An Unwanted Lagniappe From The Kitchen

 

Norovirus – Credit CDC PHIL 

Lagniappe – A little something extra given to a customer. 

# 6766

 

 

The CDC estimates that norovirus (aka the `Winter Vomiting Bug’ or less accurately, `Stomach Flu’) causes more than 20 million cases of gastroenteritis each year in the United States. Anyone who has endured it can attest that a bout with norovirus is misery incarnate.

 

The CDC maintains an extensive Norovirus webpage where they describe the illness, how it is spread, and how to avoid infection. Among known causes of foodborne illness, norovirus is the largest culprit.

 

 

The CDC’s NOROVIRUS: FOR FOOD HANDLERS page warns:

 

The virus can easily contaminate food because it is very tiny and infective. It only takes a very small amount of virus particles (fewer than 100) to make someone sick.

 

Food can get contaminated with norovirus when:

• infected people who have stool or vomit on their hands touch the food,
• it is placed on counters or surfaces that have infectious stool or vomit on them, or
• tiny drops of vomit from an infected person spray through the air and land on the food.

 

All of which makes the thorough cleaning of plates and utensils used in restaurants a priority. 

According to a PLoS One  study, published yesterday, the prescribed methods of cleaning these items in restaurants does a good job against common bacteria – like Escherichia coli K-12 and Listeria innocua – but not so well in sanitizing against norovirus.

 

The open access study is called:

 

Efficacies of Sodium Hypochlorite and Quaternary Ammonium Sanitizers for Reduction of Norovirus and Selected Bacteria during Ware-Washing Operations

Lizanel Feliciano, Jianrong Li^*, Jaesung Lee, Melvin A. Pascall^*

 

Abstract

Cross-contamination of ready-to-eat (RTE) foods with pathogens on contaminated tableware and food preparation utensils is an important factor associated with foodborne illnesses. To prevent this, restaurants and food service establishments are required to achieve a minimum microbial reduction of 5 logs from these surfaces.

 

This study evaluated the sanitization efficacies of ware-washing protocols (manual and mechanical) used in restaurants to clean tableware items. Ceramic plates, drinking glasses and stainless steel forks were used as the food contact surfaces. These were contaminated with cream cheese and reduced-fat milk inoculated with murine norovirus (MNV-1), Escherichia coli K-12 and Listeria innocua.

 

The sanitizing solutions tested were sodium hypochlorite (chlorine), quaternary ammonium (QAC) and tap water (control). During the study, the survivability and response to the experimental conditions of the bacterial species was compared with that of MNV-1.

 

The results showed that current ware-washing protocols used to remove bacteria from tableware items were not sufficient to achieve a 5 log reduction in MNV-1 titer. After washing, a maximum of 3 log reduction in the virus were obtained. It was concluded that MNV-1 appeared to be more resistant to both the washing process and the sanitizers when compared with E. coli K-12 and L. innocua.

(Continue . . . )

 

Essentially, these researchers took silverware, ceramic plates, and glassware – inoculated them with norovirus, E. coli, and Listeria – and ran them through standard dishwasher or hand washing protocols with either a bleach solution or quaternary ammonium compound (QAC) solution.

 

After that, they tested them for residual pathogens.

 

Although commercial dishwashers did a better job than did handwashing, with both, significant contamination from the norovirus remained behind.

 

The authors write:

 

Conclusions

From the results of our study, it could be concluded that QAC and sodium hypochlorite sanitizers normally used to inactivate bacteria in manual and mechanical ware-washing operations were unable to produce the same level of virus inactivation under similar conditions, irrespective of the nature of the tableware item tested.

Further studies are needed to develop more effective ware-washing protocols for the removal of viruses from food contact surfaces/tableware items. Also, the combination of different detergents and sanitizing solutions (especially those containing surfactant agents) should be evaluated since they may help to enhance the removal and inactivation of non-enveloped viruses.

 

 

Obviously, people who are sick should not be handling food, but people can shed the virus even after they stop showing symptoms.

 

So one of the keys to prevention is good hand hygiene.

Unfortunately, unlike with many other bacteria and viruses, alcohol gel doesn’t do a particularly good job of killing the virus, something we discussed last year in  CMAJ: Hand Sanitizers May Be `Suboptimal’ For Preventing Norovirus.

 

Which makes a good old fashion hand scrubbing with soap and water the best preventative.

 

The CDC recommends the following steps to protect yourself from the virus.

 

And of course, the obvious question is . . .if norovirus escapes routine dishwashing protocols, what about other viruses like Hepatitis A and influenza?

