Large shigellosis outbreak at wedding

My cousin of Barrie’s Asparagus is in the midst of the annual crop in southern Ontario, and I know they have good food safety because my students have checked them out in years past and, I’m his cousin.

Unfortunately not all growers are as diligent and any commodity can get branded as shit.

Specifically, Shigella shit.

Findings presented at the CDC’s Epidemic Intelligence Service, or EIS, conference last month found that contaminated asparagus was the likely source of an outbreak of shigellosis at a wedding party in Oregon that sickened 112 people.

The outbreak was caused by Shigella flexneri type 3a, which accounts for less than 3% of S.flexneri isolates in the United States, researchers said.

“This was one of the largest foodborne outbreaks of shigellosis in U.S. history,” Steven I. Rekant, DVM, MPH, an EIS officer with the Oregon Public Health Authority, said in a presentation. “It was the second largest ever attributed to Shigella flexneri and that type of Shigella flexneri, type 3a, is uncommon in Oregon.”

According to Rekant and colleagues, the Oregon Health Authority received reports of gastroenteritis among attendees at a wedding in August 2018 and identified S. flexneri type 3a in stool samples.

A total of 263 people attended the wedding, and 75% responded to the survey. The patients were aged 2 to 93 years, and 55% were female.

“Simply put, this was big outbreak — 112 cases were reported, with an overall attack rate of 55.7%,” Rekant said.

Of 95 patients with onset information, 97% reported illness 12 to 72 hours following the wedding. Additionally, 57 patients presented to a health care facility and 10 were hospitalized, including a 92-year-old woman. No deaths or additional cases were reported.

The investigators found that only asparagus consumption was associated with illness.

They pointed to poor hygiene on the part of the food-handler as the “likely cause of contamination.”

Rekant SI, et al. Shigellosis at a Wedding — Oregon, 2018. Presented at: Epidemic Intelligence Service conference; April 29-May 2, 2019; Atlanta.

Uh oh: health officials investigating multiple hepatitis A cases in Napa; including two food handlers

Most of the hepatitis-A-in-restaurants events follow this formula: A food handler or a server shows symptoms, the virus is confirmed, health folks provide patrons with shots and hopefully no one else gets sick.

The story in Napa County is a bit different: According to the Napa Valley Register, five people, including two food handlers at restaurants are ill and it’s unclear whether this cluster is an outbreak or a coincidence.546b8ec85be23.image

The source of the infection is under investigation. This is the first time in more than five years that acute Hepatitis A infection has been confirmed in a Napa County resident, the county said.

Two cases involve employees of La Toque restaurant and BANK Café and Bar in The Westin Verasa Napa. The source of these infections is unknown and there are no known cases involving customers, the county said in a news release.

The other three cases have no known association with these locations or other public settings, the county said.

In a county news release, Ken Frank of LT Napa Partners, which owns and operates La Toque restaurant and BANK Café and Bar, said, “La Toque restaurant and BANK Café and Bar take the health of our guests very seriously. We have strict health standards in place, and we are cooperating fully with Napa County Public Health to identify the source of the virus.”

Don Shindle, general manager of The Westin Verasa Napa, said, “We continue to assist Napa County Public Health and are taking all appropriate measures to ensure the safety of our guests and associates. We are confident that Frank and his team are diligent in following their high standards and working closely with Napa County Public Health.”



Marj’s in Alma, Ontario source of hepatitis A exposure

When I was a grad student I played in a few co-ed slopitch baseball tournaments close to Guelph, Ontario (that’s in Canada). These tournaments consisted of a lot of beer drinking and my team (which completed in the Guelph restaurant league) wasn’t great. We played one tournament in Palmerston and on the way home we stopped for greasy hamburgers at a place called Marj’s in Alma. I don’t remember much about the meal. Just that we stopped.logo

Marj’s, according to the Guelph Mercury, is dealing with a hepatitis A exposure situation.

Anyone who ate at Marj’s Village Kitchen in Alma between Jan. 2 and 20 is advised to get a Hepatitis A vaccination as soon as possible, Wellington-Dufferin-Guelph Public Health reports. 

Dr. Nicola Mercer, medical officer of health, has confirmed that an employee at the restaurant has a confirmed case of Hepatitis A and anyone who ate there in the first part of January could be at risk of infection.

“The source is no longer working at the restaurant so there is no further risk at this restaurant,” Mercer said in an interview. “We are not out to be punitive.

“But Marj’s is extremely popular—it’s always busy. There could be many hundreds who have been exposed.”

Mercer is urging customers who ate at the restaurant between Jan. 2 and Jan. 20 to get a Hepatitis A vaccine as soon as possible.

Hepatitis A incident leads Colorado restaurant to make vaccinations for staff mandatory

Ft. Collins Colarodo is home of New Belgium beer, Colorado State University, and a restaurant that has been stung by having a food handler test positive with Hepatitis A. According to thedenverchannel.comTortilla Marissa’s North of the Border Cafe is closed until public health folks give them the okay to reopen.TortillaMarissas_1403912791692_6553175_ver1.0_640_480

A food worker employed at restaurant at 2635 S. College Ave., tested positive for Hepatitis A, a disease that might be passed to others through food directly handled by the employee before any symptoms appeared, according to the Larimer County Department of Health and Environment.

