Poorly cleaned public cruise ship restrooms may predict norovirus outbreaks

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Chapman says that while dirty bathrooms can be gross, like the gotcha moments on hidden camera programs, there really isn’t any information that suggests a place with a dirty bathroom is any more or less likely to cause an outbreak than a place with a clean bathroom. Lots of restaurants have separate handwashing facilities in the kitchen, and risk-based inspection systems focus on factors that lead to illness as identified by the CDC and WHO — not the floors, walls and ceilings, and how many flies are on a fly strip.

But what about on cruise ships?

A team of researchers from Boston University School (BUSM), Carney Hospital, Cambridge Health Alliance and Tufts University School of Medicine, have found that widespread poor compliance with regular cleaning of public restrooms on cruise ships may predict subsequent norovirus infection outbreaks (NoVOs).

This study, which appears in the November 1st issue of Clinical Infectious Diseases, is the first study of environmental hygiene on cruise ships.
Outbreaks of acute gastroenteritis (AGE) often occur in close populations, such as among cruise ship passengers. Recent epidemiologic investigations of outbreaks of AGE confirmed that 95 percent of cruise ship AGE outbreaks are caused by norovirus.

Despite biannual sanitation monitoring and hand hygiene interventions among passengers and crew members, 66 ships monitored by the United States Centers for Disease Control and Prevention experienced NoV infection outbreaks (NoVOs) between 2003 and 2008.

Trained health care professionals evaluated the thoroughness of disinfection cleaning of six standardized objects (toilet seat, flush handle or button, toilet stall inner handhold, stall inner door handle, restroom inner door handle, and baby changing table surfaces) with high potential for fecal contamination in cruise ship public restrooms.

The researchers found only 37 percent of the 273 randomly selected public restrooms that were evaluated on 1,546 occasions were cleaned daily. The overall cleanliness of the six standardized surfaces on each ship ranged from four to 100 percent. Although some objects in most restrooms were cleaned at least daily, on 275 occasions no objects in a restroom were cleaned for at least 24 hours.
 

16 hospitalized and 2 deaths now linked to ground beef recall

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Following Saturday’s FSIS announcement of Fairbank Farms’ ground beef recall, a CDC spokesperson has been cited as saying that the cluster of illnesses has been expanded to 28. USA Today reports that CDCs Lola Scott Russel released information this afternoon that 16 of the ill have been hospitalized an additional death has been linked to the outbreak.

This week’s food safety infosheet focuses on the outbreak and recall.

Food Safety Infosheet Highlights:
–  Fairbank Farms recalls over 500,000 lbs of ground beef in CT, MD, VA, NC, MA, NY, NJ and PA; NH and NY deaths linked to the beef, at least 26 others ill.
– The meat juices created from thawing a frozen product like ground beef can transfer pathogens to other foods.
– Never place cooked hamburger patties on the unwashed plate that held raw patties; wash hands, counters, and utensils (like forks and spatulas) with hot soapy water after they touch raw meat.
– For a full list of recalled products, visit the FSIS release: http://tinyurl.com/yzemas7

Wendy’s VP says E. coli salad safe – provides no evidence

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From the growing catalogue of worst things to say after an outbreak of foodborne illness, Dan Moore, the owner of the Wendy’s franchise on Prospect Street in New Brunswick said yesterday,

“The senior vice-president of Wendy’s was here (on Saturday) to inspect the restaurant."

Further, all required precautions have been taken, and customers can safely eat salads, as well as any other menu items.

The Wendy’s outlet was linked to an E. coli O157 outbreak that hit four people who ate Wendy’s salads.

What any consumer would want to know is, where did the lettuce or tomatoes come from, and what kind of on-farm food safety program is being used by the producer, including water testing, testing of soil amendments, and employee sanitation. Don’t want employees wiping their butts and picking fresh lettuce; same with the Wendy’s staff.

If it only takes a senior vp to make food safe, in the absence of any evidence, then lots more food should be safe because there are lots of senior vps.

