Best communication practices in communicating a drinking water-related public health emergency

I guess someone published this again, since the Walkerton outbreak of E. coli O157 which killed seven and sickened over 2,000 k in a town of 5,000 happened in May 2000.

I know it’s not the best writing, but I tried, and it was 20 years ago. I severed on an expert (I hate that word) committee and we wrote our report.

We live near the publicaly 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 Walkerton-resident friend and what he went through in the aftermath of the E. coli O157 outbreak in drinking water.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 E. coli O157:H7 waterborne outbreak in Walkerton, Ont., Canada, in May 2000, presented a clear and present danger of risk to citizens who consumed that water — at least in retrospect. More challenging though, is to know when a risk is severe enough to warrant extraordinary communications and how best to compel citizens to comply with health advisories.

Risk theory, involving assessment, management and communication, is important to underpin discussions of how regulators, industry and citizensincorporate and act on information about risks — such as the hazards posed by E. coli O157:H7 in drinking water. Today it is well accepted that the three components of risk analysis cannot be separated and are, in fact, integrated, and that communication involves the multi-directional flow of information.

Evidence from recent water-borne disease outbreaks illustrates the importance of timeliness in health related warnings.

Timeliness of message delivery is dependent on how quickly a problem is identified, and how the message is delivered. The public can passively receive information on health related risks  from the media or the utility, or actively seek out information from information sources such as the Internet, telephone hotlines or library services (Casman et al., 2000).

In determining when to go public with health advisories, health authoritiesreport that every outbreak of food- or water-borne illness must be examine dusing factors such as severity, potential impact and incubation time of the suspect pathogen. The health risk outcome of microbiological hazards to the public should be assessed, discussed and quantified among workers from diverse disciplines, including health officials, veterinarians, food processing experts, microbiologists, medical doctors, risk analysis experts, and consumer behavior experts.

Once sufficient evidence exists to issue a public health advisory, risk messages must be designed that accurately describe the risk to individuals and provide concrete steps that individuals can take to reduce the chances of risk exposure.

Further, the number of suspected or confirmed illnesses related to the particular outbreak should be included as a matter of course in any public communications. And once health advisories have been created, a variety ofmessage delivery techniques need to be employed, again depending on the severity of the hazard, the size of the impacted population and local circumstances.

For a severe and immediate hazard such as E. coli O157:H7 in drinking water, a mixture of low-to-high technology message delivery mechanisms should be employed, including door-to-door, the buddy system, the use of existing community networks such as Neighbourhood Watch, emergency hubsite information centers and even mobile megaphones, complimented by more broader mechanisms such as local media, posting information on a website, automated telephone messages, broadcast faxes, and electronic mail distribution.

However, the key to using any of these technologies effectively is to plan ahead and be prepared.  Effective planning will establish which techniques are best for the size of the community and the existing infrastucture.  No one technology can reach all members of the target audience, therefore combining delivery methods is essential.

The current state of risk management and communication research suggests that those responsible with food and water safety risk management must be actively seen to be reducing, mitigating or minimizing a particular risk. The components for managing the stigma associated with any food safety issue seem to involve all of the following factors:

  • effective and rapid surveillance systems;
  • effective communication about the nature of risk;
  • a credible, open and responsive regulatory system;
  • demonstrable efforts to reduce levels of uncertainty and risk; and,
  • evidence that actions match words.

This report has been concerned with the second point, the ability to effectively communicate about the nature of risk. E. coli O157:H7 is not regular E. coli. It is a highly virulent and dangerous pathogen that sickens tens of thousands annually in North America and kills hundreds. Each year since the 1993 Jack-in-the-Box outbreak has brought a high profile and deadly outbreak of E. coli O157:H7 from some corner of the developed world; outbreaks that receive significant media coverage and provide new insights; Australia in 1994 (involving the related E. coli O111); Scotland and Japan in 1996; a waterpark in Atlanta, Ga in 1998. While many Canadians may be unfamiliar with such outbreaks — media coverage in Canada is superficial at best, frequently focused on the hypothetical risks posed by various food-related technologies while ignoring the carnage associated with food and water-borne pathogens

Any local efforts must be supported by a national culture of awarenessregarding a risk such as E. coli O157:H7, which has been known to cause outbreaks and severe illness, and sometimes death, for almost 20 years. When compared to outbreaks and response in the U.S., it is observed that outbreaks, particularly of E. coli O157:H7 bring a sustained policy response from the highest levels of government, including the Office of the President. While there have been many private-sector initiatives in Canada to enhance the safety of the food supply, these efforts are rarely communicated or discussed by government, short of admonitions to “cook hamburger thoroughly.