Reportedly, these researchers will be looking at those viruses next.

CDC: Investigating Multi-State Outbreak Of Shiga-Toxin Producing E. coli

 

E. coli – Photo Credit CDC

 

# 6380

 

Last year at this time you may recall that much of Europe’s public health system was embroiled in containing a massive outbreak of STEC (Shiga-toxin Producing Escherichia coli) that over a couple of months sickened more than 4,000 people and contributed to the deaths of more than 45 individuals (see Shiga toxin-producing E. coli (STEC): Update on outbreak in the EU (27 July 2011, 11:00)).

 

After more than a month of investigation the European Food Safety Authority (EFSA) zeroed in on a specific lot of imported fenugreek seeds (used for sprouting) imported from Egypt as the source of infection, although some person-to-person transmission was also suspected.

 

STEC (sometimes referred to as verocytotoxic E. coli (VTEC) or enterohemorrhagic E. coli (EHEC)) infections can produce serious illness, particularly among the very young and the elderly.

 

A particularly serious, but fairly rare complication is called HUS (hemolytic uremic syndrome) which is a type of kidney failure.  Not everyone who consumes Shiga-toxin producing strains of E. coli will develop symptoms, however, and far fewer still will go on to experience HUS.

 

 

E. Coli is believed responsible for more than 250,000 illnesses each year in the United States.  The CDC explains about STEC on their E. coli page.

 

 

What are Shiga toxin-producing E. coli?

Some kinds of E. coli cause disease by making a toxin called Shiga toxin. The bacteria that make these toxins are called “Shiga toxin-producing” E. coli, or STEC for short. You might hear them called verocytotoxic E. coli (VTEC) or enterohemorrhagic E. coli (EHEC); these all refer generally to the same group of bacteria. The most commonly identified STEC in North America is E. coli O157:H7 (often shortened to E. coli O157 or even just “O157”). When you hear news reports about outbreaks of “E. coli” infections, they are usually talking about E. coli O157.

 

In addition to E. coli O157, many other kinds (called serogroups) of STEC cause disease. These other kinds are sometimes called “non-O157 STEC.” E. coli serogroups O26, O111, and O103 are the non-O157 serogroups that most often cause illness in people in the United States.

 

Some recent outbreaks that have been investigated by the CDC over the past 18 months include:

 

2012

• Multistate Outbreak of Shiga toxin-producing Escherichia coli O26 Infections Linked to Raw Clover Sprouts at Jimmy John's Restaurants

2011

• Multistate Outbreak of E. coli O157:H7 Infections Linked to Romaine Lettuce
• Outbreak of Shiga toxin-producing E. coli O104 (STEC O104:H4) Infections Associated with Travel to Germany
• Multistate Outbreak of E. coli O157:H7 Infections Associated with Lebanon Bologna
• Multistate Outbreak of E. coli O157:H7 Infections Associated with In-shell Hazelnuts

 

The CDC is currently investigating a multi-state outbreak of STEC which has sickened 14 people across 6 states.  A common source for the infections has not yet been identified.

 

Multistate Outbreak of Shiga Toxin-producing Escherichia coli O145 Infections

Posted June 10, 2012 01:00 AM ET

Highlights

• Read the Advice to Consumers »
• A total of 14 persons infected with the outbreak strain of STEC O145 infection have been identified in 6 states.
  • The number of ill persons identified in each state is as follows: Alabama (2), California (1), Florida (1), Georgia (5), Louisiana (4), and Tennessee (1).
  • Three ill persons have been hospitalized; one death has been reported in Louisiana.
• Based on interviews conducted to date, a source for these infections has not been identified. If a specific source is identified, public health officials will advise the public and take steps to prevent additional illnesses.
• Dates for patients' onset of illness range from April 15 to May 12, 2012. It has been approximately 4 weeks since the last illness onset among reported cases. Although this indicates that this outbreak could be over, CDC continues to work with state public health officials to identify additional cases and the source of these STEC O145 infections.

 

 

Despite our modern technology, foodborne illnesses pose a heavy burden to Americans, with the CDC estimating that 1 in 6 of us (48 million) fall victim to food poisoning each year, and that 128,000 are hospitalized, and as many as 3,000 die.

