Same old same old: how to ensure guidelines are being followed; E. coli O157:H7 gastroenteritis associated with North Carolina State Fair, 2011

Notable finding: illness was associated with visit to a building in which sheep, goats, and pigs were housed for livestock competitions. Fair attendees were not intended to have physical contact with animals in the building; however, 25% of case-patients (three of 12) and 24% of control subjects (five of 21) who visited the building reported direct contact with animals.

The U.S. Centers for Disease Control and Prevention reports that on October 24, 2011, the North Carolina Division of Public Health (NCDPH) was notified of four Shiga toxin–producing Escherichia coli (STEC) infections among persons who had attended the 2011 North Carolina State Fair, held October 13–23 in Raleigh. Approximately 1 million visitors had attended the fair.

NCDPH conducted a case-control study to identify the source of transmission. A case was defined as laboratory evidence of STEC, hemolytic uremic syndrome (HUS), or acute bloody diarrhea with no other identified etiology in a person who attended the fair 1–10 days before illness onset. Active case finding was performed by using a network of hospital-based public health epidemiologists..

Passive surveillance was enhanced through notifications to public health officials, health-care providers, laboratory directors, and the public. Control subjects were recruited by contacting 11,000 randomly selected advanced ticket purchasers by e-mail with a request to participate in the investigation. Three control subjects were matched to each case by age (<18 years or ≥18 years) and date of fair attendance. A stool specimen was requested of all case-patients for laboratory confirmation of E. coli. Pulsed-field gel electrophoresis (PFGE) patterns were compared with known strains in the national PulseNet database. Case-patients’ exposures to food, animals, and fair activities were assessed by using a scripted questionnaire administered to case-patients and control subjects.

Twenty-five cases were identified with case-patients’ illness onsets during October 16–25; median age was 26 years (range: 1–77 years). Eight case-patients (32%) were hospitalized; four (16%) experienced HUS. Nineteen case-patients provided stool specimens, and 11 (44%) had laboratory confirmation of E. coli O157:H7 with matching PFGE patterns. This PFGE pattern is the eighth most common pattern in the PulseNet database and has been associated with previous foodborne outbreaks (CDC, unpublished data, 2011).

The only exposure associated with illness was having visited one of the permanent structures in which sheep, goats, and pigs were housed for livestock competitions (matched odds ratio: 5.6; 95% confidence interval: 1.6–19.2). Fair attendees were not intended to have physical contact with animals in the building; however, 25% of case-patients (three of 12) and 24% of control subjects (five of 21) who visited the building reported direct contact with animals.

A previous STEC outbreak linked to a petting zoo at the 2004 North Carolina State Fair resulted in 187 illnesses, 15 of which were complicated by HUS (1). The 2004 outbreak led to the passage of Aedin’s Law in North Carolina, which created regulations for exhibitions housing animals intended for physical contact with the public. These regulations include requirements for permitting, education, and signage to inform the public of health and safety concerns, enhanced maintenance of animal facilities, transitional entrances and exits, and easily accessible hand-washing stations. The 2011 outbreak was associated with an animal exhibit not subject to Aedin’s Law. Preventive measures such as educational signs and hand-washing facilities were in place, based on national guidelines compiled in the 2011 Compendium of Measures to Prevent Disease Associated with Animals in Public Settings. As a result of this outbreak, a multiagency task force is being created in North Carolina to evaluate the preventive measures that were in place during the 2011 state fair and to identify additional interventions that could be applied to prevent disease transmission in livestock exhibitions where physical contact with the public might occur.

A table of petting zoo/fair-related outbreaks is available at

Fewer fundraisers, more E. coli prevention, the kind that works

WBTV reports family and friends are rallying together to help raise money for two-year-old Hunter Tallent, one of several people who became sick with E. coli after attending the North Carolina State Fair in Raleigh. The state traced the outbreak back to a livestock barn at the fairgrounds.

The family is holding the fundraiser to help raise money to cover Hunter’s medical bills from his hospital stay. The family says the state has not stepped in to help.

The event is called Hunter’s Angels and will take place Saturday at 10 a.m. through noon Sunday at Cole Creek Arena in Casar.

