During 2000–2014, 140 untreated recreational water–associated outbreaks that caused at least 4,958 illnesses and two deaths were reported; 80 outbreaks were caused by enteric pathogens.
Swimmers should heed posted advisories closing the beach to swimming; not swim in discolored, smelly, foamy, or scummy water; not swim while sick with diarrhea; and limit water entering the nose when swimming in warm freshwater.
Outbreaks associated with untreated recreational water can be caused by pathogens, toxins, or chemicals in fresh water (e.g., lakes, rivers) or marine water (e.g., ocean). During 2000–2014, public health officials from 35 states and Guam voluntarily reported 140 untreated recreational water–associated outbreaks to CDC. These outbreaks resulted in at least 4,958 cases of disease and two deaths. Among the 95 outbreaks with a confirmed infectious etiology, enteric pathogens caused 80 (84%); 21 (22%) were caused by norovirus, 19 (20%) by Escherichia coli, 14 (15%) by Shigella, and 12 (13%) by Cryptosporidium. Investigations of these 95 outbreaks identified 3,125 cases; 2,704 (87%) were caused by enteric pathogens, including 1,459 (47%) by norovirus, 362 (12%) by Shigella, 314 (10%) by Cryptosporidium, and 155 (5%) by E. coli. Avian schistosomes were identified as the cause in 345 (11%) of the 3,125 cases. The two deaths were in persons affected by a single outbreak (two cases) caused by Naegleria fowleri. Public parks (50 [36%]) and beaches (45 [32%]) were the leading settings associated with the 140 outbreaks. Overall, the majority of outbreaks started during June–August (113 [81%]); 65 (58%) started in July. Swimmers and parents of young swimmers can take steps to minimize the risk for exposure to pathogens, toxins, and chemicals in untreated recreational water by heeding posted advisories closing the beach to swimming; not swimming in discolored, smelly, foamy, or scummy water; not swimming while sick with diarrhea; and limiting water entering the nose when swimming in warm freshwater.
Outbreaks associated with untreated recreational water-United States, 2000-2014
Daniel S. Graciaa, MD1; Jennifer R. Cope, MD2; Virginia A. Roberts, MSPH2; Bryanna L. Cikesh, MPH2,3; Amy M. Kahler, MS2; Marissa Vigar, MPH2; Elizabeth D. Hilborn, DVM4; Timothy J. Wade, PhD4; Lorraine C. Backer, PhD5; Susan P. Montgomery, DVM6; W. Evan Secor, PhD6; Vincent R. Hill, PhD2; Michael J. Beach, PhD2; Kathleen E. Fullerton, MPH2; Jonathan S. Yoder, MPH2; Michele C. Hlavsa, MPH2
Cassius, an adult male, died on April 12, and Naku, a 17-year-old female western lowland gorilla, died on April 29, the zoo said in a press release.
Autopsy results for the gorillas show that they died of gastrointestinal infections believed to have been caused by E. coli in their water supply, according to the zoo.
The water systems in the gorilla and bonobo areas have been disinfected, the zoo said, adding that the water supply available for consumption by the public was never affected.
Zookeepers are also using new protocols to disinfect produce, which can be another source of E. coli, according to the release.
While all animals, including gorillas and even humans, have healthy E.coli in their gut, some variants of E. coli can cause intestinal damage and disease, the zoo said.
Naku had been euthanized after veterinarians found that a portion of her intestine was no longer functioning, ABC affiliate WISN in Milwaukee reported.
Cassius and Nauku’s 8-month-old baby, Zahra, is now an orphan.
Zahra’s diet has consisted mainly of formula in the absence of her mother’s breast milk, zookeepers wrote on Twitter. She is also eating some produce, sweet potato, red pepper, and beans, the zoo said.
Surveys still suck, but the results of this one generally correlate to what we have found doing 20 years of on-farm food safety with fresh produce growers.
Outbreaks and crisis drive grower food safety concerns, prevention is a hard sell, but we’ve shown it can be done.
Understanding growers’ preferences regarding interventions to improve the microbiological safety of their produce could help to design more effective strategies for the adoption of such food safety measures by growers.
The objective of this survey study was to obtain insights for the design of interventions that could stimulate growers to increase the frequency of irrigation water sampling and water testing to reduce possible microbiological contamination of their fresh produce.
The results showed that price intervention, referring to making the intervention less costly by reducing the price via discounts, is the most effective strategy to change growers’ intentions to increase their frequency of irrigation water testing. Moreover, a sense of urgency affects their intentions to increase the frequency of irrigation water testing.
