39 sickened: Cow shit carries bugs: Campy outbreak in drinking water, Nebraska 2017

Jim still has nightmares.

It’s the helicopters.

We live near the publicly-funded Princess Alexandria hospital in Brisbane.

A helicopter flies over our house a couple of times a day bringing some victim from the outback or the coast.

The state of Queensland is really, really big.

It reminds me of my friend, Jim, and what he went through in the aftermath of the E.coli O157 outbreak in drinking water that killed seven and sickened 2,500 in the town of Walkerton, population 5,000.

Jim knew that every helicopter was someone dead or dying being flown to the medical center in London, Ontario (that’s in Canada, like Walkerton).

I think of Jim and the victims every time a chopper goes past.

The U.S. Centers for Disease Control reports a center pivot irrigation system intended to pump livestock waste water onto adjacent farmland in Nebraska malfunctioned, allowing excessive run off to collect in a road ditch near two wells that fed a municipal water supply, sickening 39 persons who consumed untreated city water. The use of culture-independent diagnostic tests facilitated case identification allowing for rapid public health response.

Access to clean water sources continues to be an important public health issue, and public health professionals should consider exposure to untreated water sources as a potential cause for Campylobacter outbreaks.

In March 2017, the Nebraska Department of Health and Human Services (NDHHS) and the Southwest Nebraska Public Health Department were notified of an apparent cluster of Campylobacter jejuni infections in city A and initiated an investigation. Overall, 39 cases were investigated, including six confirmed and 33 probable. Untreated, unboiled city A tap water (i.e., well water) was the only exposure significantly associated with illness (odds ratio [OR] = 7.84; 95% confidence interval [CI] = 1.69–36.36). City A is served by four untreated wells and an interconnected distribution system. Onsite investigations identified that a center pivot irrigation system intended to pump livestock wastewater from a nearby concentrated animal feeding operation onto adjacent farmland had malfunctioned, allowing excessive runoff to collect in a road ditch near two wells that supplied water to the city. These wells were promptly removed from service, after which no subsequent cases occurred. This coordinated response rapidly identified an important risk to city A’s municipal water supply and provided the evidence needed to decommission the affected wells, with plans to build a new well to safely serve this community.

On March 10, 2017, NDHHS was notified of five reports of campylobacteriosis in the Southwest Nebraska Public Health Department jurisdiction. Two positive culture reports and three positive culture-independent diagnostic tests, specifically a gastrointestinal polymerase chain reaction (PCR) panel, were received from persons not living together. Campylobacteriosis is a reportable condition in Nebraska, and this number of cases was higher than expected; during 2006–2016, an average of one Campylobacter case was reported in a city A resident every 3 years. Initial questioning of ill persons did not include an assessment of exposure to untreated drinking water and suggested ground beef consumption as a possible shared exposure. The Nebraska Department of Agriculture Food Safety and Consumer Protection obtained distribution records for poultry and ground beef for two local restaurants and one local grocery store. The distribution of poultry and ground beef was evaluated by reviewing the routing records of these products to their source, and no evidence of a shared poultry source was identified. The ground beef was not ground in-house at the grocery store, and the distributors that supplied ground beef to the grocery store and each of the two local restaurants were not shared. Through interviews of city A residents and business owners, investigators were made aware of a report of standing water that “smelled of cattle manure” in a roadside ditch near two municipal water wells.

A collaborative on-site investigation revealed that during the pumping of a large volume of livestock wastewater from a concentrated animal feeding operation through a center pivot irrigation system, the system malfunctioned at an undetermined time. The wastewater was intended to be placed on adjacent farmland. This malfunction allowed excessive runoff to flood a road ditch approximately 15 feet (4.6 m) from two municipal water well houses (3 and 4) that had been operating 6 days before the onset of illness in the first patient. The presence of this standing water was confirmed by city A water operators, who reported seeing water in the ditch for 4 days (February 22–25) (Figure). Pump records indicated that during February 22–27, well 3 was in use, and during February 28–March 7, well 4 was in use (Table 1). During both periods, another well (well 2) was also operating. Wells are rotated in and out of service by city operators as part of regular operations. Water is distributed through the well system without any disinfection or filtration. Routine total coliform and Escherichia coli testing of water from the distribution system was performed on March 8; however, only wells 2 and 5 were operating on that date. As part of the investigation, additional coliform and E. coli testing was performed again on March 16 on direct samples from wells 2, 3, 4, and 5; bacterial culture specifically for Campylobacter was performed on March 20 (wells 4 and 5) and 27 (wells 2 and 3). All samples were negative for coliforms and Campylobacter. No additional pump or testing records were reviewed.

