Another Cyclospora outbreak IDed in Minnesota

The Minnesota Department of Health (MDH) is investigating an increase in Cyclospora infections within the last month. To date, state health officials have identified two outbreaks together involving at least three dozen Minnesotans.

One outbreak has been identified among people who ate at Sonora Grill in Minneapolis in mid-May. To date, 17 patrons have reported illness. The restaurant is fully cooperating with the investigation, and investigators say they do not have any indication that there is an ongoing risk to patrons.

To better identify the source of infection, MDH investigators want to speak with people who ate at Sonora Grill over the weekend of May 18-May 20, regardless of whether they became ill.

“Even if you have not been sick, your information can help us identify what may have caused these illnesses and prevent future illnesses,” said Trisha Robinson, an epidemiologist supervisor with MDH. “If you ate at Sonora Grill during that weekend of May 18-20, please contact the Minnesota Department of Health Waterborne Diseases Unit at 651-201-4891.”

Infection with Cyclospora, known as cyclosporiasis, is caused by the parasite Cyclospora and is spread through consumption of imported fresh produce; it is not spread person-to-person. Washing of imported produce, or routine chemical disinfection or sanitizing methods, are unlikely to kill Cyclospora. Symptoms typically include watery diarrhea, stomach cramps, nausea, loss of appetite and weight loss. People typically become ill about a week after exposure, but this period can range from 2-14 days. Diarrhea can last several weeks or longer if not treated.

A second outbreak has been linked to Del Monte vegetable trays purchased at Kwik Trip locations. To date, 20 cases have been identified among Minnesotans in this outbreak. Cases report purchasing the vegetable trays at various Kwik Trip locations around the state. Kwik Trip is cooperating with the investigation and voluntarily removed the vegetable trays from their shelves. Consumers should not eat the following products:

Del Monte Vegetable Tray, containing broccoli, cauliflower, carrots and dill dip, 6 oz.

Del Monte Vegetable Tray, containing broccoli, cauliflower, carrots and dill dip, 12 oz.

MDH investigators are working with the Minneapolis Health Department and the Minnesota Department of Agriculture (MDA) on the Sonora Grill outbreak and with MDA and other states on the Kwik Trip outbreak.

“We do not have any indication at this time that the two outbreaks are related,” Robinson said. “Besides these outbreak cases, there are other cases of cyclosporiasis that do not appear to be related to either of these outbreaks, which is not unexpected for this time of year. We typically see increases in Cyclospora infections from May through August.”

Minnesota food plant worker gets jail time for contaminating chicken

Elizabeth Licata of Fox News reports an employee at a chicken processing plant in Minnesota has been convicted of intentionally contaminating chicken and causing a massive poultry recall in 2016.

In June of 2016 the Minnesota-based GNP Company had to recall almost 56,000 pounds of “Gold’n Plump” and “Just BARE” branded chicken after it was found to be contaminated by sand and black soil. After an investigation, 37-year-old Faye Slye of Cold Spring, Minnesota, reportedly confessed to contaminating chicken with plastic bags of dirt and sand she’d filled from the plant’s parking lot.

Slye was reportedly filmed by the company’s surveillance cameras, and there was dirt and sand from the parking lot on her sleeves.

Slye has been convicted of two counts of causing damage to property in the first degree, a felony, and she’s been sentenced to 90 days in prison. She will also be on probation for five years, and she also has to pay $200,000 to the company in restitution for causing the recall. The tainted products were reportedly shipped to foodservice and retail operations nationwide, and nearly 28 tons of poultry had to be recalled and destroyed.

Supplier connection? 27+ sick in Salmonella outbreak in Minnesota 2 Burger King’s closed

Two Burger King restaurants in Bemidji have been forced to shut their doors following a salmonella outbreak.

Minnesota Health Department tells the Star Tribune that since September, they’ve confirmed 27 cases of salmonella linked to the two fast-food restaurants.

 

Officials say there are four other possible cases. Both of the Burger King locations closed voluntarily Thursday to undergo a thorough decontamination process.

Liz Sawyer of the Star Tribune writes that since September, the Minnesota Department of Health has identified 27 confirmed cases and another four probable cases of salmonella with links to the two fast-food restaurants. Both sites voluntarily closed to the public on Thursday to begin the decontamination process.

