Whittaker: Market food safety

Ashley Nickle of The Packer wrote in Oct. 2019 (did I mention the bit about catch up, 8 broken ribs and a broken collarbone) PMA chief science and technology officer Bob Whitaker gave an impassioned presentation at Fresh Summit on the improvements that need to be made in food safety across the industry. Ten years after the formation of the Center for Produce Safety, companies can’t assert anymore that there isn’t relevant research to inform practices, Whitaker said.

Whitaker gave specific examples of potentially risky practices that are common. He mentioned setting harvest containers on the ground before they’re filled, and spoke about relying on the presence of generic E. coli in agricultural water to indicate pathogenic E. coli, along with several other examples.

Whitaker encourages companies to get competitive on food safety if that will get them to push past the status quo. He urged industry members to consider the costs when outbreaks happen, and he mentioned the death of a toddler during the 2006 outbreak linked to spinach.

“If we look at the recent issues we’ve had, we had an issue that involved water,” Whitaker said. “People said, ‘Well, we measured the water, we looked at generic E. coli.’ Well yeah, but the research has told us for years that generic E. coli does not represent the presence of pathogenic E. coli or salmonella. And In fact, at the volumes we do, we’re not going to find it.

“We also know that in every water system we’ve looked at around the U.S., I don’t care what crop, it has nothing to do with crop, every place the researchers have looked at and we’ve had a concentrated effort, we found contamination in open water sources — back east, out west, up north, doesn’t make a difference,” Whitaker said. “That’s where it is.”

Growing near concentrated animal feeding operations is another practice that the research indicates carries some risk.

“We know that dust will make the stuff travel,” Whitaker said. “Now we don’t know how far, but we know the one experiment that was done went out to 600 and it was there, so maybe it went farther …”

He also noted several practices in the field that he described as problematic yet commonplace.

“If I had a nickel for every picture I get every summer of people showing me Port-A-Johns being serviced in the field next to a harvest crop, I could have retired a couple years ago,” said Whitaker, who plans to retire from PMA in January.

“Don’t tell me it doesn’t drip, and then we wonder how we get some of these things like parasites in our fields,” Whitaker said.

He mentioned harvest sleds being left in the field overnight with the day’s debris still on them as another potential problem.

 “I’m seeing companies now breaking away from what everybody else is doing and say, ‘You know what, this is what we’re going to do,’” Whitaker said. “And we’ve always abhorred that idea. We’ve always said that food safety is something we share with each other, we don’t compete on it.

“To hell with that,” Whitaker said. “One thing this industry knows how to do is compete … You’ve always been marketing it anyway — you know you have. I see the stories. I see myself show up in people’s marketing things to their customers. I know that they’re marketing that.

“So do it,” Whitaker said. “If that’s what it’s going to take to get better, to create competition to get better, then do it. Because that’s what we need to do. We need the impetus to do it.”

Persister, I don’t even know her: STEC in produce

Bacterial persistence is a form of phenotypic heterogeneity in which a subpopulation, persisters, has high tolerance to antibiotics and other stresses. Persisters of enteric pathogens may represent the subpopulations capable of surviving harsh environments and causing human infections. Here we examined the persister populations of several shiga toxin-producing Escherichia coli (STEC) outbreak strains under conditions relevant to leafy greens production.

The persister fraction of STEC in exponential-phase of culture varied greatly among the strains examined, ranging from 0.00003% to 0.0002% for O157:H7 strains to 0.06% and 0.08% for STEC O104:H4 strains. A much larger persister fraction (0.1–11.2%) was observed in STEC stationary cells grown in rich medium, which was comparable to the persister fractions in stationary cells grown in spinach lysates (0.6–3.6%). The highest persister fraction was measured in populations of cells incubated in field water (9.9–23.2%), in which no growth was detected for any of the STEC strains examined. Considering the high tolerance of persister cells to antimicrobial treatments and their ability to revert to normal cells, the presence of STEC persister cells in leafy greens production environments may pose a significant challenge in the development of effective control strategies to ensure the microbial safety of fresh vegetables.

