Clemson researchers target vomit cleanup methods in new norovirus research

Ever since that time in 2008 when one of Amy’s French students barfed in class, we’ve sorta been obsessed with, what is the proper way to clean up barf?

Especially if norovirus is involved.

The previous story gives an idea of just how infectious this stuff is.

Two Clemson researchers who are working with the federal government to combat stomach bug outbreaks among the elderly are convinced that advancements in this field could be lifesaving. 

Clemson University professors Angela Fraser and Xiuping Jiang catered their new norovirus research project to the needs of residents in long-term care facilities.

“I just think that those of us who are fortunate need to look out for those who are vulnerable,” Fraser said. “And this is a vulnerable population.”

One of the main goals of their new project, which recently received more than $1 million in funding from the federal Agency for Healthcare Research and Quality, is to come up with easy-to-implement, cost-efficient and effective vomit cleanup procedures for soft surfaces. The hope is that this will directly combat the high percentage of norovirus outbreaks in long-term care facilities and places with similar environments. 

The study, which has funding for three years, will be done in partnership with the Centers for Disease Control and Prevention, Emory University and the University of Illinois-Chicago.

In past studies on proper vomit cleanup, Fraser and Jiang learned that there were gaps in the research, particularly when it came to the proper disinfectant to use on soft services to prevent the spread of diseases.

Chlorine bleach, the most commonly used disinfectant, mainly worked on hard surfaces and could rarely be used on soft surfaces like carpets and couches. One of the areas they realized could benefit the most from this information was long-term care facilities. 

“Long-term facilities want to create a very homelike environment, so they have lots of carpet around in comparison to hospitals and other environments,” Jiang said.

They also, of course, tend to have a high number of older adults.

“That’s people’s living environment,” Fraser said. “Do you really want people to be living where everything is just cinder block or smooth walls?”

She said because older patients are more likely to have chronic diseases, their immune systems are typically weakened as well. This means that when these older adults get infected with diseases like the norovirus, there can be a more severe expression of the disease compared to someone younger. Because of all of these factors, some view the study as even more imperative.


HUS from Shiga-toxin E. coli sucks, in kids and old people and anyone

Hemolytic uremic syndrome associated with Shiga toxin-producing Escherichia coli O157:H7 has been widely known as a common cause of acute renal failure in children.

john.barrThere are only a few reports of sporadic Shiga toxin-producing Escherichia coli-hemolytic uremic syndrome in adults in the USA.

Analyses from the 2011 outbreak of hemolytic uremic syndrome associated with Escherichia coli O104:H4 reported that mortality rates are highest in those patients with age >60-years old. Therefore, recognizing Shiga toxin-producing Escherichia coli-hemolytic uremic syndrome in older people can help early introduction of the appropriate therapy.

We describe an 86-year-old Caucasian woman, initially treated as suspected thrombotic thrombocytopenic purpura, with worsening neurological and renal functions despite plasmapheresis (plasma exchange). A subsequent normal ADAMTS13 activity level and positive stool sample for Escherichia coli O157:H7 confirmed the diagnosis of Shiga toxin-associated hemolytic uremic syndrome. We shifted our management towards aggressive supportive care. Despite conventional treatment, hemolytic uremic syndrome unfortunately led to her death.

Our case demonstrates the importance of recognizing Shiga toxin-producing Escherichia coli-hemolytic uremic syndrome as an etiology of microangiopathic hemolytic anemia in older people. According to the current literature, supportive care is the best approach for Shiga toxin-producing Escherichia coli-hemolytic uremic syndrome. Therapies such as plasma exchange and eculizumab (a complement inhibitor) are not shown to be effective in Shiga toxin-producing Escherichia coli-hemolytic uremic syndrome.

There is a dire need to continue research to find better treatment options in this disease entity with a high mortality, particularly in older people.

Hemolytic uremic syndrome associated with Escherichia coli O157:H7 infection in older adults: a case report and review of the literature

Journal of Medical Case Reports, Volume 10, Issue 175, June 2, 2016, DOI: 10.1186/s13256-016-0970-z

Heidi Ko, Hossein Maymani, and Cristhiam Rojas-Hernandez

23 sick: Salmonella death at aged care facility in Australia, nine others hospitalized

In the timely public reporting that characterizes Australia, a person has died from Salmonella at an aged care facility in the Illawarra.

r0_260_4992_3068_w1200_h678_fmaxNSW Health says cases of Salmonella first appeared in aged care homes on January 21.

An investigation has uncovered 23 cases in 10 facilities across South Eastern Sydney, the Illawarra and ACT.

Nine cases resulted in hospitalization and one death occurred after hospitalization.

The Illawarra Retirement Trust says 20 of the cases occurred in it’s care centres.

The IRT also runs a food distribution network for retirement homes.