On March 16, Nebraska Department of Environmental Quality and the Department of Agriculture conducted an additional investigation of two concentrated animal feeding operation–certified waste lagoons (a manufactured basin that collects livestock waste and water in an oxygen-deprived setting to promote anaerobic conditions as a way to manage refuse)* and associated use of three pivot irrigation systems. The investigation team observed that water from the waste lagoons had been pumped through a pivot onto an adjacent field, which is a common farming practice for fertilizing farm ground or watering crops. City operators confirmed that on February 24 they had observed flow of livestock wastewater into the road ditch near well 4. They followed the wastewater up the road ditch and reported that it came out of the farmland upstream from the wells. Investigators also obtained details of total well depths, static water levels, and pumping water levels (measured during active pumping). Wells 4 and 3 were relatively shallow, with static water levels of 21 and 22 feet, pumping levels of 25 and 26 feet, and total well depths of 43 and 46 feet, respectively; both began service in the 1930s, similar to the other wells in the system, which were also older.

While details around this event were being clarified and environmental testing was pending, an Internet-based questionnaire was designed to aid case-finding and assess potential exposures. A probable case was defined as a diarrheal illness of ≥2 days’ duration with one or more additional signs or symptoms (nausea, vomiting, fever, chills, or headache) in a city A resident, with onset during February 28–March 23, 2017. A confirmed case was defined as a person meeting the probable case definition with either stool culture or PCR-positive results for Campylobacter, or a laboratory-confirmed probable illness in a nonresident who worked, dined, or shopped for groceries in city A. Among approximately 600 city A residents, 94 (16%) completed a questionnaire to report food consumption history, drinking water source, animal exposures, and symptoms. Among questionnaire respondents, 39 (41%) campylobacteriosis cases (six confirmed and 33 probable) were identified, with illness onset from February 28–March 21 (Figure); 25 (64%) cases occurred in females and 14 (36%) in males. The median age was 34.5 years (range = 1.5–85 years). Twelve (31%) patients sought medical care, and three (8%) were hospitalized; no deaths were reported.

Data analysis indicated a significant association between ill persons and consumption of untreated, unboiled municipal tap water (OR = 7.84; 95% CI = 1.69–36.36) (Table 2). Other exposures were assessed, including unpasteurized milk, animal contact, raw poultry, and ground beef, but none demonstrated a significant association with illness. Notably, no cases were reported among the approximately 28 residents of city A’s only nursing home, which used city water but treated it with a reverse osmosis system.

Public Health Response

Wells 3 and 4 were both permanently removed from service on March 16, and no additional illnesses were reported with onset after March 21. On April 25, NDHHS reclassified these wells to Emergency Status, meaning the well can only be pumped during a case of emergency (e.g., fire, drought, etc.) for nonpotable purposes. Furthermore, meetings were held with area stakeholders to present these findings as evidence to support the award of a planning grant to city A to explore options for a new, higher-volume well to be dug to an acceptable depth in a different location.

This investigation implicates Campylobacter jejuni as the cause of this outbreak, most likely from a municipal water system contaminated by wastewater runoff from an adjacent concentrated animal feeding operation (1). In addition to environmental and statistical findings, this conclusion is consistent with prior investigations that demonstrate Campylobacter outbreaks of similar size are historically associated with contaminated water (2–7). Although laboratory testing of the water in this investigation did not yield any positive results, samples were not taken until long after the contamination event, and test results might have been affected by switches among wells supplying the system over time. These findings also suggest that routine coliform testing might not be a good indicator of the presence of Campylobacter species (8). Further, it is possible that Campylobacter in particular might be viable but not necessarily detectable by culture in water systems (9,10). The use of both culture and culture-independent diagnostic tests (PCR) were needed to detect the initial cluster of cases and early recognition of this outbreak. If culture alone had been used, only two cases would have been reported, one of which did not occur in a city A resident. Of those two culture-confirmed cases, one patient refused the interview and the other had typical Campylobacter exposures, such as live poultry, which might not have prompted such a rapid response. This investigation demonstrates the importance of considering exposure to untreated water sources as a potential cause for Campylobacter outbreaks. Including this risk factor in initial questioning could help to expedite outbreak investigations. Ultimately, early recognition and a coordinated response by several state and local agencies greatly facilitated this successful public health intervention.

