Are they judging jams? Blue-ribbon panel on the prevention of foodborne Cyclospora outbreaks

When someone says a blue-ribbon panel summarized results on the prevention of foodborne Cyclospora outbreaks, I think blue-ribbons is talking about jams or Holsteins at county fairs.

My aunt got sick from Cyclospora in some basil-based thingy in Florida (and sometimes there is for hockey for Sorenne last Sat).

She was sick for weeks.

On June 12, 1996, Ontario’s chief medical officer, Dr. Richard Schabas, issued a public health advisory on the presumed link between consumption of California strawberries and an outbreak of diarrheal illness among some 40 people in the Metro Toronto area. The announcement followed a similar statement from the Department of Health and Human Services in Houston, Texas, who were investigating a cluster of 18 cases of Cyclospora illness among oil executives.

Dr. Schabas advised consumers to wash California berries “very carefully” before eating them, and recommended that people with compromised immune systems avoid them entirely. He also stated that Ontario strawberries, which were just beginning to be harvested, were safe for consumption. Almost immediately, people in Ontario stopped buying strawberries. Two supermarket chains took California berries off their shelves, in response to pressure from consumers. The market collapsed so thoroughly that newspapers reported truck drivers headed for Toronto with loads of berries being directed, by telephone, to other markets.

However, by June 20, 1996, discrepancies began to appear in the link between California strawberries and illness caused by the parasite, Cyclospora, even though the number of reported illnesses continued to increase across North America. Texas health officials strengthened their assertion that California strawberries were the cause of the outbreak, while scientists at the U.S. Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA) said there were not yet ready to identify a food vehicle for the outbreak. On June 27, 1996, the New York City Health Department became the first in North America to publicly state that raspberries were also suspected in the outbreak of Cyclospora.

By July 18, 1996, the CDC declared that raspberries from Guatemala — which had been sprayed with pesticides mixed with water that could have been contaminated with human sewage containing Cyclospora — were the likely source of the Cyclospora outbreak, which ultimately sickened about 1,000 people across North America. Guatemalan health authorities and producers have vigorously refuted the charges. The California Strawberry Commission estimates it lost $15 million to $20 million in reduced strawberry sales.

Cyclospora cayetanensis is a recently characterised coccidian parasite; the first known cases of infection in humans were diagnosed in 1977. Before 1996, only three outbreaks of Cyclospora infection had been reported in the United States. Cyclospora is normally associated with warm, Latin American countries with poor sanitation.

One reason for the large amount of uncertainty in the 1996 Cyclospora outbreak is the lack of effective testing procedures for this organism. To date, Cyclospora oocysts have not been found on any strawberries, raspberries or other fruit, either from North America or Guatemala. That does not mean that cyclospora was absent; it means the tests are unreliable and somewhat meaningless. FDA, CDC and others are developing standardized methods for such testing and are currently evaluating their sensitivity.

The initial, and subsequent, links between Cyclospora and strawberries or raspberries were therefore based on epidemiology, a statistical association between consumption of a particular food and the onset of disease. For example, the Toronto outbreak was first identified because some 35 guests attending a May 11, 1996 wedding reception developed the same severe, intestinal illness, seven to 10 days after the wedding, and subsequently tested positive for cyclospora. Based on interviews with those stricken, health authorities in Toronto and Texas concluded that California strawberries were the most likely source. However, attempts to remember exactly what one ate two weeks earlier is an extremely difficult task; and larger foods, like strawberries, are recalled more frequently than smaller foods, like raspberries. Ontario strawberries were never implicated in the outbreak.

