatemalan health authorities and producers have vigorously refuted the charges. The California Strawberry Commission estimates it lost $15 million to $20 million in reduced strawberry sales.

Cyclospora cayetanensis is a recently characterised coccidian parasite; the first known cases of infection in humans were diagnosed in 1977. Before 1996, only three outbreaks of Cyclospora infection had been reported in the United States. Cyclospora is normally associated with warm, Latin American countries with poor sanitation.

One reason for the large amount of uncertainty in the 1996 Cyclospora outbreak is the lack of effective testing procedures for this organism. To date, Cyclospora oocysts have not been found on any strawberries, raspberries or other fruit, either from North America or Guatemala. That does not mean that cyclospora was absent; it means the tests are unreliable and somewhat meaningless. FDA, CDC and others are developing standardized methods for such testing and are currently evaluating their sensitivity.

The initial, and subsequent, links between Cyclospora and strawberries or raspberries were therefore based on epidemiology, a statistical association between consumption of a particular food and the onset of disease. For example, the Toronto outbreak was first identified because some 35 guests attending a May 11, 1996 wedding reception developed the same severe, intestinal illness, seven to 10 days after the wedding, and subsequently tested positive for cyclospora. Based on interviews with those stricken, health authorities in Toronto and Texas concluded that California strawberries were the most likely source. However, attempts to remember exactly what one ate two weeks earlier is an extremely difficult task; and larger foods, like strawberries, are recalled more frequently than smaller foods, like raspberries. Ontario strawberries were never implicated in the outbreak.

Once epidemiology identifies a probable link, health officials have to decide whether it makes sense to warn the public. In retrospect, the decision seems straightforward, but there are several possibilities that must be weighed at the time. If the Ontario Ministry of Health decided to warn people that eating imported strawberries might be connected to Cyclospora infection, two outcomes were possible: if it turned out that strawberries are implicated, the ministry has made a smart decision, warning people against something that could hurt them; if strawberries were not implicated, then the ministry has made a bad decision with the result that strawberry growers and sellers will lose money and people will stop eating something that is good for them. If the ministry decides not to warn people, another two outcomes are possible: if strawberries were implicated, then the ministry has made a bad decision and people may get a parasitic infection they would have avoided had they been given the information (lawsuits usually follow); if strawberries were definitely not implicated then nothing happens, the industry does not suffer and the ministry does not get in trouble for not telling people. Research is currently being undertaken to develop more rigorous, scientifically-tested guidelines for informing the public of uncertain risks.

But in Sarnia (Ontario, Canada) they got a lot of sick people who attended the Big Sisters of Sarnia-Lambton Chef’s Challenge on May 12, 2010.

Michael T. Osterholm, PhD, who has a lot of titles and once called me at 5 a.m. to tell me I was an asshole (maybe not the exact words, but the sentiment) and chair of the Holstein Blue-Ribbon Panel on the Prevention of Foodborne Cyclospora Outbreaks writes that the 1996 cyclosporiasis outbreak in the United States and Canada associated with the late spring harvest of imported Guatemalan-produced raspberries was an early warning to public health officials and the produce industry that the international sourcing of produce means that infectious agents once thought of as only causing traveler’s diarrhea could now infect at home. The public health investigation of the 1996 outbreak couldn’t identify how, when, where, or why the berries became contaminated with Cyclospora cayetanensis.

The investigation results were published in the New England Journal of Medicine in 1997. I was asked to write an editorial to accompany the investigation report.2 In my editorial, I noted the unknowns surrounding the C. cayetanensis contamination. The 1997 spring harvest of Guatemalan raspberries was allowed to be imported into both the United States and Canada—and again, a large outbreak of cyclosporiasis occurred. As in the 1996 outbreak, no source for the contamination of berries was found. Later in 1997, the Food and Drug Administration (FDA) prohibited the importation of future spring harvests of Guatemalan raspberries until a cause for the contamination could be demonstrated and corrective actions taken. While the FDA did not permit the 1998 importation of the raspberries into the United States, the berries continued to be available in Canada. Outbreaks linked to raspberries occurred in Ontario in May 1998. When the U.S. Centers for Disease Control and Prevention (CDC)-led investigative team published its 1997 outbreak findings in the Annals of Internal Medicine, 3 I was again asked to write an accompanying editorial.4 As I had done in my previous editorial, I highlighted how little we know about the factors associated with the transmission Cyclospora on produce and how to prevent it.

Unfortunately, the state of the art for preventing foodborne, produce-associated cyclosporiasis had changed little since the 1996 outbreak despite the relatively frequent occurrence of such outbreaks.