In Pennsylvania, three-year-old Avala Pierce of Chambersburg contracted an E. coli-related illness after a visit to Cowans Gap this summer.

She spent weeks in the Milton S. Hershey Medical Center, followed by a month on kidney dialysis. She has ongoing seizures, has suffered a stroke, and has some mobility issues, prompting Mercersburg campers to help out.

Kent and Dee Saunders, owners of Saunderosa Campground, Little Cove Road, Mercersburg, along with their campers, held an auction and other fundraisers during the camping season to raise money to help offset the costs of Pierce’s illness.

In late summer and through the fall, the Saunders were able to give the family $1,000.

The child and her family were invited to the annual campground meal Dec. 17.

After the meal, Santa Claus paid a visit, during which the campers presented the family with an additional $400 to help with Christmas.

Cowan’s Gap will be open for all activities in 2012, according to a Pennsylvania Department of Conservation and Natural Resources spokesman.

Routine E. coli testing at Cowans Gap State Park has resumed, after a period of intensified testing for the source of bacteria that the Pennsylvania Department of Health said sickened at least 18 people.

Although the source of E. coli O157 at the 1,085-acre Fulton County park wasn’t found, state officials believe it originated from human feces. They plan to use signs and handouts to emphasize proper hygiene when bathing and swimming.

An engineering study done in conjunction with testing found DCNR needed to upgrade one of two below-grade wells at Cowans Gap State Park.

E coli outbreak probed in Ireland; no worries, people ‘get better by themselves’

In what appears to be an outbreak of E. coli O157, a child and several others are understood to have suffered from severe vomiting and diarrhea in and around Inch, Ireland.

But in a move that only fuels rumor mongering, the Health and Safety Executive has confirmed there has been an outbreak of E. coli, but won’t say how many people are affected because of patient confidentiality. The source of the illness has not been traced.

It says the Department of Public Health is investigating the outbreak, but all tests taken so far have ruled out the public water supply as the cause.

A spokeswoman for HSE West who apparently has never heard of the traumatic outcomes from E. coli O157 infection said, “In the majority of cases, this is a self-limiting illness, the patients get better by themselves.”

Germany’s E. coli nightmare: Too often, politics trumps safety

The Aug/Sept. issue of Food Quality magazine contains a package of articles about lessons learned from this year’s E. coli O104 outbreak in Germany linked to raw sprouts grown from seeds produced in Egypt.

My own contribution was an attempt, at the editor’s request, to capture the uncertainty and vagaries that characterize outbreaks of food- or waterborne illness.

My friend Jim called on a Friday afternoon. Jim is a dairy farmer located on the edge of a town in Ontario, Canada, called Walkerton, and he said a lot of people were getting sick. The community knew there was a problem several days before health types went public.

On Sunday, May 21, 2000, at 1:30 p.m., the Grey Bruce Health Unit in Owen Sound, Ontario posted a notice on its website to hospitals and physicians to make them aware of a boil water advisory and inform them that a suspected agent in the increase of diarrheal cases was E. coli O157:H7.

There had been a marked increase in illness in the town of about 5,000 people, and many were already saying the water was suspect. But because the first public announcement was also the Sunday of the Victoria Day long weekend, it received scant media coverage.

It wasn’t until Monday evening that local television and radio began reporting illnesses, stating that at least 300 people in Walkerton were ill.

At 11 a.m. on Tuesday, May 23, the Walkerton hospital held a media conference jointly with the health unit to inform the public of the outbreak, to make people aware of the potential complications of the E. coli O157:H7 infection, and to warn them to take the necessary precautions. This generated a print report in the local paper the next day, which was picked up by the national wire service Tuesday evening, and subsequently appeared in papers across Canada on May 24.

These public outreach efforts were neither speedy nor sufficient. Ultimately, 2,300 people were sickened and seven died—in a town of 5,000. All the gory details and mistakes and steps for improvement were outlined in the report of the Walkerton inquiry

The E. coli O157:H7 was thought to have originated on a farm owned by a veterinarian and his family at the edge of town, someone my friend Jim knew well, a cow-calf operation that was the poster farm for Environmental Farm Plans. Heavy rains washed cattle manure into a long abandoned well-head, which was apparently still connected to the municipal system. The brothers in charge of the municipal water system for Walkerton, who were found to have been adding chlorine based on smell rather than something minimally scientific like test strips, were criminally convicted.

