Salmonella, E. coli O157, Listeria, Campy: 1.9 million foodborne illnesses in US per year

In an ongoing effort to understand sources of foodborne illness in the United States, the Interagency Food Safety Analytics Collaboration (IFSAC) collects and analyzes outbreak data to produce an annual report with estimates of foods responsible for foodborne illnesses caused by pathogens. The report estimates the degree to which four pathogens – Salmonella, E. coli O157, Listeria monocytogenes, and Campylobacter – and specific foods and food categories are responsible for foodborne illnesses.

The Centers for Disease Control and Prevention (CDC) estimates that, together, these four pathogens cause 1.9 million foodborne illnesses in the United States each year. The newest report (PDF), entitled “Foodborne illness source attribution estimates for 2017 for Salmonella, Escherichia coli O157, Listeria monocytogenes, and Campylobacter using multi-year outbreak surveillance data, United States,” can be found on the IFSAC website.

The updated estimates, combined with other data, may help shape agency priorities and inform the creation of targeted interventions that can help to reduce foodborne illnesses caused by these pathogens. As more data become available and methods evolve, attribution estimates may improve. These estimates are intended to inform and engage stakeholders and to improve federal agencies’ abilities to assess whether prevention measures are working.

Foodborne illness source attribution estimates for 2017 for salmonella, Escherichia coli O157, listeria monocytogenes, and campylobacter using multi-year outbreak surveillance data, United States, Sept.2019

CDC, FDA, USDA-FSIS

https://www.cdc.gov/foodsafety/ifsac/pdf/P19-2017-report-TriAgency-508.pdf?deliveryName=DM10264

UK still insists on steaming (rather than piping) hot to reduce Campy in chicken; scientists do a Picard face palm

The UK Food Standards Agency reports the top nine retailers across the UK have published their latest testing results on campylobacter contamination in UK-produced fresh whole chickens (covering samples tested from April to June 2019).

The latest figures show that on average, across the major retailers, 3.6% of chickens tested positive for the highest level of contamination. These are the chickens carrying more than 1,000 colony forming units per gram (cfu/g) of campylobacter. 

Results

The sampling and analyses are carried out in accordance with protocols laid down by the FSA and agreed by Industry.

Background information

Contamination levels         July-September 2018          October-December 2018    January-March 2019           April-June 2019

cfu/g less than 10   58.8% 63.1% 55.4% 59%

cfu/g 10-99   26.7% 22.3% 25.3% 25.3%

cfu/g 100-1000         11%    11.4% 15.8% 12.1%

cfu/g over 1000       3.5%   3.1%   3.5%   3.6%

We have been testing chickens for campylobacter since February 2014 and publishing the results as part of a campaign to bring together the whole food chain to tackle the problem. Campylobacter is the most common cause of food poisoning in the UK.

In September 2017 we announced changes to the survey, with major retailers carrying out their own sampling and publishing their results under robust protocols laid down by the FSA. We are continuing to sample fresh whole chickens sold at retail, however, the focus is now on the smaller retailers and the independent market.

Chicken is safe if consumers follow good kitchen practice:

Cover and chill raw chicken – cover raw chicken and store at the bottom of the fridge so juices cannot drip onto other foods and contaminate them with food poisoning bacteria such as campylobacter

Don’t wash raw chicken – thorough cooking will kill any bacteria present, including campylobacter, while washing chicken can spread germs by splashing

Wash used utensils – thoroughly wash and clean all utensils, chopping boards and surfaces used to prepare raw chicken

Wash hands thoroughly with soap and warm water, after handling raw chicken – this helps stop the spread of campylobacter by avoiding cross-contamination

Cook chicken thoroughly – make sure chicken is steaming hot all the way through before serving. Cut into the thickest part of the meat and check that it is steaming hot with no pink meat and that the juices run clear.

It’s a scientific embarrassment.

