Going public: Norovirus ‘sweet spot’ at Pennsylvania college

“It hit me like a train wreck.” This is how one of the many infected students described his symptoms of what is likely norovirus.

Stool tests performed on those who are ill haven’t confirmed this diagnosis, but Director of Health Services Dr. Goldstein said that norovirus is “likely” the culprit of the students’ symptoms, which include vomiting, diarrhea and stomach pain. Resident Advisors on campus have reported 103 cases of students having contracted the debilitating stomach bug as of Wednesday evening, according to Goldstein, Director of Health Services.

Goldstein first notified the campus community about the virus in a campus-wide email sent Monday, Feb. 4 at 2:40 p.m., but didn’t name the illness as norovirus at that time.

Some students, however, felt this email did not come soon enough. Haley Matthes ‘19 voiced her frustrations and warned students to be aware of its spreading in a post in the Lafayette College Class of 2019 Facebook group on Feb. 2.

“I’m just tired of the school waiting for a campus-wide sickness to escalate to a point where they need to send out a bulletin [or] cancel classes,” Matthes said in a follow-up email.

Matthes was also upset that extended hours weren’t offered at Bailey Health Center.

Several students in the Phi Kappa Psi fraternity have also had the virus. According to Mikey Burke ‘21, approximately 12 to 15 members of the fraternity had contracted the virus as of Tuesday, although he said he expected that number to grow.

“I think it just spread really quickly throughout the house, it originated there and spread to a lot of the brotherhood, I live in McKeen and only hung out at the [Phi Psi] house for a couple hours…and got sick,” Burke said in an email.

Bobby Longo ‘21, another Phi Psi fraternity member to have the virus, said he believed the email warning on Monday was “too late.”

“Norovirus is an extremely contagious stomach virus that spreads like wildfire. After the first or second case on campus we should have been notified… it ramps up as people go from class to class spreading it,” Longo said in an email.

According to Goldstein, his level of concern about the virus was raised when the health center began receiving phone calls and emails from concerned students and parents, as the health center was “not overwhelmed” by the number of students coming to Bailey about the virus. 

Goldstein said he wanted to find a “sweet spot” of not raising a level of hysteria but also communicating with the students. He decided to send the campus-wide email more based on “the feedback from students,” Goldstein said.

“I think what’s happening is students are self-treating and getting through this without needing to see a provider, but the numbers are pretty significant on campus. The students communicating with me was a good thing,” he said.

According to Goldstein, reports from Resident Advisors and Bailey total a little over 150, but Goldstein said there may be overlap among these reports, if for example, a student both went to Bailey and reported their illness to their RA.

While Goldstein said that the discussion of the school closing “hasn’t happened yet,” he believes certain social gatherings will be cancelled if the virus continues spreading rapidly. One event, the Lunar New Year dumpling making party hosted by ISA and ACA, was cancelled on Tuesday as a result of the spreading sickness.

University students’ hand hygiene practice during a gastrointestinal outbreak in residence: What they say they do and what they actually do
01.sep.09
Journal of Environmental Health Sept. issue 72(2): 24-28
Brae V. Surgeoner, MS, Benjamin J. Chapman, PhD, and Douglas A. Powell, PhD

Abstract
Published research on outbreaks of gastrointestinal illness has focused primarily on the results of epidemiological and clinical data collected postoutbreak; little research has been done on actual preventative practices during an outbreak. In this study, the authors observed student compliance with hand hygiene recommendations at the height of a suspected norovirus outbreak in a university residence in Ontario, Canada. Data on observed practices was compared to post-outbreak self-report surveys administered to students to examine their beliefs and perceptions about hand hygiene. Observed compliance with prescribed hand hygiene recommendations occurred 17.4% of the time. Despite knowledge of hand hygiene protocols and low compliance, 83.0% of students indicated that they practiced correct hand hygiene during the outbreak. To proactively prepare for future outbreaks, a current and thorough crisis communications and management strategy, targeted at a university student audience and supplemented with proper hand washing tools, should be enacted by residence administration.