But the government-mandated reports don’t capture the day-to-day drama and stress that people like my friend experienced. Jim and his family knew many of the sick and dead. This was a small community. News organizations from around the province descended on Walkerton for weeks. They had their own helicopters, but the worst was the medical helicopters flying patients with hemolytic uremic syndrome to the hospital in London. Every time Jim saw one of those, he wondered if it was someone he knew.

I’m not an epidemiologist, but as a scientist and journalist with 20 years of contacts, I usually find out when something is going on in the world of foodborne outbreaks.

The uncertainties in any outbreak are enormous, and the pressures to get it right when going public are tremendous.

The public health folks in Walkerton may have been slow by a couple of days while piecing together the puzzle; what happened in Germany this summer in the sprout-related outbreak of E. coli O104, a relative of O157, was a travesty.
Worse, bureaucrats seemed more concerned about the fate of farmers than that of citizens. By at least one count, 53 have died, and more than 4,200 have been sickened.

Raw sprouts are one of the few foods I won’t eat, and as many epidemiologists have pointed out, sprouts top the list of any investigation involving foodborne illness.

We at bites count at least 55 outbreaks related to raw sprouts beginning in the U.K. in 1988, sickening thousands.

The first consumer warning about sprouts was issued by the U.S. Centers for Disease Control and Prevention (CDC) in 1997. By July 9, 1999, the U.S. Food and Drug Administration (FDA) had advised all Americans to be aware of the risks associated with eating raw sprouts. Consumers were informed that the best way to control the risk was to not eat raw sprouts. The FDA stated that it would monitor the situation and take any further actions required to protect consumers.

At the time, several Canadian media accounts depicted the U.S. response as panic, quoting Health Canada officials as saying that, while perhaps some were at risk, sprouts were generally a low-risk product.

That attitude changed in late 2005, as I was flying back to reunite with a girl I had met in Kansas and 750 people in Ontario became sick from eating raw bean sprouts.

Unfortunately, what food safety types think passes for common knowledge—don’t eat raw sprouts—barely registers as public knowledge. It’s hard to compete against food porn.

Sprouts present a special food safety challenge because the way they are grown, with high moisture at high temperature, also happens to be an ideal environment for bacterial growth.

Because of continued outbreaks, the sprout industry, regulatory agencies, and the academic community in the U.S. pooled their efforts in the late 1990s to improve the safety of the product, implementing good manufacturing practices, establishing guidelines for safe sprout production, and beginning chemical disinfection of seeds prior to sprouting.

But are such guidelines being followed? And is anyone checking?


This was demonstrated by two sprout-related outbreaks earlier this year linked to sandwiches served by Jimmy John’s, a chain of gourmet sandwich shops based in Champaign, Ill.

Sprouts served on Jimmy John’s sandwiches supplied by a farm called Tiny Greens sickened 140 people with Salmonella, primarily in Indiana. In January, Jimmy John’s owner Jimmy John Liautaud said his restaurants would replace alfalfa sprouts, effective immediately, with allegedly easier-to-clean clover sprouts. This was one week after a separate outbreak of Salmonella sickened eight people in the U.S. Northwest who had eaten at a Jimmy John’s that used clover sprouts.

If the head of a national franchise is that clueless about food safety, can we really expect more from others?

Sprout grower Bill Bagby, who owns Tiny Greens Sprout Farm, said in the context of the German outbreak that, for many like him, the nutritional benefits outweigh the risk:

“Sprouts are kind of a magical thing. That’s why I would advise people to only buy sprouts from someone who has a (food safety) program in place (that includes outside auditors). We did not have (independent auditors) for about one year, and that was the time the problems happened. The FDA determined that unsanitary conditions could have been a potential source of cross-contamination and so we have made a lot of changes since then.”