If I dance, it’s poorly, but I loved it.

Canadian boy permanently brain damaged after eating lettuce contaminated with E. coli

Tyana Grundig, Greg Sadler and Asha Tomlinson report for CBC’s Marketplace (see below) that the last decade has seen recall after recall of tainted romaine lettuce coming into Canada from the United States. At least seven people have died, and hundreds have been sickened or hospitalized in both countries.

Toddler Lucas Parker was one of them.

In the fall of 2018, his parents, Nathan Parker and Karla Terry of Richmond, B.C., took Lucas and his siblings to Disneyland, their first trip outside Canada. But what they couldn’t know at the time was that a few bites of romaine salad Lucas ate one night at a small California roadside restaurant would change their lives forever. 

Soon after that dinner, an outbreak of E. coli O157: H7 contamination spread across both Canada and the United States — eventually leaving 35 people hospitalized.

Like most people who get sick from this strain of E. coli, Lucas, then two years old, didn’t show symptoms right away. When he started feeling unwell, the family headed out for the long drive home. By the time he was in a Canadian hospital, the E. coli had shut down one of his kidneys and led to two brain injuries. There are no current treatments for E. coli that can help alleviate infections or prevent complications. 

Lucas can no longer walk, talk or see. 

“Lucas was just a beaming ray of light … he was a caring person … a cheeky boy, a loving brother,” said his father, Nathan Parker. “I remember him in the hospital waking up out of a coma and looking around, just lost, not talking, not walking, not moving much. Such a brain injury that his brain was so swollen that there was no comfort, there was nothing. It was just hell.”

Bill Marler, an American lawyer and food-safety advocate who has been fighting for food safety for almost 30 years, represents Lucas and his parents. Marler has filed suit on behalf of the family against the restaurant where they ate, as well as the farm and suppliers of the lettuce; the case is currently in the discovery phase in a court system slowed down because of the COVID-19 pandemic. 

Lucas, “is the most devastatingly injured human who has survived a food-borne illness outbreak — ever,” said Marler. “The fact that he survived at all and his parents care for him as gently and as caringly as they do is a testament to them.”

Young children and older adults are most at risk of developing serious complications from E. coli O157: H7 contamination. While most people simply experience an upset stomach, some develop life-threatening symptoms, including stroke, kidney failure and seizures — and some die. 

Between 2009 and 2018, the U.S. Food and Drug Administration (FDA) and Centers for Disease Control and Prevention (CDC) say they identified 40 food-borne outbreaks of infections from this strain of E. coli in the U.S. with a confirmed or suspected link to leafy greens.

Marler says he believes cows — and a society that values convenient, bagged lettuce — are to blame.

Romaine recalls: Why our salads can make us sick

CBC’s Marketplace (that’s a TV show in Canada) notes that Canada has been hit by a number of romaine lettuce recalls. We set out to the U.S., where the majority of our leafy greens come from, to dig up why E. coli outbreaks continue to plague our food supply. We meet one B.C. family whose lives have been forever changed by a contaminated salad (thanks to Bill Marler for posting on this).

Foodborne fungus impairs intestinal wound healing in Crohn’s disease

Researchers at Washington University School of Medicine in St. Louis and the Cleveland Clinic have discovered that a fungus found in foods such as cheese and processed meats can infect sites of intestinal damage in mice and people with Crohn’s and prevent healing. Moreover, writes Tamara Bhandari of News Room treating infected mice with antifungal medication eliminates the fungus and allows the wounds to heal.

The findings, published March 12 in the journal Science, suggest that antifungal drugs and dietary changes are potential new approaches to improving intestinal wound healing and reducing symptoms of Crohn’s disease.