Surveys still suck: How likely would you go back to a restaurant involved in a foodborne illness outbreak

This study reports an investigation of the determinants of the likelihood consumers will revisit a restaurant that has had a foodborne illness outbreak, including the moderating effects of restaurant type and consumer dining frequency.

A scenario-based survey was distributed via Amazon’s Mechanical Turk to collect data from 1,034 respondents; the tally of valid responses was 1,025. Partial least squares-based structural equation modeling (PLS-SEM) showed perceived vulnerability and perceived severity to be statistically significant; both also negatively affected customer intentions to patronize restaurants cited for serving foods that caused foodborne illness outbreaks.

Results suggest that type of restaurant is a significant moderator between perceived severity and customer intentions. The type of diner, however, based on frequency, does not moderate the relationships between perceived severity and perceived vulnerability and customer intentions to patronize restaurants that served food causing a foodborne illness outbreak (FBI).

Using protection motivation theory (PMT) (Rogers, 1975), this study’s findings contribute to understanding determinants and moderators of customer intentions to revisit restaurants after a foodborne illness outbreak.

Consumers’ return intentions towards a restaurant with foodborne illness outbreaks: Differences across restaurant type and consumers’ dining frequency

Food Control

Faizan Ali, Kimberly J. Harris, Kisang Ryu

DOI : 10.1016/j.foodcont.2018.12.001

http://m.x-mol.com/paper/921130

FDA’s update on Romaine-linked outbreak investigation – it is California stuff

The normal folks who I hang out with at the hockey arena have already started asking when they can start eating Romaine again (who knew there were so many Caesar fans).

FDA’s answer to when is soon

Some places never stopped serving it. 

Earlier today I told Korin Miller at Yahoo the below:

If you happen to visit a restaurant that tries to claim its romaine is safe, it’s really best to avoid the food. “I would send it back,” Benjamin Chapman, an assistant professor and food safety extension specialist at North Carolina State University, tells Yahoo Lifestyle. “When the CDC comes out with a message that says ‘Don’t eat romaine lettuce,’ you should heed that advice,” he says. “Right now, we don’t have any indication that it’s romaine from any certain part of the country or a certain company. It’s a standing blanket statement.”

And now we’ve got more information (that’s how quickly this stuff moves).

FDA announced late today that they have narrowed their investigation to field grown Romaine from Central Coast growing regions of northern and central California.

All other lettuce is as safe as it was last week before the announcement.

FDA is taking things a step further, in a really positive way in concept – asking producers to label where it came from.

Based on discussions with producers and distributors, romaine lettuce entering the market will now be labeled with a harvest location and a harvest date or labeled as being hydroponically- or greenhouse-grown. If it does not have this information, you should not eat or use it.

There is no recommendation for consumers or retailers to avoid using romaine lettuce that is certain to have been harvested from areas outside of the Central Coast growing regions of northern and central California. For example, romaine lettuce harvested from areas that include, but are not limited to the desert growing region near Yuma, the California desert growing region near Imperial County and Riverside County, the state of Florida, and Mexico, does not appear to be related to the current outbreak. Additionally, there is no evidence hydroponically- and greenhouse-grown romaine is related to the current outbreak.

During this new stage of the investigation, it is vital that consumers and retailers have an easy way to identify romaine lettuce by both harvest date and harvest location. Labeling with this information on each bag of romaine or signage in stores where labels are not an option would easily differentiate for consumers romaine from unaffected growing regions.

A foodborne illness outbreak could cost a restaurant millions, study suggests

A single foodborne outbreak could cost a restaurant millions of dollars in lost revenue, fines, lawsuits, legal fees, insurance premium increases, inspection costs and staff retraining, a new study from researchers at the Johns Hopkins Bloomberg School of Public Health suggests.

