You see a cute bird, I see a Campylobacter factory: In Finland too

The roles of environmental reservoirs, including wild birds, in the
molecular epidemiology of Campylobacter jejuni have not been assessed in
depth.

Our results showed that game birds may pose a risk for acquiring
campylobacteriosis, because they had C. jejuni genomotypes highly similar
to human isolates detected previously. Therefore, hygienic measures during
slaughter and meat handling warrant special attention. On the contrary, a
unique phylogeny was revealed for the western jackdaw (right) isolates, and certain
genomic characteristics identified among these isolates are hypothesized to
affect their host specificity and virulence.

Comparative genomics within sequence types (STs), using whole-genome multilocus sequence typing (wgMLST), and phylogenomics are efficient methods to analyze the genomic relationships of C. jejuni isolates.

 Population Genetics and Characterization of Campylobacter jejuni Isolates
 from Western Jackdaws and Game Birds in Finland
 Sara Kovanen, Mirko Rossi, Mari Pohja-Mykrä, Timo Nieminen, Mirja
 Raunio-Saarnisto, Mikaela Sauvala, Maria Fredriksson-Ahomaa, Marja-Liisa
 Hänninen and Rauni Kivistö

 Appl. Environ. Microbiol. February 2019 85:e02365-18; Accepted manuscript
 posted online 14 December 2018, doi:10.1128/AEM.02365-18

 http://aem.asm.org/content/85/4/e02365-18.abstract?etoc

Just cook it doesn’t cut it: Salmonella in veal liver, Quebec

Salmonella enterica is one of the principal causes of foodborne zoonotic enteritis. Among the different serovars, Dublin (S. Dublin) is of particular importance due to its propensity to progress to an invasive infection in humans and due to the high proportion of multi-drug resistant strains in Canada.

Cattle are considered as the main reservoir of S. Dublin. This serotype has emerged since 2011 in the province of Quebec, Canada, in both cattle and human populations. First animal cases have been reported in calf production.

White veal are valued for the quality of their meat, offal and liver. The liver is usually consumed mildly cooked and is considered as a probable source of foodborne exposure to S. Dublin in humans. The objective of this study was to estimate the prevalence of S. Dublin positive liver after slaughtering and the seroprevalence against S. Dublin at the calf level.

Prevalence of salmonella Dublin in veal liver in Quebec, Canada from a public health perspective, February 2019

International Journal of Infectious Diseases vol. 79 pg. 75

C.M. Andela Abessolo, P. Turgeon, P. Fravalo, G. Côté, G. Eyaba, W.P. Thériault, J. Arsenault

DOI: https://doi.org/10.1016/j.ijid.2018.11.191

https://www.ijidonline.com/article/S1201-9712(18)34770-2/abstract

Developing official control in Finnish slaughterhouses, 2018

From a PhD dissertation by Jenni Luukkanen of the University of Helsinki. Here’s hoping the defence last week went well.

Official control in slaughterhouses, consisting of meat inspection and food safety inspection, has an important role in ensuring meat safety, animal health and welfare, and prevention of transmissible animal diseases. Meat inspection in the European Union (EU) includes the inspection of food chain information, live animals (ante-mortem inspection), and carcasses and offal (post-mortem inspection).

Food safety inspections are performed to verify slaughterhouses’ compliance with food safety legislation and are of the utmost importance, especially if slaughterhouses’ self-checking systems (SCSs) fail.

The aim of this study was to investigate the prerequisites for official control such as the functionality of the task distribution in meat inspection and certain meat inspection personnel-related factors. In addition, needs for improvement in slaughterhouses’ SCSs, meat inspection, and food safety inspections, including control measures used by the official veterinarians (OVs) and their efficacy, were examined. In the EU, competent authorities must ensure the quality of official control in slaughterhouses through internal or external audits, and the functionality of these audits was also studied.

Based on our results, meat inspection personnel (OVs and official auxiliaries [OAs]), slaughterhouse representatives, and officials in the central authority were mainly satisfied with the functionality of the present task distribution in meat inspection, although redistributing ante-mortem inspection from the OVs to the OAs was supported by some slaughterhouse representatives due to perceived economic benefit.

Ante-mortem inspection was assessed as the most important meat inspection task as a whole for meat safety, animal welfare, and prevention of transmissible animal diseases, and most of the respondents considered it important that the OVs perform antemortem inspection and whole-carcass condemnation in red meat slaughterhouses.

