In memorandum: Wisconsin epidemiologist Jeffrey Davis identified Milwaukee’s Cryptosporidium outbreak

I was a new doctoral student when cryptosporidiosis sickened over 400,000 people and killed 69 in Wisconsin in the spring of 1993.

I had recently started the Food Safety Network, which was bringing daily updates to scientists and public health folks who usually had to wait 6 months for the U.S. Centers for Disease Control’s Morbidity and Mortality Weekly to arrive.

It may seem trivial now, but it was a big deal in its day.

Lotsa posers and copycats over the years, so we went to barfblog.com.

Later that year, cryptosporidiosis would sicken hundreds in Kitchener-Waterloo, where I was living with my young family.

Somehow, I was speaking about this to our home-renovator-contractor-and-therapist yesterday while he unplugged our kitchen faucet.

And then I got this.

Meg Jones of the Milwaukee Journal Sentinel writes that as doctors’ offices filled with Milwaukeeans suffering from a mysterious illness in 1993, Mayor John Norquist called a meeting with state and local officials.

Norquist asked state epidemiologist Jeffrey Davis whether he would drink a glass of Milwaukee’s water and when Davis said he would not, Norquist issued a massive boil water advisory that affected more than 1 million residents.

With decades of work in public health, Davis was the perfect person to figure out a little-known parasite cryptosporidiosis could be the culprit that sickened more than 400,000 people.

As state epidemiologist for the past four decades, Davis was Wisconsin’s doctor.

He was a medical sleuth who figured out the connection between toxic shock syndrome and tampons and helped determine the infectious agent transmitted by ticks that causes Lyme disease. 

Davis, 72, died of pneumonia in Madison Jan. 16.

“Jeff’s knowledge of the literature helped identify the (Cryptosporidium) outbreak earlier. Cryptosporidiosis at that point was a pretty rare pathogen,” said State Public Health Veterinarian James Kazmierczak.

Knowing about a similar waterborne outbreak elsewhere in the U.S., Davis asked to see data on water quality in Milwaukee and noticed a spike in turbidity at the same time that people began to get sick. At the time, city water supplies were not tested for Cryptosporidium.

“Because of Jeff’s knowledge of what happened earlier with cryptosporidiosis, that became the leading suspect,” said Kazmierczak.

Davis grew up in Whitefish Bay and earned an undergraduate degree in chemistry in 1967 at University of Wisconsin-Madison and his medical degree in 1971 at the University of Chicago. He did his internship and residency in pediatrics in Florida and from 1973 to 1975 worked for the U.S. Centers for Disease Control and the South Carolina Department of Health.

After a stint at Duke University Medical Center, he returned to Wisconsin in 1978 as state epidemiologist and chief of the division of acute and communicable diseases. In 1991, his job title changed to chief medical officer and state epidemiologist for communicable diseases.

“He loved being a sleuth and medical detective, leading investigations of all sorts, from toxic shock syndrome to Legionnaires’ outbreaks, to the Cryptosporidium water supply outbreak, which was huge,” said his wife Roseanne Clark.

“He really was passionate about trying to figure out the source to reduce the impact on as many people as possible. He cared about the health of the people of Wisconsin.”

10 men ‘violently’ ill after wild venison meal

Deer meat, or venison, was a staple at Amy’s dinner table.

Me, never liked it, preferred grain-fed beef.

Guess I’m just a suburban kid.

A Brookfield, Wisconsin,  man says he and 10 of his friends all became violently ill after sharing a meal of home-cooked wild venison, but what made them sick remains a mystery.

Scott Mathison said the symptoms didn’t appear for five days after his church retreat to Black River Falls October 1st.

“I could feel the life leaving my body. I knew something was something really serious,” Mathison said Friday. “I was violently shaking, had a 104 (degree) fever when my wife took me in to urgent care. If I wouldn’t have been treated, I’m not sure I would’ve came through that.”

