A Six Flags water park and resort complex in up-state New York known as "Great Escapes", is the focus of a large norovirus outbreak.  Norovirus is transmitted from infected human carriers to food, water, and environmental surfaces. The US Centers for Disease Control and Prevention recognize noroviruses (and related viral strains) as the leading cause of foodborne illness in the US. The gastrointestinal illness is highly communicable and easily spread by hand to hand contact and even through the air. Outbreaks occur in resorts and other facilities when ill persons contaminate the environment, food and water through vomit and feces. Rapid and effective measures well-known to the public health community are needed to stop transmission. Many of these measures are developed by the US Public Health Service. Cruise lines have experienced many norovirus outbreaks and therefor there is much known about the pathogen and how to address it.

Untimely Responses to the Problem
According to the local health department a case of norovirus at the Great Escapes is defined as a person with norovirus symptoms at the resort on or after March 7, 2008. The health department  therefore belives the date of March 7 was the beginning of the outbreak, but did not for some unexplained reason begin an investigation for ten days. It is not known to this writer when the operator of the facility was first aware of that employees and patrons were becoming ill. We are also unaware of how or when the health department was officially notified of the problem. The official coordinated response to this outbreak began on March 17, a full 10 days after the outbreak apparently began. By March 21, there were already 200 cases. The number of reported cases eventually reached at least 435 as news of the incident spread.

Rapid tests using sophisticated molecular testing platforms are available to provide confirming results of norovirus infection in 24 hours, yet investigators over 1 week into the investigation still didn't have a confirming diagnosis from the state lab.  The slow state lab results were an unnecessary delay, as approved private labs are available.

Early recognition of this problem is critical. Once it is known that norovirus is in the environment, investigators can implement timely and appropriate sanitation and safety precautions to combat transmission. One example of appropriate response was the closing of the food service. But this only occured after numerous employees of the kitchen reported symptoms of norovirus. The pools, food and lodging facilities are undoubtedly contaminated. Delay in the the implementation of this and other preventive measures at this public, regulated facility likely increased the potential for the exposure of large numbers of unsuspecting people to the pathogen over several days. The licensed operator's delay in recognizing and reporting a large number of ill patrons and staff to authorities, the response of the authorities once notified, and the timeliness and effectiveness of prevention measures taken are critical questions.

Lawsuit
Four members of a family sickened by the resort have filed a lawsuit. Key issues that must be scrutinized are the delay between the start of the outbreak and notification of the health authorities, the large number of food service staff ill and whether they worked while ill, the basis for the decision to close the kitchen, and the basis for management's decision to allow the rest of the facility to remain open..

Unanswered Questions
A detailed analysis of the cases and their relationships to the food service or other environmental exposures will be key to determining the causes of this large and serious outbreak and whether the operator responded in an effective and timely manner to protect both it's employees and guests.

Could the large number of cases of illness been reduced if more timely and effective prevention measures were implemented at Great Escapes?

To read more, select the links below.

Health Department official statement Norovirus at Great Escapes Water Park
1st article from the Post Star. March 21st, 200 cases reported
2nd article from the Post Star, March 16th, 435 cases  reported
Channel 6 report. Lawsuits filed.

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Mr. Costa is a professor at the Walt Disney World Center for Hospitality and the Culinary Arts at Valencia College in Orlando, Florida and is the founder and owner of the consulting firm Environ Health Associates, Inc.  Mr. Costa is a registered professional sanitarian with 30 years of environmental heath practice in the academic, government and private sectors.

For our manual on Norovirus Contamination and Control send an email to rcosta1@cfl.rr.com

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The April 2008 issue of Journal of Food Protection contains a cool paper on a survey of Salmonella and E. coli at a greenhouse tomato farm in Mexico. During 2003 and 2004 the authors sampled over 1600 product and environmental samples, before, during and after a couple of environmental disturbances: a flood and the entry of wild animals (opossums, mice and sparrows).

The authors isolated Salmonella Montevideo, Salmonella Newport, and strains of the F serogroup  from tomatoes and go on to state that almost all of the Salmonella Newport strains were isolated from samples collected during or immediately after the flood.

