Three children have been hospitalized and another nine have lab-confirmed salmonellosis in the past three days in Ottawa (that’s in Canada; capital, eh?).

Ottawa Public Health will continue monitoring the outbreak, with the goal of trying to identify if there is a common source for the infections.

Local doctors have been advised of the outbreak and asked to be on the watch for new salmonella infections.

In Aug. 2011, Terry Brady, a spokesperson with Pennsylvania’s Department of Conservation and Natural Resources said that the lake at Cowans Gap State Park remained open, despite links to three cases of E. coli O157. “The beaches are open and actually there was a good turnout today. A link to the park has not been established."

The lake was closed the next day. Eighteen people, primarily kids, were identified with E. coli O157:H7; 10 were hospitalized. An additional 24 people were classified as suspected cases.

Swimming can be risky.

The Pennsylvania Department of Health has issued a report Cowan’s Gap E. coli outbreak. Excerpts below:

On Wednesday, Aug. 3, 2011, the Pennsylvania Department of Health (DOH) was notified by an infection preventionist at a local hospital of two children with HUS who had both reported recent visits to the same Pennsylvania State Park. One of these patients also tested positive for E. coli O157:H7. By Friday, Aug. 5, there were additional reports of E. coli in persons with exposure to the state park and its beach area.

After initial notification, the Department of Health contacted the Bureau of State Parks in the Department of Conservation and Natural Resources (DCNR). Several hypotheses were initially posed as explanations for this E. coli cluster: coincidence (this is a large lake with many swimmers each year), consumption of contaminated food or water at a nearby establishment, consumption of contaminated food or water from the park, or swimming in the park lake.

Information was gathered about previous inspections of the concession stand, water-testing results from the beach area, and other significant events at the lake.

On the recommendation of DOH, at 5:30 p.m. on Tuesday, Aug. 9, DCNR closed the lake to all water activities, including swimming, boating and fishing. On Aug. 10, DOH conducted a site visit to the park along with DCNR and DEP (Department of Environmental Protection) to view the beach, camping sites, dumping stations and other potential opportunities for contamination of water. Small samples were collected from the beach water and sediment and sent to the DOH Bureau of Laboratories for testing. DEP also sent red dye through the sewer system to check for leaks into the lake. On Aug. 11, 100 liters of water were passed through a large-volume filtration system and sent to CDC as an additional attempt to detect organisms.

Eighteen confirmed and probable cases were identified throughout the course of the investigation. Thirteen of these cases were confirmed through a diagnosis of HUS and/or lab-identification of E. coli O157:H7. Ten of the 13 confirmed cases were hospitalized, and one was known to be a secondary case, exposed to another confirmed case but not the lake itself. The majority of the cases (61 percent) were 10 years old or younger. Many of the cases were exposed between July 30 and Aug. 1, although many went to the park and swam on multiple days.

Additionally, 24 persons were classified as suspect cases because they had reported GI symptoms and exposure to the lake; no additional data was available to classify these cases further. All 11 culture-positive cases had matching PFGE patterns with an uncommon two-enzyme combination that had not been seen nationally since December 2010.

The lake had a shallow swimming area along the beach, delineated by buoys. There were recently built, functioning shower and rest-room facilities adjacent to the concession stand, both easily accessible to beach users. There was an on-site water treatment plant down-stream from the lake and no critical deficiencies were found. The red dye which was placed in the sewer system was not subsequently observed in the lake, indicating there were no leaks from the sewer system into the lake water. All water and sediment samples tested failed to grow E. coli O157:H7.

While the lake water did not test positive for E. coli O157:H7, the epidemiology clearly indicates the lake as the source of transmission. The lake was the only common factor among all of the cases, and 100 percent of the primary cases reported swimming in the lake. The vast majority of the cases in this outbreak were children. The original source of contamination of the lake was unable to be determined, though it is likely from a person who was swimming while ill.

(why? what evidence? thought the origin was unable to be determined?)

The predominance of children is typical for outbreaks of E.coli O157:H7. The shallow, warm water of this beach makes it a popular site for children; children interact with recreational water very differently than adults and are more likely to accidentally swallow water. Children are also more likely to shed the bacteria after symptoms have resolved, putting other children at risk while playing together in the water or while interacting in other settings. This is particularly a problem with diapered children.