Enhanced formation of shiga toxin-producing Escherichia coli persister variants in environments relevant to leafy greens production

Science Direct, Food Microbiology, Volume 84

Sandy Thao, Maria T. Brandl, Michelle Qiu Carter

https://www.sciencedirect.com/science/article/pii/S0740002018311353

Jimmy John’s and sprouts — again

Remember when Jimmy John’s, the sandwich favored by university faculty department meetings and college students across the U.S., sickened hundreds of people across the U.S linked to raw alfalfa sprouts so they switched to raw clover sprouts and made more people sick?

It’s happened again.

Chris Koger of The Packer reported in late Dec. 2019 that Sprouts Unlimited, Marion, Iowa, is recalling clover sprouts, which have been linked to a cluster of E. coli cases under investigation in Iowa.

The Iowa Department of Inspections and Appeals is investigating the link between the outbreak and the product from Sprouts Unlimited, according to a Dec. 27 recall notice from the company.

The sprouts were shipped to Hy-Vee and Fareway Foods stores, and Jimmy John’s restaurants.

The retail packs in the recall are in pint containers with a blue label on the lid, according to Sprouts Unlimited. The Universal Product Code is 7 32684 00013 6 is on the bottom right side of the label.

The Iowa Department of Inspections and Appeals told Sprouts Unlimited the sprouts are epidemiologically linked to the outbreak. More tests are being conducted to determine the source, according to the recall notice.

We document at least 55 sprout-associated outbreaks occurring worldwide affecting a total of 15,233 people since 1988. A comprehensive table of sprout-related outbreaks can be found here.

Failures in sprouts-related risk communication

Food Control.2012. 10.1016/j.foodcont.2012.08.022

Erdozain, M.S., Allen, K.J., Morley, K.A. and Powell, D.A.

http://www.sciencedirect.com/science/article/pii/S0956713512004707?v=s5

Nutritional and perceived health benefits have contributed to the increasing popularity of raw sprouted seed products. In the past two decades, sprouted seeds have been a recurring food safety concern, with at least 55 documented foodborne outbreaks affecting more than 15,000 people. A compilation of selected publications was used to yield an analysis of the evolving safety and risk communication related to raw sprouts, including microbiological safety, efforts to improve production practices, and effectiveness of communication prior to, during, and after sprout-related outbreaks. Scientific investigation and media coverage of sprout-related outbreaks has led to improved production guidelines and public health enforcement actions, yet continued outbreaks call into question the effectiveness of risk management strategies and producer compliance. Raw sprouts remain a high-risk product and avoidance or thorough cooking are the only ways that consumers can reduce risk; even thorough cooking messages fail to acknowledge the risk of cross-contamination. Risk communication messages have been inconsistent over time with Canadian and U.S. governments finally aligning their messages in the past five years, telling consumers to avoid sprouts. Yet consumer and industry awareness of risk remains low. To minimize health risks linked to the consumption of sprout products, local and national public health agencies, restaurants, retailers and producers need validated, consistent and repeated risk messaging through a variety of sources.

Australian smallgoods company Wintulichs recalls mettwurst products amid contamination fears

Several types of mettwurst, manufactured by a South Australian Company, have been recalled after it was discovered the products may be contaminated with harmful bacteria.

Wintulichs, based in Gawler, recalled their Metwurst Garlic 300g, 375g, 500g, 700g, Mettwurst Plain 700g and Mettwurst Pepperoni 375g products.

Food Standards Australia New Zealand say the products have been sold at Woolworths, IGA and independent stores across SA.

The recall is due to incorrect pH and water activity levels, which may lead to microbial contamination and could cause illness if consumed.

Customers should return the products to the place of purchase for a full refund.

In Australia and around the world, the incidence of reported foodborne  illness is on the increase. Regularly cited estimates suggest that Australia is  plagued with over two million cases of foodborne  illness each year, costing  the community in excess of $1 billion annually.

Based on the case studies cited here and a thorough examination of a variety of documents disseminated for public consumption, government and  industry in Australia are well aware of the challenges posed by greater public  awareness of foodborne illness. They are also well aware of risk  communication basics and seem eager to enter the public fray on contentious issues. The primary challenge for government and industry will be to provide evidence that approaches to managing microbial foodborne risks are indeed mitigating and reducing levels of risk; that actions are matching words.

There  is a further challenge in impressing upon all producers and processors the  importance of food safety vigilance, as well as the need for a comprehensive crisis management plan for critical food safety issues.