Independent auditors? Like the ones who said everything was cool, everything was OK, at Peanut Corporation of America (nine dead, 700 sick in 2008-09) and Wright County Egg (2,000 sick in 2010)?

Like the Walkerton E. coli O157:H7 outbreak in 2000, too many are using the filters of their politics to advance their own causes and saying too many dumb things in light of the sprout outbreak of 2011.

It’s really about biology and paying attention to food safety basics—no matter how much that interferes with personal politics.

E. coli found in Cowans Gap drinking water; 14 confirmed with O157 from lake

E. coli bacteria has been discovered in the potable water supply at Cowans Gap State Park, while the number of confirmed infections apparently coming from the lake has risen to 14.

According to the park’s website, the bacteria was discovered Tuesday in the raw water supply, before it entered the chlorine treatment plant. Pennsylvania

Department of Health spokesperson Christine Cronkright said the bacteria found in the drinking water was not E. coli O157:H7, the strain that has made over a dozen children sick since mid July.

On Thursday the Department of Health updated the total count of confirmed cases to 14. The latest case involves a child from Maryland. Cronkright said all of the individuals reported swimming in the lake, most of them during the last weekend in July.

Carrefour et Casino recall beef for E. coli O157

Albert Amgar provided this story from Agence France-Presse about an E. coli O157:H7 beef recall, Nikki Marcotte translated, Amy Hubbell proofed and I embellished.

At least this French company is suggesting a temperature, but doesn’t say how that is to accomplished in a hamburger patty. And while thorough cooking to the appropriate temperature (the. U.S. says 160) will destroy the bad bugs, cross-contamination in any kitchen – home, food service, retail – is a huge issue and difficult to control. Here’s the story.

It was announced Friday that the Covial company, which specializes in ground and vacuum-packed beef, is recalling batches of hamburger and fresh ground beef sold in Carrefour et Casino stores under their own label due to a risk of food poisoning.

The products have been removed from the shelves; consumers have been asked not to eat these products in which the bacteria E. Coli O157:H7 was detected during a self-check, said Covial in a statement. To date, no consumer complaints have been reported, the statement said.

The recall affects 3.8 tons of products that have been sold in the Carrefour stores, Carrefour Market, Carrefour City, Carrefour Contact, Shopi, 8 À Huit, Marché Plus, Géant Casino and Casino supermarkets, according to the source.

The batches bear the following inspection stamp: FR 15 014 032 CE. The products’ expiration dates are July 6th and 7th for the Carrefour batches and July 7th for the Casino batches.

Those affected, for Carrefour, are the Aquitaine, Auvergne, Bourgogne, Centre, Franche-Comté, Haut-Rhin, Languedoc-Roussillon, Limousin, Midi-Pyrénées, Poitou-Charentes et Rhône-Alpes regions. For Casino, the center and the southwest quarter of the country are concerned.

Thoroughly cooking the hamburgers helps prevent the consequences of a contamination of this type, the bacteria is destroyed at 65°C (149 F). The E. coli O157:H7 bacteria can cause symptoms such as gastroenteritis, sometimes accompanied by a fever, within 10 days following the consumption of the contaminated hamburgers.

In rare cases, poisoning can be followed by severe kidney complications in children and in the elderly. Consumers can call 0805 803 134 (free from a land line).

Cause of Florida woman’s near-fatal food illness a mystery; exposes failures in system

The Palm Beach Post reports this morning that Amber Dycus, 38, of Loxahatchee, Florida, went to the hospital after four days of illness. The doctors told her she was in acute kidney failure, hours from death. She endured six days of intensive care, multiple blood transfusions and, so far, 196 bags of plasma.

There are more treatments to come, and no signs yet that her kidney function is approaching normal. She feels lucky to be alive, but also very afraid – afraid of eating out, afraid of catching germs, afraid of never getting better.

Dycus desperately wants to know what did this to her. Her lawyer, Craig Goldenfarb, thinks the public ought to feel the same way.

A health department inquiry has resulted in the brief closure of a Royal Palm Beach restaurant where Dycus often ate. Inspectors found roaches, improper food temperatures, slime in the freezer and a dishwasher with almost no sanitizer in it. After a thorough cleaning and a tuneup on the dishwasher, the restaurant, Hilary & Sons, has reopened.