Officials said diners who consumed food or drinks — either dine-in or take-out — from the restaurant in the past 14 days could benefit from getting a Hepatitis A vaccination or Immune Globulin injection to reduce the risk of illness.

Shots can be obtained from private health care providers or at two special clinics the Health Department will be holding on Sunday and Monday specifically for those potentially exposed  to Hepatitis A through the restaurant.

According to a statement released by the restaurant, they are making Hep A vaccinations mandatory for their staff.

We have instituted some new procedures including all future staff will be required to get an Hepatitis A vaccination before being allowed to work at Tortilla Marissa’s;  we have written a new employee sick policy based on best practices from around the country; and created some new systems in the kitchen. All of these practices exceed the standards set by the Larimer County Health Department as we are committed to our patrons health.

Suspected norovirus outbreak linked to Vancouver restaurant after ill food handler showed up to work

A couple of years ago U.S. Centers for Disease Control & Prevention noro dude, Aron Hall, called norovirus “the perfect human pathogen” in the Journal of Infectious Diseases. Hall said with its low median infectious dose and stability, norovirus is built to be transferred.

Beyond its durability, billions of particles can be shed in every gram of feces and vomit from an infected individual and can be transferred well via fomites, food and water. IMG_4237

Sort of a nightmare for a restaurant if one of their kitchen staff shows up to work ill.

Or two of them.

According to the Vancouver Sun, that’s what happened last at Craft Beer Market.

Vancouver’s 500-seat Craft Beer Market was shut down by Vancouver Coastal Health (VCH) Wednesday because of a suspected Norovirus outbreak that could cost the company up to $20,000.

The pub-like restaurant at 85 West First, which boasts Canada’s largest craft beer selection, was closed at noon after a half dozen patrons reported being ill on the weekend, VCH said.

It was also confirmed that a few staff have been ill at work this week, so there is potential for more patrons to become ill as norovirus is highly contagious.

“Our best estimate is that it will be a couple of days before it can reopen,” said VCH director of public affairs, Gavin Wilson, in an interview. “But that’s subject to change, of course.”

Wilson said the closure order will allow for cleaning and sanitizing of the entire establishment, and that the order will be lifted when VCH is satisfied there is no further risk of transmission.

Owner-operator Scott Frank said in a release that the health and safety of their guests is a priority, adding that the restaurant was closed as a precautionary measure to ensure the safety of guests.

Frank said that the restaurant wasn’t given a formal closure notice and that just two guests and two patrons came down with “symptoms of stomach flu.”

One Craft Beer Market Facebook’s page has some info:

We take the health and safety of our guests and team members very seriously. A couple of our team members haven’t been feeling well and as a precautionary measure we have closed the restaurant as we work with Coastal Health to identify and rectify any areas of concern. Please note that no causes have been identified at this time. We will keep you posted as the day goes on. Thank you for you understanding and patience.

And a timeline that lists:

– 1 staff member was sent home on Sunday, June 15th after feeling ill
– 1 staff member felt sick prior to going into work on Tuesday, June 17th but was feeling better throughout the day



CDC: Norovirus outbreaks most often linked to infected food handlers

In 1929 Dr. John Zahorsky wrote about children developing sporadic cases of vomiting, supplemented by watery diarrhea each year between November and May – and over 30 years of clinical practice, he coined the term winter vomiting sickness. According to a 1950 Time Magazine article, Dr. Zahorsky was a pediatrician working extolling the virtues of good sanitation during birth and infant care – one of the fathers of disease prevention.m63e0603a1f1
In 1968, one of these winter vomiting sickness outbreaks occurred in an elementary school in Norwalk, OH. Teachers and students were both affected, with 32% of the primary cases spreading illness to others in their families and homes. After a collaborative investigation with researchers from NIH and Walter-Reed Army medical center a causative agent was found in the feces of the ill — a 27nm sized virus particle. Zahorsky’s illnesses then took on the name Norwalk. Since then, the name has morphed to Norwalk and Norwalk-like viruses, which begat noroviruses.
Often linked to cruise ships in popular culture, noro really is linked much more often to food handlers in food service. According to fellow NoroCORE collaborator Aron Hall and colleagues in this week’s MMWR, noroviruses are the leading cause of reported foodborne disease outbreaks nationally and most often linked to restaurants – with contamination occurring from infected food workers.
During 2009–2012, a total of 4,318 norovirus outbreaks were reported to NORS (the national outbreak reporting system -ben) , resulting in 161,253 illnesses, 2,512 hospitalizations, and 304 deaths. Foodborne transmission was the primary mode reported in 1,008 (23%) norovirus outbreaks, representing 48% of the 2,098 foodborne outbreaks reported with a single suspected or confirmed cause during the 4-year study period. Other primary transmission modes reported among the 4,318 norovirus outbreaks included person-to-person (2,976 [69%]), environmental (15 [0.35%]), waterborne (11 [0.26%]), and unknown transmission mode (308 [7%]). In 158 (16%) of foodborne norovirus outbreaks, secondary transmission through one of these other modes was reported. Norovirus outbreaks were most common in winter, with 2,394 (55%) occurring during December–February (Figure 1). Among foodborne norovirus outbreaks, 398 (39%) occurred during December–February, compared with 1,996 (60%) of nonfoodborne norovirus outbreaks.
Outbreak data (above, exactly as shown) demonstrates that winter vomiting virus is a fitting moniker.