On Feb. 1, 1995, the first report of a food poisoning outbreak in Australia  involving the death of a child from hemolytic uremic syndrome (HUS) after  eating contaminated mettwurst reached the national press. The next day, the causative organism was identified in news stories as E. coli 0111, a Shiga-toxin E. coli (STEC) which was previously thought to be destroyed by the acidity in fermented sausage products like mettwurst, an uncooked, semi-dry fermented sausage. By Feb. 3, 1995, the child was identified as a four-year-old girl and the number sickened in the outbreak was estimated at 21.

The manager of the company that allegedly produced the contaminated mettwurst had to hire security guards to protect his family home as threats continued to be made on his life, and the social actors began jockeying for position in the  public discourse. The company, Garibaldi, blamed a slaughterhouse for  providing the contaminated product, while the State’s chief meat hygiene  officer insisted that meat inspections and slaughtering techniques in  Australian abattoirs were “top class and only getting better.”

On Feb. 4, just three days after the initial, national report, the South  Australian state government announced it was implementing new food regulations effective March 1, 1995. The federal government followed suit the next day, announcing intentions to bolster food processing standards and  launching a full inquiry. Even the coroner investigating the death of the girl  said on Feb. 9 that investigations relating to inquests usually took about three months to complete, but he would start the hearing the next day if possible.

By Feb. 6, 1995, Garibaldi Smallgoods declared bankruptcy. Sales of smallgoods  like mettwurst were down anywhere from 50 to 100 per cent according to the National Smallgoods Council.

The outbreak of E. coli O111 and the reverberations fundamentally changed the public discussion of foodborne illness in Australia, much as similar outbreaks of STEC in Japan, the U.K. and the U.S. subsequently altered public perception, regulatory efforts and industry pronouncements in those countries. The pattern of public reporting and response followed a similar pattern of reporting on the medical implications of the illness, attempts to determine causation and finger pointing. Such patterns of reporting are valid; when people are sick and in some cases dying from the food they consume, people want to know why. The results altered both the scientific and public landscapes regarding microbial foodborne illness, and can inform future risk communication and management efforts.

In all, 173 people were stricken by foodborne illness linked to consumption of mettwurst manufactured by Garibaldi smallgoods. Twenty-three people,  mainly children, developed HUS, and one died. Although sporadic cases of HUS had been previously reported, this was the first outbreak of this condition recognized in Australia.

Once public attention focused on Garibaldi as the source of the offending foodstuff, the company quickly deflected criticism, blaming an unnamed Victorian-based company of supplying contaminated raw meat, and citing historical precedent as proof of safety. Garibaldi’s administration manager Neville Mead was quoted as saying that he was confident hygiene and processing at the plant were up to standard, adding, “We stand by our processing. We’ve done this process now for 24 years and it’s proved successful.” Such blind faith in tradition, even in the face of changing science-based recommendations, even in the face of tragedy, is often a hallmark of outbreaks of foodborne illness, reflecting the deep cultural and social mythologies that are associated with food.

However, given the uncertainties at the time, a spokesman with the Australian Meat and Livestock Association appropriately rejected such allegations, saying, “I believe it is irresponsible of them (Garibaldi) to make that statement when there is absolutely no evidence of that at all.” Likewise, Victorian Meat Authority chairman John Watson said his officers were investigating Garibaldi’s claims, but that even if the raw meat had come from

Victoria, the supplier may not necessarily be the source of the disease, but rather it could be based in Garibaldi’s processing techniques.

Similarly, when Garibaldi accused the watchdog South Australian Health Commission of dragging its feet with investigations, Health Minister, Dr. Michael Armitage responded by publicly stating that, “They indicated to us that they wanted their lawyers first to be involved before they provided us with information (concerning the mettwurst). It was only (after) earlier this week, under the Food Act, we issued a demand for that information, that we got it. So indeed, I would put it to Garibaldi that the boot is completely on the other foot.”

Likewise, South Australia’s chief meat hygiene officer, Robin Van de Graaff rejected such claims, saying that, “These organisms are part of a large family of bugs that are normal inhabitants of the gut of farm animals … If a tragedy like this occurs it is usually because, and it no doubt is in this case, not because of a small amount of contamination at the point of slaughter but because of the method of handling and processing after that.” The statements of government regulators would be subsequently validated.