Once epidemiology identifies a probable link, health officials have to decide whether it makes sense to warn the public. In retrospect, the decision seems straightforward, but there are several possibilities that must be weighed at the time. If the Ontario Ministry of Health decided to warn people that eating imported strawberries might be connected to Cyclospora infection, two outcomes were possible: if it turned out that strawberries are implicated, the ministry has made a smart decision, warning people against something that could hurt them; if strawberries were not implicated, then the ministry has made a bad decision with the result that strawberry growers and sellers will lose money and people will stop eating something that is good for them. If the ministry decides not to warn people, another two outcomes are possible: if strawberries were implicated, then the ministry has made a bad decision and people may get a parasitic infection they would have avoided had they been given the information (lawsuits usually follow); if strawberries were definitely not implicated then nothing happens, the industry does not suffer and the ministry does not get in trouble for not telling people. Research is currently being undertaken to develop more rigorous, scientifically-tested guidelines for informing the public of uncertain risks.

But in Sarnia (Ontario, Canada) they got a lot of sick people who attended the Big Sisters of Sarnia-Lambton Chef’s Challenge on May 12, 2010.

Michael T. Osterholm, PhD, who has a lot of titles and once called me at 5 a.m. to tell me I was an asshole (maybe not the exact words, but the sentiment) and chair of the Holstein Blue-Ribbon Panel on the Prevention of Foodborne Cyclospora Outbreaks writes that the 1996 cyclosporiasis outbreak in the United States and Canada associated with the late spring harvest of imported Guatemalan-produced raspberries was an early warning to public health officials and the produce industry that the international sourcing of produce means that infectious agents once thought of as only causing traveler’s diarrhea could now infect at home. The public health investigation of the 1996 outbreak couldn’t identify how, when, where, or why the berries became contaminated with Cyclospora cayetanensis.

The investigation results were published in the New England Journal of Medicine in 1997. I was asked to write an editorial to accompany the investigation report.2 In my editorial, I noted the unknowns surrounding the C. cayetanensis contamination. The 1997 spring harvest of Guatemalan raspberries was allowed to be imported into both the United States and Canada—and again, a large outbreak of cyclosporiasis occurred. As in the 1996 outbreak, no source for the contamination of berries was found. Later in 1997, the Food and Drug Administration (FDA) prohibited the importation of future spring harvests of Guatemalan raspberries until a cause for the contamination could be demonstrated and corrective actions taken. While the FDA did not permit the 1998 importation of the raspberries into the United States, the berries continued to be available in Canada. Outbreaks linked to raspberries occurred in Ontario in May 1998. When the U.S. Centers for Disease Control and Prevention (CDC)-led investigative team published its 1997 outbreak findings in the Annals of Internal Medicine, 3 I was again asked to write an accompanying editorial.4 As I had done in my previous editorial, I highlighted how little we know about the factors associated with the transmission Cyclospora on produce and how to prevent it.

Unfortunately, the state of the art for preventing foodborne, produce-associated cyclosporiasis had changed little since the 1996 outbreak despite the relatively frequent occurrence of such outbreaks.

Thirty-two years after that first Guatemalan raspberry-associated outbreak — and a year after produce-associated cyclosporiasis outbreaks that were linked to U.S.-grown produce — we have taken a major step forward in our understanding of these outbreaks and how to prevent them. After Fresh Express produce was identified in one of the 2018 outbreaks, I was asked by the company leadership to bring together the best minds’ around all aspects of produceassociated cyclosporiasis. The goal was to establish a Blue-Ribbon Panel to summarize state-of-the-art advancements regarding this public health challenge and to identify immediate steps that the produce industry and regulators can take to prevent future outbreaks. The panel was also formed to determine what immediate steps can be taken for any future outbreaks to expedite the scientific investigation to prevent further cases and inform public health officials. The Blue-Ribbon Panel comprises 11 individuals with expertise in the biology of Cyclospora; the epidemiology of cyclosporiasis, including outbreak investigation; laboratory methods for identifying C. cayetanensis in human and food samples and the environment; and produce production. In addition,16 expert consultants from academia, federal and state public health agencies (including expert observers from the FDA, CDC, U.S. Department of Agriculture, and California Department of Public Health), and industry, including producers and professional trade association science experts. The collaboration and comprehensiveness of this effort was remarkable. Many hundreds of hours of meetings and conference calls took place to determine our findings and establish our recommendations.

