Vaccines still work: Estimated Medicaid costs associated with hepatitis A outbreak

What is already known about this topic?

Widespread outbreaks of hepatitis A among persons who use illicit drugs (injection and noninjection) have increased in recent years. Hepatitis A is a vaccine-preventable disease.

What is added by this report?

During January 1, 2018–July 31, 2019, hepatitis A–related clinical costs among West Virginia Medicaid beneficiaries ranged from $1.4 million to $5.6 million. Among those with a substance use disorder diagnosis, costs ranged from $1.0 million to $4.4 million.

What are the implications for public health practice?

In addition to insight on preventing illness, hospitalization, and death, the results from this study highlight the potential financial cost jurisdictions might incur when Advisory Committee on Immunization Practices recommendations for hepatitis A vaccination, especially among persons who use illicit drugs, are not followed.

Estimated Medicaid costs associated with hepatitis A outbreak—West Virginia, 2018-2019

Morbidity and Mortality Weekly Report

Samantha J. Batdorf, MPH1; Megan G. Hofmeister, MD2; Tamara C. Surtees, MPH3; Erica D. Thomasson, PhD1,4; Shannon M. McBee, MPH1; Nathan J. Pauly, PhD5

https://www.cdc.gov/mmwr/volumes/70/wr/mm7008a2.htm?s_cid=mm7008a2_e&ACSTrackingID=USCDC_921-DM50427&ACSTrackingLabel=This%20Week%20in%20MMWR%20-%20Vol.%2070,%20February%2026,%202021&deliveryName=USCDC_921-DM50427

(Viruses are not cells, but they need to cells to reproduce.)

Avocados as a source of Listeria

Outbreaks of Listeria monocytogenes (L. monocytogenes) infections have historically been associated with contaminated deli meats, but recent outbreaks have been linked to produce. To date, avocados have not been identified as the source of any outbreaks of L. monocytogenes infections in the United States, but avocado samples have yielded strains that were closely related genetically to clinical L. monocytogenes isolates.

To determine whether avocados have been a source of listeriosis, we conducted a retrospective review of epidemiological data for clinical isolates that were genetically related to isolates from avocados. Using a national database, we identified clusters containing clinical and at least one avocado isolate. We then selected clusters based upon isolation dates, cluster and composition size, and available food history data. For each cluster, we assessed whether (1) avocado consumption was higher among case-patients in the cluster than among those with sporadic illnesses, and (2) whether the only food isolates within the cluster were from avocados. If both conditions were met, the link was considered “likely,” if one condition was met the link was considered “possible,” and if neither condition was met evidence was “limited.”

Five of fifteen clusters met criteria for assessment. Of these, two were classified as having “limited” evidence for a link to avocados, two as “possible,” and one as “likely.” For the cluster considered “likely”, avocado consumption was significantly higher among case-patients in the cluster compared to sporadic illnesses (Odds ratio: 8.5, 95% CI 1.5-86.5). We identified three clusters that were likely or possibly linked to avocados, suggesting avocados could be a source of listeriosis in the United States.

Messaging on safe handling might be warranted for groups at higher risk, but further research is first needed to better characterize the ecology of pathogens on avocados and likelihood of internalization of L. monocytogenes.

 

Evaluation of avocados as a possible source of listeria monocytogenes infections, United States, 2016-2019, 16 February 2021

Journal of Food Protection

Mary Pomeroy ; Amanda Conrad ; James B. Pettengill ; Monica McClure ; Allison A. Wellman ; Jessie Marus ; Jasmine Huffman ; Matthew Wise

https://doi.org/10.4315/JFP-20-419

https://meridian.allenpress.com/jfp/article-abstract/doi/10.4315/JFP-20-419/461503/Evaluation-of-avocados-as-a-possible-source-of?redirectedFrom=fulltext

Listeria outbreak linked to queso fresco made by El Abuelito Cheese Inc.