Analysis by pulsed-field gel electrophoresis revealed that some Salmonella Montevideo isolates from tomatoes, opossums, and mice displayed identical genetic patterns, suggesting that these wild animals represented a potential source of contamination.

The fun part of paper is that the authors suggest that dirty work shoes were also thought to be an important vehicle for dissemination of Salmonella into (and possibly throughout) the greenhouses (especially after being worn during the flood incident):

Contaminated worker shoes may be vehicles for contamination with enteric pathogens, from either outside the greenhouses or from one facility to another. The levels of E. coli on personal shoes were higher than those of working  shoes were before the flood. However, there was a higher  level of contamination with Salmonella and E. coli on  working shoes compared with personal shoes after the flood.

The authors go on to say that sanitary mats intended to reduce pathogen movement may not be all that effective the real-world application:

Working shoes were provided by management to the workers to wear inside the greenhouse at the suggestion of our research group after finding that personal shoes were positive for E. coli, even after shoes received a disinfection treatment with quaternary salts solution (800 ppm) on a sanitary mat. However, working shoes were not used exclusively inside the greenhouse, but were also worn to go from one facility to another. Shoes have seldom been mentioned as vehicles of contamination in food production areas. This dissemination mechanism of enteric pathogens should be considered as an important control point  during working procedures in greenhouses.

It's unclear whether this is just a notable finding, or if it represents a real risk in moving pathogens around food production systems, and needs some further investigation.  Probably don't want to use boots to stomp garlic though.

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Careful with that hedgehog, Eugene, especially in New Zealand.

The Herald on Sunday say police alleged that William Singalargh, 27, picked up the hedgehog and threw it at a 15-year-old boy in the North Island east coast town of Whakatane on February 9.

Police Senior Sgt. Bruce Jenkins said Monday,

"It hit the victim in the leg, causing a large, red welt and several puncture marks."

Police arrested Singalargh shortly after the incident, and charged him with assault with a weapon -- the hedgehog.

The Herald said the hedgehog was dead when it was collected as evidence, but did not know if it was dead or alive at the time of the alleged attack.

The Herald reported Singalargh's arrest under the headline "Raise your hands and step away from the hedgehog."

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The author of La Gringa's Blogicito, whose motto is, Gardening and living in La Ceiba, Honduras; neither is easy for this American woman, writes the FDA Inspectors left Honduras on Friday with no word whatsoever as to the results of the tests at Agrolibano. According to La Prensa, the samples are being tested in the U.S. and the results will be given next week.



She also says that little has been heard from the Honduran delegation who went to the U.S. last week to demand proof of the tests and a retraction from the FDA either. She does say that she's noticed more balanced reports from various agricultural and commercial experts saying that Honduras needs to vigilantly meet international quality and safety standards, but no admission that salmonella did exist in the melons.

While searching for the news video, I ran a across a parody of that scene on YouTube. If you speak Spanish, you may get a kick out of the video below, "Mel Melon con Salmonella." Even if you don't, you may find it humorous.

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Health officials said more than 60 people fell ill after attending a medical convention, with several reporting symptoms as they prepared to leave on flights from Washington.

Many of the victims came forward Friday, the day after attending the meeting Thursday at the Gaylord National Resort and Convention Center in Oxon Hill, Md.

Staff members of the Prince George's County health department interviewed resort workers and inspected the center to determine what caused the illness. A private company has already started cleaning.

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The New Zealand Ministry of Health is working with local and national authorities to determine the cause of an outbreak of Salmonella mbandaka, a strain rarely seen in New Zealand.

Nationally there have been 28 cases, 10 of which have occurred in the Nelson Marlborough district. A recent death occurred in an elderly woman in Nelson Hospital who had been infected with Salmonella mbandaka.

The Ministry's Director of Public Health, Dr Mark Jacobs said,

"… it's worth noting at this stage, no food premises have been implicated and all food samples tested have returned negative results."