In a considerable number of slaughterhouses, OA or OV resources were not always sufficient and the lack of meat inspection personnel decreased the time used for food safety inspections according to the OVs, also affecting some of the red meat OAs’ post-mortem inspection tasks. The frequency with which OVs observed post-mortem inspection performed by the OAs varied markedly in red meat slaughterhouses. In addition, roughly one-third of the red meat OAs did not consider the guidance and support from the OVs to be adequate in post-mortem inspection.

According to our results, the most common non-compliance in slaughterhouses concerned hygiene such as cleanliness of premises and equipment, hygienic working methods, and maintenance of surfaces and equipment. Chief OVs in a few smaller slaughterhouses reported more frequent and severe non-compliances than other slaughterhouses, and in these slaughterhouses the usage of written time limits and enforcement measures by the OVs was more infrequent than in other slaughterhouses.

Deficiencies in documentation of food safety inspections and in systematic follow-up of corrections of slaughterhouses’ non-compliance had been observed in a considerable number of slaughterhouses. In meat inspection, deficiencies in inspection of the gastrointestinal tract and adjacent lymph nodes were most common and observed in numerous red meat slaughterhouses. Internal audits performed to evaluate the official control in slaughterhouses were considered necessary, and they induced correction of observed non-conformities. However, a majority of the interviewed OVs considered that the meat inspection should be more thoroughly audited, including differences in the rejections and their reasons between OAs. Auditors, for their part, raised a need for improved follow-up of the audits.

Our results do not give any strong incentive to redistribute meat inspection tasks between OVs, OAs, and slaughterhouse employees, although especially from the red meat slaughterhouse representatives’ point of view the cost efficiency ought to be improved. Sufficient meat inspection resources should be safeguarded in all slaughterhouses, and meat inspection personnel’s guidance and support must be emphasized when developing official control in slaughterhouses. OVs ought to focus on performing follow-up inspections of correction of slaughterhouses’ non-compliance systematically, and also the documentation of the food safety inspections should be developed.

Hygiene in slaughterhouses should receive more attention; especially in slaughterhouses with frequent and severe non-compliance, OVs should re-evaluate and intensify their enforcement.

The results attest to the importance of internal audits in slaughterhouses, but they could be developed by including auditing of the rejections and their underlying reasons and uniformity in meat inspection.

Lotsa Norovirus on produce in UK

To acquire data on contamination with Norovirus in berry fruit and salad vegetables in the United Kingdom, 1,152 samples of fresh produce sold at retail in the UK were analysed for Norovirus.

Of 568 samples of lettuce, 30 (5.3%) were Norovirus-positive. Most (24/30) lettuce samples which tested positive for Norovirus were grown in the UK and 19 of those 24 samples contained NoV GI. Seven/310 (2.3%) samples of fresh raspberries were Norovirus-positive. Most (6/7) of the positively-testing fresh raspberry samples were imported, but no predominance of a genogroup, or any seasonality, was observed. Ten/274 (3.6%) samples of frozen raspberries were Norovirus-positive. The country of origin of the positively-testing frozen raspberry samples was not identified in most (7/10) instances.

The collected data add to the currently limited body of prevalence information on Norovirus in fresh produce, and indicate the need for implementation of effective food safety management of foodborne viruses.

Norovirus in produce sold at retail in the United Kingdom

Cook, N., Williams, L., & Dagostino, M. (2019). Prevalence of . Food Microbiology, 79, 85-89. doi:10.1016/j.fm.2018.12.003

https://www.sciencedirect.com/science/article/pii/S0740002018304386?dgcid=rss_sd_all

UK disease detectives: Supermarket loyalty cards to trace an E coli outbreak

Kathie Grant and Lisa Byrne write in Public Health Matters that in November 2017, supermarket loyalty cards were used to trace the source of a large E coli outbreak affecting mainly men in England. Dr Lisa Byrne leads Public Health England’s surveillance of two key bacteria that lead to food poisoning – E Coli and Listeria. Dr Kathie Grant heads the PHE Gastrointestinal Bacteria Reference Laboratory. The two work together as part of a larger team dedicated to reducing foodborne illness and below tell us how they put the pieces of this puzzle together to find the source.

If you’ve ever had food poisoning you’ll know that feeling of mentally going through everything you ate recently, trying to pinpoint what it was that might have made you ill. It’s our job to do that at a national scale.  We bring together lots of different pieces of  information from the community and the lab to try to find  the source of a food poisoning outbreak and then, working alongside other government agencies,  ensure that more people don’t get sick.