Shiga toxin-producing Escherichia coli survives storage in wheat flour for two years

Wheat flour has recently been recognised as an exposure vehicle for the foodborne pathogen Shiga toxin-producing Escherichia coli (STEC). Wheat flour milled on two sequential production days in October 2016, and implicated in a Canada wide outbreak of STEC O121:H19, was analysed for the presence of STEC in November 2018.

Stored in sealed containers at ambient temperature, the water activity of individual flour samples was below 0.5 at 6 months post-milling and remained static or decreased slightly in individual samples during 18 months of additional storage. STEC O121 was isolated, with the same genotype (stx2a, eae, hlyA) and core genome multilocus sequence type as previous flour and clinical isolates associated with the outbreak. The result of this analysis demonstrates the potential for STEC to persist in wheat flour at levels associated with outbreak infections for periods of up to two years. This has implications for the potential for STEC to survive in other foods with low water activity.

Shiga toxin-producing Escherichia coli survives storage in wheat flour for two years

Food Microbiology

AlexanderGill1TanisMcMahon1ForestDussault2NicholasPetronella2

https://doi.org/10.1016/j.fm.2019.103380

https://www.sciencedirect.com/science/article/pii/S0740002019309906

Udder Delights in Australia recalling cheese after E. coli found

Some of its most popular cheeses, including its 200g camembert and brie are being recalled. Dixie Sulda and Jessica Galletly of Adelaide Now report the SA company said there was no evidence the form of E.coli found was dangerous but it was recalling them as a precaution.

The cheeses are available from Coles and independent retailers in SA, Queensland, Victoria and WA. In NSW they also sell at Woolies and in Tasmania they are sold at independent retailers.

Udder Delights chef executive Sheree Sullivan said the team was “devastated” after small levels of the bacteria were found in some of the company’s white mould 200g cheeses.

“It is with a very heavy heart that Udder Delights is doing its first voluntary recall since we began 20 years ago,” Ms Sullivan said.

“The whole team is devastated, because we all just work so hard to create a really high quality product.

“You always learn some of your best lessons through disasters, and I never really understood what a voluntary recall was. It means you have a choice – do you want to recall or not? We decided as a business we wanted to be 100 per cent sure it was safe.

“It was great SA Health and Dairysafe confirmed it wasn’t a dangerous bacteria, which can sometimes be a little bit of sunshine in a dark cloud.”

Ms Sullivan would not speculate on what caused the contamination, but said they were working with SA Health and their quality assurance team to quickly resolve the issue.

24 now sick from shiga-toxin producing E. coli in Newfoundland and Labrador

Newfoundland and Labrador’s provincial health department is advising residents of an outbreak of E. coli bacteria.

There have been 22 cases of E.coli confirmed in the province, according to an advisory issued last Friday afternoon.

Another two suspected cases have since emerged.

Dr. Janice Fitzgerald said some of the cases are connected to an advisory issued by Memorial University last week, saying Eastern Health was investigating reports of students experiencing gastrointestinal illness.

The university said Wednesday that test results indicated one student living in residence “may have contracted the E. coli bacteria” and 21 students had reported similar symptoms.

Fitzgerald said it’s too early in the investigation to determine a cause of the outbreak.

What foods are most likely to cause illness by shiga toxin-producing Escherichia coli (STEC) and how best to control secondary infections

Two abstracts attempt to provide guidance to these important questions to reduce the toll of STEC.

FAO and WHO conclude shiga toxin-producing Escherichia coli (STEC) infections are a substantial public health issue worldwide, causing more than 1 million illnesses, 128 deaths and nearly 13 000 Disability-Adjusted Life Years (DALYs) annually.

To appropriately target interventions to prevent STEC infections transmitted through food, it is important to determine the specific types of foods leading to these illnesses.

An analysis of data from STEC foodborne outbreak investigations reported globally, and a systematic review and meta-analysis of case-control studies of sporadic STEC infections published for all dates and locations, were conducted. A total of 957 STEC outbreaks from 27 different countries were included in the analysis.

Overall, outbreak data identified that 16% (95% UI, 2-17%) of outbreaks were attributed to beef, 15% (95% UI, 2-15%) to produce (fruits and vegetables) and 6% (95% UI, 1-6%) to dairy products. The food sources involved in 57% of all outbreaks could not be identified. The attribution proportions were calculated by WHO region and the attribution of specific food commodities varied between geographic regions.