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Two California girls aged 14 and 15 are in Juvenile Hall facing animal cruelty charges over allegedly microwaving a hamster.

They also briefly put him a freezer.

An investigating police officer said the girls have admitting microwaving Bugsy because they were bored.

"These girls showed no remorse."

The Press Democrat reports that the hamster, Bugsy, survived, but three of his feet were severely burned. Lake County Animal Control Officer Morgan Hermann said the legs later turned black and the hamster chewed them off, adding,

“Now (Bugsy) has one leg."

The incident occurred in December, but it was not reported to Animal Control and police until the students had been released for Spring break.

Unlike the pic (right) this was not a happy hamster.

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The South Carolina Department of Health and Environmental Control is urging anyone who purchased barbecue at a March 30 fundraiser for the Tega Cay Volunteer Fire Department to throw the food away.

Firefighters sold approximately 3,000 servings of food and the York County Public Health Department has identified more than 40 people who became ill. Many people bought barbecue in bulk for freezing and later use.

Tests are under way to identify the cause of the illness.

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Last week,  Italy's Agriculture Minister, Paolo De Castro, (right) dug into some buffalo mozzarella for the cameras after assuring the European Commission that no mozzarella cheese contaminated with cancer-causing dioxin had been exported.

On Saturday President Manuel Zelaya of Honduras downed some homegrown cantaloupe for a CNN news crew, proclaiming, "I eat this fruit without any fear. It’s a delicious fruit. Nothing happens to me!”

Both were continuing a questionable tradition that may actually amplify the concerns of citizens when the safety of certain foods is scrutinized: roll out the politician to consume the food in question.
The list is long:

• Canadian Prime Minister Jean Chretien scarfed back a burger after the first case of mad cow disease was discovered in Canada in May 2003;
• French President Jacques Chirac and future French president Nicolas Sarkozy consumed cooked chicken during the International Agriculture show in Paris in March 2006 to bolster confidence after an outbreak of avain influenza;
• Norwegian Prime Minister Jens Stoltenberg said in 2006 he often fed salmon to his own children after Russia banned imports of fresh Norwegian salmon because of worries about toxic metals;
• Pennsylvania Governor Ed Rendell lunched at a Philadelphia Taco Bell in Dec. 2006 after an E. coli O157:H7 outbreak linked to lettuce sickened 71; and,
• most famously, former U.K. Agriculture Minister John Gummer feeding a hamburger to his four-year-old daughter Cordelia as concerns about the safety of British beef mounted in 1990 (left).

Do people believe politicians? How about company executives?

In 2000, 14,700 Japanese were sickened and 180 hospitalized after Snow Brand milk employees failed to properly clean factory pipes for weeks. As reported in The Economist, "At one point during Snow Brand’s latest poisoning scare, its befuddled boss fled a press conference shouting, 'I haven’t slept at all in the past week.'"

Snow Brand has a bit of a reputation for dramatics.

"When, almost half a century ago, some 1,900 school children fell ill after drinking Snow Brand’s powdered milk, a dismissive company executive confidently downed a glass of the drink in front of the press to allay fears of contamination. A few hours later, as expected, he was rushed to a bathroom."

Several years ago, Health Canada proposed to ban the sale of cheeses derived from raw milk, but they failed to provide a compelling case for such a ban. They also ignored the cultural and social factors—the enjoyment—that lead some people to rank specific cheeses like fine wines. Raw milk cheeses can contain the bacterium Listeria which can cause life-threatening illness and lead to miscarriages, but such cases simply had not been seen in Canada (which does not mean such cases did not exist). This left health officials arguing that such cheeses should be banned, even in the absence of Canadian-based scientific evidence to warrant such a ban. The Minister of Health at the time, David Dingwall, was soon in Quebec, scarfing down raw milk cheese for the television cameras.

People make risk/benefit decisions every time they enter an automobile, smoke a cigarette, have a drink, eat fat or enter into a relationship. Rather than eating up in front of the camera, governments, executives, even local farmers, should provide data to back up their claims of safety.

Douglas Powell is scientific director of the International Food Safety Network at Kansas State University.

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