“Some of the extreme measures we’re taking are that all of their employees need to test negative for salmonella [twice], not sooner than 24 hours apart,” said Doug Schultz, a spokesman for the state Department of Health. “Once that’s done, we can do additional cleaning and they can open again.”

Once most cases were reported this fall, the Health Department imposed strict interventions that rigorously cleaned the restaurants and barred employees with symptoms from working for 72 hours.

 

Raw is risky: Ceviche source of V. cholera 01 in Minn

As we drove the five hours yesterday to Sawtell, NSW, for a week of (ice) hockey for Sorenne, and some R&R for me and Amy (mainly me), Amy was telling me about this one time, she went to Senegal (they speak French) in 2005, and the hosts offered her Tang but she didn’t want to drink it because she had been warned about the water.

Turns out there was an on-going cholera outbreak.

I was driving and thought, should I tell her that cholera is a member of the Vibrio genus?

I kept driving.

Today, while Sorenne is working it on the ice, I’m catching up and came across this report from friends at the Minnesota Department of Health (MDH) published by the U.S. Centers for Disease Control.

On August 20, 2016, the Minnesota Department of Health (MDH) was notified of a case of Vibrio cholerae infection. The isolate was identified as serogroup O1, serotype Inaba at MDH. CDC determined that the isolate was nontoxigenic. The patient was a previously healthy woman, aged 43 years, with history of gastric bypass surgery. On August 16, she experienced profuse watery diarrhea, vomiting, abdominal cramps, and headache. On August 18, she sought care and submitted the stool specimen that yielded the V. cholerae isolate. She reported no recent travel. However, she had consumed ceviche made with raw shrimp and raw oysters at restaurant A on August 14, 49 hours before illness onset. Her husband had a similar illness with a similar incubation period after eating the same foods at restaurant A.

On August 22, MDH sanitarians visited restaurant A and obtained tags and invoices for oyster and shrimp products; the oysters were a product of the United States, and the shrimp was a product of India. Sanitarians also gathered patron contact information and credit card receipts for August 12–14. Two additional patrons reported experiencing a gastrointestinal illness that met the case definition of three or more episodes of watery stool in a 24-hour period within 5 days of eating at restaurant A; one reported eating ceviche and oysters at restaurant A. Review of complaints to the MDH foodborne illness hotline revealed a previous complaint from two persons who reported experiencing watery diarrhea after eating raw shrimp ceviche (but no oysters) at restaurant A on August 2. These persons did not provide stool specimens, but their gastrointestinal illnesses met the case definition, resulting in a total of six cases, including one laboratory-confirmed case. No other V. cholerae O1 Inaba cases were reported in the United States during this outbreak.

The Minnesota Department of Agriculture facilitated sampling of shrimp at the distributor from the same lots served at restaurant A on August 14, and most likely during August 2–13, and sent them to the Food and Drug Administration for culture. Shrimp samples yielded V. cholerae non-O1, non-O139, but V. cholerae O1 was not isolated. In response to the outbreak results, restaurant A placed consumer warnings on their menus about the risks of consuming raw or undercooked food items and identified raw menu items for consumers. Restaurant A also focused on other actions that might facilitate reduction of V. cholerae, including appropriate freezing of food items, and allowing raw food items to soak in lime juice before being served, rather than serving the items immediately after adding lime juice (1,2).

V. cholera has over 150 serogroups and has been identified in a wide range of aquatic life, including seafood (3). Whereas multiple serogroups can cause vibriosis, only serogroups O1 and O139 that also contain the cholera toxin are classified as causes of cholera (4). Previous studies have documented the presence of nontoxigenic V. cholerae O1 from environmental and shrimp samples in India and Southeast Asia (5–7).

This outbreak of domestically acquired, nontoxigenic V. cholerae infections, likely from shrimp consumption, included the first V. cholerae O1 case identified in a nontraveler in Minnesota since active surveillance for Vibrio began in 1996. Since 1996, MDH has detected 26 V. cholerae infections, 21 (81%) of which were non-O1, non- O139, and five of which were O1. Among the four O1 type cases identified before the current outbreak, all patients had a recent travel history to Micronesia or India. This outbreak demonstrates the importance of investigating all seafood eaten by patients with vibriosis. In addition, investigators should include nontoxigenic V. cholerae as a possible etiology of domestic foodborne outbreaks, particularly when foods eaten include those from V. cholerae O1–endemic areas.