Campylobacteriosis outbreak associated with contaminated municipal water supply-Nebraska, 2017

22.feb.19

CDC

Caitlin Pedati, Samir Koirala, et al

https://www.cdc.gov/mmwr/volumes/68/wr/mm6807a1.htm?s_cid=mm6807a1_e

Stool samples, Australian style

When I was in the hospital last week for recurring gall issues, I provided a stool sample to check for C. difficile.
Stool samples are the cornerstone of foodborne illness outbreak investigation.
This is what Chapman pooped in to about 8 years ago in Kansas.
Campylobacter and didn’t just hate my cooking.
I was curious about the Australian way, and followed the nurse around.
And took pictures.

You see a cute bird, I see a Campylobacter factory: In Finland too

The roles of environmental reservoirs, including wild birds, in the
molecular epidemiology of Campylobacter jejuni have not been assessed in
depth.

Our results showed that game birds may pose a risk for acquiring
campylobacteriosis, because they had C. jejuni genomotypes highly similar
to human isolates detected previously. Therefore, hygienic measures during
slaughter and meat handling warrant special attention. On the contrary, a
unique phylogeny was revealed for the western jackdaw (right) isolates, and certain
genomic characteristics identified among these isolates are hypothesized to
affect their host specificity and virulence.

Comparative genomics within sequence types (STs), using whole-genome multilocus sequence typing (wgMLST), and phylogenomics are efficient methods to analyze the genomic relationships of C. jejuni isolates.

 Population Genetics and Characterization of Campylobacter jejuni Isolates
 from Western Jackdaws and Game Birds in Finland
 Sara Kovanen, Mirko Rossi, Mari Pohja-Mykrä, Timo Nieminen, Mirja
 Raunio-Saarnisto, Mikaela Sauvala, Maria Fredriksson-Ahomaa, Marja-Liisa
 Hänninen and Rauni Kivistö

 Appl. Environ. Microbiol. February 2019 85:e02365-18; Accepted manuscript
 posted online 14 December 2018, doi:10.1128/AEM.02365-18

 http://aem.asm.org/content/85/4/e02365-18.abstract?etoc

North Koreans ordered to produce impossible amount of human manure every day to help save agriculture

Fox News is not the, uh, most reliable source, but they report North Korean dictator Kim Jong Un has commanded every citizen to turn over an impossible 200 pounds of human manure a day for fertilizer in an effort to revitalize the communist country’s struggling agriculture.

The country’s leader first made agriculture the forefront of the economic recovery during the New Year’s address.

This led to the mass mobilization of the population to fulfill the government’s wishes and ensure the human manure quotas are met. If the people don’t meet their daily quota, they have to supply over 600 pounds of compost or livestock manure, according to Radio Free Asia.

“The entire population has been mobilized to produce manure as the first major task of the year,” a source told the outlet. “The authorities in each local region task factories, institutions and citizens groups with assigning production quotas to each individual.”

“They are demanding that each person produce 100kg of human feces per day, or about 3 tons per month,” the person added. “But how on earth can it be possible for one person to make 3 tons of human feces and deliver it?”

The absurdly-high quotas are forcing the people to either collect the human manure in cold or pay cash to others for the manure.

“Most people can’t [make or collect] 100kg per day, so they end up giving what they think is sufficient. The quota is therefore meaningless,” the source told the outlet.

Campy be difficult to get rid of

Campylobacter as an inhabitant of the poultry gastrointestinal tract has proven to be difficult to reduce with most feed additives. The use of in-feed antibiotics have been taken out of poultry diets due to the negative reactions of consumer along with concerns regarding the generation of antibiotic resistant bacteria. Consequently, interest in alternative feed amendments to antibiotics has grown.

One of these alternatives, prebiotics has been examined as a potential animal and poultry feed additive. Prebiotics are non-digestible ingredients that enhance growth of indigenous gastrointestinal bacteria that elicit metabolic characteristics which are considered beneficial to the host. In addition, these compounds support microbial activities in the gastrointestinal tract that are antagonistic to the establishment of pathogens. There are several carbohydrate polymers that qualify as prebiotics and have been fed to poultry. These include mannoligosaccharides and fructooligosaccharides as the most common ones marketed commercially that have been used as feed supplements in poultry.