Australian hepatitis A outbreak still linked to semi-dried tomatoes

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Hepatitis A is one of the few causes of foodborne illness that only cycles through humans – and their poop.

So any outbreak of hepatitis A means human sewage came into contact with the food (which then wasn’t cooked) or someone shedding the virus had a poop, failed to adequately wash their hands, and then prepared an uncooked food.

Either could be happening in this on-going outbreak of hepatitis A in Australia that has sickened about 130 people and appears to be linked to semi-dry tomatoes.

Victorian health authorities revealed a further 23 cases of the infectious disease diagnosed in the past week.

Victoria’s chief health officer Dr John Carnie said that so far this year there had been 200 notifications of hepatitis A, compared to 74 at the same time last year.

A study into the increase of cases indicates that more than two thirds of people that have become ill recalled eating semi-dried tomatoes, he said.

Local producers had promised the Department of Human Services they were doing their best to reduce the risk, while importers of the tomatoes had also been instructed to ensure appropriate quality control measures were in place, he said.

Bottled semi-dried tomatoes in supermarkets were pasteurised and considered safe along with any of the cooked product such as in pizzas or quiches.

The greatest risk would appear to be at restaurants and cafes, where semi-dried tomatoes are served in foods such as salads and sandwiches.

Don’t eat poop. Or at least cook it.
 

Roy Costa to star on Dr. Oz Tuesday; Powell dresses up and gets in a couple of zingers

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In the beginning there was Oprah, and all was ideal.

Oprah begat Dr. Phil, and all was ideal, at least until his ratings started to fall.

Then Dr. Oz appeared – 55 times on Oprah – and Oprah eventually begated Dr. Oz.

The Dr. Oz show started in September 2009 and is syndicated throughout the U.S.

After hours of providing material to Dr. Oz producers about supermarket food safety, I got the call – be in New York City, Studio 6A where Conan used to shoot, we want you on the show.

On Monday, Oct. 19, 2009, Amy, Sorenne and I (I don’t like to travel without my family, that aging thing) drove from the Little Apple of Manhattan (Kansas) to Kansas City and then flew to the Big Apple of Manhattan (New York).

We got picked up by a big car and stayed at a nice hotel in Gotham.

Cool.

The next morning, Amy, Sorenne and I ventured off to 30 Rock – Rockefeller Center – for the taping. My friend Roy Costa was also there, and they gave us a dressing room with muffins and water.

It soon became apparent that 10-month-old Sorenne was not going to be comfortable waiting around for the excess of television –lots of waiting around for a couple of minutes of screen time – so Amy and Sorenne went back to the hotel.

Roy got to share the stage with Dr. Oz because of his experience as an inspector and he did a great job bobbing and weaving, trying to keep the show on track. I got to be the expert in the audience with a couple of pithy statements.

Our supermarket food safety bit is competing with the National Sex Experiment — a 50-state, 90-day incentive challenging you to have the best sex of your life — and a bunch of D-list celebrities who need the help of Dr. Oz. It is scheduled to be broadcast Tuesday, Nov. 3.

And, as in TV, the show was done with us just like that. We walked around Times Square a bit, took in the sideshow, and then went home.

Natural does not mean safe: Kansas locals still pushing unpasteurized cider

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Oh, unpasteurized apple cider, when will you stop providing food safety moments?

It was 13 years ago last night that U.S. health investigators figured out that unpasteurized juice with apple cider as a base was making people sick with E. coli O157:H7 in the Pacific Northwest region.

On Friday, Amy made a stop at a local plant and produce shop to pick up a pumpkin.

Amy writes:

The woman behind the counter quipped, “It looks like you already have a little pumpkin” motioning towards Sorenne who was hanging off my hip.

As I was paying the woman asked me, “Did you get a chance to have a swig of our apple cider?”

There was a tray with about 10 dixie cups full of cider on the counter. I had looked at them with interest while waiting to pay. I used to love apple cider but Doug has taught me to be skeptical. I asked without thinking, “Is the juice pasteurized?”