Thirty-two years after that first Guatemalan raspberry-associated outbreak — and a year after produce-associated cyclosporiasis outbreaks that were linked to U.S.-grown produce — we have taken a major step forward in our understanding of these outbreaks and how to prevent them. After Fresh Express produce was identified in one of the 2018 outbreaks, I was asked by the company leadership to bring together the best minds’ around all aspects of produceassociated cyclosporiasis. The goal was to establish a Blue-Ribbon Panel to summarize state-of-the-art advancements regarding this public health challenge and to identify immediate steps that the produce industry and regulators can take to prevent future outbreaks. The panel was also formed to determine what immediate steps can be taken for any future outbreaks to expedite the scientific investigation to prevent further cases and inform public health officials. The Blue-Ribbon Panel comprises 11 individuals with expertise in the biology of Cyclospora; the epidemiology of cyclosporiasis, including outbreak investigation; laboratory methods for identifying C. cayetanensis in human and food samples and the environment; and produce production. In addition,16 expert consultants from academia, federal and state public health agencies (including expert observers from the FDA, CDC, U.S. Department of Agriculture, and California Department of Public Health), and industry, including producers and professional trade association science experts. The collaboration and comprehensiveness of this effort was remarkable. Many hundreds of hours of meetings and conference calls took place to determine our findings and establish our recommendations.

This document, “Interim Report: Blue-Ribbon Panel on the Prevention of Cyclospora Outbreaks in the Food Supply,” summarizes the state-of-the art practices for the prevention of C. cayetanensis contamination of produce and priorities for research that will inform us as we strive to further reduce infection risk. Also, we make recommendations on how to more quickly identify and more effectively respond to produce-associated outbreaks when they occur. We greatly appreciate all the organizations represented on the panel and the expert consultants. The report does not, however, represent the official policy or recommendations of any other private, academic, trade association or federal or state government agency. Fresh Express has committed to continuing the Blue-Ribbon Panel process for as long as it can provide critical and actionable information to prevent and control Cyclospora outbreaks in the food supply.

Table: Summary of U.S. foodborne outbreaks of cyclosporiasis, 2000–2017
Year(s)* Month(s)* Jurisdiction(s)* No. of cases† Food vehicle and source, if identified‡
2000 May Georgia 19 Raspberries and/or blackberries (suspected)
2000 June Pennsylvania 54 Raspberries
2001 January–February Florida 39
2001 January New York City 3
2001–02 December–January Vermont 22 Raspberries (likely)
2002 April–May Massachusetts 8
2002 June New York 14
2004 February Texas 38
2004 February Illinois 57 Basil (likely)
2004 May Tennessee 12
2004 May–June Pennsylvania 96 Snow peas from Guatemala ⁂
2005 March–May Florida 582 ¶ Basil from Peru
2005 May South Carolina 6
2005 April Massachusetts 58
2005 May Massachusetts 16
2005 June Connecticut 30 Basil (suspected)
2006 June Minnesota 14
2006 June New York 20
2006 July Georgia 3
2008 March Wisconsin 4 Sugar snap peas (likely) ⁂
2008 July California 45 ¶ Raspberries and/or blackberries (likely)
2009 June District of Columbia 34
2011 June Florida 12
2011 July Georgia 88**
2012 June–July Texas 16
2013†† June Iowa, Nebraska, and neighboring states 162 Bagged salad mix from Mexico
2013†† June–July Texas 38 Cilantro from Mexico
2013 July Wisconsin 8 Berry salad (suspected)
2014 June Michigan 14
2014‡‡ June–July Texas 26 Cilantro from Mexico
2014 July South Carolina 13
2015 May–July Georgia, Texas, and Wisconsin 90 Cilantro from Mexico
2016 June–July Texas 6¶¶ Carrots or green cabbage (suspected)
2017 May Florida 6 Berries (suspected)
2017 May–July Texas 38*** Scallions (i.e., green onions)
2017 June Michigan 29
2017 June Tennessee 4†††
2017 June Connecticut 3
2017 July Florida 3‡‡‡

Tourist infected by brain-invading parasite after eating slug on a dare in Hawaii

If people dare you to eat a slug, don’t.

It could turn out quite badly.

I try not to be prescribtive and just tell people about risks and let them make their own decisions, but in this case, don’t eat slugs (those are slugs going after my basil in Kansas, below).

Health officials in Hawaii are warning residents and visitors to avoid slugs, snails, and rats after the US Center for Disease Control (CDC) found that three travellers visiting the state were recently infected with rat lungworm disease. One visitor got the disease because the individual ate a slug.

