Food safety, Idaho style

Posted on June 11, 2017 by Ben Chapman

The kids in Idaho are alright. Thanks to University of Idaho’s Josh Bevan and the rest of the IFT Intermountain section, I’m in Sun Valley, Idaho taking in the sites after talking some food safety stuff. I gave a talk Friday morning (slides here) on things we’ve seen on barfblog that some might consider emerging issues (kimchi, tempeh, kombucha, sous vide) and a bit on where mere mortals in the kitchen might get food safety information.

One of the things I talked about was illnesses from handling and/or eating raw flour – current with Canadian’s experiencing their second outbreak in a few months.

From CBC news (home of Hockey Night in Canada and topical food safety news):

A new, separate recall involves a batch of Rogers 10-kilogram all-purpose flour possibly contaminated with E.coli and sold at B.C. Costco stores.The recall was triggered by a Canadian Food Inspection Agency (CFIA) investigation after five people in B.C. all became infected with the same strain of E.coli.The B.C. Centre for Disease Control tested the Rogers flour purchased by one of the victims who fell ill after eating raw dough. It contained the E.coli strain O121.Rogers Foods says a direct link to its flour product has not yet been proven and that it’s working with the CFIA on investigating the situation.The company stresses that people can protect themselves by not eating raw flour or dough — the cooking process helps kill any lingering pathogens.”We must emphasize that flour is a raw agricultural product and must be thoroughly baked or cooked before eating,” Rogers Foods said in a letter to customers.

Also this week, Schaffner posed a question to a Facebook group of food safety nerds, ‘E. coli in flour: So always there and now we see it, or new problem?’

My guess, instep with lots of the responses, is it has been there in low levels resulting illnesses. But they looked sporadic with the long shelf life of the product and commingling.

Back in Idaho, I shared some of the materials that from a workshop on STEC in flour that Natalie Seymour and I organized. Karen Neil of CDC, Tim Jackson from Nestle and Scott Hood from General Mills spoke about challenges in flour food safety. The workshop focused on stuff like, there’s no kill step in the milling process, there’s literally tons of commingling and although it’s not intended to be eaten raw – sometimes it is (in cookie dough, cake mix).

And a risk factor in the 2016 Gold Medal-linked outbreak was kids handling raw tortilla and pizza dough in restaurants. There’s some other stuff known about flour – generic E. coli species have been found in flour in NZ. A survey conducted on wheat and flour milling in Australia showed no detectable Salmonella, 3.0 MPN/g of generic E. coli and 0.3 MPN/g of B. cereus recovered on average from 650 samples (from two mills).

And a 2007 US study found generic E. coli in 12.8% of commercial wheat flour samples examined.

We need better messages, better delivery and not just the same old stuff to get folks the risk information they need to make decisions.

Plague in domestic cats — Idaho, 2016

Posted on December 10, 2016 by Douglas Powell

The U.S. Centers for Disease Control and Prevention reports in May 2015, Yersinia pestis, the bacterium that causes plague, was identified in dead Piute ground squirrels (Urocitellus mollis) reported through the Idaho Department of Fish and Game’s wildlife mortality monitoring program; in June 2015, the Idaho Division of Public Health (DPH) sent an advisory to veterinarians in four southwestern Idaho counties requesting that they notify their local public health officials of suspected plague in animals.* Y. pestis was not confirmed in any pets during 2015.

During May 30–July 26, 2016, local veterinarians notified public health officials that five dogs and 12 cats were being evaluated for possible plague. Local veterinarians also performed necropsies, when applicable, to establish the diagnosis. Idaho’s Central District Health Department and Eastern Idaho Public Health coordinated with DPH on submission of specimens to the DPH Bureau of Laboratories for Y. pestis testing and interviewed veterinary staff and pet owners. Specimens from blood, spleen, liver, and lymph nodes were screened using real–time polymerase chain reaction and confirmed by culture and phage lysis testing.

Among evaluated animals, Y. pestis was isolated from six of 12 cats; five of the six were from areas in southwestern Idaho where dead ground squirrels with confirmed Y. pestis had been reported in May 2016, and one was from from eastern Idaho. Among these six cats, specimen collection occurred during May 31–July 12, 2016; cats ranged in age from 10 months to 14.5 years (median = 4 years), four (67%) were male, five (83%) resided both indoors and outdoors, and one resided outdoor only. All six cats were domestic shorthair breed and had been neutered or spayed. Fever and lymphadenopathy (n = 4, 67%) were the most commonly reported signs of illness. None of the cats had known pulmonary involvement. Three of the six cats were treated with appropriate antibiotics (1); of these, two survived and one was euthanatized. The three other cats had died or had been euthanatized. All six cats reportedly had contact with ground squirrels and other wild rodents or rabbits before becoming ill; one had flea control administered before illness onset.