But was it really the source of her illness? A series of missed opportunities, miscommunications, delays, and no small measure of scientific uncertainty means there may never be a conclusive answer.

At Palms West last month, Dycus was diagnosed with hemolytic-uremic syndrome. It’s an often fatal condition that happens when toxins cause red blood cells to shear apart and clog capillaries, shutting down the kidneys and leading to a buildup of waste in the blood.

It’s associated with outbreaks of dangerous E.coli O157 food poisoning.

Normally, when E.coli O157 is suspected, the health department is notified immediately, so that a public health investigation can be launched.

Dycus said her doctors told her she must have eaten contaminated beef. She’s grateful to them, and the nurses at Palms West, whom she says saved her life. But one thing they did not do was notify health authorities. A spokeswoman for Palms West said she could not comment.

It wasn’t until Dycus contacted a lawyer, and her lawyer called the media, that a health inquiry began. By then, a month had passed, the foods Dycus had eaten had long since disappeared, and the ability to tell exactly what sickened her had become nearly impossible to discern.

Courtesy Nailsea Court

Four Oregon children hospitalized in day care E. coli outbreak

Amy’s anxious.

For the first time in Sorenne’s 16 months, Amy is going away for a couple of days, leaving me and the kid to par–ty.

Amy and a colleague left early this morning for Montreal and the Northeast Modern Language Association annual meeting, or NeMLA. Every time she says NeMLA, I say NAMBLA. It never gets old.

I was chatting with the neighbors yesterday about how fortunate we are. We have two students provide 20 hours of child care for Sorenne – the most loved child in the world – in our house. And contrary to the expectations, Sorenne is exceedingly social. If we wanted 20 hours of day care, we’d have to pay for 40 – full-time. The U.S. has some weirdness, like 6 weeks of maternity leave. We’re fortunate.

Not so the kids at a day care center in Clark County, Washington, which has been temporarily shut down after four kids were hospitalized with E. coli O157:H7.

The Oregonian cited Dr. Alan Melnick, Clark County’s public health officer, as saying the health department learned of the first hospitalization on March 19. Soon after, three other children required hospitalization. Investigators tested stool samples from 22 children and four adult caregivers at the day care and found six carrying the O157:H7 strain but not showing symptoms.

The day care will remain closed until the affected staff show no presence of the bacteria on two consecutive tests conducted at least a day apart, Melnick said. Children who tested positive have to meet the same criteria before being allowed to attend any daycare or school.

E coli scandal at UK zoo that left dead animals to rot

Who knows what goes on in these petting zoos in the U.K., Canada or the U.S., but it appears to be a mess. That’s why kids get sick every year.

A feature in tomorrow’s (today’s) Sunday Times alleges that E. coli O157 was found at a popular children’s petting zoo where dead animals were openly left to rot for weeks.

An undercover reporter who spent several weeks working as a volunteer at the unlicensed zoo discovered:

– Corpses of animals left to decompose near where visiting children play.

– Staff alternating between working with the animals and helping out in the visitors’ cafe, wearing the same clothes and shoes.

– Cafe food stored next to dirty parrot cages.

– No hot water for handwashing except in the cafe kitchen. One worker said there had been no hot water in the toilets for five years.

– Animals suffering with painful diseases and fed inappropriate food such as chocolate, lollipops and marshmallows.

-A swab taken from the faeces of a pig in a petting area showed E coli O157 in laboratory tests.

Last year several outbreaks at petting zoos across Britain caused a number of children to require medical treatment.

Tweddle Children’s Animal Farm, which opened in Blackhall Colliery, Co Durham, five years ago, is open seven days a week, all year round, and offers family season tickets to encourage repeat visits. Its website claims it is “bursting with animal fantasticness [sic].”

The farm has a range of exotic animals, such as monkeys, ostriches, buffalo, camels and lemurs. Yet it has no zoo licence, which is a legal requirement. Only regularly inspected zoos can have a licence.

The owners, Denise and Peter Wayman, could now be prosecuted under the Zoo Licensing Act and possibly under the Animal Welfare Act.