Norovirus spread through reusable grocery bag

I was sitting on the toilet this morning, answering e-mail while trying to hurry things up and get Sorenne to school, and I responded to an e-mail from a reporter at msnbc by saying, “don’t take reusable grocery bags to the bathroom.”

I could have said, don’t take groceries to the bathroom: I’ve seen it.

In 2010, seven of 17 players on a youth girls soccer team in Oregon fell ill while attending an out-of-state tournament. But, as investigators discovered, none of the players had been in direct contact with the index case — the first girl to get sick.

Investigators were stumped.

Kimberly K. Repp, PhD, an epidemiologist with the Washington County Department of Health and Human Services in Hillsboro, Ore. said, "We conducted a very extensive interview; it’s called a shotgun interview, where we ask about every possible food exposure. There are over 800 questions on the questionnaire.”

That helped the researchers figure out what the sick people ate and what the healthy people didn’t eat.

According to a new study in today’s Journal of Infectious Diseases, authored by Repp and Bill Keene, all the girls who got sick had eaten cookies during a Sunday lunch. By Tuesday, those cookies, along with much of the other foods the girls had eaten during their stay, had been thrown away.

The connection turned out to be a reusable grocery tote bag filled with the cookies and other food items like chips and grapes that had been sitting on the floor of the bathroom where the first girl had repeatedly gotten sick.

Investigators swabbed the bag two weeks after the first person fell ill. DNA tests turned up copies of the same strain of norovirus that had infected the girls.

"This is the first-ever reported case of transmitting this virus with an inanimate object, basically," Repp says.

The first sick girl said she never touched the bag. So how did the virus get there?

Experts say viral particles likely floated over from the toilet.

All the girls had traveled in private automobiles, shared hotel rooms, and eaten at local restaurants. Eight cases were identified, including the index patient who was presumably infected prior to the trip. There was no direct contact between the original patient and her teammates after her symptoms began; before her overt symptoms began she left her room and moved in with a chaperone. The girl subsequently began vomiting and having diarrhea in the chaperone’s bathroom. The outbreak affecting the rest of the team began several days later; they were exposed by handling a bag of snacks that unfortunately had been stored in the hotel bathroom. Virus aerosolized within the bathroom likely settled onto the grocery bag and its contents. Matching viruses were found on the reusable shopping bag two weeks later.

The investigation confirmed the great potential for contamination of surfaces in norovirus outbreaks on cruise ships, in nursing homes, and in other group settings.

"While we certainly recommend not storing food in bathrooms," the authors note, "it is more important to emphasize that areas where aerosol exposures may have occurred should be thoroughly disinfected; this includes not only exposed surfaces, but also objects in the environment" that could become contaminated and spread infection. The authors point to some of the practices that can be put in place to limit outbreaks caused by such indirect contact, including disinfection of affected areas and the use of multiple bathrooms with one dedicated for use by those who are sick.

In an accompanying editorial, Aron J. Hall, DVM, MSPH, of the Centers for Disease Control and Prevention, notes that noroviruses "are perhaps the perfect human pathogens," causing an estimated 21 million cases of acute gastroenteritis annually in the U.S. alone. The investigation of this outbreak, as reported by the study authors, "provides a fascinating example of how a unique exposure and transmission scenario can result in a norovirus outbreak."

"That certainly is an area of active research, involving the dynamics of vomiting, and how are particles dispersed when somebody vomits. There is a limited range, for sure, but exactly how far it is and what the level of risk is 10 feet away or 30 feet away. Certainly, in this case, it was plenty close to allow the virus to float over onto the bag," says Aron J. Hall, DVM, MSPH, of the CDC’s division of viral diseases.

Some info:

1. Norovirus can spread infection through contact with surfaces and objects contaminated by aerosolized particles.
2. Noroviruses are highly contagious, even in low concentration, and the viruses spread efficiently from feces and vomit by direct and indirect contact.
3. Noroviruses are the leading cause of endemic diarrheal disease across all age groups, the leading cause of foodborne disease, and the cause of half of all gastroenteritis outbreaks worldwide.
4. Whenever possible, ill persons should use a separate bathroom to reduce the potential for spread of the virus. Notify family members or cleaning staff about the need for thorough disinfection of surfaces.

Brazilian boy dies after eating poisoned cookies

A 12-year-old boy died after eating cookies poisoned by two girls at his school in north-eastern Brazil, police said today.

The girls, aged 13 and 14, admitted putting a deadly dose of rat poison in the cookies, but claimed they were meant for two rival girls at their school on the outskirts of the city of Recife.

The boy, who was called to deliver the toxic cookies to allay suspicions, was not aware of the plan and ate them instead, with deadly result. He was taken to hospital in agony and died shortly afterwards.

Children sickened after eating cannabis cookies

ABC News reports that children in California and Illinois have become ill in the last several weeks after eating cookies and brownies made with marijuana.

The cookies were made by a Colorado company that says they are legal because they are sold for medical purposes. The kids apparently didn’t know that; they shared the cookies during lunch and reported feeling nauseated about half an hour later.

In the most recent case, several elementary school students from Vallejo, Calif., got sick after eating marijuana-laced cookies given to one of them by a convenience store clerk.

According to the school district, the children have been released from the hospital and are doing well.

"It’s unclear if any of the children knew the cookies contained cannabis," police Sgt. Jeff Bassett said in a press release. "The packages are not clearly marked.”

Police are still trying to find the person who gave the cookies to the store clerk.

Cook your own food at Glasgow restaurant an invitation to health problems?

The Glaswegian reports that diners are being invited to make their own dishes at a new Glasgow restaurant.

Cookie will be the first restaurant in Scotland to invite customers into the kitchen to prepare and cook the food.

They will have access to quality ingredients and be guided by a trained chef.

