Back when I thought going to conferences was important or at least a family diversion, my kids would rank the success of the trip based on the hotel water fountain.

A long-ago meeting of the International Food Protection Association in Orlando ranked particularly high.

A 2010 outbreak of Legionnaires' disease in Wisconsin has been linked to a decorative fountain in a hospital lobby, according to a study published in the February issue of Infection Control and Hospital Epidemiology, the journal of the Society for Healthcare Epidemiology of America.

When the outbreak of Legionnaires' disease was detected among eight people in southeast Wisconsin, state and local public health officials worked closely with hospital staff to launch an investigation to determine the source of the outbreak.

Through detailed interviews with patients, officials identified one hospital as the site of the contamination. Subsequent environmental testing within the hospital detected notable amounts of Legionella in samples collected from the "water wall" decorative fountain located in the hospital's main lobby.

The investigation revealed that all eight patients had spent time in the main lobby where the fountain is located. This, along with the proximity of each patient's onset of illness and the degree of Legionella contamination in the fountain strongly support the conclusion that the decorative fountain was the source of the outbreak. Hospital officials quickly shut down the fountain when it was first suspected as a source, and notified staff and approximately 4,000 potentially exposed patients and visitors. Prior to the investigation, the decorative fountain underwent routine cleaning and maintenance.

All eight patients in the Wisconsin outbreak recovered from the disease, and no cases occurred following the shutdown of the fountain.

The outbreak is notable since none of the patients with Legionnaires' disease was an inpatient at the hospital when exposed. And some patients reported only incidental exposure to the fountain, such as delivering a package or visiting the hospital pharmacy.

At the time of the outbreak there was no published information on the effectiveness of fountain disinfection and maintenance procedures to reduce the risks of Legionella contamination.

"Since our investigation, the Wisconsin Division of Public Health has developed interim guidelines advising healthcare facilities with decorative fountains to establish strict maintenance procedures and conduct periodic bacteriologic monitoring for Legionella," said Thomas E. Haupt, MS, an epidemiologist with the Wisconsin Division of Public Health and the study's lead author. "The guidelines stress that until additional data are available that demonstrate effective maintenance procedures for eliminating the risk of Legionella transmission from indoor decorative water fountains in healthcare settings, water fountains of any type should be considered at risk of becoming contaminated with Legionella bacteria."

Since this investigation, many healthcare facilities in Wisconsin shut down or removed decorative fountains in their facilities, while others enhanced their regular testing protocols to reduce the risk of Legionnaires' disease, the researchers report. Healthcare facility construction guidelines published after this outbreak stipulate that, "fountains and other open decorative water features may represent a reservoir for opportunistic human pathogens; thus they are not recommended for installation within any enclosed spaces in healthcare facilities."

EKO Australia Pty Ltd is recalling batches of their imported noodles sold in NSW in specialty Asian grocery stores.

The batches are being recalled because of the presence of Bacillus cereus, a harmful bacteria.
The recalled products are:

• Kamfen Buckwheat Noodles in 340g plastic bag with 'best before' date 2013.04.15
• Kamfen Beijing Noodles, Abalone Chicken Soup Flavour in 160g plastic bag, with 'best before' date 2013.01.15
• Kamfen Sichuan Noodles, Abalone Chicken Soup Flavour in 160g plastic bag, with 'best before' date 2013.01.15

The recall applies only to the above batches of the products and dates.

Consumers should not consume the products. Consumers can return the products to the place of purchase for a refund.

It’s botulism week at Eurosurveillance as the on-line journal summarizes three different and recent Europe-based botulism outbreaks, which represents an alarming increase over previous years.

In an overview editorial, Cowden notes the incidence of botulism in the European Union (EU) is described elsewhere, but that from 2006 and 2008, 477 confirmed cases were notified: an average of 119 cases per year, with a range of 104 to 132, and no discernable trend.

The surveillance of cases of botulism in the EU includes the three main forms of the disease but does not distinguish between them.

Food-borne botulism is caused by the ingestion of toxin produced by organisms in an anaerobic environment. It usually results from inadequately sterilised domestically canned or bottled foods.

Intestinal botulism is caused by the production in the gut of toxin by organisms which have been ingested and have proliferated. This form predominantly affects infants under a year old, often associated with the consumption of honey.

Wound botulism is caused by the production of toxin by organisms introduced into wounds. This is often associated with dirty wounds, including those following injecting drug use.

Since 2009, Eurosurveillance has published only four reports of outbreaks of food-borne botulism in Europe and only three resulted from consumption of widely distributed, commercially produced foods.

Despite only one of the four outbreaks being due to domestically prepared food, home-preserved food is generally acknowledged to be the major cause of botulism in those EU countries that have had most cases in recent years and outbreaks resulting from mass produced foods are rare.

Against this background, from September to November 2011, there were three outbreaks in three different countries in Europe. In the outbreaks which feature in this issue of Eurosurveillance, the vehicles of intoxication were demonstrated, on the basis of strong toxicological and descriptive epidemiological evidence, to have been widely distributed, commercially produced foods.

These three outbreaks present intriguing differences and similarities.

In two outbreaks, the Finnish and the Scottish, cases were confined to single households. In France cases occurred in two household clusters.

In the French and Finnish outbreaks the vehicles included olives: olive tapenades in the French outbreak, and almond-stuffed olives in the Finnish. In the Scottish outbreak, the vehicle was korma sauce.

In all three outbreaks the vehicle of intoxication was marketed in glass jars with screw-top lids.

In the French and the Scottish outbreaks the food was produced and distributed within the country of origin. In the Finnish outbreak, the food was distributed internationally from another country, Italy.

In the Finnish and the Scottish outbreaks the food was produced in industrialized units. In the French outbreak the producer was described as an “artisanal producer” although the tapenade was commercially produced and widely distributed.

In the French and the Scottish outbreaks the toxin was type A. In the Finnish outbreak it was type B.

In two outbreaks, the Finnish and the French, defects potentially explaining the contamination were identified. In the Finnish outbreak, seals in other jars from the same batch were found to have defects, although none was found to be contaminated. In the French outbreak an improper sterilization process was identified. In the Scottish outbreak the food originated from a state-of-the-art food-production facility where intensive investigation has yet to find any shortcomings, and no post-production event has been identified which could explain the contamination.

The number of cases in all three outbreaks was surprisingly low if a production fault is assumed to have affected the production of at least a whole batch of jars.

This is particularly true of the Scottish outbreak where only one household was affected, and which could be explained by the contamination of a single jar from a batch of 1,836 jars. Likewise, the Finnish outbreak affected a single household, and could be explained by only one contaminated jar of stuffed olives, despite the batch being part of a lot of 900 imported into Finland, and the product having been exported to many countries in Europe and beyond.

Only in the French outbreak does the contamination of more than one jar need to be hypothesized to explain the cases – and even here, contamination of only two jars could explain the cases. The size of the batch in the French outbreak was approximately 60 pots.

The other 3 outbreak write-ups are available at the urls below, and full-text, as always, on bites-l.

http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=20035

http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=20034

http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=20036

Stepping in dog poop is annoying, but the health hazard is unknowingly ingesting or contact with the poop.

While walking around Chicago, I came across this sign that is unique in its clarity: Pet waste transmits disease (right, exactly as shown).

It goes straight to the point and informs the public of the real reason behind the need to clean after our pets in public places.

Dog poop can spread hookworms and roundworms, both of which can infect humans and have severe consequences: ocular larva migraines from roundworms; cutaneous larva migraines from hookworms.