Fast Facts

Illnesses: 11

Hospitalizations: 10

Deaths: 1

States: 4

Recall: Yes

Investigation status: Active

The U.S. Centers for Disease Control reports that on February 28, El Abuelito Cheese Inc. recalled quesillo and requeson cheesesexternal icon, in addition to the previously recalled queso fresco cheesesexternal icon. These cheeses were made or packed at the same facility as the contaminated queso fresco.

Queso Fresco with sell-buy dates through 03/28/21

Brand names: El Abuelito, Rio Grande, Rio Lindo

The El Abuelito brand 5-lb product may be repacked by stores and sold without a brand label or labeled with a different brand.

Quesillo (Oaxaca, string cheese) with sell-buy dates through 04/16/21

Brand names: El Abuelito, El Viejito, El Paisano, El Sabrosito, La Cima, Quesos Finos, San Carlos, Ideal

Many of the quesillo products were sold in bulk (5-14 lb bags). These products may be repacked by stores and sold without a brand label or labeled with a different brand.

Requeson (ricotta) with sell-buy dates through 03/14/21

Brand names: El Abuelito, El Viejito

These products were sold in 12-oz clamshell containers.

What You Should Do

Do not eat recalled queso fresco, quesillo, or requeson cheeses. Throw them away or return them to where you bought them.

Origins of CWD in Europe

Chronic wasting disease (CWD) is a relentless epidemic disorder caused by infectious prions that threatens the survival of cervid populations and raises increasing public health concerns in North America. In Europe, CWD was detected for the first time in wild Norwegian reindeer (Rangifer tarandus) and moose (Alces alces) in 2016. In this study, we aimed at comparing the strain properties of CWD prions derived from different cervid species in Norway and North America.

Using a classical strain typing approach involving transmission and adaptation to bank voles (Myodes glareolus), we found that prions causing CWD in Norway induced incubation times, neuropathology, regional deposition of misfolded prion protein aggregates in the brain, and size of their protease-resistant core, different from those that characterize North American CWD. These findings show that CWD prion strains affecting Norwegian cervids are distinct from those found in North America, implying that the highly contagious North American CWD prions are not the proximate cause of the newly discovered Norwegian CWD cases.

In addition, Norwegian CWD isolates showed an unexpected strain variability, with reindeer and moose being caused by different CWD strains. Our findings shed light on the origin of emergent European CWD, have significant implications for understanding the nature and the ecology of CWD in Europe, and highlight the need to assess the zoonotic potential of the new CWD strains detected in Europe.

Studies in bank voles reveal strain differences between chronic wasting disease prions from Norway and North America

PNAS

Romolo Nonno, Michele A. Di Bari, Laura Pirisinu, Claudia D’Agostino, Ilaria Vanni, Barbara Chiappini, Stefano Marcon, Geraldina Riccardi, Linh Tran, Turid Vikøren, Jørn Våge, Knut Madslien, Gordon Mitchell, Glenn C. Telling, Sylvie L. Benestad, and Umberto Agrimi

https://doi.org/10.1073/pnas.2013237117

https://www.pnas.org/content/early/2020/11/18/2013237117.abstract

Vaccines work: Hep A in frozen strawberries, Germany

Following outbreaks linked to frozen strawberries in Sweden and Austria in 2018, 65 cases linked to the same hepatitis A virus strain were detected in Germany between October 2018 and January 2020, presenting in two waves.

Two case–control studies and a comparison of cases’ consumption frequencies with purchase data from a large consumer panel provided strong evidence for frozen strawberry cake as the main vehicle of transmission. Of 46 cases interviewed, 27 reported consuming frozen strawberry cake and 25 of these identified cake(s) from brand A spontaneously or in product picture-assisted recall.

Trace back investigations revealed that the Polish producer involved in the previous outbreaks in Sweden and Austria had received frozen strawberries from Egypt via a wholesaler that also delivered frozen strawberries to manufacturer of brand A. Phylogenetic analyses linked the outbreak strain to similar strains formerly isolated from sewage, stool and strawberries in Egypt. Complete trace back and timely recall of products with strong evidence of contamination is important to control an outbreak and prevent later resurgence, particularly for food items with a long shelf life.

