Consumers as CCPs; Beijing food poisoning victims urged to save vomit, feces for tests

Poop samples are not easy to collect for testing, especially if you’ve got some foodborne-inspired runs.

Collecting vomit samples could be viewed by many as just gross.

Beijing health authorities now say that customers who are involved in suspected food poisoning incidents in a restaurant should keep any leftover food, and their vomit and feces as evidence.

??The capital has a high incidence of microbial and mass food poisoning in summer and fall, said Cai Changjing, media officer of Beijing Health Inspection Institute on Monday. ??The institute has published a set of guidelines on its website, giving suggestions on how to deal with a food poisoning incident, he told the Global Times.??"Customers should keep the restaurant receipt, and then we’ll know which dishes in which restaurants have problems," Cai said.??"We also suggest people keep any leftovers, or vomit and feces as evidence," he noted. ??

Since the end of July, more than 2,000 cases of infectious diarrhea have been reported in the city, according to the Beijing News.??Li Na, 29, a resident in Beijing, said the institute’s suggestion is useful but she feels it will be hard to implement.??"It’s disgusting. I’d rather take some pills at home than collect the vomit as proof.

“If the poisoning is serious, I’ll just go to the hospital and let the doctor decide whether to keep these things," said Li.??Cai.

Seek and find: laboratory practices and incidence of non-O157 Shiga toxin–producing Escherichia coli infections

Stigi et al. report in the March, 2012, issue of Emerging Infectious Disease that in a survey of laboratories in Washington State, increased use of Shiga toxin assays correlated with increased reported incidence of non-O157 Shiga toxin–producing Escherichia coli (STEC) infections during 2005–2010.

Despite increased assay use, only half of processed stool specimens underwent Shiga toxin testing during 2010, suggesting substantial underdetection of non-O157 STEC infections.

Strains of Shiga toxin (Stx)–producing Escherichia coli (STEC) are differentiated by the O antigen on their outer membrane and are broadly classified as O157 or non-O157 STEC. The ability to produce Stx is a key virulence trait of STEC. STEC infections in humans often cause a self-limited diarrheal illness but can be complicated by hemorrhagic colitis or hemolytic uremic syndrome.

Unlike other E. coli strains, serogroup O157 isolates do not ferment sorbitol and are readily identified by culture, appearing colorless on sorbitol MacConkey agar. Both O157 and non-O157 STEC can be identified by detecting Stx with nonculture assays that became commercially available in the United States in 1995. The Centers for Disease Control and Prevention (CDC) published formal STEC testing recommendations for clinical laboratories in 2009, advocating that all stool specimens submitted for routine bacterial pathogen testing be simultaneously cultured for O157 STEC and tested with a nonculture assay to detect Stx. Use of this testing protocol ensures timely identification of all STEC infections. Exclusive testing for Stx delays specific identification of O157 STEC and may impede prompt detection of common-source outbreaks.

Non-O157 STEC infection has been a nationally notifiable condition since 2000. Although studies have documented the increased incidence of reported non-O157 STEC infections over the past decade, few have determined the proportion of laboratories that routinely test all submitted stool specimens for Stx and, to our knowledge, no study has quantified STEC testing practices by of stool specimens processed for bacterial culture. Our objectives, therefore, were to quantify statewide STEC testing practice by proportion of stool specimens processed for bacterial culture and to determine the contribution of enhanced STEC testing practice to increased reported incidence of non-O157 STEC infections.

The complete report is available at:

For Thanksgiving, I got campylobacter; food safety isn’t simple, neither are stool samples

It’s been a poopy couple of weeks. Literally. Turns out that I’ve been dealing with a Campylobacter infection for a while which has knocked me on my ass. Here’s the story.

Two weeks ago I was preparing to head to Manhattan (Kansas) to hang out with Doug, chat about a few projects, give a talk and take in the K State/Mizzou football game (with tailgating). The trip happened, but I gave a somewhat incoherent talk while sweating, slept most of my visit away, left the football game at halftime and spent two of the nights rushing to the bathroom every hour to evacuate my intestines (which sounded a bit like I was pouring a glass of water directly into the toilet). I wanted to blame Doug. He brings out the best in people.

As we walked to the game I remember saying to Doug that I wished the illness was a hangover because I knew there would be a defined end to it. It wasn’t. I didn’t eat much beyond Cheerios, yogurt and Gatorade for about a week. It was pretty nasty, probably the worst I can remember feeling.
After a feverish trip home and crashing for the remainder of the weekend I made an appointment to see the doctor to get things checked out. At this point I was a bit scared, tired of spending a couple of hours a day on the toilet and had a tender tush. I was also washing my hands like a mad man. With a one-year-old around I was super paranoid about negligently passing anything on to him. Of course, one of his favorite things to do is to stick his hands in the toilet, which is a bit like licking a raw turkey.

At the doctor, I described my symptoms, had a rectal exam (fun) and was given the materials needed for a stool sample. I’m not going to lie; I was a bit excited by the stool sample stuff. I was looking for anything to cheer myself up and I kept thinking about the ironic blog post at the end of the ordeal. Or as my friend Steve said “Wow – [Campylobacter] sucks. Although once you’re healthy again, it automatically becomes funny.” Yes it does.

The idea of stool sample harvesting was way more fun than the actual act. It’s amazing any foodborne illnesses are confirmed with stool samples because the process is a bit nuts.  It took some thinking to figure out how to catch the sample without contaminating it with water or urine. The final decision was to use the bucket from our salad spinner – which has now been retired – and place it in the toilet bowl. I then proceeded to do what I had been doing eight or nine times a day and produced a sample. I had three vials to fill (one for C. difficile, one for parasites and another for other pathogens), and a bonus margarine-like tub for “other things.” The vials were easy, they came with their own spoons. After ten swipes across the base of the former salad spinner I was able to messily get the rest of the sample collected in the tub. Then came the clean-up.  This whole episode took me about 45 minutes and made me think I was on Dirty Jobs.

I proudly returned to the doctor’s office with samples in hand and then waited a few days. On Monday I received a call from the physician’s assistant explaining that I’m now the owner of a culture-confirmed Campylobacter infection. The doctor prescribed some ciprofloxacin and I’m feeling much better than I was 13 days ago.

My stool is beginning to resemble what it did before this whole ordeal, but I’m not totally done. Although rare, I could still develop arthritis problems or Guillain-Barr syndrome (an immune system issue that can lead to paralysis) but I hope not.

I’ve been telling folks over the past couple of days about the campylobacterosis and the responses can be grouped into two categories: “that’s ironic;” and, “where do you think you got it?” The second question is more interesting and easier to answer: I’m not sure.

The Campylobacter could have come from lots of sources. It might have been something Dani or I did at home.  We try to avoid cross-contamination and I’m religious about using a food thermometer, but those practices reduce, not eliminate, risks. I eat out a few times a week and put my trust in the front-line staff at restaurants to do what they can to keep me from getting sick. I also eat a lot of fresh produce that could be contaminated with fecal matter pretty much anywhere from farm-to-fork. Who knows? 

Being a food safety nerd I’m still waiting on follow-up information on the typing and whether I’m part of a larger cluster of illnesses.  If I am, maybe that will help answer the source question. To be continued.

What this incident has shown me, better than I understood before, is that foodborne illness really isn’t as simple as some make it out to be. I like to think that I have some basic knowledge about what I can do to avoid it.  But I still spent 13 days on the toilet and I don’t really know what led to the fun.