While the symptoms included night sweats and high fevers, the lack of gastro-intestinal issues convinced Mathison that he didn’t have food poisoning. And he later learned that he wasn’t alone in feeling ill.

“I found out one of the other guys was sick, and then I found another one was sick and so we started calling and checking and we were all having the exact same symptoms, and we realized we didn’t have the flu,” he said.

Mathison said their doctors still don’t know what ailed the men, but antibiotics seem to help.

Kids develop HUS in Wisconsin

So sad. Kids developed hemolytic uremic syndrome from an E. coli infection in Wisconsin, source of contamination is unknown.

The La Crosse County Health Department is investigating eight cases of a “particularly nasty form” of the e-coli bacteria that forced the hospitalization of six children.
Some of the children have recovered and been released from the hospital, said Paula Silha, education manager at the Health Department who declined to name where the children live for privacy concerns.
The families are concerned about messages that might appear on social media, in particular, Silha said.
E-coli is a bacterial infection that is more common during the summer months. Cases can be linked or individual.
The variant in these cases, e-coli 0157, is “a particularly nasty form, which produces a toxin that can be harmful to the body organs such as the kidneys,” Silha said.
The hospitalized children had developed hemolytic uremic syndrome, a toxin that can damage kidneys, she said.
This form also is called shiga toxin-producing escherichia coli, and the Health Department is working with the Wisconsin Division of Health to contain the outbreak, Silha said.
The ongoing investigation has not identified a single source of infection or contamination.
The first reports came in early in the month, and additional people are being tested, she said.
E-coli is transmitted by eating contaminated food or water and by contact with fecal material from infected people or animals, she said.
Annual reports for the past several years indicate an average of two to three cases a year, although 30 were counted last year, Silha said, adding, “I cannot tell from the annual report if they were all related to one outbreak or if they came in a few at a time.’
Person-to-person spread of bacteria is possible and may occur in family settings, day care centers and nursing homes. Children younger than 5 and the elderly are the most susceptible to infection from e-coli.

The rest of the story can be found here.

‘Some will rob you with a 6-gun, some with a fountain pen’ Why people are smuggling butter into Wisconsin

Maple syrup thefts in Quebec; adulterated olive oil from Italy; horse meat filler in the EU and apparently everywhere.

The mob’s got its fingers in all kinds of food fraud, but leave it to Wisconsin to quaintly produce a butter smuggler.

Whenever Jean Smith leaves her home in Waukesha, Wisconsin, to visit relatives out of state, she’ll stop in Nebraska to load up on blocks of Kerrygold butter, imported from Ireland, which is banned in the state that calls itself, “America’s Dairyland.”

“Ms. Smith brings back as much Kerrygold butter with her when she visits family in Nebraska,” said a civil lawsuit she and three other butter-lovers filed against Wisconsin in a state court last month. “She keeps large amounts of the butter in her home refrigerator in the hopes that she will have enough to last her until her next out-state trip.”

Kerrygold says the “winds, rain and warming influence of the Gulf Stream all contribute to the lush grass” where the Ireland-based company’s happy cows graze before they’re milked to create butter that’s “silky and creamy and glow a healthy, golden yellow.”

It may be specially crafted but the product is what’s called “ungraded butter,” which doesn’t carry the familiar USDA stamp of approval or in this case a Wisconsin grade. The state is the only one in the U.S. to declare it “unlawful to sell, offer or expose for sale, or have in possession with intent to sell, any butter at retail unless it has been graded.”

M. L. Nestel of The Daily Beast writes that Smith’s lawsuit is the first of three dealing with the butter law this year. In one federal lawsuit, Kerrygold accuses a competitor of trademark infringement for selling “Irishgold” butter. In another federal lawsuit, a small ungraded artisanal butter company called Minerva claims its butter is getting cut out of the Wisconsin market over an outdated technicality.

The 1953 law was rarely enforced until now, maybe because the grading process is grueling.