The findings, which will be published online on Apr. 16 in the journal Public Health Reports, are based on computer simulations that suggest a foodborne illness outbreak can have large, reverberating consequences regardless of the size of the restaurant and outbreak. According to the model, a fast food restaurant could incur anywhere from $4,000 for a single outbreak in which 5 people get sick (when there is no loss in revenue and no lawsuits, legal fees, or fines are incurred) to $1.9 million for a single outbreak in which 250 people get sick (when restaurants loose revenue and incur lawsuits, legal fees, and fines).

Americans eat out approximately five times per week, according to the National Restaurant Association. The Centers for Disease Control and Prevention (CDC) estimates that approximately 48 million people get sick, 128,000 are hospitalized and 3,000 die each year due to food-related illnesses, which are often referred to as food poisoning.

For the study, the researchers developed a computational simulation model to represent a single outbreak of a particular pathogen occurring at a restaurant. The model broke down results for four restaurant types: fast food, fast casual, casual and fine dining under various parameters (e.g., outbreak size, pathogen, and scenarios).

The model estimated costs of 15 foodborne pathogens that caused outbreaks in restaurants from 2010 – 2015 as reported by the CDC. Examples of the pathogens incorporated in the model were listeria, norovirus, hepatitis A, E. coli and salmonella. The model ran several different scenarios to determine the impact level ranging from smaller outbreaks that may incur few costs (i.e., no lawsuits and legal fees or fines) to larger outbreaks that incur a high amount of lawsuits and legal fees.

“Many restaurants may not realize how much even just a single foodborne illness outbreak can cost them and affect their bottom line,” says Bruce Y. Lee, MD, MBA, executive director of the Global Obesity Prevention Center (GOPC) at the Bloomberg School. “Paying for and implementing proper infection control measures should be viewed as an investment to avoid these costs which can top a million dollars. Knowing these costs can help restaurants know how much to invest in such safety measures.”

The research team found that a single outbreak of listeria in fast food and casual style restaurants could cost upwards of $2.5 million in meals lost per illness, lawsuits, legal fees, fines and higher insurance premiums for a 250-person outbreak. When looking at the same circumstances for fine dining restaurants, $2.6 million in costs were incurred. The subsequent costs of outbreaks can be major setbacks for restaurants and are sometime irreversible. For example, Chi-Chi’s restaurant went bankrupt and closed their doors in the U.S. and Canada permanently due to a hepatitis A outbreak in 2003. In the past decade, several national restaurant chains have lost significant business due to food-illness outbreaks.

“Even a small outbreak involving five to 10 people can have large ramifications for a restaurant,” says Sarah M. Bartsch, research associate at the Global Obesity Prevention Center and lead author of the study. “Many prevention measures can be simple, like implement adequate food safety staff training for all restaurant employees and apply sufficient sick leave policies, and can potentially avoid substantial costs in the event of an outbreak.”

Fareway chicken salad now linked to 170 illnesses

As the foodborne epidemiologists used to say, ‘it’s always the potato salad’; usually referring to staph toxin outbreaks – where dishes sit out at room temperature either in the preparer’s home, during the transport, or before everyone lines up to eat.

Except, it’s not always the potato salad. Sometimes it’s the chicken salad.

CDC updated it’s page on their investigation into a salmonellosis outbreak linked to chicken salad sold at Faraway grocery stores.

Another 105 ill people from 6 states were added to this investigation since the last update on February 22, 2018. The newly reported ill people likely bought contaminated chicken salad before it was recalled. Public health agencies receive reports on Salmonella illnesses two to four weeks after illness starts.

On February 21, 2018, Triple T Specialty Meats, Inc. recalled all chicken salad produced from January 2, 2018 to February 7, 2018.

The recalled chicken salad was sold in containers of various weights from the deli at Fareway grocery stores in Illinois, Iowa, Minnesota, Nebraska, and South Dakota from January 4, 2018, to February 9, 2018.

