11 sick: New York state investigating Cyclospora outbreak

Bethany Bump of the Times Union writes that New York state and local health departments are investigating an outbreak of cyclosporiasis in the Capital Region.

The gastrointestinal illness, which can spread through contaminated food and water, has been confirmed in 11 people so far.

Symptoms began around mid-June, and several of the patients reported eating at the Italian American Community Center in Albany, Prime Life Restaurant at the Beltrone Senior Living Community Center in Colonie, and a private buffet held at Union College in Schenectady, state health officials said.

While cyclosporiasis is endemic in some areas of the world, outbreaks in the U.S. are often associated with imported fresh produce that have been contaminated with a fecal parasite known as Cyclospora cayetanensis.

State health officials say there is no indication that the parasite was spread by poor food handling or preparation at local establishments, which are cooperating with the investigation. Instead, contamination often occurs prior to arrival at food distribution centers and restaurants, they said, and is not easily removed by standard rinsing.

Additional dining establishments may be identified as the investigation continues, they added.

Mr. Poop: Mystery serial pooper strikes in Japan

Jackie Salo of the NY Post writes that Tokyo authorities are searching for a mystery pooper who repeatedly has left feces in the same shopping district.

The male perpetrator known as “Mr. Poop” has reportedly relieved himself on the streets of the Akihabra district on at least 10 occasions over the last three months, according to the Tokyo Reporter.

In one incident, the mystery pooper, who is believed to be in his 30s, was caught with his pants down as he fled. His dropped trousers were black and he was carrying a blue backpack, witnesses said.

Nearby business owners are sick of his crap.

Dozens of Swiss soldiers hit by vomiting bug, 4 in critical condition

The Straits Times reports more than 40 military staff and recruits at an academy in central Switzerland were taken to hospital on Thursday (July 4) after they suddenly fell violently ill, the government said.

In a statement, the Swiss defence department said that on Thursday afternoon, 43 recruits and members of the Jassbach academy in Linden, in Bern Canton, suddenly suffered from acute gastrointestinal problems, with diarrhoea and vomiting.

My brain hurts

It’s a strange thing having your brain disappear.

Amy has encouraged me to write about it.

I’m not sure I can.

I was crying on the phone with my parents the other day, talking about how my grandfather started showing signs of Alzheimer’s at 56 (my age).

It’s emotionally complex and I’m not sure how to handle it.

But it’s happening.

I watched it in my grandfather, I know it’s happening to me.

And my 77-year old mother is going to be here in a couple of days after making a 30-hour flight half-way around the world to see her sick son.

Don’t swallow pool water: Cryptosporidiosis outbreaks – United States, 2009-2017

The U.S. Centers for Disease Control reports that Cryptosporidium is the leading cause of outbreaks of diarrhea linked to water and the third leading cause of diarrhea associated with animal contact in the United States.

During 2009–2017, 444 cryptosporidiosis outbreaks, resulting in 7,465 cases were reported by 40 states and Puerto Rico. The number of reported outbreaks has increased an average of approximately 13% per year. Leading causes include swallowing contaminated water in pools or water playgrounds, contact with infected cattle, and contact with infected persons in child care settings.

What are the implications for public health practice?

To prevent cryptosporidiosis outbreaks, CDC recommends not swimming or attending child care if ill with diarrhea and recommends hand washing after contact with animals.

More Brits could still die from human form of mad cow disease

More Brits could be affected by mad cow disease as experts warn many could be infected without knowing. A second wave of deaths related to eating beef contaminated with Bovine Spongiform Encephalopathy (BSE) – or mad cow disease – could sweep the UK.

In 1993 Britain’s worst food scandal saw 4.4 million cows culled and claiming the lives of 177 people who had developed the human form of it, called Creutzfeldt-Jakob disease (vCJD). Since then, strict controls have been in place to prevent BSE contaminating food products and the use of meat and bone mix is illegal. But humans could be affected for up to 50 years, warn experts. Neurology professor, Richard Knight, of Edinburgh’s CJD Surveillance Unit, told a BBC investigation – airing July 11 – that it is still unclear how many could be affected. He said: ‘There is still so much uncertainty about this disease.

‘And one of the things that is uncertain is how many people in the UK are silently infected. ‘At the moment I have to say we are simply not sure, but every prediction suggests there are going to be further cases.’ vCJD is caused by prions, which are infectious agents made up mainly of proteins. A study of a similar disease in 2009, caused by prions, showed the disease may incubate undetected for much longer. All affected had carried the same MM genetic makeup, but in 2009 victim Grant Goodwin, 30, became the first person to die of vCJD, despite carrying the different gene type of MV. In 2014, a British man, 36, became the second MV carrier to die from the disease.

NZ mussels at centre of food poisoning outbreak

Seafood lovers have been warned to be careful with raw mussels after an outbreak of food poisoning.

New Zealand Food Safety announced on Friday it’s seen an uptick in the number of people contracting food poisoning from Vibrio parahaemolyticus.

Most of the people who got sick ate commercial grown mussels harvested in Coromandel.

“It is possible that the strain of vibrio parahaemolyticus is unusually aggressive, which may mean that even low numbers could cause illness,” NZ food safety director of regulation Paul Dansted said.

“Additional testing of mussels and the waters that they are being grown in is also underway to help us understand why this has happened.

“The mussels at the centre of the outbreak were all bought in their raw state, in the shell. They are not the mussels that can be bought in plastic pottles. Those mussels are cooked and marinated and are not affected.”

NZ Food Safety says people need to be careful when cooking mussels and heat them above 65C. It’s also advised to wash hands after handling shellfish, and avoid cross-contamination between raw and cooked shellfish.

US study charts changes in food safety practices

Tom Karst of The Packer writes U.S. growers are using less risky irrigation sources and are sanitizing their equipment more often than 20 years ago. 

Geez that’s about how long my group was doing on-farm food safety and looking at those exact questions.

Guess on-farm food safety is just a John Prine song.

Those observations are part of a new study called “Changes in U.S. Produce Grower Food Safety Practices from 1999 to 2016,” authored by economists Gregory Astill, Travis Minor and Suzanne Thornsbury.

The study is available online without cost until July 5.

“Since 1999, and before the implementation of U.S. Standards for the Growing, Harvesting, Packing, and Holding of Produce for Human Consumption, the share of growers who use practices that reduce the risk of microbial contamination increased,” the study concluded.

The study said fewer growers use flowing surface water for irrigation and more growers use well water. As organic production has increased over time, the study found that more growers use manure and compost. And while more growers’ fields are next to livestock, the authors said more growers use fencing around production areas.

“The most prominent example of change is the increase in frequency that growers and sanitize harvest tools,” the study said. “The decrease in growers who never wash harvest tools is drastic as is the decrease in those who never sanitize.” 

Even with the increase in food safety practices, the study said more needs to be done.

“The data available for this article also demonstrates a real need to implement more frequent measures of food safety practices within this rapidly evolving industry,” the authors said.

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.

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.

She was sick for weeks.

It’s the fog of outbreaks..

Like the fog my daughter played in last Sat. at the Gold Coast.

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.