In the European and American sub-regions of the WHO, the primary sources of outbreaks were beef and produce (fruits and vegetables). In contrast, produce (fruits and vegetables) and dairy were identified as the primary sources of STEC outbreaks in the WHO Western Pacific sub-region.

The systematic search of the literature identified useable data from 21 publications of case-control studies of sporadic STEC infections. The results of the meta-analysis identified, overall, beef and meat-unspecified as significant risk factors for STEC infection. Geographic region contributed to significant sources of heterogeneity. Generally, empirical data were particularly sparse for certain regions.

Care must be taken in extrapolating data from these regions to other regions for which there are no data. Nevertheless, results from both approaches are complementary, and support the conclusion of beef products being an important source of STEC infections. Prioritizing interventions for control on beef supply chains may provide the largest return on investment when implementing strategies for STEC control.

Second up, in 2016, we reviewed preventive control measures for secondary transmission of Shiga-toxin producing Escherichia coli (STEC) in humans in European Union (EU)/European Free Trade Association (EEA) countries to inform the revision of the respective Norwegian guidelines which at that time did not accommodate for the varying pathogenic potential of STEC.

We interviewed public health experts from EU/EEA institutes, using a semi-structured questionnaire. We revised the Norwegian guidelines using a risk-based approach informed by the new scientific evidence on risk factors for HUS and the survey results.

All 13 (42%) participating countries tested STEC for Shiga toxin (stx) 1, stx2 and eae (encoding intimin). Five countries differentiated their control measures based on clinical and/or microbiological case characteristics, but only Denmark based their measures on routinely conducted stx subtyping. In all countries, but Norway, clearance was obtained with ⩽3 negative STEC specimens. After this review, Norway revised the STEC guidelines and recommended only follow-up of cases infected with high-virulent STEC (determined by microbiological and clinical information); clearance is obtained with three negative specimens.

Implementation of the revised Norwegian guidelines will lead to a decrease of STEC cases needing follow-up and clearance, and will reduce the burden of unnecessary public health measures and the socioeconomic impact on cases. This review of guidelines could assist other countries in adapting their STEC control measures.

Mapping of control measures to prevent secondary transmission of STEC infections in Europe during 2016 and revision of the national guidelines in Norway

Cambridge University Press vol. 147

  1. Veneti(a1)(a2)H. Lange (a1)L. Brandal (a1)K. Danis (a2) (a3) and L. Vold 

DOI: https://doi.org/10.1017/S0950268819001614
https://www.cambridge.org/core/journals/epidemiology-and-infection/article/mapping-of-control-measures-to-prevent-secondary-transmission-of-stec-infections-in-europe-during-2016-and-revision-of-the-national-guidelines-in-norway/1990D2338B220F80F0E683DF6F622A40

British girl, 2, dies from E. coli after holiday in Turkey

A two-year-old British girl has died after contracting E.coli while on holiday in Turkey.

Allie Birchall came down with the severe illness after returning to the UK following a stay at a luxury resort east of the coastal city of Antayla.

Her family were forced to turn off Allie’s life support machine just two weeks after their holiday because of complications caused by the illness.

The family had travelled to Turkey with tour operator Jet2 Holidays on 12 July and said they had concerns about the hygeine of the Turkish resort.

Katie Dawson, Allie’s mother, said her daughter did not start getting ill until five days after getting back to their home in Atherton, Greater Manchester.

According to Ms Dawson, Allie began suffering with stomach cramps, diarrhoea, loss of appetite and lethargy before being admitted to Royal Bolton Hospital on July 30.

The hospital confirmed Allie had contracted Shiga-Toxin producing E.Coli (STEC), which later led to her developing deadly Haemolytic Uraemic Syndrome (HUS) – a life-threatening complication related to the poisoning.

Allie was moved to the Manchester Royal Infirmary and put in an induced coma on August 1.

An MRI scan was carried out, which revealed that she had sustained severe brain trauma and damage. Katie had to make the difficult decision to terminate Allie’s life support following the advice from doctors.

“While nothing will bring her back, we need to know what caused her illness and if anything could have been done to prevent it.

The family have now instructed specialist international serious injury lawyers, Irwin Mitchell, to investigate what happened.

Public Health England is also currently investigating the matter, and an inquest has been opened to examine the circumstances surrounding Allie’s death.