The eaterie is the brainchild of Scots-Italian architect Domenico Del Priore.

He hopes the concept of "horizontal cooking" will break down barriers between chef and diner.

Inspired by open family restaurants in Italy, Domenico predicts "self cooking" will be the next big thing.

How will health inspectors view the latest trend? Especially with cross-contamination issues.

ABC News: 3 kinds of E. coli linked to Nestle’s cookie dough

Brian Hartman of ABC News is reporting that investigators have linked at least three different kinds of E. coli to Nestle’s cookie dough but they remain stumped as to just how the bacteria got in the product.

DNA testing of E. coli found in an unopened package of cookie dough at Nestle’s plant in Danville, Va., determined the genetic fingerprint of the E. coli found at the plant is different than E. coli that has been linked to a 30-state outbreak that has sickened at least six dozen people, and that an altogether different strain of E. coli was found in dough recovered from the home of a victim.

Dr. David Acheson, the Food and Drug Administration’s assistant commissioner for food safety said,

“The investigation is winding up. It is not exactly over yet. But we have not figured out the likely ingredient. … It is unlikely that we will ever make a final determination of how this contamination occurred. … Theres no indication that this was deliberate.”

Cooking with Pooh

Last night while Doug was cooking dinner and we were feeding Sorenne some rice cereal and squash, I noticed we still had a tube of Pillsbury Cookie Dough in the refrigerator leftover from last week’s cookie experiment. We decided to make some cookies and free up more space in the fridge.

Doug reminded me, as I got ready for the extremely complicated process of slicing the dough to put on a cookie sheet, that I needed to treat the product as though it were contaminated. I said, “But this isn’t the recalled dough.” To which Doug responded, “Just because it wasn’t recalled doesn’t mean that it isn’t contaminated.” True that. So we were careful not to cross-contaminate. We put the tube on a cutting board. I used a pair of scissors to open it up and immediately put them in the dishwasher. I sliced up the dough, put it on the cookie sheet, washed my hands thoroughly, and Doug took care of the actual baking.

The cookies were not nearly as delicious as the ones Katie and I used to make during her 5 month stay in Manhattan, and I’m sure they contained some dairy, but we ate all of the cookies anyway.

This week Tom sent us a book advertisement from, “Cooking with Pooh: Yummy Yummy Cookie Cutter Treats.” If you’re potentially cooking with poo, be careful not to cross-contaminate and do not eat uncooked dough.


Possible poop remnants and Nestle’s raw cookie dough

During the evening of Thursday, June 18, the Colorado Department of Public Health and Environment urged Coloradans not to eat raw Nestle Toll House cookie dough because of possible contamination with E. coli O157:H7.

The next morning, the U.S. Food and Drug Administration warned consumers not to eat any varieties of prepackaged Nestle Toll House refrigerated cookie dough due to the risk of contamination with E. coli O157:H7. At the same time, Nestlé announced a voluntary recall of all Toll House refrigerated cookie dough products, “out of an abundance of caution.”

My colleague Evan managed to get some of that recalled cookie dough, I got some other cookie dough, and we made cookies.

In the latest video from the Safe Food Café, I stress that cookie dough is a raw product (although the eggs have been pasteurized in any commercial product) and can therefore cross-contaminate anything in the kitchen, and that the warning labels and safe-handling instructions on packages of raw cookie dough are terrible.

D-listed and the problem with raw cookie dough

Michael K of celebrity blog D-listed encapsulates the problem with Nestle, raw cookie dough, labels and E. coli O157:H7, which has so far sickened 66 people in 28 states.

If you get the craving to eat cookie dough this weekend, lick this picture and don’t eat the real thing or you may doody until you dieeeeeee. … This weekend the grocery stores are totally going to be full of single depressed ladies trading in their unused cookie dough for SnackWells.

Why do they always recall delicious things? They never recall crap like peas or multi-grain Cheerios. … I always eat raw cookie dough. I tell myself that I’m going to bake it like a normal person, but then suddenly the bowl is empty and I have the guilties.

Cookie dough? Cookie dough contaminated with E. coli O157:H7?

In yet another example of different jurisdictions having different opinions about when to go public, the Colorado Department of Public Health and Environment sent out a press release last night urging Coloradans not to eat raw Nestle Toll House cookie dough because of possible contamination with E. coli O157:H7.

If the link is proven, cookie dough would join a long list of foods like produce, pet food, peanut butter and pot pies that consumers really have very little control over; it’s up to the producers and processors. Which makes various consumer education programs like FightBac sorta backwards. Consumers have a role in food safety, but not with this stuff.

Colorado state health officials, the CDC and several other state health departments are investigating an outbreak of E. coli O157:H7 infections.

To date, 66 cases from 28 states have been identified. Preliminary evidence from the multi-state investigation suggests that Nestle Toll House cookie dough may be the source of the outbreak, although further investigation is ongoing.

Five cases have been reported in Colorado in the following counties: Denver, Douglas (2), Jefferson and Weld. Two of the people have been hospitalized, and one has developed a severe complication called hemolytic uremic syndrome. Of the four people interviewed so far by the state health department, all had consumed the raw cookie dough during the week before they became ill.

Alicia Cronquist, the foodborne disease epidemiologist at the state health department, said,

“We can’t be certain that raw cookie dough is the source of these infections, but we are concerned enough that it might be and want consumers to be aware.”

Daniel Rifkin, Wholesale Food Program manager for the Department of Public Health and Environment’s Consumer Protection Division, said,

“Nestle is currently evaluating what actions they will take regarding their product. In the meantime, it is important that consumers do not eat or use raw Nestle Toll House cookie dough for now. If you decide to use the product, ensure that the cookies are cooked thoroughly and wash your hands well after handling the raw dough. More information will be forthcoming.”