The notice, issued late last month, warns people to inspect produce and wash fruit and vegetables that could have small slugs or snails. These gastropods get the rat lungworm parasite (also known as an Angiostrongylus Infection) by eating rat faeces, and rats eat the infected slugs and snails, forming a continuous vile circle. Sometimes, humans get looped in by eating an uncooked snail. Once the parasite has infected a host, it can move to the brain and cause a type of meningitis, and eventually lead to death. There is not a treatment for rat lungworm disease, according to the CDC.

The recent Hawaii health department notice states that it does inform travellers visiting Hawaii about the disease through signage, but acknowledges it needs to do better. “We recognise that there is more work to be done in educating residents and visitors and making sure they know how to prevent the spread of this disease,” the notice reads.

Fancy food ain’t safe food: Three Brit kids hospitalized after sickness bug outbreak at 5-star Menorca hotel

Charlotte Nisbet and Neil Murphy of the Mirror write that three British children have been hospitalised after a ‘frightening sickness bug’ outbreak at a five-star resort.

Louise Hunter, of St Helens, Merseyside, booked a family holiday to Insotel Punta Prima Resort & Spa, Menorca, Spain, with her husband Steven, 44, and their children Rosie, four, and Sarah, two.

Their trip quickly turned ‘hellish’ when Sarah woke in the early hours of the Sunday morning, May 3, having spent just one full day at the resort.

Louise, 36, says the toddler ‘projectile vomited in her sleep’ before both children became unwell with diarrhoea.

She claims both her children were later taken to a local hospital and given intravenous fluids and medication.

They consulted holiday illness compensation lawyers Hudgell Solicitors on their return after spending £2,000 on their all-inclusive holiday.

The legal specialists are now working with another family who have claimed they suffered a similar ordeal.

Jade Fulbrook, 33, booked her husband Dave and their family, a break for £2,800 between May 6 and 13 with their children, Zachary, 12, Buddy, six, Oscar 10 and three-year-old Bella, from Dorset.

Jade claims both herself and Oscar were hospitalised with acute gastroenteritis and dehydration after contracting a sickness bug at the resort.

The cause of the sickness bug is unknown, but solicitors are now investigating.

A TUI UK spokesperson said: “We are very sorry to hear of these customers’ experiences on their holiday. As this is now a legal matter, it would be inappropriate to comment further.

“We’d like to reassure customers that we regularly audit all of our hotels in respect of health and safety, including hygiene.”

Large shigellosis outbreak at wedding

My cousin of Barrie’s Asparagus is in the midst of the annual crop in southern Ontario, and I know they have good food safety because my students have checked them out in years past and, I’m his cousin.

Unfortunately not all growers are as diligent and any commodity can get branded as shit.

Specifically, Shigella shit.

Findings presented at the CDC’s Epidemic Intelligence Service, or EIS, conference last month found that contaminated asparagus was the likely source of an outbreak of shigellosis at a wedding party in Oregon that sickened 112 people.

The outbreak was caused by Shigella flexneri type 3a, which accounts for less than 3% of S.flexneri isolates in the United States, researchers said.

“This was one of the largest foodborne outbreaks of shigellosis in U.S. history,” Steven I. Rekant, DVM, MPH, an EIS officer with the Oregon Public Health Authority, said in a presentation. “It was the second largest ever attributed to Shigella flexneri and that type of Shigella flexneri, type 3a, is uncommon in Oregon.”

According to Rekant and colleagues, the Oregon Health Authority received reports of gastroenteritis among attendees at a wedding in August 2018 and identified S. flexneri type 3a in stool samples.

A total of 263 people attended the wedding, and 75% responded to the survey. The patients were aged 2 to 93 years, and 55% were female.

“Simply put, this was big outbreak — 112 cases were reported, with an overall attack rate of 55.7%,” Rekant said.

Of 95 patients with onset information, 97% reported illness 12 to 72 hours following the wedding. Additionally, 57 patients presented to a health care facility and 10 were hospitalized, including a 92-year-old woman. No deaths or additional cases were reported.

The investigators found that only asparagus consumption was associated with illness.

They pointed to poor hygiene on the part of the food-handler as the “likely cause of contamination.”

Rekant SI, et al. Shigellosis at a Wedding — Oregon, 2018. Presented at: Epidemic Intelligence Service conference; April 29-May 2, 2019; Atlanta.

