FDA investigating contaminated pig ear treats connected to Salmonella

One of daughter Sorenne’s chores is to feed our two cats every night, with their special anti-neurotic food.

And every night I say, wash your hands.

Same with Ted the Wonder Dog and treats.

With the recent announcements of the Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention (CDC) investigating contaminated Pig Ear Treats connecting to Salmonella, Pet Supplies Plus is advising consumers it is recalling bulk pig ear product supplied to all locations by several different vendors due to the potential of Salmonella contamination. Salmonella can affect animals eating the products and there is risk to humans from handling contaminated pet products, especially if they have not thoroughly washed their hands after having contact with the products or any surfaces exposed to these products.

Testing by the Michigan Department of Agriculture and Rural Development revealed that aging bulk pig ear product in one of our stores tested positive for Salmonella. We have pulled bulk pig ear product from the shelves at all of our stores and have stopped shipping bulk pig ears from our Distribution Center. We are working with the FDA as they continue their investigation as to what caused the reported Salmonella related illnesses.

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.

Vaccines work: Widespread outbreaks of Hepatitis A across the U.S.

Since March 2017, the U.S. Centers for Disease Control Division of Viral Hepatitis (DVH) has been assisting multiple state and local health departments with hepatitis A outbreaks, spread through person-to-person contact.

The hepatitis A vaccine is the best way to prevent HAV infection.

The following groups are at highest risk for acquiring HAV infection or developing serious complications from HAV infection in these outbreaks and should be offered the hepatitis A vaccine in order to prevent or control an outbreak:

People who use drugs (injection or non-injection)

People experiencing unstable housing or homelessness

Men who have sex with men (MSM)

People who are currently or were recently incarcerated

People with chronic liver disease, including cirrhosis, hepatitis B, or hepatitis C

One dose of single-antigen hepatitis A vaccine has been shown to control outbreaks of hepatitis A and provides up to 95% seroprotection in healthy individuals for up to 11 years.1,2

Pre-vaccination serologic testing is not required to administer hepatitis A vaccine. Vaccinations should not be postponed if vaccination history cannot be obtained or records are unavailable.

CDC has provided outbreak-specific considerations for hepatitis A vaccine administration.

At A Glance

Since the outbreaks were first identified in 2016, 24 states have publicly reported the following as of June 21, 2019

Cases: 20,512

Hospitalizations: 11,776 (57%)

Deaths: 194

State-Reported Hepatitis A Outbreak Cases as of June 21, 2019

State-Reported Hepatitis A Cases and Clinical Outcomes
State Case Total Hospitalizations
n (%)
Deaths Outbreak
Start Date
Data Current
Through
Total 20512 11776 (57%) 194
States with an ongoing outbreak
Alabamaexternal icon 84 NR (NR) NR 9/1/2018 6/19/2019
Arizonaexternal icon 396 309 (78%) 2 11/1/2018 6/20/2019
Arkansasexternal icon 343 NR (NR) NR 2/7/2018 6/7/2019
Coloradoexternal icon 74 47 (64%) 0 10/1/2018 6/19/2019
Floridaexternal icon 1876 1353 (72%) 21 1/1/2018 5/31/2019
Georgiaexternal icon 437 292 (67%) 1 6/1/2018 6/14/2019
Idahoexternal icon 26 14(54%) 1 1/1/2019 6/20/2019
Illinois external icon 126 75(60%) 0 9/1/2018 6/19/2019
Indianaexternal icon 1581 851 (54%) 4 11/1/2017 6/21/2019
Kentuckyexternal icon 4715 2277 (48%) 58 8/1/2017 6/8/2019
Louisiana external icon 302 178 (59%) 1 1/1/2018 6/21/2019
Massachusettsexternal icon 363 298 (82%) 5 4/1/2018 6/14/2019
Michiganexternal icon 916 735 (80%) 28 8/1/2016 6/19/2019
Missouriexternal icon 323 163(50%) 2 9/1/2017 6/19/2019
New Hampshireexternal icon 138 83 (60%) 1 11/1/2018 6/18/2019
New Mexicoexternal icon 126 100 (79%) 2 11/8/2018 6/20/2019
North Carolinaexternal icon 85 60 (71%) 1 1/1/2018 6/17/2019
Ohioexternal icon 3070 1841 (60%) 10 1/1/2018 6/17/2019
South Carolinaexternal icon 147 108 (73%) 1 11/1/2018 6/14/2019
Tennesseeexternal icon 1791 1085 (60%) 10 12/1/2017 6/21/2019
Virginiaexternal icon 71 45 (63%) 0 1/1/2019 6/20/2019
West Virginiaexternal icon 2533 1249 (49%) 23 3/19/2018 6/21/2019
States with a declared end to their outbreak
Californiaexternal icon 708 464 (66%) 21 11/1/2016 4/11/2018
Utahexternal icon 281 152 (54%) 3 5/8/2017 2/12/2019