Notes from the field: Vibrio cholerae Serogroup O1, Serotype Inaba — Minnesota, August 2016

CDC MMWR

Victoria Hall, Carlota Medus, George Wahl, Alida Sorenson, Melanie Orth, Monica Santovenia, Erin Burdette, Kirk Smith

https://www.cdc.gov/mmwr/volumes/66/wr/mm6636a6.htm?s_cid=mm6636a6_e

 

E. coli O157 claims sister; brother remains critical in Minn.

Two siblings, Kade and Kallan Maresh from Maple Lake, Minnesota, were stricken with E. coli O157, possibly after visiting a petting zoo.

The family’s Caring Bridge site broke the sad news on Sunday when it reported that Kallan lost her battle with the deadly strain.

Bill Hudson of CBS Minnesota reports she died one week after shiga toxin-producing E. coli O157 raced through her young body.

“It’s very serious, potentially fatal,” says George Canas, M.D., with Kidney Specialists of Minnesota.’

The state Health Department is investigating where the E. coli exposure was. Possibly, something as simple as a trip to a petting zoo and transferring the bacteria onto the child’s hands and their mouth. It’s also common to acquire an exposure by eating unsanitary meat, produce or dairy.

The severe case eventually claimed Kallan’s life just a week after she was rushed to Masonic Children’s Hospital. Fortunately, her older brother, Kade, continues his fight, although his situation remains extremely serious.

Petting zoo: Minnesota 10-year-old awarded $7.55 million in E. coli settlement

Maury Glover of Fo 9 reports a jury awarded $7.5 million to a Rosemount, Minnesota family after a young girl contracted E. coli from a petting zoo at Dehn’s Pumpkins in Dayton.

emma-rosemount-girl-e-coli_1479962267763_2325612_ver1-0_640_360In 2013, Emma Heidish spent a month overcoming a potentially deadly form of kidney disease which cause her kidneys to shut down and required surgery and near constant dialysis.

On Tuesday, a Hennepin County jury found the owners of the farm where she got E. coli, Dehn’s Pumpkins in Dayton, negligent for not taking steps to prevent their animals from transmitting diseases and awarded Emma $7.5 million.

Emma was one of seven people sickened in an October 2013 E. coli O157:H7 outbreak linked by the Minnesota Department of Health to cows in the animal attraction  at Dehn’s Pumpkins, LLC, a business located in Dayton, MN.

The bulk of the money is for future medical bills and pain and suffering.

“It is one of the largest verdicts in the country for an E. coli outbreak for a condition like this one and its one of the largest involving a petting zoo case,” Emma’s attorney, Fred Pritzker, said. “The people who run the pumpkin patch are decent people. It’s not that they were mean spirited. But, what they didn’t know caused a great deal of pain and suffering for my clients.”

Since the outbreak, the popular pumpkin patch no longer operates a petting zoo, but Pritzker sais animal attractions like it are not regulated or inspected.

His firm will push for a new law, named after Emma, requiring petting zoos to follow safety precautions, like having hand washing stations nearby to help prevent the spread of the disease.

“There have been 150 to 200 cases of outbreaks involving animals in public settings in the last 15 years, Pritzker said

Pritzker says Emma probably won’t see all the money because the farm’s insurance doesn’t have that much coverage.

A table of petting zoo outbreaks (which needs to be updatd) is available at https://barfblog.com/wp-content/uploads/2014/04/Petting-Zoo-Outbreaks-Table-4-8-14.xlsx

Minneapolis sees rise in foodborne illness from nororvirus, Vibrio in oysters

When I think Minnesota, I think raw oysters.

No, I never think that about anywhere.

raw.oysters.minnJeremy Olson of the Star Tribune reports that city health inspectors in Minneapolis are investigating a summer increase in foodborne illnesses related to norovirus and Vibrio, a bacteria found in raw oysters.

The increases were highlighted in the city’s “food establishment” newsletter, released Thursday.

“The reason for the spike in norovirus outbreaks is not known,” the advisory stated. “The Vibrio outbreaks are due to higher concentrations of bacteria in some oyster beds during the summer.”