Continued molecular surveillance of hepatitis A is needed to identify outbreaks and monitor the success of food safety interventions.

Resurgence of an international hepatitis A outbreak linked to imported frozen strawberries, Germany, 2018 to 2020

Eurosurveillance

Claudia Ruscher1 , Mirko Faber2 , Dirk Werber1 , Klaus Stark2 , Julia Bitzegeio1 , Kai Michaelis2 , Daniel Sagebiel1 , Jürgen J Wenzel3 , Julia Enkelmann2

https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2020.25.37.1900670?emailalert=true

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.

Listeria, caramel apples and food contact surfaces

The 2014 caramel apple listeriosis outbreak was traced back to cross-contamination between food contact surfaces (FCS) of equipment used for packing and fresh apples. For Washington State, the leading apple producer in the U.S with 79% of its total production directed to the fresh market, managing the risk of apple contamination with Listeria monocytogenes within the packing environment is crucial. The objectives of this study were to determine the prevalence of Listeria spp. on FCS in Washington State apple packinghouses over two packing seasons, and to identify those FCS types with the greatest likelihood to harbor Listeria spp.

Five commercial apple packinghouses were visited quarterly over two consecutive year-long packing seasons. A range of 27 to 50 FCS were swabbed at each facility to detect Listeria spp. at two timings of sampling, (i) post-sanitation and (ii) in-process (three hours of packinghouse operation), following a modified protocol of the FDA’s Bacteriological Analytical Manual method.

Among 2,988 samples tested, 4.6% (n=136) were positive for Listeria spp. Wax coating was the unit operation from which Listeria spp. were most frequently isolated. The FCS that showed the greatest prevalence of Listeria spp. were polishing brushes, stainless steel dividers and brushes under fans/blowers, and dryer rollers. The prevalence of Listeria spp. on FCS increased throughout apple storage time. The results of this study will aid apple packers in controlling for contamination and harborage of L. monocytogenes and improving cleaning and sanitation practices of the most Listeria-prevalent FCS.IMPORTANCE Since 2014, fresh apples have been linked to outbreaks and recalls associated with post-harvest cross-contamination with the foodborne pathogen L. monocytogenes These situations drive both public health burden and economic loss and underscore the need for continued scrutiny of packinghouse management to eliminate potential Listeria spp. niches. This research assesses the prevalence of Listeria spp. on FCS in apple packinghouses and identifies those FCS most likely to harbor Listeria spp. Such findings are essential for the apple packing industry striving to further understand and exhaustively mitigate the risk of contamination with L. monocytogenes to prevent future listeriosis outbreaks and recalls.

Prevalence of listeria species on food contact surfaces in Washington state apple packinghouses, 2021

Applied Environmental Microbiology

Blanca Ruiz-Llacsahuanga 1Alexis Hamilton 1Robyn Zaches 1Ines Hanrahan 2Faith Critzer 3

DOI: 10.1128/AEM.02932-20

https://pubmed.ncbi.nlm.nih.gov/33608295/

10 dead, 24 sick: Listeria in cheese in Switzerland

Swiss authorities are investigating if cheese from one company is linked to the deaths of 10 people with listeriosis since 2018.

The Schwyz Public Prosecutor’s Office has opened criminal proceedings in connection with Listeria in dairy products and is investigating allegations against the owner of the cheese firm.

A total of 34 cases are believed to have been infected with the same Listeria strain that was detected in brie from the dairy, according to the criminal complaint. Ten of the 34 sick people died. This resulted from analyzes commissioned by the federal government.

The ongoing investigation, with Schwyz police, includes whether the business owner is responsible for the illnesses and has violated food law.