Piping hot: Publication of year 4 Campylobacter retail chicken survey

The Food Standards Agency (FSA) has published the Year 4 report for the UK retail chicken survey which took place between August 2017 and July 2018. Samples were collected every quarter but after the first quarter only minor retailers were tested. The UK’s top nine retailers have carried out their own sampling since September 2017.

The report found that high level campylobacter contamination in UK chickens has decreased considerably, but remains high in smaller retailers, independents and butchers.

Rebecca Sudworth, Director of Policy at the Food Standards Agency, said:

“Retailers have achieved significant reductions in levels of campylobacter contamination since the retail chicken survey began in 2014. The FSA will continue to engage with industry and particularly smaller retailers, butchers and independents to build on this progress.” …

Make sure chicken is cooked thoroughly and steaming hot all the way through before serving. Cut into the thickest part of the meat and check that it is steaming hot with no pink meat and that the juices run clear.

Use a tip-sensitive digital thermometer and stick it in.

E. coli found in Icelandic meat

Keeping with all things Icelandic, E. coli was found in 30% of lamb samples and 11.5% of beef samples in a test carried out by the Icelandic Food and Veterinary Authority (MAST). The particular strain discovered is known as STEC, or shiga-toxin producing E. coli. This is the first time lamb and beef have been screened for STEC in Iceland.

The testing was carried out on around 600 samples of lamb, beef, pork, and chicken of both Icelandic and foreign origin between March and December 2018. The purpose of the testing was to determine the prevalence of pathogenic micro-organisms in products when they reach the consumer, and for this reason the samples were taken from shops.

Campylobacter and salmonella were not detected in pork or chicken samples, with the exception of a single sample of pork from Spain. MAST attributes this to improved preventative measures in slaughterhouses.

MAST points to several ways consumers can reduce the risk of infection from salmonella, campylobacter, and E. coli, including cooking meat all the way through and taking care to avoid cross-contamination. Most E. coli is found on the surface of meat, and therefore is killed by frying or grilling, but when meat is ground, the bacteria is distributed throughout. Therefore, hamburgers and other types of ground meat should be cooked through.

But what does that mean?

Use a tip-sensitive digital thermometer.

100 sick: Ice-maker in Iceland: stops sales to suppliers

E. coli was found in a water pool that is close to the infected area on Askøy. Nearly 100 primary school students have been sick Friday, and several have been admitted to hospital.

Later on Friday, Haukeland Hospital reported that it is campylobacter bacteria that cause intestinal infection, which has been detected in admitted from Askøy. Campylobacter is a bacterium that E-coli often finds along with.

Isbjørn Is has used the water in the municipality both in the products and for cleaning equipment. Kolseth explains that all the products in which it enters water are heat treated – so that no pathogenic bacteria can survive. However, they use lower temperature water for rinsing and cleaning parts and smaller equipment.

– This means that there can potentially be poor quality water on parts of our equipment when production starts. We have to have full control of this, says Kolseth.

2 dead, 2,000 sick from campy in water in Norway

MRT reports that a  patient from a southern Norway island with contaminated water has died after being hospitalized with gastrointestinal symptoms, authorities said Thursday.

Erik Vigander of the regional hospital entity in southern Norway said the bacteria Campylobacter was found in the patient’s system. That’s the same bacteria identified in other people sickened since E. coli was found in a reservoir that supplied drinking water for the island of Askoey.

Vigander says the patient who died Wednesday also had “a very serious underlying” health disorder and an autopsy will be performed to determine “the ultimate cause of death.”

A 1-year-old child from the island died last week of an infection in the digestive tract, but it was not clear whether the death was linked to the water contamination.

About 2,000 people have fallen sick. Since June 6, 64 have been hospitalized.

Hospital tests have shown that Campylobacter was found in at least three dozen cases.

Local newspaper Askoeyvaeringen reported that there had been been safety issues with the waterworks in the Askoey municipality, and feces was recently found near a reservoir that supplied part of the area’s drinking water.

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.

 

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