 

While we await news of the source of this outbreak, the CDC’s advice to consumers is valid and should be heeded 365 days a year, regardless of whether an outbreak of E. coli is being investigated or not:

 

Multistate Outbreak of Shiga Toxin-producing Escherichia coli O145 Infections

Advice to Consumers

• No source has been identified for this outbreak, and therefore we do not have specific consumer advice at this time.  Recommendations for protecting against STEC infections are provided below.  If a specific source is identified for this outbreak, public health officials will advise the public and take steps to prevent additional illnesses.
• Practice proper hygiene, especially good hand washing
  • Wash your hands thoroughly after using the bathroom or changing diapers and before preparing or eating food. Wash your hands after contact with animals or their environments (at farms, petting zoos, fairs, even your own backyard).
  • Always wash your hands before preparing and feeding bottles or foods to  your infant, before touching your infant's mouth, and before touching pacifiers or other things that go into your infant's mouth.
  • If soap and water aren't available, use an alcohol-based hand sanitizer. These alcohol-based products can quickly reduce the number of germs on hands in some situations, but they are not a substitute for washing with soap and water.
• It is also important to keep all objects that enter infants' mouths (such as pacifiers and teethers) clean.
• Know your risk for food poisoning.  People at higher-risk for foodborne illness are pregnant women and newborns, children, older adults and those with weak immune systems.
• Cook meats thoroughly. Ground beef and meat that has been needle-tenderized should be cooked to a temperature of at least 160°F/70˚C. It’s best to use a thermometer, as color is not a very reliable indicator of how thoroughly meat has been cooked.
• Avoid consuming raw milk, unpasteurized dairy products, and unpasteurized juices (like fresh apple cider).
• Avoid swallowing water when swimming or playing in lakes, ponds, streams, swimming pools, and backyard “kiddie” pools.
• Prevent cross-contamination in food preparation areas by thoroughly washing hands, counters, cutting boards, and utensils after they touch raw meat. 
• Please see the FoodSafety.gov E.coli web site for information on what you can to  prevent from getting infected with STEC.
• Persons who think they might be ill with STEC should consult their healthcare providers.

The good news is that no new cases have been reported to local health departments since the middle of May, suggesting that this outbreak may all ready be winding down.

 

Tales From The Crypto

 

 

# 6359

 

Earlier today (June 1st), the UK’s Health Protection Agency  issued a statement on their investigation into an unusually large number of gastrointestinal illnesses being reported across England due to the Cryptosporidium parasite, or as it is commonly called, “Crypto”.

 

Since this little nasty is one of the most common causes of waterborne diseases among humans (even in developed countries), and it is often acquired during the summer swimming season, today seemed like a good day to take a look at this hardy little parasite.

 

First, the HPA announcement, which has as yet been unable to locate a common source for the outbreaks reported across England over the past 3 weeks.

 

Increase in cases of cryptosporidiosis

1 June 2012

The Health Protection Agency (HPA) can confirm it is investigating a recent increase in cases of the gastrointestinal infection, cryptosporidiosis, across four regions in England – the North East, Yorkshire, West Midlands and East Midlands.

 

To date, 267 cases of cryptosporidiosis have been confirmed in the affected areas since 11 May 2012, compared to 73 cases across the four regions for the whole of May 2011.

 

The HPA is leading a multi-agency investigation to determine whether these recent cases are linked. So far investigations have not identified a possible source of infection and the distribution of cases suggests it is unlikely that public water supplies are implicated.

 

Cryptosporidiosis is caused by a tiny organism called Cryptosporidium, which is found in soil, food, water, or surfaces that have been contaminated with infected human or animal droppings. People can become infected by consuming contaminated water or food, by swimming in contaminated water, for example in lakes or rivers, or through contact with infected animals. The most common symptom is diarrhoea, which can range from mild to severe.

(Continue . . . )

 

 

Photo Credit CDC PHIL 

 

 

Although rarely fatal in healthy individuals, `Crypto’ can be deadly for the very young, the very old, and those with compromised immune systems. 

 

Occasionally campers, swimmers, or those drawing water from untreated wells will contract Crypto here in the United States.  The largest outbreak occurred in Milwaukee in 1993, when Cryptosporidium entered the public water supply (exactly how, remains a mystery), and sickened 400,000 people and killed more than 100 who were immunocompromised.

 

Cryptosporidium is chlorine resistant, making it particularly difficult to eliminate from water sources.  The Milwaukee incident has led to increased water testing, and the use of ozone, filters, and other interventions across the nation to help make our water supply safer.

 

Measures that are pretty much unavailable for most of the developing world.

 

 

According to an EID Journal study published in early 2011, there are estimated to be nearly 750,000 Crypto infections in the United States each year (see Foodborne Illness Acquired in the United States—Major Pathogens), although fewer than 8,000 are usually laboratory confirmed.