“We’re not suggesting that people stop eating cheese and processed meat; that would be going far beyond what we know right now,” said first author Umang Jain, PhD, an instructor in pathology & immunology at the School of Medicine. “What we know is that this foodborne fungus gets into inflamed, injured tissue and causes harm. We’re planning to perform a larger study in people to figure out if there’s a correlation between diet and the abundance of this fungus in the intestine. If so, it is possible dietary modulation could lower levels of the fungus and thereby reduce symptoms of Crohn’s disease.”

Crohn’s is a subtype of inflammatory bowel disease. As the name suggests, it is driven by chronic inflammation in the digestive tract and primarily treated with immunosuppressive medications. Crohn’s patients endure repeated cycles of gastrointestinal symptom flare-up and remission. During a flare, their digestive tracts are dotted with inflamed, open sores that can persist for weeks or even months.

To understand why intestinal ulcers take so long to heal in some people, Jain and senior author Thaddeus Stappenbeck, MD, PhD, formerly at Washington University and now at the Cleveland Clinic, studied mice whose intestines had been injured. By sequencing microbial DNA at the site of injury, they discovered that the fungus Debaryomyces hansenii was abundant in wounds but not in uninjured parts of the intestine.

People acquire the fungus through their food and drink, Jain said. D. hansenii is commonly found in all kinds of cheeses, as well as sausage, beer, wine and other fermented foods.

FDA, California agricultural stakeholders launch multi-year study to enhance food safety

This is a few months old, but if Frank’s in it, I’ll run it, late but not never.

The following quote is attributed to Frank Yiannas, FDA Deputy Commissioner for Food Policy and Response:

The FDA is committed to providing innovative food safety approaches that build on past learnings and leverage the use of new information and data. Today we’re announcing a partnership with the California Department of Food and Agriculture (CDFA), the University of California, Davis, Western Center for Food Safety (WCFS), and agricultural stakeholders in the Central Coast of California to launch a multi-year longitudinal study to improve food safety through enhanced understanding of the ecology of human pathogens in the environment that may cause foodborne illness outbreaks.”

“The launch of this longitudinal study follows a series of E. coli O157:H7 outbreaks in recent years linked to California’s leafy greens production regions, particularly three outbreaks that occurred in Fall 2019. Due to the recurring nature of outbreaks associated with leafy greens, the FDA developed a commodity-specific action plan to advance work in three areas: prevention, response, and addressing knowledge gaps. We’ve already made great strides executing our 2020 Leafy Greens Shiga toxin-producing E. coli (STEC) Action Plan by engaging with state partners to implement new strategies for preventing outbreaks before they occur, collaborating with industry partners to assess and augment response efforts when an outbreak occurs, and analyzing past leafy greens outbreaks to identify areas of improvement important to enhance leafy greens safety.”

“In alignment with the FDA’s New Era of Smarter Food Safety initiative, the findings from this longitudinal study will contribute new knowledge on how various environmental factors may influence bacterial persistence and distribution in the region, and how those factors may impact the contamination of leafy greens.”

The California longitudinal multi-year study will examine how pathogens survive, move through the environment and possibly contaminate produce, through work with water quality, food safety, and agricultural experts from CDFA, the WCFS, representatives from various agriculture industries, and members of the leafy greens industry.

Foodborne illness source attribution estimates for 2018 for Salmonella, Escherichia coli O157, Listeria monocytogenes, and Campylobacter using multi-year outbreak surveillance data, United States, December 2020

The U.S. Centers for Disease Control and Prevention reported in Dec.2020 that each year in the U.S.an estimated 9 million people get sick, 56,000 are hospitalized, and 1,300 die of foodborne disease caused by known pathogens. These estimates help us understand the scope of this public health problem. However, to develop effective prevention measures, we need to understand the types of foods contributing to the problem.