We study and monitor many different stomach bugs – some of which you may never have heard of! While stomach bugs are a part of life, PHE works with organisations such as the Food Standards Agency and the Animal and Plant Health Agency to try and prevent them.

Every so often we see a spike in the number of cases.  When this happens it is important that we find the link between the cases and the cause of their illness.  To do this we need to identify the exact strain of a bug to understand if people have got ill from the exact same source.

Whole Genome Sequencing (WGS) ‒ a relatively new process for showing us the makeup of a bacterium or virus’s genes ‒ has changed the way we can find the cause of an outbreak and stop more people getting ill. You can learn more about the process and how it works in our explainer blog.

Before WGS it could take weeks to identify bacteria and sometimes the bacteria could be missed. This slowed down any investigations  as we could not be sure that all the case histories we were taking could be linked to an outbreak – there was a lot of ‘noise’ and false lines of enquiry. With WGS, we can rapidly and accurately identify if bacteria of cases are the same strain and rule out people from our investigation who just happened to be ill at the same time, but with a different illness.

It has also expanded what the word ‘outbreak’ means as we can link cases across several years and different countries, meaning we can more accurately piece together a picture of how something in the food supply chain impacts human health.

Scientists working in the Gastrointestinal Bacteria reference laboratory at Public Health England. The team are processing samples from people who have reported gastrointestinal symptoms, to understand the exact cause of their illness.

Identifying the source of an outbreak is a lot like putting together a jigsaw puzzle, combining multiple pieces of evidence to get the full picture. Sometimes, a common source is obvious, such as when a group of people get ill after eating the same meal, at the same restaurant, on the same day. But other times, we need to use an arsenal of investigative tools, as was the case in a recent E coli outbreak.

In November 2017 our surveillance system alerted us to 12 cases of E coli O157 – (a particular form of E coli), over a six week window. E coliO157 is a relatively rare cause of food poisoning, with only about 700 cases a year, but it can cause a very severe illness. Because of this, any case of E coli O157 identified by doctors and laboratories must be reported to Public Health England.  We monitor the number of cases with our surveillance systems to find any patterns.

Very quickly our reference laboratory used WGS which showed that the cases had the identical genetic “fingerprint” and the work began to trace the source of infection. The majority of people who became ill were men, which was unusual as E coli outbreaks are often linked to salad items ‒ traditionally more likely to be eaten by women.

It took a few rounds of interviews – carried out by colleagues in local authorities – to zero in on the potential source of food poisoning, and a picture started to emerge that implicated burgers from a particular retailer.

We asked the supermarket to analyse the loyalty card records of those who had become ill, to help identify the particular burger product the cases had eaten.  As you can imagine, there were many different types of burgers supplied by the supermarket and it’s often difficult for people to remember exactly what they ate.

Working with the Food Standards Agency we were able to identify that all the cases had bought a particular brand of burger, leading to a product recall to ensure others didn’t get sick. The recall involved removing all the suspected batches of burgers from the supermarket shelves. The supermarket also contacted people who had bought the burgers, advising them not to eat them and return them for a refund.

Sometimes, as in this case, we can rapidly find what is making people ill and quickly remove it from sale. It’s an exciting role and we get a real sense of satisfaction out of using our skills to help people in this way. Other times it can be more frustrating – some outbreaks remain unsolved and it’s a real worry that people will get sick because we can’t eliminate a threat from food distribution.

The role really keeps us on our toes. Our surveillance systems mean that we have a good sense of patterns of illness across the year and how we can intervene to stop people getting unwell – but changes to food habits can catch us by surprise. For instance, raw milk has become more popular recently, bringing with it all the disease risks you would expect from a product that has come straight from a cow without any treatment to kill off bacteria!

In another case, eight people in the UK were affected while on holiday in Germany that was related to seeds.  The seeds were decoratively used as a garnish on salads and were difficult for cases to remember eating. Nearly 1,000 people in Germany got ill in that outbreak and one of the approaches by authorities was to use tourist photos of food to try and identify the common item in meals that could be making people sick.

Solving food borne illness outbreaks can be a real challenge, but by using a variety of the different tools available to us we can quickly intervene to stop people getting ill.