Cases of norovirus, a highly contagious bug that causes severe vomiting and diarrhea, are not required to be reported to the Minnesota Department of Health, but the state agency has received reports of a slight uptick that is unusual for this time of year.

Sanitation sucks: Federal court orders Minnesota sprout and noodle company to cease operations

On July 15, 2016, the U.S. District Court for the District of Minnesota entered a consent decree of permanent injunction between the United States and Kwong Tung Foods, Inc., doing business as Canton Foods; its president and owner, Vieta “Victor” C. Wang; and its vice-president, Juney H. Wang, for significant and ongoing violations of the Federal Food, Drug, and Cosmetic Act (FD&C Act) and its implementing regulations. The business, located in Minneapolis, Minnesota, sells rice and wheat noodles, and mung bean and soy bean sprouts.

Canton 2The U.S. Department of Justice brought the action on behalf of the FDA. The complaint that accompanied the consent decree alleges that Kwong Tung Foods, Inc. has an extensive history of operating under unsanitary conditions in violation of current Good Manufacturing Practice (cGMP) regulations and the FD&C Act. The FDA conducted multiple inspections, most recently in 2014 and 2015, and the FDA investigators observed repeated unsanitary conditions, including, rodent excreta pellets too numerous to count, improper cleaning, mold-like substances on equipment, failure to prevent cross-contamination from allergens and improper employee sanitation practices. Despite receiving a Warning Letter and participating in regulatory meetings with the FDA, Kwong Tung Foods, Inc., and Victor and Juney Wang failed to take adequate corrective actions to ensure the safety of their food. Additionally, the FDA worked with the Minnesota Department of Agriculture (MDA) to resolve this matter.

“The FDA expects food companies to follow cGMP regulations, and when a company does not address violations and sanitary protocols are being neglected, it poses potentially hazardous conditions,” said Melinda K. Plaisier, the FDA’s associate commissioner for regulatory affairs. “The FDA is taking the necessary actions to protect consumers and the U.S. food supply.”

Food, especially produce, is vulnerable to contamination with pathogenic microorganisms if exposed to unsanitary conditions during growing, harvesting, packing, holding or manufacturing, processing or transportation. Rodents in a facility are an additional cause for concern as they can sometimes carry and transfer bacteria and pathogenic microorganisms, like Salmonella, onto food. Salmonella can cause serious and sometimes fatal infections in young children, frail or elderly people, and others with weakened immune systems.

As a result of this action, Kwong Tung Foods, Inc. is prohibited from directly or indirectly receiving, processing, manufacturing, preparing, packing, holding, and/or distributing any article of food at or from its facility. If Kwong Tung Foods Inc. intends to resume operations, the company must notify the FDA, and, among other requirements, retain an independent food safety expert to ensure Kwong Tung Foods, Inc. has and implements, to the FDA’s satisfaction, an appropriate written Sanitation Control Program. If it resumes operations, Kwong Tung Foods, Inc. must also retain an independent laboratory to conduct analyses of its food processing environment and food products, and provide employee training on sanitation and appropriate food handling techniques.

Although no illnesses have been reported in connection with Kwong Tung Foods Inc., consumers with complaints about any FDA-regulated products can report problemsto their district office consumer complaint coordinator.

The FDA, an agency within the U.S. Department of Health and Human Services, protects the public health by assuring the safety, effectiveness, and security of human and veterinary drugs, vaccines and other biological products for human use, and medical devices. The agency also is responsible for the safety and security of our nation’s food supply, cosmetics, dietary supplements, products that give off electronic radiation, and for regulating tobacco products.

Stop playing with Just Bare chicken: In-house tampering behind need to recall 27 tons

In-house tampering is being blamed for GNP Co. of central Minnesota recalling more than 27 tons of chicken over the weekend after contaminants were detected in some of the product that was distributed primarily to food service and institutional outlets.

Just-Bare-Chicken-1The recall involving the Gold’n Plump and Just Bare brands by the Upper Midwest’s leading chicken manufacturer follows the company disclosing the discovery of sand and black soil in the chicken. GNP is the parent of the popular Gold’n Plump brand.