Cat owners, their household members, and veterinary staff were advised to be alert for fever and other plague symptoms (2) in themselves and other pets that might have had contact with the ill cats. Veterinary staff members were reminded about methods to prevent occupational exposure when managing pets suspected of having plague (1). In June 2016, an updated plague advisory was sent to veterinarians in four southwestern Idaho counties and eight eastern Idaho counties.^† Local public health districts used the Idaho Health Alert Network to enhance situational awareness among health care providers and issue guidance on management and reporting of plague cases. Public communication strategies to raise awareness about the risk for and prevention of Y. pestistransmission to persons and pets included an online map of plague-affected areas, warnings posted in affected public areas, and press releases advising residents about preventive measures. No human plague cases were reported.

Cat-associated human plague cases, including fatalities, have been reported in the western United States since 1977 (3). Compared with dogs, cats are highly susceptible to plague illness and can transmit disease to humans directly through exposure to respiratory droplets and infectious body fluids associated with bites or scratches (1). Cats could also carry infected fleas into households. Y. pestis–infected cats usually develop fever, anorexia, lethargy, and lymphadenitis (submandibular in approximately 75% of cases); approximately 10% of cases are pneumonic (4) and present the most risk to pet owners and veterinary staff members. During 1926–2012, six (43%) of all primary pneumonic cases of human plague that occurred in the United States had contact with domestic cats (5). No plague vaccine for pets is available.

Veterinarians should consider the diagnosis of plague in pets, including cats, with compatible signs and exposure to rodent habitats, rodents, or ill pets in areas where plague is endemic or epizootic. Suspicion of plague should trigger the following actions by veterinary staff: 1) implementation of personal protective measures, including wearing masks and gloves; 2) isolation of the ill pet; 3) assessment of pulmonary involvement; 4) initiation of diagnostic testing for Y. pestis; 5) prompt administration of antibiotic therapy; 6) implementation of flea control for affected animals and the hospital environment; 7) provision of advice on household flea control to pet owner; and 8) notification of public health officials (1). Pet owners can reduce the risk for plague in pets by controlling pet roaming, implementing a flea control program, and minimizing rodent habitats and food sources inside and outside the home. Additional information on prevention of plague is available at http://www.cdc.gov/plague/prevention/index.html.

Shigella blooms in South Central Idaho

Posted on April 16, 2016 by Douglas Powell

South Central Public Health District warns the community of increases cases of infectious disease Shigellosis, also known as Shigella, in South Central Idaho Thursday.

In 2015, 17 cases of Shigellosis were reported in the region. Since the beginning of 2016, 14 cases have been reported. The infectious disease has been reported in Blaine, Minidoka, Twin Falls and Jerome counties.

“Many people are unfamiliar with Shigella and what causes it,” said Tanis Maxwell, SCPHD Epidemiologist, in a news release. “Shigella is a bacteria present in the fecal matter of an infected individual. The symptoms of Shigella are watery or bloody diarrhea, abdominal pain, and fever.”

Public health types have better things to do: 8 sick from raw milk in Idaho

Posted on October 22, 2015 by Douglas Powell

Idaho Public Health officials are investigating eight illnesses in southwest Idaho likely associated with drinking unpasteurized (raw) milk.

To date, four Campylobacter and four E.coli O157:H7 cases have reported drinking raw milk produced by the Natural Farm Fresh Dairy of Kuna in the week prior to getting sick. The investigation is ongoing with Southwest and Central District Health departments, working in association with the Idaho State Department of Agriculture.

“If people have recently purchased raw milk from this dairy, we advise them not to drink it and to discard it,” says Dr. Leslie Tengelsen, State Public Health Veterinarian with the Idaho Department of Health and Welfare.

The Idaho State Department of Agriculture is working with Natural Farm Fresh Dairy to confirm if the raw milk from that facility was the source of the reported illnesses. The dairy is fully cooperating with the investigation and issued the following statement: “Natural Farm Fresh is committed to providing a safe and wholesome product to its customers. Effective immediately, we are voluntarily removing all raw milk products currently on the shelves in retail stores and we will discontinue further distribution of our raw milk until additional product testing is completed.”

Wasted resources on raw milk: Regulators not pursuing raw milk sales in Wisc.

Posted on June 17, 2015 by Douglas Powell

There’s rules, and then there’s rules.

And as long as no one gets sick, it doesn’t hit the chatting classes, and no goes to jail, they’re just rules (sorta).

I’ve always said, hypocrisy is parents’ disease.

Applies to regulators too, apparently.