Director of the Communicable Diseases Branch of NSW Health, Vicky Sheppeard said, “Facilities are no longer serving foods considered as likely risks, for example food that is not reheated prior to serving.”

No mention of temperatures that would be considered safe.

Illawarra Shoalhaven Local Health District public health director Curtis Gregory said the elderly residents were mainly suffering from vomiting and diarrhea, but there were also problems from lack of hydration and some residents had high fevers.

Salmonellosis is one of the most common notifiable conditions in NSW, with more than 3000 people diagnosed each year and many going undiagnosed.

The bacteria is mainly spread to people when they eat undercooked food made from infected animals – including meat, poultry, eggs and their by-products – or salad items fertilised by manure.

“It’s a fairly uncommon type of salmonella called bovismorbificans and we think it is linked to salad products,” Mr Gregory said.

“Specifically we believe it may be due to the fertiliser or cow manure used to grow those salad products.”

Increase in Salmonella Poona in England and Wales

There’s an apparent and on-going outbreak of Salmonella Poona that’s primarily affecting the elderly in the UK.

The Laboratory of Gastrointestinal Pathogens (LGP) has reported 49 non-travel associated, fully sensitive cases of Salmonella Poona with specimen dates on or after 24 October 2011 to 19 March 2012. This compares with 21 and 33 cases reported during the whole of 2009 and 2010 respectively. Those affected range from four months to 88 years of age with 65% of all cases aged over 60 years and a median age of 69.5 years; men and women are similarly affected.

Cases have been found across England and Wales, with most cases occurring in the South West (28%), South East (16%) and Wales (14%) regions. So far, no cases have been reported in London and the East Midlands and 14 cases have received treatment in hospital.

The Salmonella Poona isolates from 41 of the cases have been further typed by pulsed field gel electrophoresis (PFGE) and all but one has the same PFGE profile XB.0003. This strain is indistinguishable from a strain seen in an outbreak in Sweden in 2010; however, a source was not been confirmed for that outbreak.

I did a little digging, but couldn’t find much about the 2010 Sweden outbreak. Anyone know? Suspect foods?

Should people over 50 heat cold cuts to avoid listeria?

The risk may be small, but the failures are tragic.

Governments routinely warn that immunocompromised people, including expectant mothers and the elderly, should refrain from certain ready-to-eat refrigerated foods like deli meats and smoked salmon because of the risk of listeriosis.

Elizabeth Weise writes in today’s USA Today that the U.S. Centers for Disease Control and Prevention has been saying for at least 11 years now that people over 50 and especially those over 65 should avoid hot dogs, lunch meats, cold cuts and other deli meats unless they are reheated to 165 degrees — "steaming hot" in CDC’s words.

The government also says you shouldn’t keep an open package of sliced deli meat more than five days, all to reduce the risk of infection from a bacteria called listeria. But some question whether the country’s been paying attention.

Barbara Resnick, incoming president of the American Geriatrics Society and a professor of nursing at the University of Maryland, knows of no one over that age who heats deli meats to that level and says she’s never seen a case of listeriosis in a patient.

Neil Gaffney, spokesman for the U.S. Department of Agriculture’s Food Safety Inspection Service said, "When it comes to food safety, we’re serious: People at risk for listeriosis should not eat hot dogs, luncheon meats or deli meats unless they are reheated until steaming hot. Thoroughly reheating food can help kill any bacteria that might be present. If you cannot reheat these foods, do not eat them."

Mike Doyle, a professor of food microbiology at the University of Georgia said about 85% of listeriosis cases are linked to cold cuts or deli meats, and that today almost all packaged lunch meats contain either added sodium lactate, an acid formed by fermentation, or potassium lactate, fermented from sugar, as antimicrobials. That’s what he looks for when he buys cold cuts.

And based on FSIS risk-assessment data, meats sliced at the store pose a greater risk than meats pre-sliced at federally inspected establishments

Listeria and cold cuts were ranked just last week as the third worst combination of a food and a pathogen in terms of the burden they place on public health, costing $1.1 billion a year in medical costs and lost work days, according to a study by the University of Florida’s Emerging Pathogen Institute.

Douglas Powell a professor of food safety at Kansas State University, said, "And you can’t see, taste or smell that it’s there.”

CDC also says don’t keep opened packages of lunch meat, or meat sliced at the local deli, for longer than three to five days. That’s another one no one pays attention to, says Kansas’ Powell.

"Anecdotally, lots of people keep cold cuts in their refrigerator far longer than they should. People keep them for one to two weeks. That’s the key message. If you get it from the deli counter, four days max."

What wasn’t included in the story is evidence of listeria-related tragedies in other countries – countries that may not have approved those listeria-restraining additives.