 

For most healthy individuals, a Crypto infection is an unpleasant, but not life threatening illness.  The most common symptoms (which generally last 1 to 2 weeks) are:

 

• Watery Diarrhea
• Stomach cramps or pain
• Dehydration
• Nausea
• Vomiting
• Fever
• Weight loss

 

And some people (the lucky ones) will have no symptoms at all. Most people with healthy immune systems will recover without any specific treatment, beyond drinking lots of fluids to prevent dehydration. 

 

As far as how it is spread, the CDC lists:

 

Crypto lives in the intestine of infected humans or animals. An infected person or animal sheds Cryptosporidium parasites in the stool. Millions of Crypto parasites can be released in a bowel movement from an infected human or animal. Shedding begins when the symptoms begin and can last for weeks after the symptoms (e.g., diarrhea) stop. You can become infected after accidentally swallowing the parasite. Crypto may be found in soil, food, water, or surfaces that have been contaminated with the feces from infected humans or animals. Crypto is not spread by contact with blood. Crypto can be spread:

• By putting something in your mouth or accidentally swallowing something that has come in contact with the stool of a person or animal infected with Crypto.
• By swallowing recreational water contaminated with Crypto. Recreational water can be contaminated with sewage or feces from humans or animals.
• By swallowing water or beverages contaminated by stool from infected humans or animals.
• By eating uncooked food contaminated with Crypto. All fruits and vegetables you plan to eat raw should be thoroughly washed with uncontaminated water.
• By touching your mouth with contaminated hands. Hands can become contaminated through a variety of activities, such as:
  • touching surfaces (e.g., toys, bathroom fixtures, changing tables, diaper pails) that have been contaminated by stool from an infected person,
  • changing diapers,
  • caring for an infected person, and
  • handling an infected cow or calf.

 

 

Given its prevalence in the environment, and the number of human infections each year, prevention is key.

Again from the CDC.

 

 

Prevention & Control of Cryptosporidiosis

The following recommendations are intended to help prevent and control cryptosporidiosis.

Practice Good Hygiene

Everywhere

• Wash hands with soap and water for at least 20 seconds, rubbing hands together vigorously and scrubbing all surfaces:
  • Before preparing or eating food
  • After using the toilet
  • After changing diapers or cleaning up a child who has used the toilet
  • Before and after tending to someone who is ill with diarrhea
  • After handling an animal or animal waste

At child care facilities

• To reduce the risk of disease transmission, children with diarrhea should be excluded from child care settings until the diarrhea has stopped.

At recreational water venues (pools, interactive fountains, lakes, ocean)

• Protect others by not swimming if you are experiencing diarrhea (this is essential for children in diapers). If diagnosed with cryptosporidiosis, do not swim for at least 2 weeks after diarrhea stops.
• Shower before entering the water.
• Wash children thoroughly (especially their bottoms) with soap and water after they use the toilet or their diapers are changed and before they enter the water.
• Take children on frequent bathroom breaks and check their diapers often.
• Change diapers in the bathroom, not at the poolside.

Around animals

• Minimize contact with the feces of all animals, particularly young animals.
• When cleaning up animal feces, wear disposable gloves, and always wash hands when finished.
• Wash hands after any contact with animals or their living areas.

Outside

• Wash hands after gardening, even if wearing gloves.

Immunocompromised persons

• Avoid close contact with any person or animal that has cryptosporidiosis. Cryptosporidiosis can become a life threatening disease for immunocompromised persons.
• Do not handle animal feces because infection can be life threatening for immunocompromised persons.

 

To learn more about Crypto, the CDC maintains a large Crypto Information Site.

FDA Releases 2nd Edition Of the `Bad Bug Book’

 

 

 

 

# 6266

 

For the disease geek’s virtual bookshelf, the FDA has updated their Bad Bug Book – and the 264 page reference on foodborne pathogens is now available for download as a PDF file from the FDA’s Food Safety website.

 

 

The new edition was released earlier this week - and in addition to a wealth of scientific and technical data - includes a `For Consumers’ box of less-technical information on each pathogen.

 

Here is how the FDA describes the offering.

 

Bad Bug Book 2nd Edition

Foodborne Pathogenic Microorganisms and Natural Toxins Handbook

Available in PDF (2.62MB).

The second edition of the Bad Bug Book, published by the Center for Food Safety and Applied Nutrition, of the Food and Drug Administration (FDA), U.S. Department of Health and Human Services, provides current information about the major known agents that cause foodborne illness.

 

The information provided in this handbook is abbreviated and general in nature, and is intended for practical use. It is not intended to be a comprehensive scientific or clinical reference.