Hepatitis A alert for customers who recently ate at Quadra Fairway Market in BC

It’s much better to get vaccinated before exposure.

Customers who recently ate at the Fairway Market deli on Quadra Street in Victoria, British Columbia (that’s in Canada) are urged to get vaccinated for hepatitis A after an employee tested positive for the virus this week.

The Vancouver Island Health Authority is urging anyone who ate deli food prepared in-store on March 18, 19, 20, 22, 25 or 26 to receive a hepatitis A vaccine as a precaution.

Drop-in immunization clinics for Fairway Market employees and eligible members of the public will take place Saturday and Sunday at the Victoria Health Unit, located at 1947 Cook St., from 1 p.m. to 5 p.m.

Customers at the deli between March 7 and 15 may also have been exposed to the virus but vaccines will no longer be effective because too much time has passed, said Charmaine Enns, a VIHA medical health officer.

"It becomes of interest to the public and to us when that [infected] person is a food handler, because then it’s not just that person’s circle of close contacts who is at risk, it’s the general public now at risk," Enns said.

Sickies should stay home

Over the past couple of weeks my kids have had pink eye and either rotovirus or norovirus. It’s been a mess. We had to miss a couple get togethers including a birthday party. The boys weren’t feeling all that bad but we didn’t really want to expose other kids to the pathogens. My friend, whose daughter’s party we missed, thanked usfor keeping our kids away and reducing their risk of dealing with the same illnesses.

According to WDIO, Minnesota Department of Health investigators believe that 60 patrons of the Greysolon Ballroom in Duluth, MN who came down with norovirus in early December can blame an ill food handler.

Doug Schultz, a spokesperson for the agency, said those folks had the Norovirus, which was probably transferred to the food by a sick worker. He said there is no evidence anyone else has gotten sick since.

We spoke with Sean Stepan, a Greysolon Ballroom spokesperson, last month. He told us they hadn’t had any parties cancel reservations, and had not seen a decline in business. Stepan said customers did ask questions about whether they should have any concerns, but offered their support.

Having a food safety culture where an ill staff member shows up and prepares food isn’t the type of place I want to eat.

Hepatitis A at Newmarket, Ontario Tim Hortons

The Toronto Star reports that a health alert was issued today after it was discovered that two employees of a Newmarket Tim Hortons were found infected with Hepatitis A.

York Region Public Health was notified of a case of hepatitis A at the Tim Hortons at 16545 Yonge St., near Savage Rd., on April 21. Following the initial investigation, it was decided the risk to customers was very low based on the employee’s position.

"He was not involved in food handling," said York Region medical officer of health Dr. Karim Kurji. "Given that, we didn’t feel the need to notify the public."

Oops, because…

The next day investigators conducted routine tests and offered immunization to workers. These tests revealed a second case, which was discovered on April 24. It was decided the risk of contamination to the public in this case was higher.

"The overall assessment when investigating the risk with the second case was the employee was handling food," said Kurji. "It was prudent for us to reach out to public and take necessary precautions.

York Region Public Health is holding a vaccine clinic Monday from 4 p.m. to 8 p.m. in the auditorium of the Newmarket Health Centre. People who ate food from this Tim Hortons between April 13 and April 22 are eligible for the vaccine. However, anyone who ate there between April 2 and April 22 could be infected.

Hep A happens a lot, but the way this one has been handled raises a few questions for me:

I wonder why the folks who ate at the Hortons before April 13th are excluded from eligibility from the vaccine? Does someone need to prove (with a receipt?) that they ate there between April 13 and 22nd? Who bears the cost if someone wants to get an IGG shot and is excluded? What happens if that individual gets sick?

This week’s food safety infosheet was about Hep A in a produce handler in Colorado.

A break from listeria: Don’t clean up barf and then head straight into the kitchen

This week’s food safety infosheet focuses on a norovirus outbreak linked to a North Carolina BBQ restaurant in Lexington, NC.  Health authorities have been reported as saying that they believe a food handler, who was not displaying symptoms of a norovirus infection, brought the virus into the kitchen after caring for a family member who was ill. 

Message is: If you are looking after someone who has diarrhea or has been vomiting, it’s really important to not introduce the pathogen into a food preparation or handling setting.  Wash your hands and make sure there aren’t any virus aerosols on your clothes (that happens when you vomit with noro; maybe change them before you head into the kitchen).

You can download the infosheet here.