Twenty-three elderly people died in Canada in 2008 after eating listeria-laden cold-cuts from Maple Leaf Foods. Later that year, listeria in soft cheese in Quebec led to 38 hospitalizations, of which 13 were pregnant and gave birth prematurely. Two adults died and there were 13 perinatal deaths.

The New South Wales Food Authority said last month the Authority provides information on listeria to pregnant women to allow them to make an informed food choice regarding the risk and how to minimize it. It is not to say that every piece of deli meat has Listeria on it, but some foods have a higher potential rate of contamination than others, and it is better to avoid them.

The risk of acquiring listeriosis is low. However the consequences for a pregnant woman contracting listeriosis are dire.

While the Authority may be accused of ‘being over the top’, we may also be accused of neglecting pregnant women if we did not provide this information so pregnant women could make informed choices in what they eat.

Over the last 5 years in Australia there have been between 4 and 14 cases of listeriosis diagnosed in pregnant women or their babies each year. These infections have resulted in the deaths of 8 fetuses or newborn babies.

Salmonella sickens eight at Maryland nursing home

Salmonella sickened eight people at Homewood at Crumland Farms nursing home in Frederick, Maryland over the past four months.

The News-Post reports one person died after being hospitalized for salmonella, although Homewood’s executive director, Eric Nichols, said the death was from other complications.

Darlene Armacost, communicable disease program manager for the Frederick County Health Department said,

"The last onset of a case was in early November. We are still monitoring the situation."

Health department officials have inspected Homewood repeatedly, Armacost said. The entire Environmental Health Services branch of the department, the section that inspects restaurants, has visited the kitchen many times, she said.

Nichols said the kitchen was found to be very clean in all inspections.

Know thy suppliers: UK Kosher Deli fined for supplying meat unfit for human consumption

A kosher food supplier has been ordered to pay £27,000 by the courts for selling a pot of chopped liver containing a potentially deadly bacteria.

Bosses of Kosher Deli UK Ltd., based on the Claremont Industrial Estate, in Claremont Way, Cricklewood, admitted supplying 1kg of meat contaminated with Listeria to a residential care home in May 2008.

An investigation into the company, lead by Barnet Council’s environmental health team, was launched after an 89-year-old care home resident was diagnosed with listeriosis.

A judge at Wood Green Crown Court on Monday said serious issues at Kosher Deli had been set out in an audit report by the Meat Hygiene Service, but accepted the offence represented a lapse over a short period of time in a business which had been operating for 74 years.

Albert Bendahan, managing director of Kosher Deli, said it was “exasperating” that the case was brought based on one allegation from a care home resident, and insisted the family run company took every precaution to ensure food safety was maintained, adding,

“We continuously test and monitor our products, instruct and train our staff and live up to the requirements and beyond of the Food Standards Agency Guidelines.”

Try harder.

5 sick, 2 dead from Listeria in Texas

An on-going cluster of low-level Listeria has sickened seven people in three Texas counties this year, killing two of them.

The Express-News reports the patients — five from Bexar County and one each from Travis and Hidalgo counties — developed listeriosis.

Roger Sanchez, senior epidemiologist with the Metropolitan Health District, said genetic analysis found the identical strain of bacteria in all the patients, suggesting they were infected by the same food item. But because of the small numbers and the dispersal of cases — two of the patients lived 300 miles apart — it might be difficult to pinpoint the cause, adding,

“This is not a large outbreak. What made it bad is that it has infected people who are fragile, elderly people.”

Sanchez said the infected patients ranged from ages 66 to 93. Most had serious underlying health problems, and all but one were hospitalized either before or during their infection.

The first case was reported in January, the most recent May 6.

Canada tells old people to cook deli meats two years after 22 died

Almost two years after 22 elderly Canadians died from eating Maple Leaf deli meats, the Canadian government has decided to remind Canadians of the importance of food safety for older adults.

Health Canada and the Canadian Food Inspection Agency tell older Canadians they should separate, clean, chill and cook, and make sure to cook hot dogs and deli meats until they are steaming hot before eating them.

The best the 6-figure bureaucrats who came up with this – and there were many – could do was borrow piping hot from the U.K.?

So is that standard advice now for aged-care facilities across Canada, where the staff dieticians were completely clueless about the potential for deli-meats to be contaminated with listeria? Is this Maple Leaf-sanctioned advice? Will it appear on warning labels for vulnerable populations, including pregnant women?

A second resident has died of Salmonella at UK care home

An elderly woman who was admitted to Sunderland Royal Hospital after eight cases of Samonella were confirmed at Millum House Care Home in Roker, Sunderland, has died.

A post-mortem examination to establish the cause of her death is to be carried out.

The news follows the death of great-grandmother Myra Robinson, 72, who died in hospital last Saturday following the outbreak.

The remaining patients, who include three members of staff at the three-storey home, have recovered.

Health chiefs are investigating, but the cause of the outbreak still remains unclear.