After eating raw rodent’s kidney for ‘good health’ Mongolia couple died of bubonic plague

On May 1, 2019, a couple in Mongolia died from bubonic plague after eating raw marmot meat, sparking a quarantine that trapped tourists for days.

Ariuntuya Ochirpurev, a World Health Organization official, told the BBC.

Ochirpurev told BBC that the couple ate the rodent’s raw meat and kidney, which is believed to be good for health in the area.

“After the quarantine (was announced) not many people, even locals, were in the streets for fear of catching the disease,” Sebastian Pique, an American Peace Corps volunteer in the area, told AFP.

Bubonic plague can be transmitted via infected fleas and animals, like prairie dogs, squirrels, rats and rabbits, the U.S. Centers for Disease Control and Prevention says.

Cryptosporidiosis in Norway associated with self-pressed apple juice

In the autumn of 2018, an outbreak of cryptosporidiosis affected adult employees from the same company in Western Norway. The organism was Cryptosporidium parvum, GP60 subtype IIaA14G1R1.

All those infected had drunk from the same container of self-pressed apple juice. Incubation period (1 week) and clinical signs were similar among those infected, although some experienced a more prolonged duration of symptoms (up to 2–3 weeks) than others.

The infections resulted after consumption from only one of 40 containers of juice and not from any of the other containers. It seems that although Cryptosporidium oocysts were detected in a sample from another container, the contamination did not affect the whole batch. This is perhaps indicative of a restricted contamination event, either from contaminated ground in the orchard, or during collection of the fruit, or during processing.

Although outbreaks of foodborne cryptosporidiosis have previously been associated with consumption of contaminated apple juice, most of the more recent outbreaks of foodborne cryptosporidiosis have been associated with salad vegetables or herbs. This outbreak, the first outside U.S. reported to be associated with apple juice, is a timely reminder that such juice is a suitable transmission vehicle for Cryptosporidium oocysts, and that appropriate hygienic measures are essential in the production of such juice, including artisanal (non-commercial) production.

Robertson, L. J., Temesgen, T. T., Tysnes, K. R., & Eikås, J. E. (2019). An apple a day: An outbreak of cryptosporidiosis in Norway associated with self-pressed apple juice. Epidemiology and Infection, 147. doi:10.1017/s0950268819000232

http://www.bibme.org/bibliographies/228541420?new=true

Tangled up in blue: Finding food safety purpose

I used to write up the U.S. Centers of Disease Control with the enthusiasm of a teenage going on a date.

It was current, it was confident and it was cool.

Now, not so much.

Maybe it’s just me, but I’m tired of watching Salmonella and other foodborne illnesses flatline, even if a Senator brings a day-old bucket of KFC into a hearing to make some sort of metaphorical point.

I’ll say the same thing I say every year: the numbers aren’t changing because the interventions are in the wrong place.

When national organizations go agenst the World Health Organization and don’t mention on-farm food safety, then they’re missing the source.

According to Food Business News, illness was more prevalent in 2018, according to preliminary surveillance data from the Centers for Disease Control (C.D.C.) and Prevention. Incidents of Campylobacter, Salmonella and Cyclospora infections increased last year, according to FoodNet 2018 preliminary data released by the C.D.C. The increases were due, in part, to more infections being diagnosed using culture-independent diagnostic tests (C.I.D.T.s), but the C.D.C. noted the possibility that the number of infections actually is increasing.

Campylobacter infections were the commonly identified infection in FoodNet sites since 2013 with poultry being the major source of infection.  More infections are being diagnosed, the C.D.C. said, because more laboratories use C.I.D.T.s to detect Campylobacterand other pathogens. C.I.D.T.s detect the presence of a specific genetic sequence of an organism. The tests produce results more rapidly because they do not require isolation and identification of living organisms.

Reducing Campylobacter infections will require more knowledge of how case patients are becoming infected, the C.D.C. said. The pathogen can contaminate raw chicken or poultry juices, and cross-contamination can impact hands, other foods or kitchen equipment.

“Focusing on interventions throughout the food production chain that reduce Campylobacter bacteria in chicken could lead to fewer illnesses in people,” the C.D.C. said. “Whole genome sequencing might help us figure out the contribution of various sources and help target interventions.”

Salmonella infections, the second most common infection, also appear to be increasing, according to the preliminary report. The most common Salmonella serotypes were Enteritidis, Newport and Typhimurium. Additionally, Enteritidis infections are not decreasing despite regulatory programs aimed at reducing Salmonella in poultry and eggs.