This document, “Interim Report: Blue-Ribbon Panel on the Prevention of Cyclospora Outbreaks in the Food Supply,” summarizes the state-of-the art practices for the prevention of C. cayetanensis contamination of produce and priorities for research that will inform us as we strive to further reduce infection risk. Also, we make recommendations on how to more quickly identify and more effectively respond to produce-associated outbreaks when they occur. We greatly appreciate all the organizations represented on the panel and the expert consultants. The report does not, however, represent the official policy or recommendations of any other private, academic, trade association or federal or state government agency. Fresh Express has committed to continuing the Blue-Ribbon Panel process for as long as it can provide critical and actionable information to prevent and control Cyclospora outbreaks in the food supply.

Table: Summary of U.S. foodborne outbreaks of cyclosporiasis, 2000–2017
Year(s)* Month(s)* Jurisdiction(s)* No. of cases† Food vehicle and source, if identified‡
2000 May Georgia 19 Raspberries and/or blackberries (suspected)
2000 June Pennsylvania 54 Raspberries
2001 January–February Florida 39
2001 January New York City 3
2001–02 December–January Vermont 22 Raspberries (likely)
2002 April–May Massachusetts 8
2002 June New York 14
2004 February Texas 38
2004 February Illinois 57 Basil (likely)
2004 May Tennessee 12
2004 May–June Pennsylvania 96 Snow peas from Guatemala ⁂
2005 March–May Florida 582 ¶ Basil from Peru
2005 May South Carolina 6
2005 April Massachusetts 58
2005 May Massachusetts 16
2005 June Connecticut 30 Basil (suspected)
2006 June Minnesota 14
2006 June New York 20
2006 July Georgia 3
2008 March Wisconsin 4 Sugar snap peas (likely) ⁂
2008 July California 45 ¶ Raspberries and/or blackberries (likely)
2009 June District of Columbia 34
2011 June Florida 12
2011 July Georgia 88**
2012 June–July Texas 16
2013†† June Iowa, Nebraska, and neighboring states 162 Bagged salad mix from Mexico
2013†† June–July Texas 38 Cilantro from Mexico
2013 July Wisconsin 8 Berry salad (suspected)
2014 June Michigan 14
2014‡‡ June–July Texas 26 Cilantro from Mexico
2014 July South Carolina 13
2015 May–July Georgia, Texas, and Wisconsin 90 Cilantro from Mexico
2016 June–July Texas 6¶¶ Carrots or green cabbage (suspected)
2017 May Florida 6 Berries (suspected)
2017 May–July Texas 38*** Scallions (i.e., green onions)
2017 June Michigan 29
2017 June Tennessee 4†††
2017 June Connecticut 3
2017 July Florida 3‡‡‡

Tourist infected by brain-invading parasite after eating slug on a dare in Hawaii

If people dare you to eat a slug, don’t.

It could turn out quite badly.

I try not to be prescribtive and just tell people about risks and let them make their own decisions, but in this case, don’t eat slugs (those are slugs going after my basil in Kansas, below).

Health officials in Hawaii are warning residents and visitors to avoid slugs, snails, and rats after the US Center for Disease Control (CDC) found that three travellers visiting the state were recently infected with rat lungworm disease. One visitor got the disease because the individual ate a slug.

The notice, issued late last month, warns people to inspect produce and wash fruit and vegetables that could have small slugs or snails. These gastropods get the rat lungworm parasite (also known as an Angiostrongylus Infection) by eating rat faeces, and rats eat the infected slugs and snails, forming a continuous vile circle. Sometimes, humans get looped in by eating an uncooked snail. Once the parasite has infected a host, it can move to the brain and cause a type of meningitis, and eventually lead to death. There is not a treatment for rat lungworm disease, according to the CDC.

The recent Hawaii health department notice states that it does inform travellers visiting Hawaii about the disease through signage, but acknowledges it needs to do better. “We recognise that there is more work to be done in educating residents and visitors and making sure they know how to prevent the spread of this disease,” the notice reads.