The findings of this survey support the hypothesis that, to date, safety is not perceived as a quality control issue under normal circumstances, but safety becomes an overriding attribute in a food crisis.
Understanding preferences for interventions to reduce microbiological contamination in Dutch vegetable production
June 2018, Journal of Food Protection vol. 81 no. 6
A. P. M. VAN ASSELDONK,1*L. MALAGUTI,2M. L. H. BREUKERS,1 and H. J. van der FELS-KLERX2,3
Electrolyzed Water as a Novel Sanitizer in the Food Industry: Current Trends and Future Perspectives
SME Rahman, Imran Khan, and Deog-Hwan Oh
Electrolyzed water (EW) has gained immense popularity over the last few decades as a novel broad-spectrum sanitizer. EW can be produced using tap water with table salt as the singular chemical additive. The application of EW is a sustainable and green concept and has several advantages over traditional cleaning systems including cost effectiveness, ease of application, effective disinfection, on-the-spot production, and safety for human beings and the environment. These features make it an appropriate sanitizing and cleaning system for use in high-risk settings such as in hospitals and other healthcare facilities as well as in food processing environments. EW also has the potential for use in educational building, offices, and entertainment venues. However, there have been a number of issues related to the use of EW in various sectors including limited knowledge on the sanitizing mechanism. AEW, in particular, has shown limited efficacy on utensils, food products, and surfaces owing to various factors, the most important of which include the type of surface, presence of organic matter, and type of tape water used. The present review article highlights recent developments and offers new perspectives related to the use of EW in various areas, with particular focus on the food industry.
The situation that Life Hacker’s Nick Douglas presented to me was (I’m paraphrasing here slightly): hey, I’m gonna leave a glass of water out over night and I know it’s not going to be a problem after a couple of hours, but I can’t leave that water there for a few weeks can I, because it will go bad, right?
My answer (paraphrased as well) I guess it depends what you mean by bad. The water will probably taste different the longer it sits there. Yeast, mold and algae might float into it, but as far as pathogens go, my take is that it’s really low risk.
I told him that the water wasn’t the issue, it’s what gets introduced to the water like food debris or some other nutrient source. And then a pathogen. Or poop. Poop has both.
My quote was, ‘What would matter is if, like, someone had poop on their finger and stuck it in there.’
It’s not like I thought water rots, OK? I just thought that there’s enough bacteria floating around a home, or in tap water, or on your lips when you take a sip, that given a month alone in a glass, it might grow and then make you sick. But, as food safety specialist Dr. Benjamin Chapman tells me in a mildly embarrassing phone call, it won’t.
But there must be some way it could, right? Yes, Dr. Chapman says, if you didn’t wash the glass properly, and left a nutrient like juice or other sugary remnants.
But even if you’ve drunk out of the glass, getting your mouth on it, leaving a lip print, and then leaving out the glass — even then, he says, you’re not going to poison yourself with your own mouth bacteria.
Obviously, if the water supply is contaminated, all bets are off. If it was toxic when it left the tap, it’s still toxic after sitting out. But apparently, as long as it started out fine, even super-gross-tasting old water is healthy to drink, and I’m an ignorant hydrophobe. Fine. But I’m not alone. I only got curious because cooking blog The Kitchn asked the same question — or maybe they were stating the obvious for rubes like me.
Their fortitude paid off. Scientists were able to study an important question: whether a person’s blood type affects the severity of an “Enterotoxigenic E. coli” infection, the leading cause of traveler’s diarrhea.
It turns out, there was a difference in severity by blood type: Those with blood type A got sick sooner, and experienced more severe symptoms, than those with blood type B or O, the researchers said. [Top 7 Germs in Food that Make You Sick]
What’s more, the study uncovered an explanation for these findings: It appears that the bacteria release a protein that attaches to intestinal cells in people with blood type A, but not in people with other blood types.
The new finding might one day lead to the development of a vaccine that could reduce disease severity in people with type A blood. “A vaccine targeting this protein would potentially protect the individuals at highest risk for severe disease,” study senior author Dr. James Fleckenstein, an associate professor of medicine and molecular microbiology at Washington University School of Medicine in St. Louis, said in a statement.
The study was published online (May 17) in The Journal of Clinical Investigation.