Public health messages about healthy swimming need to continue to be communicated, particularly at places with lots of children. The public needs to be reminded not to swim, or allow their children to swim, when they are experiencing diarrhea. Parents should try to keep their children from swallowing swimming water as much as possible. Finally, practicing good hygiene before and after swimming will help prevent contamination of water.

Surveys still suck.

Using I-own-a-thermometer as an indicator of thermometer use is as useful as I-own-a-sink therefore I wash my hands. Or, I own a toilet, so I always hit the bowl. Or … use your imagination.

Researchers at the U.S. Food and Drug Administration report in the Journal of Food Protection that the use of a food thermometer is the best way to ensure that meat, poultry, and other foods reach an internal temperature sufficient to destroy foodborne pathogens.

The 1998, 2001, 2006, and 2010 Food Safety Surveys were used to analyze changes in food thermometer ownership and usage for roasts, chicken parts, and hamburgers in the United States.

But surveys still suck.

The paper notes that when E. coli O157:H7 was first associated with ground beef in the 1980s, the U.S. Department of Agriculture (USDA) recommended that consumers cook hamburgers until the meat was ‘‘brown or pinkish brown in the center. However, as a result of research that showed that one out of four hamburgers may be brown in the center before reaching a safe internal temperature, the USDA changed its advice to consumers— instead of using color as an indicator of doneness in hamburgers, consumers should use a food thermometer to ensure that a safe temperature has been reached. In May 2000, the USDA launched the Thermy educational campaign to encourage consumers to use a food thermometer when cooking small cuts of meat, such as hamburgers and chicken parts. The USDA also provided guidance to consumers about the safe temperature for various cuts of meat and poultry.

Ho Phang and Christine Bruhn reported earlier in JFP that in video observation of 199 California consumers making hamburgers and salad in their own kitchens, handwashing was poor, only 4% used a thermometer to check if the burger was safely cooked, and there were an average of 43 cross-contamination events per household. They concluded Thermy had not been successful.

We did our own survey with 40 people brought in to cook a chicken meal in a Kansas State kitchen and videotaped their behaviors. Many participants reported owning a food thermometer (73%) and nearly half (42.5%) of participants reported knowing the suggested end temperature for cooking poultry to ensure doneness. When asked the final recommended internal temperature for chicken, the mean response was 214°F with a range of responses from 140°F to 450°F. (The correct answer is 165F)

Of those participants observed measuring the internal temperature of the product, only three used the thermometer correctly. During observation, two individuals who used the thermometers failed to remove protective casings prior to taking internal temperature readings, and therefore used the instruments incorrectly.

Surveys do not measure behaviors: they give an indication of what people think their behavior is, or what the survey person wants to hear, but that isn’t going to get people to use a thermometer (tip-sensitive, digital).

An outbreak of illness might have more to do with the final results than the actual tennis at the BNP Paribas Open tournament in Indian Wells, California, which is about to move into its second week.

In late-in-the-day matches Sunday, third-seeded Petra Kvitova, last year's Wimbledon champion, was ousted by fast-rising American Christina McHale, 2-6, 6-2, 6-3, and said afterward that she had been ill, had taken antibiotics and had "lost a bit of my fitness."

Roger Federer went through his opponent, Denis Kudla of the U.S., 6-4, 6-1, and then, looking pale and sounding hoarse, admitted afterward in his news conference that he wasn't feeling well, nor were members of his family.

"I'm the best off in the family," he said.

At least eight players have defaulted since the tournament began, most of them complaining of a stomach virus.

In Michigan, the Taylor Sportsplex was evacuated Sunday after an unknown illness swept a wave of hockey players into local emergency rooms, according to officials.


Fire Chief Bob Tompos said about 20-25 high-school-age hockey players got sick simultaneously with apparent flu-like symptoms, causing several players to vomit on benches and inside the locker room.



The sudden occurrance prompted a call to the fire department to investigate the building as the sick players began heading to nearby hospitals with families. Some went by ambulance if parents weren't yet on the scene.

"Rather than make them wait, we wanted to err on the side of caution," Tompos said, "so they were transported [by ambulance] with implied consent." An official evacuation was called about 10:30 p.m.