More recently several non-digestible oligosaccharides have also been identified as possessing prebiotic properties when implemented as feed supplements. While prebiotics appear to be generally effective in poultry and limit establishment of foodborne pathogens such as Salmonella in the gastrointestinal tract, less is known about their impact on Campylobacter.

This review will focus on the potential of prebiotics to limit establishment of Campylobacter in the poultry gastrointestinal tract and future research directions.

Potential for prebiotics as feed additives to limit foodborne campylobacter establishment in the poultry gastrointestinal tract

Frontiers in Microbiology

Sun A. Kim, Min J. Jang, Seo Y. Kim, Yichao Yang, Hilary O. Pavlidis, and Steven C. Ricke

doi: 10.3389/fmicb.2019.00091

https://www.frontiersin.org/articles/10.3389/fmicb.2019.00091/abstract

Raw is risky: 83 now sick with Salmonella from raw milk cheese in France

The number of people sick from Salmonella in reblochons, a type of raw milk cheese specific to the Savoy region of the Alps in France, has risen from 14 to 83.

Public Health France first withdrew the reblochons on Nov. 24, 2018.

Of the 83 people identified so far, 65 were able to be interviewed by the ARS Auvergne-Rhône-Alpes and Public Health France about their symptoms and their food consumption before the onset of symptoms. Symptoms range from 16/09 to 19/11, with a peak in week 40 (from 1st to 07/10/2018). Fifteen people were hospitalized for their salmonellosis: they are now out and are well; no deaths have been reported. Consumption of reblochon with raw milk before the onset of symptoms is reported by 80% of the cases confirmed by the CNR and interviewed.

UK father paralysed after food poisoning issues safety warning to others

ITV news reports a father who became paralysed after contracting a rare illness from food poisoning has issued a warning to others about food safety.

Dai Braham, 40, was left paralysed from the nose down after becoming unwell while watching his six-year-old son play rugby in April.

Within a matter of days, he was in an induced coma.

Father-of-two Dai was a keen bodybuilder and fitness fanatic

It was only later that medical staff discovered the fitness fanatic from Bridgend had been suffering from food poisoning campylobacter – which led to the rare autoimmune disorder Guillian-Barré Syndrome.

At his worst point, he found himself unable to breathe without a ventilator and without a voice.

“It’s the scariest thing in the world. You are basically locked in your own body”, Dai said.

“Your mind is fine and you know what you want your body to do but you just can’t do it.

“It was horrible, I couldn’t communicate with anyone. I could blink to say yes or no or use a letter card. Then I would use words on a board to spell out certain words.”

Dai has spent the last eight months in hospital and has only recently learned to walk again.

What is Guillain-Barré syndrome?

It is thought to be caused by a problem with the immune system, and can be triggered by infections including food poisoning and the flu as well as by vaccinations, surgery or injury.

Symptoms of the condition include numbness, pins and needles, muscle weakness, and problems with balance and co-ordination.

Campy in puppies: Petland store faces 3rd lawsuit this year alleging it knowingly sold sick puppies

A Petland store in Michigan is facing its third lawsuit this year after a man said he was hospitalized after buying a puppy later found to be sick from the store.

Doug Rose said he became infected with Campylobacter — a multi-drug resistant infection — after he and his wife Dawn purchased Thor, a beagle-pug mix puppy that the couple said was infected with parasites, suffered from coccidia and giardia, and had an upper respiratory infection, The Oakland Press reported.

The couple said the same veterinary clinic that gave the dog a clean bill of health through the Petland in Novi also diagnosed the puppy with a number of ailments.

Symptoms of Campylobacter infections can include abdominal pain, diarrhea, headache, fever, nausea and vomiting.

The couple is seeking monetary compensation after Doug Rose said he required multiple weeks of medical treatment.

Randy Horowitz, who owns the Petland in the Detroit suburb, told the newspaper the case would be resolved to “reflect the facts.”

lawsuit filed by 17 plaintiffs against Horowitz was dismissed earlier this year. The lawsuit alleged that Horowitz knowingly sold puppies suffered from genetic defects.

A lawsuit was filed in April by nine families alleging that puppies they purchased suffered from a number of medical issues.

Other pet owners have claimed puppies they purchased from that Petland location became sick.

In January, the Centers for Disease Control and Prevention released results of a multi-state investigation that showed 113 cases of Campylobacter across 17 states linked to pet stores. A majority of people reported becoming sick after coming in contact with a puppy purchased from a Petland store or after coming in contact with another human who had recently purchased a dog from a Petland store.