NR: not publicly reported

“Outbreak-associated” status is currently determined at the state level in accordance with each state’s respective outbreak case definition.

Outbreak-related hepatitis A deaths are defined at the state level in accordance with each state’s respective hepatitis A-related death definition. Some states are reviewing death certificates on a regular basis to actively find hepatitis A-related deaths, while other states are utilizing passive surveillance.

Outbreak start date is defined at the state level and may represent the earliest onset date of an outbreak case (AR, AZ, UT), the left censor date for which cases are considered part of the outbreak based on the state outbreak case definition (AL, CA, CO, FL, GA, ID, IL, IN, KY, LA, MA, MI, MO, NC, NH, OH, SC, TN, VA), or when a state declared a hepatitis A outbreak (NM, WV).

CDC’s Response

In response to all hepatitis outbreaks, CDC provides ongoing epidemiology and laboratory support as well as support on vaccine supply and vaccine policy development. When requested, CDC sends “disease detectives” to affected areas to evaluate and assist in an outbreak response. CDC alerts other public health jurisdictions of any increases in disease. All jurisdictions are encouraged to be watchful for increases in hepatitis A cases. CDC also works with state and local health officials to ensure hepatitis A vaccine is targeted to the correct at-risk populations and that supply is adequate.

Postexposure Prophylaxis

Postexposure prophylaxis (PEP) is recommended for unvaccinated people who have been exposed to hepatitis A virus (HAV) in the last 2 weeks; those with evidence of previous vaccination do not require PEP.

PEP consists of:

Hepatitis A vaccine for people aged ≥12 months

Hepatitis A virus-specific immunoglobulin (IG) for specific populations

PEP Recommendations:

ACIP Recommendations for Use of Hepatitis A Vaccine for Postexposure Prophylaxis and for Preexposure Prophylaxis for International Travel

Supplement 1. Provider Guidance on Risk Assessment and Clinical Decision-making for Hepatitis A Postexposure Prophylaxis

NOTE: CDC recommends that all children be vaccinated against hepatitis A at age 1 year. Parents or caregivers who are unsure if a child has been vaccinated should consult the child’s health-care provider to confirm vaccination status.

HAV Specimen Requests

State health departments wanting to submit specimens must contact CDC at hepaoutbreaklab@cdc.gov for approval before shipping specimens to CDC.  Only specimens that that have tested positive for anti-hepatitis A IgM and meet any of the following criteria will be considered.

Specimen from a case patient in a county that has not yet reported a hepatitis A case in an at-risk population;

Specimen from a case patient who doesn’t report any known risk factors or contact with at-risk populations (e.g., household or sexual contact, volunteering at a homeless shelter);

Specimen from a case patient suspected to be associated with foodborne transmission;

Archived/stored specimen from a patient who has died, and whose classification as an outbreak-related death requires nucleic acid testing beyond anti-HAV IgM-positivity; or

Other patient specimens not meeting the above criteria that require nucleic acid testing or molecular characterization (to be discussed on a case-by-case basis).

Dear Colleague Letter pdf icon[PDF – 6 MB] from CDC Division of Viral Hepatitis Director regarding Submission of Patient Specimens to CDC for Hepatitis A Testing.