A grader has to assess in sequential steps the “flavor and aroma, body and texture, color, salt, package and by the use of other tests or procedures approved by the department for ascertaining the quality of butter in whole or part,” according to the state’s website on the matter.

The story goes on to outline the minutia of grading standards, protectionism and bullshit claims.

And, like most food porn, has nothing to do with safety.

Not the 4-H: 21 confirmed sick with Salmonella in 8 US states from contact with dairy bull calves

The U.S. Centers for Disease Control (CDC) is working with Wisconsin health, agriculture, and laboratory agencies, several other states, and the U.S. Department of Agriculture Animal and Plant Health Inspection Service (USDA-APHIS) to investigate a multistate outbreak of multidrug-resistant Salmonella Heidelberg infections.

Portrait of the cute baby bull calf

Portrait of the cute baby bull calf

Public health investigators used the PulseNet system to identify illnesses that may have been part of this outbreak. PulseNet, coordinated by CDC, is the national subtyping network of public health and food regulatory agency laboratories. PulseNet performs DNA fingerprinting on Salmonella bacteria isolated from ill people by using techniques called pulsed-field gel electrophoresis (PFGE) and whole genome sequencing (WGS). CDC PulseNet manages a national database of these DNA fingerprints to identify possible outbreaks.

Twenty-one people infected with an outbreak strain of Salmonella Heidelberg have been reported from eight states.

Among 19 people with available information, illnesses started on dates ranging from January 11, 2016 to October 24, 2016. Ill people range in age from less than 1 year to 72, with a median age of 21. Sixty-two percent of ill people are female. Among 19 ill people with available information, 8 (42%) reported being hospitalized, and no deaths have been reported.

WGS showed that isolates from ill people are closely related genetically to one another. This close genetic relationship means that people in this outbreak are more likely to share a common source of infection.

Epidemiologic, traceback, and laboratory findings have identified dairy bull calves from livestock markets in Wisconsin as the likely source of infections. Dairy bull calves are young, male cattle that have not been castrated and may be raised for meat. Dairy bull calves in this outbreak have also been purchased for use with 4-H projects.

In interviews, ill people answered questions about any contact with animals and foods eaten in the week before becoming ill. Of the 19 people interviewed, 15 (79%) reported contact with dairy bull calves or other cattle. Some of the ill people interviewed reported that they became sick after their dairy bull calves became ill or died.

One ill person’s dairy calves were tested for the presence of Salmonella bacteria. This laboratory testing identified Salmonella Heidelberg in the calves. Further testing using WGS showed that isolates from ill people are closely related genetically to isolates from these calves. This close genetic relationship means that the human infections in this outbreak are likely linked to ill calves.

As part of routine surveillance, the Wisconsin State Laboratory of Hygiene, one of seven regional labs affiliated with CDC’s Antibiotic Resistance Laboratory Network, conducted antibiotic resistance testing on clinical isolates from the ill people associated with this outbreak. These isolates were found to be resistant to antibiotics and shared the same DNA fingerprints, showing the isolates were likely related to one another.

dairy-male-calves-salmonellaWGS identified multiple antimicrobial resistance genes in outbreak-associated isolates from fifteen ill people and eight cattle. This correlated with results from standard antibiotic resistance testing methods used by CDC’s National Antimicrobial Resistance Monitoring System (NARMS) laboratory on clinical isolates from two ill people in this outbreak. The two isolates tested were susceptible to gentamicin, azithromycin, and meropenem.  Both were resistant to amoxicillin-clavulanic acid, ampicillin, cefoxitin, ceftriaxone, chloramphenicol, nalidixic acid, streptomycin, sulfisoxazole, tetracycline, and trimethoprim-sulfamethoxazole and had reduced susceptibility to ciprofloxacin. Antibiotic resistance limits treatment options and has been associated with increased risk of hospitalization, bloodstream infections, and treatment failures in patients.