The Interagency Food Safety Analytics Collaboration (IFSAC) is a tri-agency group created by the Centers for Disease Control and Prevention (CDC), the U.S. Food and Drug Administration (FDA), and the U.S. Department of Agriculture’s Food Safety and Inspection Service (USDA-FSIS). IFSAC developed a method to estimate the percentages of foodborne illness attributed to certain sources using outbreak data from 1998 through the most recent year for four priority pathogens: Salmonella, Escherichia coli O157, Listeria monocytogenes, and Campylobacter. IFSAC described this method and the estimates for 2012 in a report, peer-reviewed journal article, and at a public meeting. IFSAC derived the estimates for 2018 using the same method used for the 2012 estimates, with some modifications. The data came from 1,459 foodborne disease outbreaks that occurred from 1998 through 2018 and for which each confirmed or suspected implicated food was assigned to a single food category. The method relies most heavily on the most recent five years of outbreak data (2014 – 2018). Foods are categorized using a scheme IFSAC created that classifies foods into 17 categories that closely align with the U.S. food regulatory agencies’ classification needs. Salmonella illnesses came from a wide variety of foods.

More than 75% of Salmonella illnesses were attributed to seven food categories: Chicken, Seeded Vegetables (such as tomatoes), Pork, Fruits, Other Produce (such as nuts), Eggs and Turkey. E. coli O157 illnesses were most often linked to Vegetable Row Crops (such as leafy greens) and Beef. Over 75% of illnesses were linked to these two categories. Listeria monocytogenes illnesses were most often linked to Dairy products and Fruits. More than 75% of illnesses were attributed to these two categories, but the rarity of Listeria monocytogenes outbreaks makes these estimates less reliable than those for other pathogens. Non-Dairy Campylobacter illnesses were most often linked to Chicken. Over 75% of non-Dairy foodborne illnesses were attributed to Chicken, Other Seafood (such as shellfish), and Turkey, with Campylobacter illnesses most often linked to Chicken. An attribution percentage for Dairy is not included because, among other reasons, most foodborne Campylobacter outbreaks were associated with unpasteurized milk, which is not widely consumed, and we think these over-represent Dairy as a source of illness caused by Campylobacter. Removing Dairy illnesses from the calculations highlights important sources of illness from widely consumed foods, such as Chicken.

This collaborative effort to provide annual attribution estimates continues IFSAC’s work to improve foodborne illness source attribution, which can help inform efforts to prioritize food safety initiatives, interventions, and policies for reducing foodborne illnesses. These consensus estimates allow all three agencies to take a consistent approach to identifying food safety priorities to protect public health. For more information on IFSAC projects visit https://www.cdc.gov/foodsafety/ifsac/projects/index.html.

Raw is risky: Beware fresh produce and E. coli

Technology Networks reports that E. coli food poisoning is one of the worst food poisonings, causing bloody diarrhea and kidney damage. But all the carnage might be just an unintended side effect, researchers from UConn Health report in the 27 November issue of Science Immunology. Their findings might lead to more effective treatments for this potentially deadly disease.

Escherichia coli are a diverse group of bacteria that often live in animal guts. Many types of E. coli never make us sick; other varieties can cause traveler’s diarrhea. But swallowing even a few cells of the type of E. coli that makes Shiga toxin can make us very, very ill. Shiga toxin damages blood vessels in the intestines, causing bloody diarrhea. If Shiga toxin gets into the bloodstream it can cause kidney failure.

“This is especially common in children; about 15% of kids with Shiga toxin-producing E. coli infections get kidney disease, and some can suffer long term kidney damage,” says UConn Health immunologist Sivapriya Vanaja.

A group of Shiga toxin-producing E. coli called enterohemorrhagic E. coli, or EHEC, are especially common in the United States. When you hear that a batch of romaine lettuce is being recalled because of a dangerous outbreak of food poisoning, it’s almost certainly due to EHEC.

EHEC normally live in cattle without making them sick. It used to be relatively common to have EHEC outbreaks coming from unhygienically prepared ground meat, but stringent regulations on slaughterhouses have made this less common. Now it’s more likely for EHEC to appear on vegetables grown in fields adjacent to cattle or manure runoff.

But no matter where it comes from, once EHEC bacteria get inside a human, the infection is hard to treat. Antibiotics tend to make it worse—when the bacteria feel themselves dying, they make more Shiga toxin. And EHEC are very good at inhibiting the part of the immune system that normally responds early to this kind of infection, allowing them to grow unchecked in the human gut.