 

Each chapter in this book is about a pathogen – a bacterium, virus, or parasite – or a natural toxin that can contaminate food and cause illness. The book contains scientific and technical information about the major pathogens that cause these kinds of illnesses.

 

A separate “consumer box” in each chapter provides non-technical information, in everyday language. The boxes describe plainly what can make you sick and, more important, how to prevent it.

E. Coli: In the Raw (cookie dough)

 

 

 

# 5998

 

Little noticed by the public, since it happened more or less at the same time as the emergence of 2009’s H1N1 virus, was a multistate outbreak of Shiga toxin-producing Escherichia coli (STEC) O157:H7.

 

Although more people were likely infected and experienced only minor symptoms, 77 patients with E. coli related illness were identified across 30 states.

 

Of these, 35 were hospitalized, and 10 developed HUS (Hemolytic Uremic Syndrome), a serious form of kidney failure. The victims were predominantly female (71%), and under the age of 19 (66%)

 

The CDC’s investigation (see archived details) determined:

 

Preliminary results of this investigation indicate a strong association with eating raw prepackaged cookie dough. Most patients reported eating refrigerated prepackaged Nestle Toll House cookie dough products raw.

 

This was the first time that the consumption of raw cookie dough had been associated with E. coli infection.

 

Nestle instituted a voluntary recall, while the FDA and CDC warned consumers not to eat any varieties of prepackaged Nestle Toll House refrigerated cookie dough. They warned that those with products on hand should discard them, rather than cooking them, as consumers might get the bacteria on their hands and on other cooking surfaces.

 

Fast forward 2 1/2 years and we have a study from the IDSA – embargoed until midnight last night – that warns of the dangers of eating raw cookie dough and recommends that manufacturers find ways to make it safer.

 

The 8 page PDF file is available at the link below.

 

A Novel Vehicle for Transmission of Escherichia coli O157:H7 to Humans: Multistate Outbreak of E. coli O157:H7 Infections Associated With Consumption of Ready-to-Bake Commercial Prepackaged Cookie Dough—United States, 2009

 

Published by Oxford University Press on behalf of the Infectious Diseases Society of America 2011.
DOI: 10.1093/cid/cir831

Karen P. Neil,Gwen Biggerstaff, J. Kathryn MacDonald, Eija Trees, Carlota Medus,  Kimberlee A. Musser, Steven G. Stroika, Don Zink, and Mark J. Sotir

 

 

Although the contaminated ingredient in this recalled batch of cookie dough was never conclusively identified, flour – which does not undergo a `kill step’ to rid it of pathogens – was strongly suspected.

 

We’ve a press release on all of this from the IDSA, excerpts of which you’ll find below.

 

Ready-to-bake cookie dough not ready-to-eat, study of E. coli outbreak finds

Consumer education and manufacturing changes may help prevent illness

[EMBARGOED FOR DEC. 9, 2011] The investigation of a 2009 multistate outbreak of Shiga toxin-producing Escherichia coli (STEC), an important cause of bacterial gastrointestinal illness, led to a new culprit: ready-to-bake commercial prepackaged cookie dough. Published in Clinical Infectious Diseases and available online, a new report describing the outbreak offers recommendations for prevention, including a stronger message for consumers: Don't eat prepackaged cookie dough before it's baked.

 

<SNIP>

 

The study authors conclude that "foods containing raw flour should be considered as possible vehicles of infection of future outbreaks of STEC." Manufacturers should consider using heat-treated or pasteurized flour, in ready-to-cook or ready-to-bake foods that may be consumed without cooking or baking, despite label statements about the danger of such risky eating practices, the authors conclude. In addition, manufacturers should consider formulating ready-to-bake prepackaged cookie dough to be as safe as a ready-to-eat food item.

(Continue . . . )

 

 

Eating raw cookie dough is apparently a popular culinary choice, based on the results of a Google search with the terms `eating raw cookie dough’.  

 

You’ll find abundant questionable `advice’ on the safety of this practice, including instructions on how to make `safe to eat’ raw cookie dough by eliminating `raw eggs’.

 

Much of this counsel needs to be taken with a pinch of salt (and a 350 degree oven for 15 minutes), since eggs aren’t the only potential source of contamination.

 

Since the 1980s more than 180 outbreaks of E coli have been reported across the United States from a variety of sources. This past summer, more than 4,000 people across Europe were sickened, and roughly 50 killed, by an E. coli outbreak traced to sprouts.