Don’t kiss your guinea pigs; cute pets linked to Salmonella outbreak

Add the popular classroom pet, the guinea pig, to the list of kid-infecting-pathogen-factories with chicks, turtles, hedgehogs and puppies.

CDC reports today that whole genome sequencing has linked 9 cases of Salmonella Enteriditis to the furry rodents.

CDC began investigating in December 2017 when CDC PulseNet identified a cluster of three Salmonella Enteritidis infections that whole genome sequencing showed were closely related genetically.

A review of the PulseNet database identified six more closely related illnesses dating back to 2015. These illnesses were added to the outbreak case count. Nine people infected with the outbreak strain of Salmonella Enteritidis have been reported from eight states.Illnesses started on dates ranging from July 17, 2015 to December 15, 2017.
One person was hospitalized, and no deaths were reported.

Epidemiologic and laboratory evidence indicates that contact with pet guinea pigs is the likely source of this multistate outbreak.Four of the seven people interviewed reported contact with a guinea pig or its habitat in the week before getting sick. The outbreak strain of Salmonella was identified in a sample collected from an ill person’s pet guinea pig in Vermont.

Oh, and maybe think about Salmonella risks if you decide to eat guinea pig meat as well. In 2013, 81 people in Minnesota got sick after eating guinea pig meat sourced from an illegal back-room slaughtering operation.

I prefer my rodents talking and riding boats.

 

Confused consumers: Canadians say E. coli in romaine outbreak is over; U.S. says it’s leafy greens

Outbreaks of foodborne illness are fraught with uncertainties.

It’s OK to admit, to do the best with the info available, and get on with things.

On January 10, 2018, the Public Health Agency of Canada reported that an outbreak of Shiga toxin-producing E. coli O157:H7 infections (STEC O157:H7) they had identified was linked to romaine lettuce appears to be over.

As of January 10, 2018, there were 42 cases of E. coli O157 illness reported in five eastern provinces. Individuals became sick in November and early December 2017. Seventeen individuals were hospitalized. One individual died.

In the United States, the Centers for Disease Control, several states, and the U.S. Food and Drug Administration continue to investigate a multistate outbreak of 24 STEC O157:H7 infections in 15 states. Since CDC’s initial media statement on December 28, seven more illnesses have been added to this investigation. The last reported illness started on December 12, 2017.

The likely source of the outbreak in the United States appears to be leafy greens, but officials have not specifically identified a type of leafy greens eaten by people who became ill.  Leafy greens typically have a short shelf life, and since the last illness started a month ago, it is likely that contaminated leafy greens linked to this outbreak are no longer available for sale. Canada identified romaine lettuce as the source of illnesses there, but the source of the romaine lettuce or where it became contaminated is unknown.

Whole genome sequencing (WGS) showed that the STEC O157:H7 strain from ill people in the United States is closely related genetically to the STEC O157:H7 strain from ill people in Canada. WGS data alone are not sufficient to prove a link; health officials rely on other sources of data, such as interviews from ill people, to support the WGS link. This investigation is ongoing. Because CDC has not identified a specific type of leafy greens linked to the U.S. infections, and because of the short shelf life of leafy greens, CDC is not recommending that U.S. residents avoid any particular food at this time.

In the United States, a total of 24 STEC O157:H7 infections have been reported. Among the 18 ill people for whom CDC has information, nine were hospitalized, including one person in California who died. Two people developed hemolytic uremic syndrome, a type of kidney failure.

The Public Health Agency of Canada identified romaine lettuce as the source of the outbreak in Canada. In the United States, the likely source of the outbreak appears to be leafy greens, but health officials have not identified a specific type of leafy greens that sick people ate in common.