Firefighters first checked the building's air quality to rule out issues like unsafe levels of carbon monoxide.

"The oxygen level was fine, so we weren't too concerned about that," Tompos said, adding that other samples from the Sportsplex — including the water supply — will immediately be sent to an independent lab in the morning for analysis.

 Unseasonably warm temperatures and possibly the crowd's size caused the air conditioning system to unexpectantly kick on, so air duct samples also will get tested, Tompos said.



Basketball player and armchair health inspector DeMarcus Cousins of the Sacramento Kings managed to score 15 points, five assists, three steals and two blocks in Friday’s victory over the Dallas Mavericks.

Cowbell Kingdom reports Cousins became ill early Wednesday and missed Kings’ shootaround as a result. He was a last minute lineup scratch before the Kings won 99-98 over the New Orleans Hornets on Wednesday.

“I don’t want to call out the restaurant,” responded Cousins when asked what caused the ordeal. “I don’t want them to lose business. But I had some food that morning and my stomach was hurting and I was throwing up.”

Some food that morning ain’t real specific. Did Mr. Basketball star provide a stool sample to the local health unit so they could possibly match with other instances of foodborne illness? And if there’s evidence food at a restaurant caused illness, don’t you have a responsibility to go public to help prevent others from getting ill?

Basketball is almost as boring as baseball and cricket – combined.

Don’t eat poop.

But if you do, make sure it’s cooked.

Comforting or not, we eat poop in a variety of forms. Dogs seem to enjoy it.

D.C. Innes of World Magazine reports Japanese scientist Mitsuyuki Ikeda has developed a way to turn human feces into simulated beef. He takes “sewage mud,” which is high in protein on account of its bacteria content, adds soy proteins and food coloring, puts it through his machine, and out comes chuck.

Now, there is reason to believe that this story might be a hoax, but Douglas Powell, a food safety expert at Kansas State University, views it as technologically plausible. So it’s worth considering the idea.

Innes asked me if I would eat a burger made out of poop.

Maybe, but it would have to be safely cooked.

Innes cites a bunch of philosophy I thought was cool about the same time I thought The Doors were musical and poetic genius -- everyone experiments in college – and concludes that even if “harvesting scat for food would be efficient, there is this problem: It’s beneath human dignity. Dignity is not a “scientific” concept. You can’t isolate dignity in a Petri dish, but empirical science is not our only window onto reality.

Is what we leave behind after evacuating only so much protein, carbohydrates, lipids, and minerals? Are we? If we are, then God is dead and all is permitted. But no one lives that way. That summary of life does not account for life as we know it. In that respect, it’s bad science. C.S. Lewis argues that seeing man through only this lens means “the abolition of man.”

Powell, the food safety professor, is fine with this new fare, so long as we cook it thoroughly. We eat plants that grow in soil fertilized with dung, don’t we? But we don’t eat the dung.

Of course not.

World magazine: Today’s News, Christian Views.

A new report concludes the federal government should provide more specific public guidance on the license approval requirements of vaccines that could reduce the incidence of E. coli O157:H7 and friends in cattle.

Because right now, it’s bureaucratic, and no one can offer a clear explanation.

The U.S Government Accountability Project in report GAO-12-257 (for sticklers) also concluded the Secretary of Agriculture should explore practices employed by other countries that are not currently used in the U.S. for reducing shiga-toxin producing E. coli (STEC) in cattle and consider whether the identified practices can inform U.S. efforts.

From the report:

U.S. Department of Agriculture (USDA) and university researchers identified several treatments administered before cattle are slaughtered, or preslaughter interventions, that could reduce Shiga toxin-producing Escherichia coli (STEC) in cattle. Such preslaughter interventions include bacteriophages (viruses that infect and kill bacteria), probiotics (live bacteria that can benefit the digestive system), vaccines (biological preparations that alter the immune system), and sodium chlorate (chemical that kills the STEC O157:H7 strain). However, few manufacturers have submitted applications for preslaughter intervention products to target STEC according to officials from USDA and the Food and Drug Administration. One exception is for vaccines to reduce STEC O157:H7.