 

For more on how to avoid E. coli infection, and what to do if you are affected, visit foodsafety.gov’s  E. coli webpage.

 

 

http://www.foodsafety.gov/poisoning/causes/bacteriaviruses/ecoli/

Referral: Maryn McKenna On The Listeria Outbreak

 

 

# 5870

 

 

Everyone’s favorite `scary disease girl’, Maryn McKenna updates us on the ongoing outbreak of listeriosis reported in 18 states due to contaminated cantaloupes.

 

This outbreak is unique, in that Listeria has never been found in cantaloupe before, and exactly how this contamination occurred is still unknown.

 

I’ll just step out of the way, and direct you to:

 

Cantaloupe Outbreak: 13 Dead, 18 States, More To Come

• By Maryn McKenna
• September 28, 2011

Safety Issues After The Storm Passes

 

 

 

Photo Credit NOAA 

# 5883

 

 

With hurricane conditions forecast along a major stretch of the Atlantic coast this weekend, people need to be aware that many of the dangers from a hurricane come after the storm has passed.

 

Downed electrical lines, power outages, dangerous debris, flood waters, fallen limbs, weakened and compromised structures, and even displaced wildlife can pose threats in the days and weeks following the storm.

 

A review, therefore, of some of those threats and how to avoid them:

 

First, many people may find themselves without electrical power for hours, or possibly even days. In extreme cases, as we saw with Hurricane Katrina in 2005, power may be out much longer.

 

And when that happens some of the food that people have in their homes can go bad quickly. Particularly during the heat of summer.

 

The USDA maintains a Food Safety and Inspection website with a great deal of consumer information about how to protect your food supplies during an emergency, and how to tell when to discard food that may no longer be safe to consume.

 

Yesterday they posted the following news release. Follow the link to read it in its entirety:

 

USDA Offers Food Safety Tips In Advance of Hurricane Irene

 

WASHINGTON, D.C., Aug. 24, 2011 -- The U.S. Department of Agriculture's Food Safety and Inspection Service (FSIS) is issuing recommendations for residents in states that might be affected by Hurricane Irene to minimize the potential for foodborne illnesses in the event of power outages, flooding, and other problems that could be associated with the storm.

 

"Hurricanes not only pose dangers to people's physical safety, but the resulting power outages and other effects of hurricanes also can affect the safety of the food people may rely upon after hurricanes strike," said FSIS Administrator Al Almanza. "The American public should be aware of things they can do to protect the safety of their food before and after natural events."

(Continue . . . )

 

Next stop, an audio podcast (5 minutes) and some short food safety videos.

 

Surviving a Power Outage: Don't Be in the Dark When it Comes to Food Safety (Jun 2, 2010; 4:45) | Script
FSIS Food Safety staff discusses tips on how to be food safe during a power outage.

 

USDA TV Feature Stories

Food Safety Advice for Power Loss (2:10) | Spanish (3:02)

USDA Food Safety Advice after Power Loss (1:26)

 

Next we’ve this extensive guide on food safety during and after severe storms and Hurricanes.

 

A Consumer's Guide to Food Safety: Severe Storms and Hurricanes

Note: This text-only version of the Guide has been optimized for accessibility. The illustrated PDF version (2.1MB) is recommended for printing.

• Power Outages
• Safety of Food in Containers Exposed to Flood Waters
• Removing Odors from Refrigerators & Freezers
• Refrigerator Foods
• Frozen Food
• Food Safety Contacts for Areas Affected by Severe Storms and Hurricanes

 

 

Another concern dealing with power outages is the use of generators, and improvised cooking or heating , which if done improperly can result in (preventable) Carbon Monoxide poisonings.

 

In Carbon Monoxide: A Stealthy Killer I wrote in depth on the issue, but this brief video from the CDC will provide you with an overview.

 

Chainsaw accidents also figure prominently after many weather-related disasters. The CDC maintains a chainsaw safety webpage: 

 

Preventing Chain Saw Injuries During Tree Removal After a Disaster

Be aware of the risk of chain saw injury during tree removal

Each year, approximately 36,000 people are treated in hospital emergency departments for injuries from using chain saws. The potential risk of injury increases after hurricanes and other natural disasters, when chain saws are widely used to remove fallen or partially fallen trees and tree branches.

 

 

And finally, from the Boston office of the National Weather Service, these post-hurricane safety tips.

 

Post Hurricane Safety

Though the hurricane has passed, many dangers still exist. You must be alert at all times and follow the directions from your local officials.