The woman looked at me as if to say, of course not, but she said, “No, but there is a preservative in it,” sort of apologetically for the preservative not being natural.

“No thanks then, and especially not for my daughter.” “Oh no!” she replied. “I didn’t mean for her but for you.” I left it at that. I was in a hurry, the woman was helping me to the car with the pumpkin, and maybe she just didn’t know better.

In my mind I was screaming, “Lady, I don’t want to die from your juice either.” I called Doug to thank him for teaching me about food safety. Four years ago I would have unthinkingly and gladly drank the cider. And if I had a child, I would have also offered it to her, not knowing about E. coli or even questioning whether someone in a store would serve me unsafe food.

From the cider files:

In October, 1996, 16-month-old Anna Gimmestad of Denver drank Smoothie juice manufactured by Odwalla Inc. of Half Moon Bay, Calif. She died several weeks later; 64 others became ill in several western U.S. states and British Columbia after drinking the same juices, which contained unpasteurized apple cider –and E. coli O157:H7. Investigators believe that some of the apples used to make the cider may have been insufficiently washed after falling to the ground and coming into contact with deer feces.

In the fall of 1998, I accompanied one of my four daughters on a kindergarten trip to the farm. After petting the animals and touring the crops –I questioned the fresh manure on the strawberries –we were assured that all the food produced was natural. We then returned for unpasteurized apple cider. The host served the cider in a coffee urn, heated, so my concern about it being unpasteurized was abated. I asked: "Did you serve the cider heated because you heard about other outbreaks and were concerned about liability?" She responded, "No. The stuff starts to smell when it’s a few weeks old and heating removes the smell."

Here’s the abstract from a paper Amber Luedtke and I published back in 2002:

A review of North American apple cider outbreaks caused by E. coli O157:H7 demonstrated that in the U.S., government officials, cider producers, interest groups and the public were actively involved in reforming and reducing the risk associated with unpasteurized apple cider. In Canada, media coverage was limited and government agencies inadequately managed and communicated relevant updates or new documents to the industry and the public.

Therefore, a survey was conducted with fifteen apple cider producers in Ontario, Canada, to gain a better understanding of production practices and information sources. Small, seasonal operations in Ontario produce approximately 20,000 litres of cider per year. Improper processing procedures were employed by some operators, including the use of unwashed apples and not using sanitizers or labeling products accurately.

Most did not pasteurize or have additional safety measures. Larger cider producers ran year-long, with some producing in excess of 500,000 litres of cider. Most sold to large retail stores and have implemented safety measures such as HACCP plans, cider testing and pasteurization. All producers surveyed received government information on an irregular basis, and the motivation to ensure safe, high-quality apple cider was influenced by financial stability along with consumer and market demand, rather than by government enforcement.
 

Shoot, shovel and shut up – the wrong approach for animal and zoonotic diseases

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Daughter Sorenne woke up around 6:15 a.m. after a big Halloween night (thanks for the costume, Katie). Then the clocks on the computer changed and I realized it was 5:15 a.m.

Damn you daylight savings.

So while Sorenne plays on the floor and fills her diaper, I’m looking at a poignant release from the France-based World Organization for Animal Health, inexplicably referred to as OIE (it’s a French thing) reiterating the importance of animal health rules to control human disease.

When the first case of bovine spongiform encephalopathy or mad cow disease was discovered in Canada in May, 2003, Alberta premier Ralph Klein famously declared that any

"self-respecting rancher would have shot, shovelled and shut up."

In 1184, city leaders in Toulouse, France, introduced some of the first documented measures to oversee the sale of meat: profit for butchers was limited to eight per cent; the partnership between two butchers was forbidden; and, selling the meat of sick animals was forbidden unless the buyer was warned.

By 1394, the Toulouse charter on butchering contained 60 articles, 19 of which were devoted to health and safety.

As outlined by Madeleine Ferrières, a professor of social history at the University of Avignon, in her 2002 book, Sacred Cow, Mad Cow: A History of Food Fears, the goal of regulations at butcher shops — the forerunners of today’s slaughterhouse — was to safeguard consumers and increase tax revenues. Animals from the surrounding countryside were consolidated at a single spot — the evolving slaughterhouse, originally inside city walls — so taxes could be more easily gathered, and so animals could be physically examined for signs of disease.