Yes E. coli is natural: Texas Natural Meats recalls frozen raw ground beef products for E. coli O103

Texas Natural Meats, a Lott, Texas establishment, is recalling approximately 489 pounds of frozen raw, ground beef products that may be contaminated with Shiga toxin-producing E. coli (STEC) O103, the U.S. Department of Agriculture’s Food Safety and Inspection Service (FSIS) announced today.

The frozen raw, ground beef items were produced on Aug. 8, 2017.  The following products are subject to recall:  [View Label (PDF only)]
1.00-lb. bags of “Green Field Farms Rogers Texas Ground Beef.”  The bags display the “PRODUCTION DATE 08.08.2017” and also display the “EXPIRATION DATE 08.08.2020.”  The bags are labeled “COOK USE ONLY” with the instruction “DO NOT refreeze after defrosting.”  
The products subject to recall bear establishment number “EST. 34449” inside the USDA mark of inspection. These items were shipped to a retailer who sold the product at a farmer’s market in Roger, Texas.
The problem was discovered on June 19, 2018 by FSIS during routine inspection activities. The product was tested by the establishment and found to be positive for STEC O103 under their sampling program. …

The only way to confirm that ground beef is cooked to a temperature high enough to kill harmful bacteria is to use a food thermometer that measures internal temperature, http://1.usa.gov/1cDxcDQ.

Shiga-toxin E. coli in dairy cattle near Brisbane

Sure it’s almost 20 years old. But a reminder.

Over a 12-month period, 588 cattle faecal samples and 147 farm environmental samples from three dairy farms in southeast Queensland were examined for the presence of Shiga-toxigenic Escherichia coli (STEC). Samples were screened for Shiga toxin gene (stx) using PCR.

Samples positive for stx were filtered onto hydrophobic grid membrane filters and STEC identified and isolated using colony hybridisation with a stx-specific DNA probe. Serotyping was performed to identify serogroups commonly associated with human infection or enterohaemorrhagic Escherichia coli (EHEC). Shiga-toxigenic Escherichia coli were isolated from 16.7% of cattle faecal samples and 4.1% of environmental samples. Of cattle STEC isolates, 10.2% serotyped as E. coli O26:H11 and 11.2% serotyped as E. coli O157:H7, and the E. coli O26:H11 and E. coli O157:H7 prevalences in the cattle samples were 1.7 and 1.9%, respectively.

Prevalences for STEC and EHEC in dairy cattle faeces were similar to those derived in surveys within the northern and southern hemispheres. Calves at weaning were identified as the cattle group most likely to be shedding STEC, E. coli O26 or E. coli O157. In concurrence with previous studies, it appears that cattle, and in particular 1-14-week-old weanling calves, are the primary reservoir for STEC and EHEC on the dairy farm.

A longitudinal study of Shiga-toxigenic Escherichia coli (STEC) prevalence in three Australian diary herds

Veterinary microbiology, Volume 71, Issue 1-2, Pages 125-37, Jan 1, 2000

https://espace.library.uq.edu.au/view/UQ:a5186cb

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.”

The global burden of crypto in children under 5

The protozoan Cryptosporidium is a leading cause of diarrhoea morbidity and mortality in children younger than 5 years. However, the true global burden of Cryptosporidium infection in children younger than 5 years might have been underestimated in previous quantifications because it only took account of the acute effects of diarrhoea. We aimed to demonstrate whether there is a causal relation between Cryptosporidium and childhood growth and, if so, to quantify the associated additional burden.

Methods

The Global Burden of Diseases, Injuries, and Risk Factors study (GBD) 2016 was a systematic and scientific effort to quantify the morbidity and mortality associated with more than 300 causes of death and disability, including diarrhoea caused by Cryptosporidium infection. We supplemented estimates on the burden of Cryptosporidium in GBD 2016 with findings from a systematic review of published and unpublished cohort studies and a meta-analysis of the effect of childhood diarrhoea caused by Cryptosporidium infection on physical growth.

Findings

In 2016, Cryptosporidium infection was the fifth leading diarrhoeal aetiology in children younger than 5 years, and acute infection caused more than 48 000 deaths (95% uncertainty interval [UI] 24 600–81 900) and more than 4·2 million disability-adjusted life-years lost (95% UI 2·2 million–7·2 million). We identified seven data sources from the scientific literature and six individual-level data sources describing the relation between Cryptosporidium and childhood growth. Each episode of diarrhoea caused by Cryptosporidium infection was associated with a decrease in height-for-age Z score (0·049, 95% CI 0·014–0·080), weight-for-age Z score (0·095, 0·055–0·134), and weight-for-height Z score (0·126, 0·057–0·194). We estimated that diarrhoea from Cryptosporidium infection caused an additional 7·85 million disability-adjusted life-years (95% UI 5·42 million–10·11 million) after we accounted for its effect on growth faltering—153% more than that estimated from acute effects alone.

