Did mountain goats cause cryptosporidium outbreak in Oregon drinking water?

Dr. Bill Keene has cracked some novel outbreaks: deer poop on strawberries, norovirus on baby changing tables, salmonella in Guatemalan canteloupe.

Now, the senior state epidemiologist with the Oregon Health Division, is asking, were mountain goats the source of a cryptosporidium outbreak in Baker City, Oregon, that sickened at least 14 people and potentially hundreds?

The Baker City Herald reports that most of the confirmed crypto cases in the U.S. over the past 20 years — there were 7,656 confirmed or probable cases in 2009, and 8,951 in 2010 — were linked to sources such as swimming pools and daycare centers, Mountain Goat nanny and kidsnot municipal drinking water, according to the federal Centers for Disease Control and Prevention. For example, an outbreak of crypto that sickened at least 18 in Hull, UK, earlier this month was linked to a childrens’ splash pool.

If another theory about the Baker City outbreak pans out — that the crypto source was feces from mountain goats that live near Goodrich Reservoir — that would be the first such case in crypto annals, at least in the U.S., Keene said.

“I’m pretty sure mountain goats have never been tested (for crypto),” Keene said.

(Cougars or feral cat poop that entered drinking water are believed to have been the source of a toxoplasmosis outbreak in Victoria, B.C. in 1995 that sickened at least 110 and upwards of 3,000.)

Keene said crypto “has been around forever,” and that small numbers of oocysts likely are present in most surface water.

But given the rarity of outbreaks caused by municipal water supplies — including ones, like Baker City’s, that use unfiltered surface water — it seems that Baker City’s ordeal could be “the exception proving the rule,” he said.

Although federal statistics show a sharp increase in crypto cases starting in the 1980s, Keene said that trend likely reflects more widespread testing rather than an actual spread in crypto.

Until the 1980s crypto tests were rare, and they required a high level of expertise.

What brought the bug into the mainstream, so to speak, was the AIDS epidemic of the 1980s. Because AIDS patients have severely compromised immune systems they are especially vulnerable to crypto.

“People were dying from this,” Keene said.

Today, crypto tests are easier and more effective, and doctors and other officials are much more likely to suspect crypto than they used to be, he said.

Speaking of tests, Keene said the “official” count of 14 crypto cases in Baker City certainly doesn’t reflect the total number of infections.

That’s almost always the case in outbreaks, he said, because with otherwise healthy people the infection usually doesn’t cause symptoms that require medical attention, so relatively few people ever have stool samples tested.

Keene, who was in Baker City for several days before returning to his Portland office on Monday afternoon, said he and colleagues visited 21 Baker City homes and talked with 62 residents.

Of those, 18 had had symptoms consistent with crypto, Keene said — 29 percent of the total.

Keene said he wouldn’t conclude from that small sample size that one-third of residents were infected — that would be almost 3,000 people — but he said the total cases “could easily be in the hundreds.”

21 sick from raw milk in Oregon; again ‘people missed the boat on one of the great advances in public health – pasteurization’

Oregon health officials suspect two more illnesses are part of a raw milk outbreak traced nearly three weeks ago to a farm near Wilsonville.

William Keene, senior epidemiologist with Oregon Public Health, told Lynne Terry of The Oregonian the two adults had both consumed raw milk from Foundation Farm, including one person who continued to drink it after being warned about the outbreak.

Keene said one was sickened by campylobacter, the other by cryptosporidium, making 21 likely cases in the outbreak. Nineteen others were infected with E. coli. One of the worst foodborne pathogens, E. coli O157:H7 was on rectal swabs from two of the farm’s four cows. Milk and manure from the farm also tested positive for the same bacteria.

State epidemiologists did not test for campylobacter or cryptosporidium so they don’t know for sure that the two new cases are linked to Foundation Farm milk, but Keene said it’s likely.

Cryptosporidium and campylobacter repeatedly turn up in raw milk, he said, along with other harmful bacteria.

Four children who drank the milk were hospitalized with acute kidney failure, which is associated with E. coli O157:H7. As of Friday, they were still in the hospital, Keene said.

Two of the patients — 14 and 13 — are Portland area middle schoolers. The others are 3 and 1 years old.

A fifth child from Lane County, who drank the milk while visiting relatives in the Portland area, was hospitalized and released.

"We’ve documented yet another unfortunate incident where people missed the boat on one of the great advances in public health — pasteurization," Keene said.

A table of raw milk related outbreaks is available at http://bites.ksu.edu/rawmilk.

Seek and ye shall find salmonella in sprouts

I don’t know why Jimmy John’s continues to serve raw sprouts on its sandwiches, continues to make people sick, and continues to get sued.

The Oregon Department of Human Services reported yesterday that clover sprouts produced by Sprouters Northwest, Inc. of Kent, Wash. have been fingered as the source of a separate salmonella outbreak that has sickened three in Oregon and four in Washington. Reported illnesses began between Dec. 4 and Dec. 17. No hospitalizations or deaths have been reported.

The Oregonian reports the Northwest sprout outbreak dates to Dec. 4 when a woman in Bend was sickened by salmonella. In a routine food survey, she told Deschutes County health authorities she had eaten sprouts from Jimmy John’s.

In the past two years, the sandwich chain has been linked to four sprout outbreaks, including one at the end of 2010. Nearly 100 people were sickened by alfalfa sprouts sold by Jimmy John’s in the Midwest.