Traceback information available at this time indicates that most calves in this outbreak originated in Wisconsin. Wisconsin health and agriculture officials continue to work with other states to identify herds that may be affected.

 

Wisconsin health officials report two cases of cryptosporidiosis

Waukesha County health officials said Thursday they’re investigating two confirmed cases of cryptosporidiosis.

diaper-poolThose affected recently swam at the Princeton Club in New Berlin, but the original source is unknown, a county spokeswoman said.

“Princeton Club has been very cooperative, have followed all Waukesha County Environmental Health requirements and have taken steps that go above and beyond the standards to ensure appropriate prevention steps are taken,” Julianne Davan said in a statement.

She said it’s not uncommon for annual reports of cryptosporidiosis, and the number of cases in Waukesha County this year is consistent with previous years.

Salmonella killed otters at Wisconsin Zoo

Robert Herriman of Outbreak News Today reports on June 8, the NEW Zoo located near Green Bay, WI announced the deaths of three North American River Otters saying a mother and four of her pups were sickened by a rapidly-progressing gastrointestinal problem.

river-otter-1062574_640Two of the pups were saved, while the mother and two pups did not survive.

The Wisconsin Veterinary Diagnostic Laboratory concluded salmonella poisoning was the culprit that caused the otter deaths.

According to veterinarian, Dr. Tracey Gilbert, the strain of salmonella involved was one that otters would typically survive after experiencing symptoms for a few days. However, the mother’s body was under unusual stress as she was feeding the four pups, making her vulnerable to the infection. The strain is resistant to all but two types of antibiotics.

NEW Zoo officials say that the surviving otter pups are doing well and there is no sign of salmonella infection among any other animals at the zoo.

40 sick: Tourism breakfast hosts Norovirus outbreak

The Door County, Wisc. tourism breakfast event held on Tuesday, May 3 resulted in 40 of the 117 attendees and employees at the Sandpiper Restaurant at Maxwelton Braes in Baileys Harbor stricken with Norovirus.

sandpiper3.20356Following the protocols required for a Norovirus outbreak, the restaurant has taken precautions to sanitize surfaces that may have come into contact with this virus, the Door County Public Health Department said in a news release. The establishment has since opened and continues to operate without further incident.

Raw milk legislation gains supporters in Wisconsin, but illegal to sell homemade muffins

An attempt to legalize the sale of unpasteurized milk direct from a farm to consumers has gained some traction in the Wisconsin Legislature, but opponents say they aren’t backing down.

sorenne.doug.muffinAssembly Bill 697 would allow a dairy farmer to sell raw milk, and raw-milk products such as butter and cheese, directly to consumers on the farm where the milk and dairy products were produced. Current law generally prohibits the practice.

AB 697, which now has sponsorship from at least 18 members of the Assembly and three members of the Senate, also exempts dairy farmers from needing a dairy plant or food processing license if the only milk products they process are raw-milk items sold on the farm.

In 2015, state officials suspended for 30 days the Grade-A milk production permit of a Durand dairy farm blamed for a raw-milk illness outbreak that sickened nearly 40 people.

Raw milk advocates say the risks to public health have been exaggerated and the decision to buy an unpasteurized dairy product ought to be left to the consumer.

Wisconsin is one of only two states to ban entrepreneurs from selling cookies, muffins and breads simply because they are made in a home kitchen.

“That means that even if you sell one cookie at a farmers market, to your neighbor, somewhere in your community, you can go to jail for up to six months or even be fined up to $1,000. That’s not only unfair, it’s unconstitutional,” attorney Erica Smith told Wisconsin Watchdog Wednesday on the Vicki McKenna Show , on NewsTalk 1310 WIBA.

Smith is with the Institute for Justice, a nonprofit law firm that “fights against unreasonable government restrictions on individuals’ economic liberty,” according to the Virginia organizations website.

Prove that it’s safe.