 

‘Basically rotting alive’: Family shocked by massive bedsore threatening man’s life

When I spent my summer of 1982 in jail for killing two people in a car crash, I spent a couple of months teaching other inmates basic reading – from kindergarten level on up – and then spent a couple of months working the day shift at Participation House in Brantford, cleaning up patient’s shit.

When I got out of jail and went back to uni — on parole — I spent my weekends working at Participation House in Kitchener.

Typically, I’d work 4 p.m. to midnight Saturday, sleep in the office apartment or with some local girl, then work 8 a.m. to 4 p.m. Sunday, and then hitchhike back home to Guelph.

This is how quadriplegics empty their bowels: I would insert a suppository, chat with the dude or dudess for 20 minutes, then the poop would start flowing and I’d clean it up.

It was humbling work.

And we always worried about bedsores.

For months, Linda Moss and her two sisters took shifts at their father’s bedsides.

But while they sat and held his hand nearly every day, an unseen wound festered beneath his bed sheets.

(I’m not dying — yet —  but have made a special request for my wife to hold my hand; she’s not interested)

A bedsore had been silently forming on Bob Wilson’s backside, eating away at his flesh until it left a gaping hole bigger than a football.

Bedsores seriously under-reported, health-care experts say

Expert says pressure injuries such as bedsores are preventable

“We couldn’t believe what we saw,” Moss said.

“It was black, dead, rotted skin. He was basically rotting alive, and we had no idea.”

Eric Vandewall, president of Joseph Brant Hospital in Burlington, located about 60 kilometres southwest of Toronto, said he personally apologized to Wilson and his family for what happened, and staff are investigating.

“We are currently conducting a comprehensive and thorough review of Mr. Wilson’s care while he was at Joseph Brant Hospital and we will hold further meetings with Mr. Wilson’s family to share and discuss the results of our review,” he said.

‘It’s to the bone, and it’s pretty horrific’

Wilson, who is 77, fell in November and suffered a brain injury.

“It’s devastating,” said Moss. “It’s torture, and we felt a sense of guilt, because if [we’d known], we could have helped turn him, or something.

“What baffles us is how could a medical team and several people … put a Band-Aid over black, dead, rotted skin and not raise the flag?”

Vandewall said the hospital’s routine for immobile patients includes turning them daily and checking for pressure ulcers.

Um, we did that 40 years ago.

 

We’re all hosts on a viral planet

About 1986, I was a MSc graduate student working on Verticillium (that’s a fungus) in tomatoes), published a couple of peer-revived papers, and then became the editor of the student newspaper (circ 25,000) after writing a science column about cats for a year because they were the first warm-blooded pets I had ever had.

I think my friend Mary knows what I’m talking about.

I also spent a lot of time looking through the electron microscope, which was also a great place to have sex.

I had a lot of sex there.

Researchers in the Agriculturpal Research Service (ARS) Electron and Confocal Microscopy Unit can magnify a cell’s internal structures to 200,000 times their size, flash freeze mites in liquid nitrogen to create striking “snapshots” as they feed, and create color-enhanced images that show a virus infecting its host. The resulting images help scientists determine how agricultural pests and pathogens feed, reproduce, respond to threats, and survive.

A sampling of the unit’s digital photo album shows the eclectic nature of its efforts.

The team also has a unique 3D printing capability that allows them to transform the images they create into hand-size 3D models that are the most structurally accurate models of mites and other organisms currently available. The researchers hope that one day they will be able to upload the 3D files to an online database so that anyone with a 3D printer can reproduce them to use as instructional aids, in research, or for scientific outreach.

Raw is risky: Mongolia: Careful with that marmot, Eugene

Ryan Miller of USA Today reports a Mongolian couple died from the bubonic plague after eating raw marmot meat, sparking a quarantine that trapped tourists for days, officials said Monday.

According to AFP, the couple died May 1 in a remote area of the country’s Bayan-Ölgii province, which borders China and Russia.

A six-day quarantine of 118 people who had come in contact with the couple, including locals and a number of foreign tourists, had been lifted as of Tuesday, Ariuntuya Ochirpurev, a World Health Organization official, told the BBC.

Ochirpurev told BBC that the couple ate the rodent’s raw meat and kidney, which is believed to be good for health in the area.

“After the quarantine (was announced) not many people, even locals, were in the streets for fear of catching the disease,” Sebastian Pique, an American Peace Corps volunteer in the area, told AFP.

Bubonic plague can be transmitted via infected fleas and animals, like prairie dogs, squirrels, rats and rabbits, the U.S. Centers for Disease Control and Prevention says.

CDC doesn’t say this song is boring and self-indulgent, but I always liked the title.