Käserei Vogel AG, based in Steinerberg, a municipality of Schwyz, found Listeria in semi-hard cheese and at its production site in May this year. The company issued a recall, told authorities and informed its buyers to remove the products from shelves. The cheesemaker has already closed the business. More than 25 items sold across Switzerland were recalled and distribution also included Belgium and Germany.

Listeriosis caused by persistence of listeria monocytogenes serotype 4b sequence type 6 in cheese production environment

Emerging Infectious Diseases vol. 27

Magdalena Nüesch-Inderbinen , Guido V. Bloemberg, Andrea Müller, Marc J.A. Stevens, Nicole Cernela, Beat Kollöffel, and Roger Stephan

https://wwwnc.cdc.gov/eid/article/27/1/20-3266_article

A nationwide outbreak of human listeriosis in Switzerland was traced to persisting environmental contamination of a cheese dairy with Listeria monocytogenes serotype 4b, sequence type 6, cluster type 7488. Whole-genome sequencing was used to match clinical isolates to a cheese sample and to samples from numerous sites within the production environment.

Staphylococcus and meat production chain

Staphylococcus saprophyticus is a primary cause of community-acquired urinary tract infections (UTIs) in young women. S. saprophyticus colonizes humans and animals but basic features of its molecular epidemiology are undetermined.

We conducted a phylogenomic analysis of 321 S. saprophyticus isolates collected from human UTIs worldwide during 1997–2017 and 232 isolates from human UTIs and the pig-processing chain in a confined region during 2016–2017. We found epidemiologic and genomic evidence that the meat-production chain is a major source of S. saprophyticus causing human UTIs; human microbiota is another possible origin. Pathogenic S. saprophyticus belonged to 2 lineages with distinctive genetic features that are globally and locally disseminated. Pangenome-wide approaches identified a strong association between pathogenicity and antimicrobial resistance, phages, platelet binding proteins, and an increased recombination rate.

Our study provides insight into the origin, transmission, and population structure of pathogenic S. saprophyticus and identifies putative new virulence factors.

Foodborne origin and local and global spread of staphylococcus saprophyticus causing human urinary tract infections

Emerging Infectious Diseases vol. 27 no. 3

Opeyemi U. Lawal, Maria J. Fraqueza, Ons Bouchami, Peder Worning, Mette D. Bartels, Maria L. Gonçalves, Paulo Paixão, Elsa Gonçalves, Cristina Toscano, Joanna Empel, Małgorzata Urbaś, M. Angeles Domínguez, Henrik Westh, Hermínia de Lencastre, and Maria Miragaia 

https://wwwnc.cdc.gov/eid/article/27/3/20-0852_article?ACSTrackingID=USCDC_331-DM50174&ACSTrackingLabel=Emerging%20Infectious%20Diseases%20Journal%20-%20Volume%2027%2C%20Issue%203%20-%20March%202021%20Issue%20Now%20Online&deliveryName=USCDC_331-DM50174

Raw is risky: Contaminated seafood

It’s been a rough few months of outbreaks related to seafood, especially the raw stuff.

More than 500 kilograms of raw oysters from Vietnam were recently seized by Taiwan’s Food and Drug Administration (FDA) after the products were found to be contaminated with dangerous foodborne viruses,

The FDA said it had seized a shipment of 270 kg of raw oysters contaminated with hepatitis A.

Two other shipments of raw oysters totaling 255 kg, meanwhile, were found to be tainted by norovirus, the agency said, adding that all the products had been confiscated and destroyed.

By Nov. 2020, Florida state health officials reported 33 cases of Vibrio vulnificus in 20 counties, including six deaths had been reported

In Dec. 2020, it was reported that sushi bars at two Harris Teeter stores in Concord, North Carolina, sickened 159 people.

Health officials said that many of the sick people developed symptoms like vomiting, diarrhea, fever, muscle aches, and abdominal cramps, but they did not confirm the type of infection.

Last Sept., New Brunswick health officials (that’s a province in Canada) uncovered at least nine cases of Vibrio parahaemolyticus, a bacteria found in shellfish that causes gastrointestinal illness in humans.