State and local public health officials continue to interview sick people in the United States to determine what they ate in the week before their illness started. Of 13 people interviewed, all 13 reported eating leafy greens. Five (56%) of nine ill people specifically reported eating romaine lettuce. This percentage was not significantly higher than results from a survey of healthy people in which 46% reported eating romaine lettuce in the week before they were interviewed.  Based on this information, U.S. health officials concluded that ill people in this outbreak were not more likely than healthy people to have eaten romaine lettuce.  Ill people also reported eating different types and brands of romaine lettuce. Currently, no common supplier, distributor, or retailer of leafy greens has been identified as a possible source of the outbreak. CDC continues to work with regulatory partners in several states, at the U.S. Food and Drug Administration, and the Canadian Food Inspection Agency to identify the source.

Although the most recent illness started on December 12, there is a delay between when someone gets sick and when the illness is reported to CDC. For STEC O157:H7 infections, this period can be two to three weeks. Holidays can increase this delay. Because of these reporting delays, more time is needed before CDC can say the outbreak in the United Stated is over. This investigation is ongoing.

Two outbreaks? One outbreak? Two different products? Same product? Romaine?

I dunno.

I’m having trouble agreeing with the avoid-romaine-in-the-US statement from Consumer Reports. Maybe it’s the same outbreak; maybe it’s not (and CDC didn’t say a lot about whether Canadian and US cases even have the same pfge match). Could be same pathogen on different product.

Just not sure yet. And public health folks share more about uncertainty; PHAC, share any info you have on distribution of the romaine you think it is.

Go public. Share data with the people.

Canadian STEC/lettuce outbreak leads to a death

Every day I eat food that doesn’t kill me. Or hasn’t yet.

I get kinda emotional when I read about a death linked to food.

While billions of servings of food every year don’t lead to tragedy, when it does I take notice.

I’ve met folks who continue to suffer the life-long impacts of foodborne pathogens; people who have watched their loved ones in pain in a hospital bed and ultimately them.

All from food.

According to an updated statement from the Public Health Agency of Canada, 30 people across Canada are dealing with E. coli O157 linked to romaine lettuce.  There’s not a lot of details though.

Currently, there are 30 cases of E. coli O157 illness under investigation in five provinces: Ontario, (6), Quebec (5), New Brunswick (5), Nova Scotia (1), and Newfoundland and Labrador (13). Individuals became sick in November and December 2017. Twelve individuals have been hospitalized. One individual has died. Individuals who became ill are between the ages of 4 and 80 years of age. The majority of cases (70%) are female.

Many individuals who became sick reported eating romaine lettuce before their illnesses occurred. The Canadian Food Inspection Agency is working with public health officials to determine the source of the romaine lettuce that ill individuals were exposed to.

No one should die as a result of food they ate.

Chili cook-off outbreak; we’ve been doing this for x years and no one has been ill

No one thinks their food is going to make anyone sick. After 15 years in food safety that’s what I’ve learned.

I’ve heard it from restaurants, processors, extension folks, event organizers. Whoever.

Turns out, that’s just wishful thinking.

If there’s an event, like say, a chili cook-off, and folks don’t know how pathogens get in food and grow, someone is probably gonna get sick.

Sorta like what happened last week in Chincoteague, Virginia.

According to Delaware.gov, Virginia regulators are looking into illnesses after a bunch of people got sick following a chili competition.

The Virginia Department of Health (VDH) began investigating a gastrointestinal disease outbreak shortly after a number of people who attended the event developed nausea, vomiting, diarrhea and fever. Illness in a Delaware resident who reportedly attended the event, may be linked.

VDH, reached out to neighboring states’ health departments, including the Delaware Division of Public Health, and asked for assistance in getting their residents to complete the survey, whether they became ill or not. The survey can be found at https://redcap.vdh.virginia.gov/redcap/surveys/?s=RPPDH7DWDF. VDH estimates 2,500 attendees from multiple states were present at the cook-off. The investigation is ongoing. Anyone with additional questions should call the Accomack County, Virginia Health Department at 757-302-4268.