An Australian prof-type who is traveling in the U.S. sent this picture from Idaho today, another state of many grappling with the ambition and angst of sick people.

Approaching summer, when city dwellers often seek fresh food from area farms, Wisconsin state regulators say they’re not aggressively pursuing cases against farmers who illegally sell raw, unpasteurized milk to the public, but the laws are still in place.

“Some people are simply willing to take their chances with the authorities…while others are quite deep in the underground. Certainly I will protect my farmer,” said Margo Redmond of Madison, a board member of the Wisconsin Raw Milk Association.

Wisconsin has been at the center of a national controversy over raw milk sales. That’s partly because of the trial of Loganville farmer Vernon Hershberger, who in 2013 was acquitted of three criminal charges that included operating an unlicensed retail store and operating a dairy farm and dairy processing facility without licenses.

Earlier this year, state officials suspended for 30 days the Grade-A milk production permit of a Durand dairy farm blamed for a raw-milk illness outbreak that sickened nearly 40 people.

But some raw milk consumers say state officials have been less aggressive since the Hershberger trial.

“That’s what we have been assuming and hoping for,” Redmond said.

Wow.

Always the kids: raw goats milk in Idaho sickens at least 2

Posted on February 26, 2015 by Douglas Powell

On August 27, 2014, the Idaho Department of Health and Welfare’s Division of Public Health (DPH) was notified of two cases of cryptosporidiosis in siblings aged <3 years. Idaho’s Southwest District Health (SWDH) investigated and found that both children had consumed raw (unpasteurized) goat milk produced at a dairy licensed by the Idaho State Department of Agriculture (ISDA) and purchased at a retail store. Milk produced before August 18, the date of illness onset, was unavailable for testing from retail stores, the household, or the dairy.

Samples of raw goat milk produced on August 18, 21, 25, and 28, taken from one opened container from the siblings’ household, one unopened container from the retailer, and two unopened containers from the dairy, all tested positive for Cryptosporidium by real-time polymerase chain reaction (PCR) at a commercial laboratory. On August 30, ISDA placed a hold order on all raw milk sales from the producer. ISDA and SWDH issued press releases advising persons not to consume the raw milk; SWDH issued a medical alert, and Idaho’s Central District Health Department issued an advisory to health care providers about the outbreak.

All seven of Idaho’s Public Health Districts and DPH continued to monitor cryptosporidiosis reports submitted from Idaho health care providers and laboratories statewide as required by Idaho law. Public Health Districts investigated reports by interviewing ill persons or their parents using a standardized questionnaire. After the hold order, SWDH and the Central District Health Department identified nine ill persons in four households. Four persons who had regularly consumed raw goat milk produced before August 18 experienced symptoms of gastroenteritis, and five household members who had not consumed the milk experienced onsets of symptoms of gastroenteritis 3–8 days after the first household member became ill. No other common exposures were identified. CDC case definitions for cryptosporidiosis were used (1). In total, the 11 ill persons were aged 2 months–76 years (median = 11 years); six were female. One patient was hospitalized. Stool specimens were obtained in three primary cases (i.e., illnesses in those who drank the raw goat milk) and three secondary cases (i.e., illness in contacts of those who drank the raw goat milk); CDC isolated Cryptosporidium parvum subtype IIaA16G3R1 from all six. The last reported outbreak-associated illness was a secondary case with an onset date of September 3.

In addition to the four tested milk samples from containers, five of five milk samples collected along the production line on September 2 tested positive for Cryptosporidium by PCR at the commercial laboratory. Testing of all nine milk samples (four from containers and five from the production line) at CDC for Cryptosporidium by PCR and direct fluorescent antibody test was negative. CDC and the commercial laboratory collaborated to validate the negative result by using sequencing to determine that false-positive results at the commercial laboratory were likely caused by goat DNA amplification during PCR. An inspection of the dairy did not reveal any obvious contamination sources. Water from the producer’s well tested negative at Idaho Bureau of Laboratories for Cryptosporidium by direct fluorescent antibody test after ultrafiltration. Goat stool was unavailable for testing. Negative results led ISDA to release the hold order on September 18.

Epidemiologic evidence implicated contaminated raw goat milk as the outbreak source. It was not possible to obtain confirmatory laboratory evidence of milk contamination. Milk consumed before illness onset was unavailable for testing and could have been subjected to a single, undetected contamination event. No other common source was identified, and isolation of the identical Cryptosporidium genotype from ill persons did not disprove a common source. This outbreak highlights an infrequently reported cryptosporidiosis risk from unpasteurized milk (2,3), the value of sequencing to validate PCR protocols, the utility of genotyping Cryptosporidium isolates for strengthening epidemiologic evidence, and the risk for secondary transmission of Cryptosporidium. An increasing number of enteric outbreaks are associated with raw milk consumption (4,5). Resources for consumers, health care providers, and public health officials regarding risks from raw milk consumption are available at http://www.cdc.gov/foodsafety/rawmilk/raw-milk-index.html.

