Duty to tell: ‘We should have been told about Norovirus outbreak’

A man who fell violently ill after contracting Norovirus at a UK seaside hotel says he should have been warned of an outbreak before his stay.

norovirus.elderly womanLeslie Yeaman, 70, took his wife Pauline, 71, to The Grand Hotel in Scarborough for a five- day break earlier this month on a National Holidays trip.

Mrs Yeaman suffers from a low immune system after suffering from cancer three times.

She uses a wheelchair and was also diagnosed with Parkinson’s disease in July.

Mr Yeaman, who fell ill two days into his stay, says the virus could have had potentially fatal consequences for his wife, who also fell ill after they returned to their Kingswood home.

He said: “I lost my sister before Christmas and it was a really traumatic time. We cancelled Christmas and I told Pauline I would take her for a short break.”

The couple checked into the hotel on Monday, January 5, but by Wednesday, Mr Yeaman had become violently ill with sickness and diarrhoea.

He said: “I am a carer for my wife and I couldn’t do anything for her. The next day, we decided to cut our losses.”

He said he endured an agonising drive back to Hull, whereby he spent the next 34 hours in bed ill.

His wife then also became poorly.

Public Health England, which investigated cases of the infection at the hotel, has told the Mail the outbreak was investigated from December 23 until January 19, when it was declared over.

Mr Yeaman says National Holidays should have had a duty of care to inform him and his wife of the outbreak.

He said: “The chemotherapy has destroyed Pauline’s immune system. We never had the chance to cancel. They never said to us there was a virus in the hotel.

“Six other people went home when we did.”

Fancy food ain’t safe food, Spain edition: Food poisoning sucks even for food safety experts

Elizabeth Meltz, Director of Environmental Health for Batali & Bastianich Hospitality Group (B&BHG), writes on Mario Batali’s blog that even for a healthy person, food poisoning sucks. If you are remembering the last time you had it and thinking it wasn’t that bad, you are lying to yourself. (The joke goes: First you are afraid you’re going to die and then you are afraid you are not going to die.) For a person with a compromised immune system of any kind, it could truly mean death.

elizabeth meltz_headshotAnother common part of my job is following up with the (very few) complaints of foodborne illness we might get from guests. It is very difficult for anyone (myself included) to ascertain what made them sick and when. Incubation periods, and correspondingly, onset times for the most common food forms of foodborne illness: Staphylococcus auerus, E. coli, Salmonella, etc. vary greatly. Salmonella, the most common cause of food borne illness, has an average onset time of 18 to 36 hours. So though people usually assume it was the last thing (or place) they ate that made them sick, it quite often is not.

My job and my personal life made a head on collision last week. My father had a successful lung transplant a year and a half ago. He had a rare condition called pulmonary fibrosis, for which there is no other treatment. He was cleared for travel in the spring and wanted to celebrate by torturing us all with a family trip to Madrid. My husband, Alex, who also works for B&BHG, made lunch and dinner reservations for every day at a Michelin-starred chef’s latest outpost, or some other highly recommended haunt. We had every must-eat place in Madrid on our schedule.

We ate so well I thought I would die; around 1a.m. on Jan. 1, I really did think I would. I had been complaining of nausea since we finished dinner around 11pm. My mom just kept saying we had been eating too much, but I knew something was wrong. And then — I will spare you the details — I was lying on the bathroom floor, well aware that I officially had food poisoning. I was only the first to fall. My mom was sick within the hour and Alex was in writhing pain by 2a.m.

I was panic-stricken. If my dad gets sick, he could die. He’s on all kinds of immunosuppressant medication and his body can’t handle a bacterial or viral infection of any kind. I’m half moaning, half yelling to my mom in the other room, “Put dad on a plane now please!” I think she thought I was in a feverish state, which I was, but I was serious. He was still not sick, and neither was my brother, which gave me hope, but I was terrified.

Because the thought of food made me want to throw up more, I was struggling to go through what we had all eaten in the past few days to see what commonalities I could find to identify the culprit. Because of my dad’s condition, he doesn’t eat anything that’s raw, including vegetables, so that made the tuna tartar a good candidate. However Daniel, my brother, had eaten some of the tartar — maybe he just had a stronger immune system? The tartar was rolled into five separate piles, maybe his pile was handled differently?

So I spent New Year’s Eve in Spain in a pool of sweat, fighting back vomit as I pondered what made me sick and hoping my dad doesn’t die.

But I’m OK with this now. My dad didn’t get sick and die. And though I could have done without the refresher, it strengthened my resolve and reminds me of why we do what we do. No one, not even the healthiest person, should spend any night projectile vomiting. And no one should have to worry about taking a life or death chance when they walk into one of our restaurants.

Beware the fungus: FDA says dietary supplements containing live bacteria or yeast could cause problems in immunocompromised persons

The U.S Food and Drug Administration is warning health professionals of the risks associated with the regarding use of dietary supplements containing live bacteria or yeast in immunocompromised persons. A premature infant administered a dietary supplement, ABC Dophilus Powder (Solgar), as part of in-hospital course of treatment, developed gastrointestinal mucormycosis caused by the mold Rhizopus oryzae and died. Rhizopus oryzae mold was found to be present as a contaminant in an unopened container of the ABC Dophilus Powder, which is formulated to contain three species of live bacteria.

abc-dophilus-powderFDA, along with the Centers for Disease Control and Prevention (CDC) and the Connecticut Department of Public Health, are investigating the death of this preterm infant who developed gastrointestinal mucormycosis.  In mid-November, Solgar issued a recall for certain lots of ABC Dophilus Powder and public health warnings were issued advising customers and consumers not to use the recalled product.