Missed phone calls, changing stories: How E. coli spread at the San Diego County Fair

More than 1.1 million people had already passed through the gates of the San Diego County Fair this summer by the time an E. coli outbreak forced the closure of all animal exhibits and rides.

News that a 2-year-old boy had died after picking up the particularly nasty infection, which was also contracted by three other children with animal contact at the fair, stirred alarm within the community. Many had already roamed the midway, stuffed themselves full of fair food and passed through the venue’s cavernous livestock barns en route to pig races, pony rides and the petting zoo.

Paul Sisson of The San Diego Union Tribune reports hundreds of emails and other documents obtained through Public Records Act requests show that, while the public health team was able to move quickly, more frequent county case reviews, a more modern medical records system and more prompt and accurate responses from families with infected children might have gotten the investigation started days earlier.

The decision to shut down the animal exhibits on June 29, records show, came after four days of a behind-the-scenes scramble by the county’s public health department. With one death already on the books, they decided to notify the public even though testing had not yet confirmed that all four of those first four cases had E. coli infections.

It quickly became clear those initial instincts were accurate. In the following weeks, an additional seven people, plus two more whose infections weren’t confirmed, came forward, including another young boy who nearly died after suffering severe complications that attacked his kidneys.

Records show that zeroing in on the fairgrounds was no simple task. Epidemiologists had to eliminate a broad range of possible locations, from restaurants to a busy daycare center, before they were able to zero in on the fairgrounds.

And there was plenty of other work that had to be done simultaneously. County records show that the department investigated 435 disease cases in June alone. Of those, there were 43 cases of shiga toxin-producing E. coli reported that month, forcing disease detectives to sift out the 11 eventually confirmed to be part of the outbreak.

Determining whether there are connections between cases requires interviews with each subject or their legal guardians. Depending on the type of pathogen involved, it’s a process that often relies on frail human memory to recall the finest possible details of possible exposure routes from foreign travel and foods consumed to places visited and close contact with others.

The investigative process doesn’t get started until the health department is notified, usually after a test result administered in a doctor’s office or hospital comes back positive.

Subjects often aren’t interviewed until weeks after they got infected because many infections have incubation periods measured in days or weeks and it usually takes time before individuals decide to seek medical attention and additional time for medical providers to make a diagnosis.

Often, those charged with reading these particularly fragile tea leaves learn to trust their instincts, and that was certainly the case with the fairgrounds outbreak.

Emails show that the county’s epidemiology team first began to suspect that it might have an outbreak on its hands on June 24, the day that 2-year-old Jedidiah King Cabezuela (right) was admitted to the intensive care unit at Rady Children’s Hospital with severe kidney problems.

While discussing his condition, an epidemiologist noted that the boy had visited the fair before he got sick. And, she said, the county had been notified just before Cabezuela’s death of another boy, this one 9 years old, who tested positive for the type of toxin produced by the E. coli strain causing so much difficulty for Cabezuela.

Though the 2-year-old and 9-year-old hadn’t eaten the same foods at the fair, and the older boy’s parents said he didn’t visit animal areas, the fact that both visited the same location was enough for the epidemiologist to suggest that the department “should at least keep an eye on” the 9-year-old, even though he never got sick enough to need hospitalization.

By Tuesday, June 25, the public health department received the news that Cabezuela died overnight, and that information pushed the team to begin a relentless search for similar shiga toxin-producing E. coli infections.

They quickly found a report of a 13-year-old girl who had a positive toxin test after visiting the fair on June 8. Her parents had told interviewers that she had contact with animals and had eaten fair food afterward without first washing her hands.

Another girl, this one age 11, had also had a positive test but her parents had not returned repeated calls for an interview. It would not become clear that she, too, had visited the fair and had contact with animals until her parents were finally reached on June 28, the same day that the county announced it would close all public animal exhibits.

Then there was the 9-year-old boy mentioned in that prescient June 24 email. His parents initially said that he had no animal contact at the fair, but in subsequent interviews those parents remembered that, yes, their son did visit the livestock barn when the family visited on June 13.

With three, then four cases all reporting food consumption and animal contact at the fairgrounds, food inspectors descended on five different food vendors who sold items that the kids reported eating and found no traces of E. coli contamination.