For Those Who Have Evacuated

• Do not return to your home until you have been directed to do so.
• Upon returning, do not turn on any electric or gas service until the safety of these utilities has been confirmed.
• Be sure to check all electronic equipment for water damage before use. If you are uncertain, throw the item away. It is better to be safe than to risk electrocution.
• Try to be patient. Emergency officials will be working hard to return you to your home as quickly, and more importantly safely, as possible.

Tips For Everyone To Follow

• If there has been structural damage to your home, or to trees in your yard, be very careful. Ask for assistance from Fire and Rescue officials before you risk getting injured from fallen debris.
• Test drinking water for potability. Heed any boil water orders from local officials. Wells should be pumped out, and the water tested, before drinking.
• Get bottled water. Have enough on hand to supply 1 gallon of water to each person in your family for drinking and sanitation each day. It is quite possible that local water supplies may be contaminated.
• If power remains disrupted use flashlights. Candles left unattended can start fires.
• Be sure to guard against spoiled food. If the power was disrupted, food in the refrigerator may have spoiled.Freezers will keep food for several days if the doors were left closed after the power went off. Do not refreeze food once it begins to thaw.
• Do not use fresh food exposed to flood waters. Wash canned foods thoroughly before opening.

Beware of Outdoor Hazards

• Watch for loose or dangling power lines. Do not enter flood waters where there may be submerged appliances. Many lives are lost by electrocution.
• Be extra careful when clearing fallen trees and limbs with a chain saw. Power lines could be entangled.
• Do not be a victim of a chain saw accident. When in doubt, leave the work to professionals.
• If you have a generator, be sure to turn the master power switch in your circuit breaker box off prior to turning the generator on. Also, be sure that the generator is outdoors and in a well ventilated area.

Take your time and be extra careful. Do not be afraid to ask for assistance. If there has been damage to your property, contact your insurance agent, but have patience for there will be many others with damage as well.

 

It’s In The Bag

 

 

 

# 5743

 

 

An interesting report appears this week in Pediatrics, the journal of the AAP, on the temperature and safety of brown-bagged school lunches prepared at home.

 

The surprising results appear in an  article called:

 

Temperature of Foods Sent by Parents of Preschool-aged Children

Fawaz D. Almansour, MS, Sara J. Sweitzer, PhD, RD, LD, Allison A. Magness, BS,  Eric E. Calloway, BS, Michael R. McAllaster, BS, Cynthia R. Roberts-Gray, PhD, Deanna M. Hoelscher, PhD, RD, LD, CNS, Margaret E. Briley, PhD, RD, LD

 

 

Essentially, researchers tested the temperature of perishable food items brought to school 90 minutes before lunch at 9 central Texas day-care centers, and found the following:

 

• 39% (n = 276) of the 705 lunches analyzed had no ice packs
• 45.1% (n = 318) had 1 ice pack
• 88.2% (n = 622) of lunches were at ambient temperatures
• Only 1.6% (n = 22) of perishable items (n = 1361) were in the safe temperature zone.
• Even with multiple ice packs, the majority of lunch items (>90%) were at unsafe temperatures.

 

In the abstract, the authors write:

 

Conclusions: These results provide initial data on how frequently sack lunches sent by parents of preschool-aged children are kept at unsafe temperatures.

Education of parents and the public must be focused on methods of packing lunches that allow the food to remain in the safe temperature zone to prevent foodborne illness.

 

 

While most parents probably believe that including one or more ice packs are enough to keep food at a safe temperature, the evidence suggests otherwise. 

 

Consuming perishable foods that have been allowed to exceed the recommended storage temperature doesn’t necessarily mean your child will get sick, but it can certainly increase the odds.

 

With that in mind, Foodsafety.gov has some tips on how to pack lunches to reduce the chances of sending an out-of-control biological experiment to school with your child.

 

 

Keep School Lunches Safe

 

Posted September 07, 2010 

By Diane Van, USDA's Food Safety and Inspection Service

As children head back to school this fall, parents and caretakers may wonder, “What’s the most important thing that the kids should take to school with them?” From my perspective as a food safety specialist, I’d recommend an insulated lunch box as the best investment of the school year. For a few dollars, an insulated lunch box can keep children healthy and engaged to learn by protecting them from foodborne illness.

If you pack perishable food in an old-fashioned brown paper bag, it can be unsafe to eat by lunchtime. When children are sent home sick or stay home because of illness, it’s difficult for them to succeed in their school work.

 

Insulated lunch boxes help maintain food at a safe temperature until lunchtime. Perishable lunch foods, such as cold cut sandwiches and yogurt, can be left out at room temperature for only 2 hours before they may become unsafe to eat. But, with an insulated lunch box and a chilled freezer gel pack, perishable food can stay cold and safe to eat until lunch.