FDA is informing healthcare providers that dietary supplements, including those that are formulated to contain live bacteria or yeast, are generally not regulated as drugs by the FDA.  As such, these products are not subject to FDA’s premarket review or approval requirements for safety and effectiveness, nor to the agency’s rigorous manufacturing and testing standards for drugs, including testing for extraneous organisms.



Leukemia patients, pregnant women at greatest risk of listeriosis

People with certain conditions, including leukemia, other cancers and pregnancy, are at the greatest risk of getting sick from the foodborne bacterium Listeria, French researchers report in a new study.

Doctors and public health officials have known that these conditions make people more vulnerable to listeriosis, but this study is the first to rank the size of the risk for people with each condition.

The results "will help focus risk communication for the medical community," said Ramon Guevara, an epidemiologist for the County of Los Angeles Department of Public Health, who was not involved in the study.

The study looked at nearly 2,000 cases of listeriosis in France — affecting 39 out of every 10 million people — from 2001 to 2008.

Despite its rarity, listeriosis is still considered an important public health concern because it’s relatively deadly compared to other food-borne illnesses, lead author Dr. Véronique Goulet at the Institut de Veille Sanitaire in Saint-Maurice wrote in an email to Reuters Health.

More than 400 of the 2,000 people who developed listeriosis died.

None of the cases involved an outbreak.

About one in six of the listeriosis cases in France affected pregnant women.

Incidence of Listeriosis and related mortality among groups at risk of acquiring Listeriosis
Clinical Infectious Diseases
Véronique Goulet, Marjolaine Hebert, Craig Hedberg, Edith Laurent, Véronique Vaillant, Henriette De Valk, and Jean-Claude Desenclos
Background. Listeriosis is a foodborne disease of significant public health concern that primarily affects persons with recognized underlying conditions or diseases that impair cell-mediated immunity. The degree of risk posed by the different underlying conditions is crucial to prioritize prevention programs that target the highest risk populations.

Methods. We reviewed cases of listeriosis reported in France from 2001 to 2008. Numbers of cases and deaths were tabulated by age and underlying condition. Measures of the impact of specific underlying conditions on the occurrence of listeriosis were calculated. For estimating the total number of persons living with specific diseases, we applied prevalence estimates of these diseases to the French population. Underlying conditions were ranked by the degree to which they increased the risk of listeriosis.

Results. From 2001 to 2008, 1959 cases of listeriosis were reported in France (mean annual incidence 0.39 per 100 000 residents). Compared with persons <65 years with no underlying conditions, those with chronic lymphocytic leukemia had a >1000-fold increased risk of acquiring listeriosis, and those with liver cancer; myeoloproliferative disorder; multiple myeloma; acute leukemia; giant cell arteritis; dialysis; esophageal, stomach, pancreas, lung, and brain cancer; cirrhosis; organ transplantation; and pregnancy had a 100–1000-fold increased risk of listeriosis.

Conclusions. To be effective and acceptable to physicians and patients, listeriosis prevention strategies should be targeted based on evidence of increased risk. Stringent dietary guidance, to avoid specific foods with a high risk for Listeria contamination, should be targeted to pregnant women and to others at highest risk of listeriosis.

Should deli meats be on the menu for pregnant women and at medical care facilities?

After four kids, I was familiar with the look.

“How long have you been pregnant,” I asked the thirty-something as we filled our plates during the catered lunch at a meeting in 2000 in Ottawa.

“About six weeks.”

The American media had been filled with coverage of listeria after the 1998-1999 Sara Lee Bil Mar hot dog outbreak in which 80 were sickened, 15 killed and  at least 6 pregnant women had miscarriages. Risk assessments had been conducted, people were talking about warning labels, and especially, the risks to pregnant women.

There was no such public discussion in Canada.

So as I watched the pregnant PhD load up on smoked salmon, cold cuts and soft cheese for lunch, I wondered, do I say something?

One of the biggest risks in pregnancy is protein deficiency. What if smoked salmon, cold cuts and soft cheeses were this woman’s biggest source of protein? (Turns out they were.)

Another big risk factor is stress. I didn’t want to freak her out. Besides, who the hell am I to say anything?

We sat together during lunch and chatted about babies, her aspirations and how she was feeling. Eventually I introduced the subject of listeria by talking about a risk assessment that had recently been published by the U.S. Food and Drug Administration, and that maybe she would be interested in looking at the results. I felt sorta goofy.

Eight years later, I don’t feel so goofy. Instead I’m frustrated at the lack of awareness, not only amongst pregnant women but amongst the elderly, other immunocompromised individuals, and the institutions and professionals that are supposed to look out for others.

Most of the now 12 confirmed and 6 suspected deaths related to Maple Leaf deli meats were consumed in places like nursing homes.

The Ontario Association of Non-Profit Homes and Services for Seniors, an umbrella group, was unaware of the recommendation that immunocompromised avoid deli meats to reduce the risk of listeria, unless they are thoroughly heated.

Association executive director Donna Rubin said,

"We’ve contacted dietitians that have long-standing experience in our homes and they’ve never been warned about listeriosis or deli meats being a huge issue or that they should be avoided.”

An Ontario Health Ministry spokesman said it has no specific policy against serving sliced meats in nursing homes, and Health Canada officials said banning certain foods from seniors homes is not in its jurisdiction. Health Canada has never recommended health facilities stop serving deli meats, noting that hospitals are a provincial responsibility.

In Calgary, two nursing home operators, Carewest and Bethany Care Society, confirmed some of their facilities serve cold meats.

Janice Kennedy, a Bethany spokeswoman, said,

"If public health says not to serve cold cuts to seniors, then we wouldn’t. We’re still meeting requirements."

It all sounds bureaucratic to me, as the death toll increases.

And the pregnant woman? When I saw her at another meeting a couple of months later, she thanked me for providing her with information about listeria and risky foods for pregnant mothers.