Interpretation

Our findings show that the substantial short-term burden of diarrhoea from Cryptosporidium infection on childhood growth and wellbeing is an underestimate of the true burden. Interventions designed to prevent and effectively treat infection in children younger than 5 years will have enormous public health and social development impacts.

Morbidity, mortality, and long-term consequences associated with diarrhoea from cryptosporidium infection in children younger than 5 years: A meta-analyses study

The Lancet Global Health, DOI: https://doi.org/10.1016/S2214-109X(18)30283-3

Ibrahim A Khalil, Christopher Troeger, Puja C Rao…

https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(18)30283-3/abstract#.WyQRPA3swGY.twitter

Funding

The Bill & Melinda Gates Foundation.

Reality research: Norovirus in restaurant bathrooms

Long-time friend and friend of the barfblog.com, Don Schaffner, a professor of microbiology at Rutgers University (right, sort of as shown) writes:

More than seven years ago I had the good fortune to be contacted by my colleague, Dr. Lee-Ann Jaykus (below, left, exactly as shown).

She asked if I wanted to be involved in what was at the time going to be a remarkable endeavor. She was going to lead a team of scientists competing to earn a $25 million grant from the USDA focused on understanding Norovirus.

Norovirus causes more foodborne disease than any other microorganism. Because it is often self-limiting, and seldom fatal, it gets a little attention. It’s also a remarkably difficult organism to study. One of the reasons it has been difficult to study is that there had no way to culture the organism outside it’s human host. This meant that anyone wanting to do research with the organism had to have a supply of frozen poop containing the virus.

One of the goals of the ambitious project lead by Dr. Jaykus was to finally crack the code which would allow scientists to culture the virus in the laboratory. Spoiler alert, we got the grant. We were all excited to learn recently that thanks in large measure to the USDA Grant, that riddle has been solved.

This USDA Grant also allowed a number of other research projects too numerous to recount here, but I do want to tell the story of one.

Early on in our efforts on the ground, my colleague, Angie Fraser reached out and asked if I wanted to be part of an extensive survey of restaurant bathroom for Norovirus. I was delighted to say yes, and we began

I have to express my sincere appreciation to Cortney Leone whom led the project. She had the unenviable task of having to oversee researchers in three U.S. states, charged with collection of the data for this project. I also owe huge debt of gratitude to my graduate student Hannah Bolinger who led our data collection efforts in New Jersey.  Thanks also to the NJ team of graduate students, undergraduate students and significant others who visited public bathrooms around the state (Louis Huang, Pierce Gaynor, Sarah Hossain, Sneha Sreekumar, Jenny Todd-Searle, and Arthur Todd-Searle).

(Schaffner, this isn’t an Academy Award acceptance speech, on with it — dp.)

Because we wanted to ensure that our data were representative, we collected data from nine different counties in New Jersey. This turned out to be a lot harder than you might think. New Jersey is a home rule state.

This means that public health operates at the municipal level, with minimal oversight from the state. Our first task was to compile lists of food service establishment from the three regions of New Jersey.

This was easy to do in less densely populated regions, where the municipal entity was the county. We could simply contact the county, and through appropriate freedom of information act paperwork, obtain a list of all of the restaurants in the county. This was far more difficult in the densely settled parts of the state, where obtaining a list require contacting each and every municipality in the county, and filling out each municipalities’ different paperwork, in some cases mailing a paper check to cover photocopying costs, and then eventually taking the information we received back, and putting it into a standardized database. All of this was required before we could even begin to collect the first piece of data.

Thanks to Hanna’s outstanding work, we were eventually able to produce a robust enough database that we could proceed with data collection. Hannah lead a team of students that visited restrooms in and around New Jersey. This was harder than it sounded, as often the information provided by the  municipalities was out of date, and the students arrived at a location, only to learn that the restaurant was closed, or the location was incorrect.

Eventually, the teams in all three states had collected enough swabs and sent the samples back to CDC for analysis.