During 2000–2014, 493 outbreaks associated with treated recreational water caused at least 27,219 cases and eight deaths. Outbreaks caused by Cryptosporidium increased 25% per year during 2000–2006; however, no significant trend occurred after 2007. The number of outbreaks caused by Legionella increased 14% per year.
The aquatics sector, public health officials, bathers, and parents of young bathers can take steps to minimize risk for outbreaks. The halting of the increase in outbreaks caused by Cryptosporidium might be attributable to Healthy and Safe Swimming Week campaigns.
Outbreaks associated with treated recreational water — United States, 2000–2014
Centers for Disease Control and Prevention
Michele C. Hlavsa, MPH; Bryanna L. Cikesh, MPH; Virginia A. Roberts, MSPH; Amy M. Kahler, MS; Marissa Vigar, MPH; Elizabeth D. Hilborn, DVM; Timothy J. Wade, PhD; Dawn M. Roellig, PhD; Jennifer L. Murphy, PhD; Lihua Xiao, DVM, PhD; Kirsten M. Yates, MPH; Jasen M. Kunz, MPH; Matthew J. Arduino, DrPH; Sujan C. Reddy, MD; Kathleen E. Fullerton, MPH; Laura A. Cooley, MD; Michael J. Beach, PhD; Vincent R. Hill, PhD; Jonathan S. Yoder, MPH
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 the first public announcement was also the Sunday of the Victoria Day long weekend and 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 11:00 a.m., on Tuesday May 23, the Walkerton hospital jointly held a media conference with the health unit to inform the public of outbreak, make the public aware of the potential complications of the E. coli O157:H7 infection, and to tell the public 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.
Ultimately, 2,300 people in a town of 5,000 were sickened and seven died. All the gory details and mistakes and steps for improvement were outlined in the report of the Walkerton inquiry.
Paul Hunter of the Toronto Star writes it was a glorious, sun-warmed afternoon after a long winter. Robbie Schnurr’s blinds were closed. He was finalizing his plans to die.
“Pretty much where I’m laying right now, where I’ve been for years,” he said, reflexively patting the bedsheet between him and the half-finished bottles of water kept within easy reach.
“What does a person do when they know they’re going to die within hours? I mean, do you walk over and look out the window? I can’t walk anyways. I guess you just wait for the time to pass and then you miss the hors d’oeuvres.”
It’s been 18 years since a deadly E. coli outbreak devastated the rural town of Walkerton, 150 kilometres northwest of Toronto. Seven people perished. A further 2,500, half the population, took ill. Most eventually got better. Schnurr never did.
Poisoned like the others, his health declined slowly and painfully until he lived in a sort of limbo: a prisoner in his own body, in his own bed, here in his 11th-floor Mississauga condo, a 71-year-old alone and feeling largely forgotten.
The former OPP officer and investigator with Ontario’s Office of the Fire Marshal was in constant pain from a degenerative nerve disease. Doctors, he said, told him he would continue to decline. There was no hope of improvement.
His legs had wasted away. Numbness in his fingers made it impossible for him to write or button a shirt; he opened bottles of painkillers with his mouth. He was losing sight in his right eye; the hearing in one ear was already gone. He’d leave his home only every two weeks, strapped on a gurney to be transported to the Queensway Health Centre for an intravenous immunoglobulin treatment. He went for the last time in late April.
On May 1, a doctor came to him.
In the company of his younger sister, Barbara Ribey, her husband, Norm, and two friends, Schnurr fulfilled his wish for a physician-assisted death.
“I just won’t live like this anymore,” he explained the day before that final moment. “There’s nothing to look forward to, there’s no goals in life. There’s nothing.”
Before he took ill, Schnurr said he “had the world by the ass.” He wanted people to know that. He also didn’t want forgotten what happened at Walkerton and how it cheated him, and others from his hometown, in life and left a heartbreaking legacy.
Schnurr said he also recently spoke to two old friends from the OPP who’d had no idea of what became of him.
He wanted everyone to know. So he invited the Star to his home to share his story and explain his decision.
Schnurr was, as it would have been described in another era, a man’s man, living like he was the lead in a 1970s action movie.
Mustachioed and handsome, he drove fast cars (the last a black Corvette), lived for long stretches on his 35-foot boat (where the parties were frequent) and had a closet full of Armani and Hugo Boss suits and silk ties. He owned a condo in Mexico and, befitting a Hollywood star, he always seemed to have a beautiful date on his arm.
“Women loved Robbie,” said Ribey.