E. coli found in Icelandic meat

Keeping with all things Icelandic, E. coli was found in 30% of lamb samples and 11.5% of beef samples in a test carried out by the Icelandic Food and Veterinary Authority (MAST). The particular strain discovered is known as STEC, or shiga-toxin producing E. coli. This is the first time lamb and beef have been screened for STEC in Iceland.

The testing was carried out on around 600 samples of lamb, beef, pork, and chicken of both Icelandic and foreign origin between March and December 2018. The purpose of the testing was to determine the prevalence of pathogenic micro-organisms in products when they reach the consumer, and for this reason the samples were taken from shops.

Campylobacter and salmonella were not detected in pork or chicken samples, with the exception of a single sample of pork from Spain. MAST attributes this to improved preventative measures in slaughterhouses.

MAST points to several ways consumers can reduce the risk of infection from salmonella, campylobacter, and E. coli, including cooking meat all the way through and taking care to avoid cross-contamination. Most E. coli is found on the surface of meat, and therefore is killed by frying or grilling, but when meat is ground, the bacteria is distributed throughout. Therefore, hamburgers and other types of ground meat should be cooked through.

But what does that mean?

Use a tip-sensitive digital thermometer.

100 sick: Ice-maker in Iceland: stops sales to suppliers

E. coli was found in a water pool that is close to the infected area on Askøy. Nearly 100 primary school students have been sick Friday, and several have been admitted to hospital.

Later on Friday, Haukeland Hospital reported that it is campylobacter bacteria that cause intestinal infection, which has been detected in admitted from Askøy. Campylobacter is a bacterium that E-coli often finds along with.

Isbjørn Is has used the water in the municipality both in the products and for cleaning equipment. Kolseth explains that all the products in which it enters water are heat treated – so that no pathogenic bacteria can survive. However, they use lower temperature water for rinsing and cleaning parts and smaller equipment.

– This means that there can potentially be poor quality water on parts of our equipment when production starts. We have to have full control of this, says Kolseth.

Everyone’s got a camera: Burger King employee mopping tables edition

 A restaurant employee was caught on camera cleaning tables with a mop.

A customer recorded the video at a Burger King restaurant on Thursday night.

“It was disgusting, honestly. I had just ate on that table. Did you do this yesterday? Do you do this every night? Did you do this, this morning?” the customer asked.

Katie Duran recorded the video, and now, she has questions for the restaurant.

After sending the video to Burger King’s corporate office, she received this response:

“Thank you for bringing this matter to our attention, and rest assure that your comments have been forwarded to the appropriate management team.”

News4Jax looked into the restaurant’s inspection report with the state and found seven basic violations and one intermediate violation. The violations included vents in the kitchen containing mold and the interior of the freezer soiled with food residue.

E. coli: Kentucky teen is back in the game after life-threatening illness

Sixteen-year-old Anna Rexford is, according to this story, a winner. Not only is she the goalkeeper for the two-time state champions West Jessamine High School girls’ soccer team, Anna was named MVP for the tournament two years in a row. After her first season at West Jessamine, she committed to playing for University of Cincinnati and is a contender to play in the Allstate All-America Cup this summer. Clearly, Anna is at the top of her game. But just three short years ago, a harrowing illness made her future uncertain.

Anna Rexford on June 7, 2019. Photo by Mark Cornelison | UKphoto

In July 2016, Anna and her mother Tracy went on a week-long mission trip to Haiti. Tracy is a nurse, and the two spent the week doing health screenings and nutrition programs for children. Anna played with the local children nonstop during that week, challenging them to soccer and leading them in games.

“She gave 110 percent,” said Tracy. “She was always with the kids, playing and giving her whole heart to them.”

Within hours of returning home to Wilmore, Anna began to feel unwell. She had pounding headache and her whole body hurt. Her mother took her temperature. It was a staggering 106.8 degrees.