But the Jimmy John’s store in Bend only uses clover sprouts from Sprouters Northwest, and that company was not implicated in the Midwest outbreak.

Initially, the woman appeared to be a solitary case. Then on Dec. 17, a 3-year-old boy in Bend got sick after munching on a sandwich from Jimmy John’s.

That prompted William E. Keene, a senior epidemiologist at Oregon Public Health Division and his colleagues to whirl into action. They contacted the FDA and Washington state authorities, which in turn found four more cases linked to Sprouters Northwest clover sprouts.

Then on Monday, Keene learned that a woman in Multnomah County had been sickened, hours after the recall was announced.

Keene was quoted as saying, “This is at least the 13th sprout-caused outbreak that has sickened Oregonians since 1995, when we first started warning consumers about the risks of eating sprouts. Anyone concerned about foodborne disease should consider this before eating sprouts.”

This is the fourth time since 1997 that Sprouters Northwest sprouts have been cited as a source of salmonella contamination, Keene said.

Sprouters Northwest owner Bill Jones said Monday the brand is widely sold in major retail chains, including Albertsons and Safeway.

So I’m sure Albertson’s and Safeway will be forthcoming with the food safety audit reports of Sprouters Northwest as a supplier, to convince consumers that food safety is job one.

Said Keene, "This is a food to avoid. If you’re concerned about getting sick, I wouldn’t eat sprouts."

The original table of North American raw sprout-related outbreaks is available at:

Taco Bell implicated in two salmonella outbreaks sickening more than 150

The always colorful and geographically precise, Bill Keene, senior epidemiologist with Oregon Public Health, told The Oregonian yesterday that mystery Mexican-style fast food chain restaurant A is Taco Bell.

"It’s been clear for weeks that Taco Bell was the source for many of the illnesses. It’s equally clear that it’s not all Taco Bell. It’s also not a single Taco Bell restaurant."

The first cases appeared at the beginning of April and continued through the third week in July. Dozens were sickened in Wisconsin, Indiana, Ohio and Kentucky, with a sprinkling of cases across the rest of the country. One person in Oregon — a woman in her 20s in Klamath County — got sick.

Keene said,

"It’s very striking to have two such similar outbreaks at roughly the same time and both of them affecting Taco Bell. The similarities might be a coincidence."

Although no one food or menu item has been named a culprit, Keene said epidemiologists think that lettuce, tomatoes or both were to blame.

"It’s not 100 percent sure it’s one or the other but those are the chief suspects," he said. "We’ve been unable to tease them apart because everyone eats both."

Keene said the food involved in the outbreaks was clearly contaminated before reaching Taco Bell franchises.

"It’s not something that they’re doing wrong. One of the products that they using in their food was contaminated."

The company did not return a phone call seeking comment.

CDC officials would not confirm that the company involved in the outbreaks was Taco Bell.

Naming a restaurant could have an economic impact on the company’s bottom line, said Kristen Nordlund, an agency spokeswoman.

The outbreak is also considered to be over though both the FDA and CDC are continuing to investigate.

"There’s no inherent reason for people to stop eating at Taco Bell now," Keene said.

Don’t kiss frogs or turtles, whether it’s in a Disney film or not

On Jan. 7, 2010, the U.S. Centers for Disease Control and Prevention issued a summary report regarding on a Multistate Outbreak of Human Salmonella Typhimurium Infections Associated with Aquatic Frogs — United States, 2009.

During April–July 2009, the Utah Department of Health identified five cases of Salmonella Typhimurium infection with indistinguishable pulsed-field gel electrophoresis (PFGE) patterns, predominantly among children. In August,
CDC began a multistate outbreak investigation to determine the source of the infections. This report summarizes the results of this ongoing investigation, which, as of December 30, had identified 85 S. Typhimurium human isolates with the outbreak strain from 31 states. In a multistate case-control study, exposure to frogs was found to be significantly associated with illness (63% of cases versus 3% of controls; matched odds ratio [mOR] = 24.4). Among 14 case-patients who knew the type of frog, all had exposure to an exclusively aquatic frog species, the African dwarf frog.

On Feb. 1, 2010, the U.K. Daily Express published its version of the story, saying kids were getting sick kissing frogs by copying the Disney movie, The Princess and the Frog. I knew it was far-fetched, but sorta fun and published an edited version as a barfblog post.

A couple of readers took me to task, but the original CDC report was solid. Leave it to Bill Keene, senior epidemiologist with the Oregon state Public Health Division, to wrap things up.

The outbreak has spread like the plague across the U.S. since the release of Disney’s film, "The Princess and the Frog," according to news reports and bloggers from Britain to Japan.

Problem is the story, which was fabricated from a whimsical quote in The Oregonian and on Oregonlive.com in December, is not true.

But the basic facts in that Oregonian story — 50 sickened, including many young girls, by salmonella traced to frogs — were just too good not to spin into a Internet sensation based on a quote by William Keene.

Keene said, cracking a verbal smile, that it’s not a good idea to kiss frogs, which carry salmonella.

But there is no evidence that girls are smooching the amphibians after seeing the movie.

"This is a totally mythical story," Keene said. "But it’s funny so it’s being picked up."

From the sensationalist Daily Express in Britain, which appears to have spun out the first story, the warning has fired up news sites, chat rooms and bloggers from Europe to Asia.