The end result of all this work was published in the Journal of Food Protection. Although our goal was to visit 750 commercial food establishments, we actually visited 751 establishments, in which 1,044 bathrooms and 4,163 surfaces were swabbed.  Four swab samples were collected from each bathroom: (i) the underside of the toilet seat where it connects to the toilet bowl, (ii) the flush handle of the toilet, (iii) the inner door handle of the stall door or, when there was no stall door, the inner door handle of the outer door, and (iv) the hot water knob of the sink faucet.

In the end 61 (1.5%) of 4,163 swabs were presumptively positive for human norovirus, and 9 of these were confirmed by sequencing.  This is similar to what others have found.

Almost half (30) of positive swabs were found on the underside of the toilet seat. About 20% were found on the toilet flush handle (13) and the inner handle of the stall or outer door (11). Only 11% (7) of positive swabs were found on the sink faucet handle.  Our results suggest that areas further away from the toilet are less likely to harbor norovirus contamination; toilet surfaces (especially the underside of the seat) would be closest to vomiting and diarrheal events during which high numbers of norovirus particles could be shed.

Chain restaurants had significantly more positive samples than non-chains (p = 0.0273). Unisex bathrooms had significantly more positive samples than female bathrooms (p = 0.0163).  Bathrooms with bar soap had significantly more positive samples than liquid soap bathroom (p = 0.0056) and foam soap bathrooms (p = 0.0147), but note that only 3 bathrooms out of 751 actually used bar soap. Bathrooms containing a trash can attached to the paper towel dispenser had significantly more positive samples than bathrooms with a free-standing trash can (p = 0.0004).

Although[the NoroCORE grant recently ended,I know there will be continued publications coming for many years, several of which will come from my lab, that will serve to further advance our understanding of Norovirus, and the means by which it can be controlled.

Prevalence of Human Noroviruses in Commercial Food Establishment Bathrooms

CORTNEY M. LEONE, MUTHU DHARMASENA, CHAOYI TANG, ERIN DiCAPRIO, YUANMEI MA, ELBASHIR ARAUD, HANNAH BOLINGER, KITWADEE RUPPROM, THOMAS YEARGIN, JIANRONG LI, DONALD SCHAFFNER, XIUPING JIANG, JULIA SHARP, JAN VINJÉ, and ANGELA FRASER (2018) Prevalence of Human Noroviruses in Commercial Food Establishment Bathrooms. Journal of Food Protection: May 2018, Vol. 81, No. 5, pp. 719-728.

https://doi.org/10.4315/0362-028X.JFP-17-419

http://jfoodprotection.org/doi/abs/10.4315/0362-028X.JFP-17-419?code=fopr-site

Although transmission of human norovirus in food establishments is commonly attributed to consumption of contaminated food, transmission via contaminated environmental surfaces, such as those in bathrooms, may also play a role. Our aim was to determine the prevalence of human norovirus on bathroom surfaces in commercial food establishments in New Jersey, Ohio, and South Carolina under nonoutbreak conditions and to determine characteristics associated with the presence of human norovirus. Food establishments (751) were randomly selected from nine counties in each state. Four surfaces (underside of toilet seat, flush handle of toilet, inner door handle of stall or outer door, and sink faucet handle) were swabbed in male and female bathrooms using premoistened macrofoam swabs. A checklist was used to collect information about the characteristics, materials, and mechanisms of objects in bathrooms. In total, 61 (1.5%) of 4,163 swabs tested were presumptively positive for human norovirus, 9 of which were confirmed by sequencing. Some factors associated with the presence of human norovirus included being from South Carolina (odd ratio [OR], 2.4; 95% confidence interval [CI], 1.2 to 4.9; P < 0.05) or New Jersey (OR, 1.7; 95% CI, 0.9 to 3.3; 0.05 < P < 0.10), being a chain establishment (OR, 1.9; 95% CI, 1.1 to 3.3; P < 0.05), being a unisex bathroom (versus male: OR, 2.0; 95% CI, 0.9 to 4.1; 0.05 < P < 0.10; versus female: OR, 2.6; 95% CI, 1.2 to 5.7; P < 0.05), having a touchless outer door handle (OR, 3.3; 95% CI, 0.79 to 13.63; 0.05 < P < 0.10), and having an automatic flush toilet (OR, 2.5, 95% CI, 1.1 to 5.3; 0.05 < P < 0.10). Our findings confirm that the presence of human norovirus on bathroom surfaces in commercial food establishments under nonoutbreak conditions is a rare event. Therefore, routine environmental monitoring for human norovirus contamination during nonoutbreak periods is not an efficient method of monitoring norovirus infection risk.