Schnurr skied, he rollerbladed, he had a black belt in karate. As a teen, he played every sport he could. He excelled at hockey and was never afraid to drop the gloves. In baseball, a fastball in the low to mid-90s caught a scout’s eye, and he went off to pitch in the minors in North Carolina.
“I know I could have made the big leagues, but I didn’t know how long it would take,” he said. “And there was this girl that wanted me to get married. When I got home she handed me an application for the OPP.”
The policing job idea stuck, but the thought of marriage didn’t. Schnurr became a cadet at 19, was sworn in and got his gun at 21. He said he was shot twice and stabbed twice. He lost hearing in one ear because of target shooting practice. He investigated motorcycle gangs — “We didn’t get along real well, the bikers and I” — and major crimes.
He moved from Owen Sound to Kenora to Manaki before landing in Orillia in the early 1980s shortly before a train derailed in nearby Medonte. The fire marshal’s office was impressed with how he handled that case and suggested he apply. Schnurr said he beat out 800 other candidates for the job and was soon sent off to train with the FBI to become an expert in explosions.
In newspapers during the ’80s and ’90s, Schnurr was frequently quoted standing among the ashes at one fire or another. He figured he investigated some 2,000 fires. At one point, he helped profile and hunt down an arsonist who was terrorizing Toronto’s west end. On another case, the torching of a church, he received death threats.
Through his working life, sports remained important, as he coached youth baseball and organized instructional clinics around the province.
Though single at the end, he had married twice, had a daughter, Samantha, whom he adored and a grandson, Kaiden, born in January.
Tough as he was, through a twist of fate Schnurr was exiled from the world he embraced so enthusiastically.
“Now, I can’t even get down the goddamned hall,” he said. “To make a long story short, I was screwed.”
Schnurr didn’t even live in Walkerton when he encountered his kryptonite there. He’d gone to his hometown for his mother’s memorial in mid-May of 2000. When he returned to Mississauga, he realized he’d forgotten his suit jacket. With Victoria Day weekend coming, he decided to make a quick return trip to Walkerton to pick it up and see a couple of friends on the Friday before the holiday traffic got heavy.
“It was a really hot and muggy day and when I got there, I took a pitcher of water and chugalugged it,” he said.
That began a weekend of hell that lasted 18 years.
“I had blood coming out of both ends,” he said of the next 48 hours, spent feeling groggy and on the floor of his condo. “It was almost two days before I could get any help because I wasn’t strong enough.”
Walkerton’s water supply had been contaminated. A heavy rainstorm washed cow manure carrying a strain of E. coli O157:H7 into a vulnerable town well and, because of improper chlorination, the lethal bacteria was not destroyed.
The poison was passed on through tainted tap water and made thousands sick with severe gastrointestinal issues, including bloody diarrhea, in one of the worst public health disasters in Canadian history. A landmark, seven-year study of those who fell ill, released in 2008, determined there were legacy illnesses from the tragedy. Patients who had confirmed gastroenteritis had a 30 per cent higher risk of high blood pressure or kidney damage.
The study found that 22 children who became sick in 2000 had permanent kidney damage, but treatment had stopped that illness from getting worse.
Dr. William Clark, a kidney specialist at London Health Sciences Centre who led the study, looked again three years ago at the victims of Walkerton, and found that although “there is no doubt some people have had significant long-term problems” when compared with similar small towns, Walkerton is actually doing “somewhat better” when it comes to kidney and heart issues.
That, he suggests, could be related to a post-crisis medical screening program involving about 4,000 residents. It not only identified health issues related to the contamination, but also picked up ailments such as diabetes and hypertension, allowing physicians to get those patients on proper medication.
Clark said the kidney and heart issues of Walkerton residents have improved, but “there’s no doubt they’re on more medication” than comparable groups.
Schnurr had no idea others were also poisoned as he floundered on his condominium floor in 2000. He didn’t know why he was sick, even as an ambulance eventually took him, in blood-soaked clothes, to the hospital. He also wondered why all the medical staff took such keen interest in his Walkerton roots. Then, on one of the muted televisions at the hospital, he started to see familiar faces from his hometown.
“I’m going, ‘What’s going on?’ (A hospital worker) said to me, ‘You haven’t heard about the E. coli epidemic in Walkerton?’ Bang. It all came together.”
Schnurr returned to work until 2002, but he got progressively weaker. His retirement plan had been to take a lucrative position investigating insurance fraud in the U.S., or set up his own business. Instead, he struggled with balance, falling often, and forgot things. At 55, he could no longer work.