Additional Vaccination Information

Outbreak-specific considerations for hepatitis A vaccine administration

MMWR – The dose of GamaSTAN™ S/D has recently been changed

Current Vaccine Shortages & Delays – Information on Vaccine Supply

For Immunization Managers – Information on Vaccines Purchased with 317 Funds

Professional Resources

Medscape Commentary: Hepatitis A: Breaking Out All Overexternal icon

Archived webinar: Preventing and Controlling Hepatitis A in Jails and Prisons from the National Institute of Corrections, BOP and CDCexternal icon

HAN: Update: Widespread Outbreaks of Hepatitis A among People Who Use Drugs and People Experiencing Homelessness across the United States – March 2019

COCA Call On-Demand Webinar for Clinicians: Hepatitis A Outbreaks in Multiple States – CDC Recommendations and Guidance – Nov. 2018

HAN: Outbreak of Hepatitis A Virus (HAV) Infections among Persons Who Use Drugs and Persons Experiencing Homelessness– June 2018

MMWR: Hepatitis A Virus Outbreaks Associated with Drug Use and Homelessness — California, Kentucky, Michigan, and Utah, 2017

Posters on how to clean up and disinfect to help prevent spread of hepatitis A virusexternal icon from Water Quality & Health Council

Updated CSTE clinical case definition for acute viral hepatitis A

CDC guidance on viral hepatitis surveillance and case management

CDC training on hepatitis A serology 

Hepatitis A general FAQs for Health Professionals

Educational Resources

CDC is developing educational materials to support the outbreak at the state and local levels. Most materials include an area where local information can be inserted. Your organization’s contact information can be typed into the blue colored rectangle. To upload your logo, click on the white space below the blue colored rectangle. In the pop-up box, select browse and upload a PDF version of your logo.

Fact Sheets

One page visual fact sheets encouraging vaccination for:

people who use drugs pdf icon[PDF – 244 KB]

gay and bisexual men pdf icon[PDF – 332 KB]

people experiencing unstable housing or homelessness pdf icon[PDF – 282 KB]

people who are or were recently in jail or prison pdf icon[PDF – 282 KB]

Two page visual fact sheet pdf icon[PDF – 615 KB] that includes information on hepatitis A prevention, transmission, symptoms and encourages multiple populations to get vaccinated

Pocket Cards

Outbreak of hepatitis A Pocket Card pdf icon[PDF – 786 KB] to localize with organization information and outlines who should get vaccinated and the symptoms of hepatitis A

Printing Instructions: These cards should be printed double-sided on 4.25” x 5.5” perforated postcard templates that print four double-sided cards per page. The print settings must be set to “Actual size” or “Custom Scale 100%” to ensure accurate alignment of the two sides of the cards.

Get Vaccinated Pocket Card pdf icon[PDF – 455 KB] to localize with information where to go to get the vaccine and who should get vaccinated

If You’re Sick Pocket Card pdf icon[PDF – 470 KB] to localize with information on where to go for medical care and the symptoms of hepatitis A

Pocket Card Printing Instructions: These cards should be printed double-sided on business card templates that print six double-sided cards per page. The print settings must be set to “Actual size” or “Custom Scale 100%” to ensure accurate alignment of the two sides of the cards.

279 sick: Salmonella infections again linked to backyard poultry

People, seriously, stop kissing your chicks.

The U.S. Centers for Disease Control reports that since the last update on May 16, 2019, illnesses in an additional 227 people and 20 states have been added to this investigation. Four Salmonella serotypes have also been added.

A total of 279 people infected with the outbreak strains of Salmonella have been reported from 41 states.

40 (26%) people have been hospitalized and no deaths have been reported.

70 (30%) people are children younger than 5 years.

Epidemiologic and laboratory evidence indicate that contact with backyard poultry, such as chicks and ducklings, from multiple hatcheries is the likely source of these outbreaks.

In interviews, 118 (77%) of 153 ill people reported contact with chicks or ducklings.

People reported obtaining chicks and ducklings from several sources, including agricultural stores, websites, and hatcheries.

One of the outbreak strains making people sick has been identified in samples collected from backyard poultry in Ohio.

People can get sick with Salmonella infections from touching backyard poultry or their environment. Backyard poultry can carry Salmonella bacteria but appear healthy and clean and show no signs of illness.