In a study led by Morena Havira, a postdoctoral fellow in Vanaja’s lab, the team wanted to know how EHEC suppresses the immune system. The body normally responds to early stages of E. coli infections by activating an enzyme that kicks off an alarm inside cells. The cell bursts open to release a cloud of warning molecules that call other parts of the immune system to come and fight the bacteria.

But EHEC squashes that early response. To figure out how it does that, Vanaja and her colleagues decided to see which individual gene in EHEC was responsible. They took many different varieties of EHEC from a bacterial mutant library, and infected immune cells with them.

The team found that cells infected with EHEC that was missing the gene for Shiga toxin mustered a higher immune response compared to normal EHEC.

It was surprising. Shiga toxin is very well-studied for its toxic activity; it wasn’t known that it had another function,” Dr. Vanaja says. So Shiga toxin’s stealthy suppression of the immune system may have a link to all the bloody drama that ensues. Spurred on by this exciting observation, they conducted a series of detailed molecular studies, which revealed that Shiga toxin blocks a protein from bursting open the infected cell and alerting the body of infection.

Now that Vanaja and her colleagues know the specific molecular step Shiga toxin interferes with inside the immune cells, they are trying to figure out how, exactly, it blocks it. Once they know that, they may be able to find medicines that prevent toxin from interfering with immune responses.
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No hair, sharper blog, more love: US E. coli investigation details

Yeah, I fell again a couple of weeks ago, lost a lot of blood, so the doc wanted to have a look at the two contusions.

She started shaving the back of my head, the long hair that gives me strength, and eventually my friend and I told the doc, “Let’s try something different and take it all off.”

There are those who call me Uncle Fester.

The U.S. Centers for Disease Control, public health and regulatory officials in several states, the U.S. Food and Drug Administration (FDA), and the U.S. Department of Agriculture’s Food Safety and Inspection Service (USDA-FSIS) are collecting different types of data to identify the food source of a multistate outbreak of E. coli O157:H7 infections.

As of February 1, 2021, a total of 16 people infected with the outbreak strain have been reported from 5 states.

Illnesses started on dates ranging from December 23, 2020, to January 7, 2021.

Sick people range in age from 10 to 95 years, with a median age of 31, and 88% are female. Of 12 people with information available, 9 have been hospitalized. Of 11 people with information, 3 developed a type of kidney failure called hemolytic uremic syndrome (HUS). One death has been reported from Washington.

State and local public health officials are interviewing people to find out what foods they ate in the week before they got sick.

The continuing prevalence of shiga-toxin producing E. coli in produce

Chris Koger of The Packer writes the U.S. Centers for Disease Control and Prevention has added 16 more people to an E. coli outbreak investigation of unknown origin, bringing the total to 39. Cases have been reported in 18 states; there have been no deaths.

According to the CDC’s Nov. 23 update, “Of the 22 ill people interviewed to date, all reported eating a variety of leafy greens, like spinach (16), romaine lettuce (15), iceberg lettuce (12), and mixed bag lettuce (8). No single type or brand of leafy greens or other food item has been identified as the source of this outbreak. CDC is not advising people avoid any particular food at this time.

Dole Fresh Vegetables, Inc. is voluntarily recalling a limited number of cases of organic romaine hearts. The products being recalled are Dole™ Organic Romaine Hearts 3pk (UPC 0-71430-90061-1), combined English/French packaging, with Harvested-On dates of 10-23-20 and 10-26-20, and Wild Harvest Organic Romaine Hearts (UPC 7-11535-50201-2), with Harvested-On dates of 10-23-20 and 10-26-20.  The recall is being conducted due to a possible health risk from E. coli in the two products.  Dole Fresh Vegetables is coordinating closely with regulatory officials. No illnesses have been reported to date in association with the recall. 

Pathogenic E. coli can cause diarrhea, severe stomach cramps and vomiting.  Most people recover within a week, but some illnesses can last longer and can be more severe.

This precautionary recall notification is being issued due to an isolated instance in which a package of Dole™ Organic Romaine Hearts – 3pk yielded a positive result for pathogenic non-O157 E.coli STEC in a routine sample collected at a retail store by the Michigan Department of Agriculture and Rural Development. There is no indication at this time that this positive result is related to any illnesses nor consumer complaints and it is not associated with the strains connected to the ongoing outbreaks currently under regulatory investigation. 