Schnurr said the bacterial infection destroyed his immune system and that led to his current neurological disorder. Press reports, years after the Walkerton disaster, chronicled Schnurr’s struggles as a lingering victim.
Doctors eventually diagnosed Schnurr with chronic inflammatory demyelinating polyneuropathy (CIDP), a neurological disorder that causes the body’s immune system to attack and destroy the myelin sheath that envelops nerves. It’s comparable to stripping the insulation off electrical wires. Symptoms include tingling in the feet and hands as well as progressive weakness in the legs and arms. For Schnurr, it also brought debilitating pain.
“Anything too hot or too cold on him would almost be like tinfoil on a tooth filling,” Ribey said.
CIDP, a rare disorder, typically follows an infection in the body that messes up the immune system. There is always a suspected trigger, but the exact cause can’t be pinned down.
Clark, the lead health investigator at Walkerton, said research hasn’t shown a good correlation between E. coli O157:H7 and CIDP.
“But I’m not excluding it because the reality is any inflammatory event may … contribute to the onset of an autoimmune disorder, which CIDP really is,” he said.
At first, Schnurr could “furniture walk” around his condo, using a cane and clutching at various items to keep his balance. But there were too many tumbles, too many sutures and too many broken bones. Five times, he ended up in the hospital. Once he fell into his television, pushing it through the drywall.
“When I could get out of bed, I’d go down into the living room and sit there and stare,” he said. “I wouldn’t even answer the phone.”`
When his legs got weaker, Schnurr would crawl around his home, sometimes till his knees bled. For the past decade, even that was too much.
“I would often hope and pray I would get some kind of something to make me well,” he said. “I know now that’s not going to happen and …”
The rest of that thought preoccupied his mind, he said, for almost 10 years. He wanted out of a life that hurt to live. Before assisted death became legal in Canada in 2016, he considered going to Switzerland, where it was available.
“I’m not afraid. I’m not scared. I’m almost looking … I am looking forward to it because I’ll be gone,” he said.
“I think most people, well, I know most people, they don’t want to die. They want to live, but life is no fun for me. I can’t go anywhere. I can’t do anything. My body is breaking down more and more. So I discussed it with doctors and family. They agreed with me. So here I am.”
Schnurr was resolute in his decision, approaching his own death with an almost clinical detachment — “There was never a tear,” Ribey said — as he wondered about timing and process. He said he cleaned up any debts and other paperwork so his sister wouldn’t be burdened. He got someone to throw away all his pills and he said goodbye to those who mattered.
“I’m rational. I’m in pain, but I’m always in pain,” he said. “I gave it a lot of thought. It’s not something you decide overnight.”
On his birthday on July 14, 2017, he posted on Facebook that it would be his last.
“Going back a month ago up till present, I was ticking the days off,” he said. “I just didn’t want to suffer anymore. The pain and suffering and lack of friends, you know. I’m basically here alone with the exception of the people that come in and clean.”
On the first day of May, in the afternoon, Ribey lay down next to her brother. It was time. A doctor administered three injections.
“I was lying beside him and holding his hand and he just put his head down on mine and said, ‘How’s my little sister?’ And that’s when I started to cry. Then I said something like, thank you for being such a kind brother and a good brother to me. I’m going to miss you … I told him I loved him.”
She said it was “very, very peaceful and very quick.”
For Schnurr, a man broken beyond repair, the pain stopped.
This study explores the effect of bed sediment resuspension on Escherichia coli on concentrations in the water column and the persistence of E. coli in the water column and bed sediments of the Yarra River estuary in South‐Eastern Australia. Using sediment cores, we identified that the resuspension of both surficial sediments (e.g., by tidal movements) and deeper bed sediments (e.g., by large storm events) can increase E. coli concentrations in the water column by up to 20 times in estuaries in oceanic climates. Bed sediment resuspension can result in increased E. coli concentrations in the water column even up to 24 days after E. coli first enters the estuarine water.
This study demonstrates that faecal microorganisms, such as E. coli, can persist for extended periods in estuarine bed sediments, which may then be re‐entrained into the water column via recreational activities, high flow events, or tidal fluctuations. If the survival and resuspension processes observed here hold true for pathogenic microorganisms, the resuspension of bed sediments may indeed represent an increased public health risk.
Escherichia coli survival and transfer in estuarine bed sediments