Cryptosporidiosis associated with consumption of unpasteurized goat milk — Idaho, 2014

CDC MMWR 64(07);194-195

Mariana Rosenthal, Randi Pedersen, Scott Leibsle, Vincent Hill, Kris Carter, Dawn M. Roellig

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6407a9.htm?s_cid=mm6407a9_e

Hold order lifted on Idaho dairy after two potentially sickened with crypto

Posted on October 2, 2014 by Douglas Powell

Raw goat milk tested at Treasured Sunrise Acres turned up negative for an illness that left two sick in August.

The hold order preventing the Parma dairy farm from selling its milk was lifted Sept. 18, according to a post on the dairy’s Facebook page.

Public health officials recommended the public throw away any raw milk bought from the dairy between Aug. 24 and Aug. 31, but the release of the hold order posted to the Facebook page said all the samples of raw goat and cow milk tested negative for cryptosporidiosis.

100 sick: Norovirus outbreak linked to Eagle Island in Idaho

Posted on July 18, 2014 by Douglas Powell

Patient samples from a recent outbreak of illness at Eagle Island State Park have tested positive for norovirus, the Central District Health Department said in a news release Wednesday afternoon.

More than 100 cases of vomiting and diarrhea were reported to CDHD this Monday and Tuesday, prompting the Idaho Department of Parks and Recreation to close the swimming area at Eagle Island. Park staff is working with CDHD and DEQ to lower lake levels and thoroughly disinfect impacted facilities.

The swimming areas at Eagle Island will remain closed for two weeks to allow for drainage and refill of the lake. All other areas at the park will remain open for recreational use.

Norovirus is the most common cause of sudden-onset vomiting and diarrhea, CDHD reports.

19 sick in apparent Crypto outbreak in Idaho

Posted on August 11, 2012 by Douglas Powell

Within the past 10 days the Central District Health Department has seen 19 cases of cryptosporidiosis. During a normal year the health district might see 10 cases.

The Idaho Statesman reports the health department has advised area swimming pool operators of the situation and many responded by hyper-chlorinating the pools, a technique that kills the parasite. Still, those efforts can be rendered ineffective when people carrying the disease use recreational waters.

“We know the hot weather is driving people to seek relief in area pools, lakes and rivers,” Kimberly Link, Program Manager for Communicable Disease Control at CDHD, said in a press release. “If you’ve been ill with diarrhea we can’t emphasize enough how important it is to stay out of recreational waters for at least two weeks after your symptoms resolve.”

66 sick with Salmonella in another chick outbreak

Posted on July 24, 2012 by Douglas Powell

Another chick outbreak; they’ve always been there, but people of all professions may be more attuned to the chick link.

Idaho now joins the club as the source of the fifth Salmonella outbreak linked to mail-order chicks and ducklings to surface since 2011.

The U.S. Centers for Disease Control reports 37 people infected with the outbreak strain of Salmonella Hadar have been reported from 11 states.

Eight ill persons have been hospitalized. No deaths have been reported.

And, unfortunately, once again a high proportion of the sick are children 10 years of age or younger (37%).

Epidemiologic, laboratory and traceback findings have linked this outbreak of human Salmonella infections to contact with live poultry from Hatchery B in Idaho.

The mail-order hatchery has not been named at the request of state authorities. Public health investigators are using the PulseNet system to identify cases of illness that may be part of these outbreaks.

Live poultry were purchased from agricultural feed stores or direct from the mail-order hatchery. Ill persons reported purchasing live poultry for backyard flocks to produce eggs or meat, or to keep as pets. Seventeen (85%) of 20 ill persons with available purchase information reported purchasing live poultry from various locations of 13 different agricultural feed store companies in multiple states. Because the potential for Salmonella infection exists wherever these live poultry are sold, and not just at one feed store, CDC’s recommendations apply wherever these poultry are sold.

Findings of multiple traceback investigations of live poultry from homes of ill persons have identified Hatchery B in Idaho as the source of chicks and other live poultry. The owners of the mail-order hatchery are working closely with public health and agriculture officials to address this outbreak. Hatchery B is a participant in the USDA-National Poultry Improvement Plan which is a program to eliminate Salmonella pullorum and Salmonella typhoid from breeder flocks but does not certify freedom from other strains of Salmonella in birds. Because the hatching season has ended for this year, Hatchery B is not currently producing live poultry for sale. Live poultry infected with Salmonella can appear healthy and clean, but still shed Salmonella germs that can make people sick.

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