For preslaughter interventions, USDA exercises responsibilities for licensing and regulating STEC vaccines. However, USDA’s approval requirements for these vaccines are unclear, according to some industry representatives. Specifically, USDA’s general guidance does not address some of the unique challenges faced by manufacturers of animal health products seeking STEC vaccine approval. For example, the guidance does not explain that, if studies conducted in the laboratory are insufficient to demonstrate efficacy, the manufacturer would also need to demonstrate that the vaccine is effective in a field setting such as a feedlot. In contrast, the Canadian Centre for Veterinary Biologics provides more specific guidance about when it requires the use of laboratory or field studies to demonstrate efficacy for vaccine license applications. Without guidance that gives manufacturers clear and more specific information they need to submit for an acceptable application, the approval process for STEC vaccines could face potential delays.

In addition to STEC O157:H7, which it stated in 1994 was an adulterant—a substance that renders food injurious to human health—in September 2011, USDA determined that six other STEC strains were adulterants in raw ground beef and beef trim (meat left after steaks and roasts are cut from beef). USDA has tests for these six strains and plans to use them in slaughter plants starting in June 2012. However, it may be difficult and time-consuming to confirm positive test results because certain test components are either not commercially available for all strains or do not always provide clear results. USDA is working to improve the tests and to find a commercial supplier for one key test component. Also, a few companies voluntarily test for these strains.

Some foreign governments have practices that could be relevant to U.S. efforts to reduce STEC in cattle such as the following:

The European Parliament and the Council of the European Union require certain measures, such as verification of cleanliness by an inspector, to ensure that the cattle going to slaughter are clean. In contrast, USDA assesses the health of cattle but does not inspect for cleanliness.
At least 12 European Union member countries collected and reported data on STEC in live cattle in 2009. USDA has conducted STEC testing in live cattle, but has not tested since 1999.
When a person becomes ill from E. coli in Sweden, government officials try to determine the specific farm that sold the contaminated cattle so that other carcasses from the farm can be tested for STEC. USDA does not trace the STEC source back to the farm.

The complete report is available at http://www.gao.gov/products/GAO-12-257.

According to the Monterey Herald and KION a bunch of students at Los Arboles Middle School spent a bunch of time barfing yesterday. 110 kids had symptoms including nausea, vomiting, stomach cramps and diarrhea. Enough kids got sick that school nurses called in the health department and fire department as back-up.

To say Los Arboles Middle School student Paradise Williams had a rough morning is an understatement.
"It didn't feel good, it didn't feel good at all," says Williams.

The sixth grader was in math class Thursday morning when she felt dizzy, got cramps and started throwing up. The school got so many other students with the same symptoms, it set up a makeshift clinic with nurses in the school's gym. When Paradise rushed there, 30 other students were already there.

"At the time it was bad," says Williams. "Everyone was around trash cans throwing up holding their stomachs, crying, throwing up, drinking water, throwing up the water."

The amateur epidemiologists cited in the story are guessing that a bad batch of out of date rice is to blame (not so sure on that one -ben).

By the afternoon, that number grew to 110 students. The Monterey County Health Department is investigating what caused the stomach flu. But, several students including Paradise suspect bad rice was served for breakfast at the nearby teen center. That angers Paradise's mother.

"Are they looking on the dates of their food? Are they taking inventory on the dates? I don't want this to happen again," says Williams.

But, the school district isn't confirming that and called today's sickness "rare."

Rare probably isn't the right word to use here - acute and messy is probably better - and likely provides little comfort to the barfing tweens and their families. The school folks should be talking about their food safety risk-reduction systems (USDA requires a HACCP-based program for school meals provided under their nutrition program) and the type of stuff they have in place to limit spread (like hand soap in the restrooms).

Thanks to a sharp-eyed barfblog contributor for the tip.
 

A total of 25 persons infected with the outbreak strain of Shiga toxin producing E. coli (STEC) O26 have been reported from 8 states.

The U.S. Centers for Disease Control says results of the epidemiologic and traceback investigations indicate eating raw clover sprouts at Jimmy John's restaurants is the likely cause of this outbreak.
March 8, 2012

The 11 new ill persons have been reported from Alabama, Michigan, and Ohio. Of the 24 ill persons with available information, 21 (87%) reported consuming sprouts at Jimmy John's restaurants in the 7 days preceding illness.