Food poisoning ruled out, officials concluded that the E. coli exposure was most likely down to animals and, with the cooperation of the fair board, shut down all public access to animal exhibits and rides on June 29. Testing never did pinpoint the exact source of contamination, though the fair’s petting zoo and pony rides were ruled out.

Once public health nurses do their phone interviews and build up as clear a picture as they can of the circumstances surrounding each individual case, epidemiologists can begin looking for patterns, keeping an eye out for clusters of patients in specific geographic areas or with other commonalities such as foreign travel or consumption of tainted food.

A table of petting zoo outbreaks is available at https://www.barfblog.com/wp-content/uploads/2017/08/Petting-Zoo-Outbreaks-Table-7-26-17.xlsx

A timeline of the E. coli outbreak at the San Diego County Fair

May 31– San Diego County Fair opens

June 8 –11-year-old and 13-year-old girls visit fair

June 10 –13-year-old becomes ill

June 12 –11-year-old becomes ill after a second fair visit

June 13 – 9-year-old boy visits fair

June 15 – 2-year-old Jedidiah Cabezuela visits fair

June 16 – 9-year-old becomes ill

June 18 – Investigator call parents of 11-year-old, get no reply

June 19 – 13-year-old reports visiting animal areas at fair; Jedidiah becomes ill; county holds weekly analysis meeting

June 20 – Jedidiah admitted to Rady Children’s Hospital

June 21 – 4-year-old and 38-year-old who later test positive for E. coli infections visit fair

June 22 – Jedidiah diagnosed with severe E. coli infection; 6-year-old Ryan

Sadrabadi, 2-year-old Cristiano Lopez and his mother, Nicole Lopez, and another 2-year-old girl, visit the fair

June 23 – Family confirms Jedidiah visited fair’s animal exhibits; one-year-old girl later confirmed to have E. coli infection visits the fair

June 24 – Jedidiah dies from kidney failure; 9-year-old’s fair attendance confirmed, animal contact denied; County epidemiologist raises red flag about possible case cluster at fair; Nicole Lopez becomes ill, treated at Kaiser La Mesa

June 25 – County learns of Jedidiah’s death, begins exploring fair connections in depth

June 26 –Ryan, 2-year-old girl and 1-year-old become ill

June 28 – Family of 9-year-old revises statement, confirms visiting livestock barn; Family of 11-year-old confirms she visited sheep exhibit at fair; County announces E. coli cluster at Del Mar Fairgrounds; County inspects five food booths visited by first four cases, no E. coli found; Cristiano becomes ill

June 29 – County inspects all 160 food booths at fair, finds no E. coli contamination; All animal areas at the fair are closed; four-year-old becomes ill

June 30 – Ryan becomes ill diagnosed with E. coli infection

July 1 – 6-year-old’s case reported to county

July 2 – Cristiano admitted to Kaiser Permanente San Diego Medical Center with worsening symptoms, diagnosed with E. Coli infection

July 3 – 2-year-old girl and 4-year-old’s cases reported to county

July 4 – Fair closes with an attendance that exceeds 1.5 million; Cristiano’s infection reported to county; Cristiano transferred to Rady Children’s Hospital, undergoes dialysis for hemolytic uremic syndrome that attacks his kidneys

July 6 – 38-year-old becomes ill

July 9 – 38-year-old’s infection reported to county

July 10 – 30-year-old’s and 1-year-old’s infections reported to county

July 29 – Three families file claims against fair board, alleging they weren’t properly warned of E. coli risk

July 31 – Environmental and animal testing fail to reveal a clear source of outbreak, but exposure in fair’s livestock barn deemed “likely”

Best practices for planning events encouraging human-animal interactions

Zoonoses and Public Health

G. Erdozain , K. KuKanich , B. Chapman  and D. Powell

http://onlinelibrary.wiley.com/doi/10.1111/zph.12117/abstract?deniedAccess

Educational events encouraging human–animal interaction include the risk of zoonotic disease transmission. It is estimated that 14% of all disease in the US caused by Campylobacter spp., Cryptosporidium spp., Shiga toxin-producing Escherichia coli (STEC) O157, non-O157 STECs, Listeria monocytogenes, nontyphoidal Salmonella enterica and Yersinia enterocolitica were attributable to animal contact. This article reviews best practices for organizing events where human–animal interactions are encouraged, with the objective of lowering the risk of zoonotic disease transmission.