‘My five-year-old son died with E. coli after eating infected meat at school. He would have been 21 this year’

I’m sorry I missed this story in Wales Online from Sept. 13, 2020, as I was doing my own recovering.

Cathy Owen writes that Sharon Jeffreys dreads this time of year.

As children return for the start of the school year, she relives what happened to her family 15 years ago over and over, and over again.

It was only two weeks into the start of the school year at Deri Primary in 2005 when her eldest son Chandler came home with stomach pains and the beginning of a nightmare for the young family.

Chandler had contracted E. coli O157 after eating contaminated food that had been supplied to the school by a local butcher.

But worse was to come after his younger brother Mason also became ill with the food poisoning.

The five-year-old had only just switched from taking packed lunches to having school dinners because he was so fond of chips and sausages.

“It was the worse decision I ever made,” says Sharon. “Mason loved his food. He was taking sausages and chips off the plates of children, so we decided to switch him to school dinners and he was really happy.”

Mason and eight-year-old Chandler were one of more than 150 schoolchildren and adults struck down in the south Wales outbreak. Thirty-one people were admitted to hospital, but Mason was the only one to die.

He had suffered high temperatures, stomach pains and had hallucinations and was admitted to Bristol children’s hospital, but died of kidney failure.

Today, his mum Sharon remembers every moment of those terrifying days.

“It will be 15 years on September 13 when Chandler first became ill,” she remembers. “When Mason started to be sick I tried to do everything I possibly could. Mason’s condition deteriorated considerably and he started to hallucinate saying he could see slugs and frogs.

“He went a yellow colour and started sweating like he’d just come out of a shower. Mason died two weeks later in unbearable pain.”

Reflecting on the amount of time that has passed, Sharon says: “I just can’t believe how long it has been, it feels like such a long time since I last saw him.

“It is still very difficult to think about, but at this time of year I always relive that awful time. I always dread September coming along because it takes me back there.

“I will never get over it, but I have had to learn how to live with it, but little things can take me back there. Like I see a blade of grass, or hear something and it takes me back with a jolt.

“After Mason died it was really busy, there was the inquest and then the legal proceedings, so I didn’t actually face what had happened for a long time, and then it went quiet and it was like trying to scramble out of a big black hole.

“Mason would have been 21 in December. He should have been looking forward to celebrating that milestone in his life.

“Chandler is 23 now, but he is not the same person. He and Mason were so close, it has left a big hole in his life.

“My younger son is 16 and it has affected his life too. He can’t remember Mason because he wasn’t even one at the time, and that upsets him.”

Fifteen years on and Sharon and her family still feel that they have been denied justice.

Bridgend butcher William Tudor, 56, was jailed for breaching hygiene laws by allowing raw meat to come into contact with cooked ham and turkey.

public inquest in 2010 heard how Tudor put cash before hygiene for years and may have caused other food poisoning outbreaks.

Butcher William Tudor was jailed for 12 months

It was claimed he bought cheap frozen New Zealand mutton and passed it off as prime Welsh lamb and staff who brought him rotten meat unfit for consumption were told to “mince it up” and use it in faggots.

Sharon went  on to immerse herself in other food safety issues, including a push to make restaurant inspection disclosure – scores on doors – mandatory in Wales. Voluntary disclosure misses the point and if large cities like Toronto, New York and Los Angeles can figure out how to make it mandatory so can Wales.

Disclosure became mandatory in Wales and Northern Ireland in Nov. 2013, thanks in part – or largely — to Sharon’s efforts.

The rest of the UK, and Australia, wallows in a voluntary system: lousy score, don’t post it.

“The food hygiene rating scheme is very important and it is good that more people are more aware after what happened,” says Sharon.

“It is a bit concerning to hear that Covid might have an impact on some council environmental services, but we need to make sure there are more officers carrying out inspections and making sure that best practice is being followed.

“I have heard back from people that they have used our story as part of their training for cooks and kitchen staff.

“Before Mason’s death I had never really heard of E. coli. I had heard the name, but didn’t know much about it.

“Now, I think people are definitely more aware. That is good to know, good to know that people haven’t forgotten, even after all these years.”