It’s no different today: slaughterhouses are common collection points to examine animals for signs of disease and to collect various levies. And like medieval times, one of the most basic rules is animals that cannot walk are forbidden from entering (the slaughterhouse or city).

Bernard Vallat, Director General of the World Organisation for Animal Health (OIE), reminded the world this morning that veterinary legislation is the foundation of any efficient animal health policy.

Veterinary legislation is a critical infrastructure element for all countries. In many OIE Member countries, the veterinary legislation has not been updated for many years and is obsolete or inadequate in structure and content for the challenges facing veterinary services in today’s world.

Dr Vallat says that it is important that the veterinary services have the authority to enter livestock premises and other establishments and take the actions needed for early detection, reporting and rapid and effective management of any animal diseases as soon as they are detected. Such actions include the capacity to seize animals and products, to impose standstills, quarantine, testing and other procedures; to control animals and products at frontiers; and to require the destruction and safe disposal of animals and all articles considered to present a risk of disease transmission and to public health. These activities represent the core activities of veterinary services in the field of animal health control and veterinary public health and the legislation must provide the necessary authority as a minimum.

Ground beef recall linked to cluster of E. coli O157 illnesses in New England

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USDA FSIS has announced a recall of 545,699 pounds of fresh ground beef products that may be contaminated with E. coli O157:H7 and distributed in seven states. According to FSIS, the product has been linked to a cluster of illnesses in New England.

There are quite a few recalls going on most of the time; this one is notable because this product has been linked to an outbreak of illnesses at a camp in Massachusetts. It’s also notable because bulk amounts of the product were shipped down the East Coast for further processing. Retail outlets receiving some of this product include Shaw, Giant, Price Chopper,Trader Joe’s, BJs and others.

From the press release:
"Products for further processing:
Cases of 10-pound "FAIRBANK FARMS FRESH GROUND BEEF CHUBS."
     Each case bears the establishment number "EST. 492" inside the USDA mark of inspection; has package dates of "09.14.09," "09.15.09," or "09.16.09;" and sell-by dates of "10.3.09," "10.4.09," or "10.5.09. These products were distributed to retail establishments in Maryland, Massachusetts, North Carolina, New Jersey, New York, Pennsylvania, and Virginia for further processing. However, these products at retail will likely not bear the package dates and sell-by dates listed above. Customers with concerns should contact their point of purchase."

It is unlikely that any of the product is still being sold fresh at retail stores (the best-if-sold-before dates range from mid-September to early October) but it’s likely that the affected beef is still around in freezers. The meat juices from thawing can provide a nice vehicle for pathogen transfer.

Stick it in with a tip-sensitive digital thermometer (in multiple spots) to ensure that ground beef has reached a safe temperature and be vigilant in containing meat juices when thawing frozen meats. Juicy is good, nasty meat juice spread around the kitchen isn’t.

9 outbreaks, 2 dead, 130 ill from same Salmonella across UK

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The Telegraph reports this morning that around 130 people have fallen ill with the same strain of Salmonella linked to poultry and eggs since August across England and Wales

Five outbreaks have been linked to oriental restaurants, three to other restaurants and one was in a care home.

Two people with the infection died in the care home, which has not been named by officials, but post mortem results have proved inconclusive about the cause of death.

Three other people have been treated in hospital, a report from the Health Protection Agency said.
 

E. coli O157:H7 outbreak linked to Wendy’s salads in New Brunswick

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The Daily Gleaner reports this morning that four people have been stricken with E. coli O157:H7 after eating salad at a Wendy’s restaurant in Fredericton, New Brunswick (that’s in Canada).

The cases of E. coli O157:H7 are believed to be linked to salads prepared and served at the Prospect Street restaurant. There’s no evidence to suggest a public health concern at other restaurant locations. Public Health Services is continuing its investigation into the matter.