Follow these tips to stay healthy with your backyard flock:

Always wash your hands with soap and water right after touching backyard poultry or anything in the area where they live and roam.

Adults should supervise handwashing by young children.

Use hand sanitizer if soap and water are not readily available.

Don’t let backyard poultry inside the house, especially in areas where food or drink is prepared, served, or stored.

Set aside a pair of shoes to wear while taking care of poultry and keep those shoes outside of the house.

 

Damn you, hedgehogs: 27 now sick from Salmonella

The U.S. Centers for Disease Control reports that since the last update on March 29, 2019, illnesses in an additional 10 people and six states have been added to this investigation.

Twenty-seven people infected with the outbreak strain of Salmonella Typhimurium have been reported from 17 states.

Two people were hospitalized. No deaths have been reported.

Forty-two percent are children aged 12 or younger.

Epidemiologic and laboratory evidence indicate that contact with pet hedgehogs is the likely source of this outbreak.

Don’t kiss or snuggle hedgehogs, because this can spread Salmonella germs to your face and mouth and make you sick.

Don’t let hedgehogs roam freely in areas where food is prepared or stored, such as kitchens.

Clean habitats, toys, and supplies outside the house when possible. Avoid cleaning these items in the kitchen or any other location where food is prepared, served, or stored.

They are not cute and funny. They are Salmonella factories.

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.

 

Peeing in pools: Survey says half of Americans use swimming pools as communal bathtubs

Quixem Ramierz of KTXS writes that a lot of people pee in swimming pools.

I was one of them one of them.

A new survey finds more than half of Americans (51 percent) use swimming pools as a communal bathtub– either swimming as a substitute for showering or using the pool to rinse off after exercise or yardwork. And, still, Americans knowingly make pools dirty despite nearly two-thirds (64 percent) of respondents saying pool chemicals do not eliminate the need to shower before swimming.

“When dirt, sweat, personal care products, and other things on our bodies react with chlorine, there is less chlorine available to kill germs,” said Dr. Chris Wiant, chair of the Water Quality & Health Council. “Rinsing off for just 1 minute removes most of the dirt, sweat, or anything else on your body.”

The survey revealed 40 percent of Americans admit they have peed in the pool as an adult. Peeing in the pool reacts with chlorine and reduces the amount of chlorine available to kill germs.

“The bottom line is: Don’t pee in the pool,” said Michele Hlavsa, chief of CDC’s Healthy Swimming program. “Swimming is a great way to be physically active and not peeing in the pool is a key healthy swimming step.”

Worry about it: 1 dead, 7 sick from Listeria linked to deli-sliced products: Is steaming hot the same as piping hot?

I do not buy stuff from the deli-counter. I buy stuff that is pre-packaged and may contain antimicrobials, depending on what country you are in.

It’s all about the slicers, whether it’s the little ones at the deli counter or the huge industrial ones in food facilities – I’m looking at you Maple Leaf, source of 23 dead in 2008 in Canada – and how hard they are to properly clean.

Should deli meats be served in hospitals or aged care facilities where the immunocompromised abound?

The U.S. Centers for Disease Control reports a total of 8 people infected with the outbreak strain of Listeria monocytogenes have been reported from 4 states.

All 8 people have been hospitalized, and one death has been reported from Michigan.

Epidemiologic and laboratory evidence indicates that meats and cheeses sliced at deli counters might be contaminated with Listeria monocytogenes and could make people sick.

In interviews, ill people report eating different types and brands of products, including meats and cheeses, purchased from and sliced at deli counters in many different retail locations.

The outbreak strain has been identified in samples taken from meat sliced at a deli and from deli counters in multiple stores.

A single, common supplier of deli products has not been identified.

CDC is not advising that consumers avoid eating products prepared at delis, or that retailers stop selling deli-sliced products.

Retailers should clean and sanitize deli slicers.d

This outbreak is a reminder that people at higher risk for severe Listeria infection should handle deli-sliced meats and cheeses carefully to prevent illness. Pregnant women and their newborns, adults age 65 and older, and people with weakened immune systems are more likely to get sick with listeriosis.