Salmonella cases double in Denmark

Ben Hamilton of CPH Post reports there were twice as many salmonella outbreaks in Denmark in 2017 than in the previous year.

In total, there were 25 outbreaks, and 1,067 people became ill as a result.

The increase is partly blamed on improved ways of detecting outbreaks. ‘Whole genome sequencing’, for example, makes it easier to detect the same source of infection.

“We hope it can lead to a decline in salmonella cases in the long term,” noted Luise Müller, an epidemiologist at Statens Serum Institut.

“It should enable us to become better at deducing why some foods are more likely to make people sicker than others.”

Danish-produced pork was the biggest culprit, while there were no cases sourced to chicken.

Foodborne outbreaks in general are increasing. In 2017, there were 63, up from 49 in the previous year.

The biggest culprit is campylobacter, a bacterium that made 4,257 people ill in 2017.

Minimizing the risk of Campylobacter and Salmonella illnesses associated with chicken liver

Good luck with that.

Most people undercook chicken liver because they follow food porn bullshit on cooking shows (yes, we did that research 15 years ago, see below

FSIS is issuing this guideline to promote a reduction in pathogens in raw chicken liver products and to promote thorough cooking of these products.

Similar to other raw poultry products, chicken liver can be contaminated with pathogens such as Campylobacter and Salmonella. Surface contamination can result from insanitary dressing procedures, as well as from the processing environment.

In addition to surface contamination, chicken liver can contain pathogens internally, even when chickens are dressed in a sanitary manner. Studies have demonstrated the presence of Campylobacter in the internal tissue of between 10% and 90% of tested chicken livers after the external surface was sanitized (Boukraa et al., 1991; Barot et al., 1983; Baumgartner et al., 1995; Firlieyanti et al., 2016; Whyte et al., 2006). Additionally, researchers have detected Campylobacter and Salmonella in the liver of chickens previously free of these pathogens after experimental oral inoculation (Chaloner et al., 2014; Knudsen et al., 2006; Sanyal et al., 1984; Borsoi et al., 2009; Gast et al., 2013; He et al., 2010). Pathogens are thought to spread from the intestine to the internal liver tissue via the biliary, lymphatic, or vascular systems, although the exact route is unclear.

Some recipes for chicken liver dishes, such as pâté, instruct the preparer to only partially cook the liver (e.g., by searing). Partial cooking may kill pathogens on the external surface, but will likely not kill all pathogens in the internal tissue. Any internal pathogens that survive in products made from inadequately cooked chicken liver could make consumers sick. Inadequate cooking was a contributing factor in many of the reported illness outbreaks associated with chicken liver.

The main message for food preparers at retail food outlets and foodservice entities and at home is that chicken liver dishes, like all poultry products, should be consumed only after being cooked throughout to a safe minimum internal temperature of 165 °F (73.9 °C) as measured with a food thermometer (Food Code,3-401.11).

That’s a little clearer than piping fucking hot, UK idiots.

For food safety reasons, this should be done regardless of preferences. In addition, with respect to storage, FSIS recommends using chicken liver within one to two days if stored in a refrigerator set at 40 °F or below, or within three to four months if frozen at 0 °F or below.

 Mathiasen, L.A., Chapman, B.J., Lacroix, B.J. and Powell, D.A. 2004. 

Spot the mistake: Television cooking shows as a source of food safety information, Food Protection Trends 24(5): 328-334.

Consumers receive information on food preparation from a variety of sources. Numerous studies conducted over the past six years demonstrate that television is one of the primary sources for North Americans. This research reports on an examination and categorization of messages that television food and cooking programs provide to viewers about preparing food safely. During June 2002 and 2003, television food and cooking programs were recorded and reviewed, using a defined list of food safety practices based on criteria established by Food Safety Network researchers. Most surveyed programs were shown on Food Network Canada, a specialty cable channel. On average, 30 percent of the programs viewed were produced in Canada, with the remainder produced in the United States or United Kingdom. Sixty hours of content analysis revealed that the programs contained a total of 916 poor food-handling incidents. When negative food handling behaviors were compared to positive food handling behaviors, it was found that for each positive food handling behavior observed, 13 negative behaviors were observed. Common food safety errors included a lack of hand washing, cross-contamination and time-temperature violations. While television food and cooking programs are an entertainment source, there is an opportunity to improve their content so as to promote safe food handling.