“Our own inspections turned it up,” said Lexann Reischl, a GNP spokeswoman, “and two food service customers called and told us they found the same material.”

In a statement issued Sunday afternoon, the company said, “Extraneous foreign matter … is linked to an isolated product tampering incident that occurred at the company’s Cold Spring processing plant the week of June 6.”

An employee, who has since been fired, is believed to be behind the contamination, Reischl said.

Cold Spring Police Sgt. Jason Blum said Sunday “there is a known suspect” being investigated, but an arrest has not been made.

We never had a problem: 10 sick with crypto linked to Minn. farm visit

The Litchfield Independent Review reports the Minnesota Department of Health is investigating an outbreak of diarrheal illness possibly linked to school students visiting Nelson Farm southwest of Litchfield.

girl with rabbitMore than 10 cases of diarrheal illness, including three confirmed cases of Cryptosporidium infection, have been reported from five different schools. In all cases, individuals had taken field trips to Nelson Farm, according to a health advisory issued by the agency May 26.

On the morning of May 26, Department of Health officials visited the farm to tour its facilities, according to Nelson Farm owner Don Nelson.

“Right now we don’t even know if it came from our farm,” he said. “We won’t know until next week (when the test results come back).”

Outbreaks associated with farm animal contact may include multiple pathogens including Salmonella, Campylobacter, Shiga toxin-producing E. coli (STEC), and Cryptosporidium, the health advisory states. The incubation period for these illnesses range from 12 hours to as long as 14 days.

Don said he was informed the evening of May 25 of the possible outbreak, which came as a surprise to both himself and his wife, Sonja.

“We’ve done this for 30 years, and we have never ever have been called on this before,” Sonja said.

“We won’t deny that there is chance we wouldn’t have anything because everything has bacteria,” she added, but emphasized that the Department of Health has not confirmed whether Nelson Farm caused the outbreak.

topleftDon said Department of Health officials were impressed with the overall state of the farm, noting that they had positive comments on the farm’s hand washing areas and where visitors eat.

“I’m very, very concerned because we want to make it a healthy experience on the farm,” Don said. “That’s our goal.”

Since being notified by the state, Don has called all the schools that visited Nelson Farm since May 9 to see if children have gotten sick, one of which was the School of St. Philip.

Nearly 20 kindergarten, first-grade and second-grade students at the School of St. Philip visited the farm May 23 for their annual spring field trip.

“At this point we have not heard of any instances associated with that outbreak,” Principal Michelle Kramer said.

While on the farm, students toured an old barn, visited animals, played in the hay barn and had lunch at the farm.

“I’m sure we’ll be back at Nelson Farm next year. These things happen, and we have to take every precaution that we can, but we’re not going to cut them out of our school schedule because they have a very great deal to add to our programming here,” Kramer said.

For Don and Sonja, the investigation has become a teaching opportunity in how to prevent the transmission of illnesses.

“Thirty years ago it was our goal to get close to the animals to give the best possible learning experience,” Don said.

Many of the students who are visiting the farm are now more susceptible to diseases than 30 years ago, he explained.

“Our young students don’t play in the dirt as much, not around as many farm animals, generally live in cleaner environments such as schools, homes, businesses, therefore immunity and resistance to diseases is lower today,” Don said.

Another time for Don’s version of the hygiene hypothesis. For now, focus on the kids.

A table of petting zoo outbreaks is available at https://barfblog.com/wp-content/uploads/2016/05/Petting-Zoo-Outbreaks-Table-5-5-16.xlsx

Best practices for planning events encouraging human-animal interations

Zoonoses and Public Health 62:90-99

Erdozain , K. KuKanich , B. Chapman and  D. Powell, 2015

http://onlinelibrary.wiley.com/doi/10.1111/zph.12117/abstract?deniedAccess

Educational events encouraging human–animal interaction include the risk of zoonotic disease transmission. ‘It is estimated that 14% of all disease in the USA caused by Campylobacter spp., Cryptosporidium spp., Shiga toxin-producing Escherichia coli (STEC) O157, non-O157 STECs, Listeria monocytogenes, nontyphoidal Salmonella enterica and Yersinia enterocolitica were attributable to animal contact. This article reviews best practices for organizing events where human–animal interactions are encouraged, with the objective of lowering the risk of zoonotic disease transmission.