People who are at higher risk for Listeria infection should avoid eating lunch meats, cold cuts, or other deli meats, unless they are heated to an internal temperature of 165°F or until steaming hot just before serving.

If you develop symptoms of a Listeria infection after eating deli-sliced products, contact a healthcare provider and tell them you ate deli-sliced products. This is especially important if you are pregnant, age 65 or older, or have a weakened immune system.

If you have eaten deli-sliced products and do not have any symptoms of a Listeria infection, most experts believe that tests or treatment are not needed, even for people who have a higher chance of Listeria infection.

Listeria bacteria can survive at very low temperatures and can spread easily to other foods and surfaces. Consumers should clean refrigerators, kitchen countertops, utensils, and other surfaces that touch deli-sliced products.

You can take steps to prevent Listeria infection:

Don’t let juice from lunch meat and hot dog packages get on other foods, utensils, and food preparation surfaces.

Wash hands after handling deli meats, lunch meats, deli cheeses, and hot dogs.

Store opened packages of meat sliced at a local deli no longer than 3 to 5 days in the refrigerator.

Why whole genome sequencing is important for food safety

In 1999, I gave a talk to hundreds of farm leaders in Ottawa and told them that DNA fingerprinting – via PulseNet – would revolutionize foodborne illness outbreak investigations and that farmers better be prepared (the pic is from a 2003 awards ceremony where I was acknowledged for my outreach and extension efforts, the hair was fabulous).

Twenty years later and whole genome sequencing is even further piecing together disparate outbreaks.

Joanie Stiers of Farm Flavor writes that Michigan’s laboratory toolbox now includes whole-genome sequencing, allowing public health officials to stop the spread of foodborne illness faster than ever.

Since January of 2017, the Michigan Department of Agriculture and Rural Development (MDARD) has actively used whole-genome sequencing to precisely identify illness-causing pathogens and defend against widespread outbreaks of foodborne diseases.

MDARD’s Geagley Laboratory works in tandem with laboratories in the U.S. Food & Drug Administration’s GenomeTrakr network, which allows global collaboration in the fight against foodborne illness.

“With food now being distributed worldwide, illness can be spread from anywhere in the world,” says Ted Gatesy, laboratory manager of the microbiology section at Geagley Lab, which houses the whole-genome sequencing. “Using whole-genome sequencing, an illness can be tracked, for the most part, to the point in the food chain where it originated.

Raw is risky: Drug-resistant brucellosis linked to raw milk

The U.S. Centers for Disease Control and Prevention and state health officials are investigating potential exposures to Brucella strain RB51 (RB51) in 19 states, connected to consuming raw (unpasteurized) milk from Miller’s Biodiversity Farm in Quarryville, Pennsylvania. One case of RB51 infection (brucellosis) has been confirmed in New York, and an unknown number of people may have been exposed to RB51 from drinking the milk from this farm. This type of Brucella is resistant to first-line drugs and can be difficult to diagnose because of limited testing options and the fact that early brucellosis symptoms are similar to those of more common illnesses like flu.­

The New York case is the third known instance of an infection with RB51 associated with consuming raw milk or raw milk products produced in the United States. The other two human cases occurred in October 2017 in New Jersey and in August 2017 in Texas. Those cases reported drinking raw milk from an online retailer and a Texas farm, respectively. In addition to these three confirmed cases, hundreds of others were potentially exposed to RB51 during these three incidents.

RB51 is a live, weakened strain used in a vaccine to protect cows against a more severe form of Brucella infection that can cause abortions in cows and severe illness in people. On rare occasions, cows vaccinated with RB51 vaccine can shed the bacteria in their milk. People who drink raw milk from cows that are shedding RB51 can develop brucellosis.

People who consumed raw milk or raw milk products from this dairy farm since January 2016 may have been exposed and should talk to their doctor.

People who are still within six months of the date they last consumed the raw milk are at an increased risk for brucellosis and should receive antibiotics to prevent an infection and symptoms, and should monitor their health for possible symptoms for six months. If symptoms develop, they should see their doctor immediately for testing.

Milk samples from Miller’s Biodiversity tested positive for RB51. A cow that tested positive for RB51 has been removed from the milking herd.