“I knew, as a nurse, that was almost incompatible with life and that we needed to get help,” said Tracy.

Anna was admitted to Kentucky Children’s Hospital and diagnosed with a rare case of four different strands of E.coli, two of which were toxic. She was showing signs of sepsis, a bacterial infection of the blood, as well as organ failure.

“There was one particular night where I didn’t think she would make it,” said Tracy. “There were some confusing times, questioning God, “‘God, you called a 14-year-old passionate Christian to go and serve, and you want to end it like this? You want to end it where she dies?'”

Hey kids, who wants rocks in their wraps?

CBS  reports that frozen breakfast wraps are being recalled because there might be small rocks in the bacon.

Ruiz Food Products is recalling more than 246,000 pounds of frozen egg, potato, bacon and cheese wraps because the bacon may be contaminated with small rocks, according to the U.S. Food Safety and Inspection Service.

The recall affects the following products:

8-Pack family size film packages containing “EL MONTEREY EGG, POTATO, BACON & CHEESE SAUCE BREAKFAST WRAPS” with “Best if Used By” dates of 01/17/2020 and 01/18/2020 and lot codes 19017 and 19018.

The products subject to recall bear establishment number “EST. 17523A” on the back of the package.

Ruiz Foods received three consumer complaints about foreign material in the wraps. The company also received a report of a potential injury from eating the product.

FYI, those wraps sound disgusting, without the rocks.

California man dies at Dominican Republic resort after drinking scotch from minibar, niece says

Lisa Fernandez of Fox 10 writes that another American tourist has died in the Dominican Republic: The latest casualty is a California man who fell critically ill at an all-inclusive resort about a month before three others died in their rooms, Fox News has learned.

In all, six U.S. tourists have died in recent months while vacationing in the Dominican Republic – a trend that the FBI is now investigating. 

Robert “Bob” Bell Wallace, 67, of Modesto, and who grew up in Redwood City, became sick almost immediately after he had a scotch from the room minibar at the Hard Rock Hotel & Casino resort in Punta Cana in April, his niece, Chloe Arnold, told Fox News on Sunday. He was in the Dominican Republic to attend his stepson’s wedding. He is survived by his wife, Beverly Tickenoff Wallace, according to his obituary. The two had three children between each other. 

Punta Cana is a town at the easternmost tip of the Dominican Republic and touches the Caribbean Sea and the Atlantic Ocean. The spot is known for its beaches and lavish resorts. 

Norovirus strains don’t all look alike

Leemor Joshua-Tor of the Howard Hughes Medical Institute writes a new structural analysis of four norovirus strains reveals that the virus’s shell varies in size and molecular arrangement – a surprise finding that could help scientists developing vaccines. 

The discovery, reported June 10, 2019, in the journal Proceedings of the National Academy of Sciences, overturns nearly two decades of conventional wisdom about norovirus. Until now, the only structural data about the virus that scientists had came from a single, not particularly prevalent, strain.

“Everyone thought that all the strains would look about the same – like the one that was solved 20 years ago,” says Howard Hughes Medical Institute Investigator Leemor Joshua-Tor. “It turns out that they don’t!”

Joshua-Tor’s team used a microscopy technique called cryo-electron microscopy (cryo-EM) to visualize the shells of four viral strains, including one responsible for up to roughly 80 percent of norovirus outbreaks. That strain was 71 percent larger (by volume) than the one previously reported. Its shell was also decorated with a different pattern of molecular spikes.

Those structural details will be crucial for scientists working on vaccines or antiviral therapies to treat norovirus infection, says Joshua-Tor, a structural biologist at Cold Spring Harbor Laboratory (CSHL). Though norovirus causes about 21 million cases of foodborne illness in the United States every year, there are currently no approved therapies.

At least one vaccine candidate is working its way through clinical trials now. But CSHL study coauthor James Jung says scientists will need to take the virus’s newfound variation into account – so any new vaccine protects against a broad array of strains.