 

Why keep food cold? Harmful bacteria multiply rapidly in the "Danger Zone" — the temperatures between 40 and 140 °F. So, perishable food transported without a cold source won't stay safe long.

 

Here are some other tips to keep food safe until lunchtime:

• Clean Hands: Always make sure your hands are clean before preparing lunches. And, make sure your children understand that they need to wash their hands thoroughly before eating lunch or snacks. “Washing hands thoroughly” means using soap and warm water, and rubbing hands for 20 seconds (the time it takes to sing “Happy Birthday” twice). If water is not available, provide moist towelettes or hand sanitizing gels in the lunch box.
• Freeze your juice box: You can freeze juice boxes and use them as freezer packs. By lunchtime, the juice should be thawed and ready to drink.
• Hot Foods: To keep hot foods hot, use an insulated bottle like a thermos for foods such as soup, chili, or stew.
• Non-Perishable Food: Some food is safe without a cold source. Lunch items that don't need to be refrigerated include whole fruits and vegetables, hard cheese, canned meat and fish, chips, breads, crackers, peanut butter, jelly, mustard, and pickles.

If the lunch box comes home with food in it, make sure to throw away any perishable food items, because they have been unrefrigerated too long!

 

If you have any other questions about packing lunches safely or have other food safety questions, feel free to contact us at the Hotline (1-888-674-6854 toll-free) or

 

 

In other words, you might want to reconsider the wisdom of sending that unrefrigerated egg-salad-sandwich in your child’s lunchbox in the middle of August.

Who knew?

EFSA Task Force Report On E. Coli O104:H4

 

 

Photo Credit – ECDC 

 

# 5672

 

 

The European Food Safety Authority (EFSA) has released an updated task force report on the enterohaemorrhagic Escherichia coli (EHEC) outbreak that has affected more than 4000 people (including 47 fatal cases) across 13 nations in Europe since mid-May.

 

Although we’ve seen other E. Coli outbreaks in the past, this one is remarkable both for the total number of victims, and the virulence of this emerging 0104:H4 strain of E. Coli.

 

During the opening weeks of the outbreak suspicions regarding the source of the infection were cast in a variety of directions, causing serious economic harm to produce growers in Spain and elsewhere. 

 

Over the past two weeks, investigators have zeroed in on fenugreek seeds imported from Egypt as being the likely source of the E. Coli contamination.

 

Two links this morning, along with some excerpts from the EFSA’s press release and technical report.  Follow the links to read them in their entirety.

 

 

EFSA publishes report from its Task Force on the E. coli O104:H4 outbreaks in Germany and France in 2011 and makes further recommendations to protect consumers

Press Release
5 July 2011

The EFSA Task Force established to coordinate investigations to track down the possible source of the French and German outbreaks of E. coli O104:H4 has concluded that one lot of fenugreek seeds imported from Egypt and used to produce sprouts is the most likely common link between the two outbreaks.

 

However, it cannot be excluded that other lots of fenugreek imported from Egypt during the period 2009-2011 may be implicated. Based on these findings, EFSA recommends to the European Commission that all efforts be made to prevent any further consumer exposure to the suspect seeds and that forward tracing be carried out in all countries which may have received seeds from the concerned lots.

 

In this context, EFSA continues to advise consumers not to grow sprouts for their own consumption and not to eat sprouts or sprouted seeds unless they have been cooked thoroughly.

<SNIP>

 

The analysis of information from the French and German outbreaks leads to the conclusion that an imported lot of fenugreek seeds which was used to grow sprouts imported from Egypt by a German importer, is the most likely common link but other lots may be implicated. The report highlights that negative results from microbiological tests carried out on seeds cannot be interpreted as proof that a lot is not contaminated with STEC.

(Continue . . . )

 

Details on the trace back investigation that has led the EFSA to conclude that contaminated fenugreek seeds are behind this outbreak are contained in the technical document below.

 

The actual report is a 23-page PDF file.  The link below is to the summary.

 

 

 

Tracing seeds, in particular fenugreek (Trigonella foenum-graecum) seeds, in relation to the Shiga toxin-producing E. coli (STEC) O104:H4 2011 Outbreaks in Germany and France

Question number: EFSA-Q-2011-00817
Issued: 5 July 2011

Report (0.1 Mb)

Summary

On the 21^st of May 2011, Germany reported an ongoing outbreak of Shiga-toxin producing Escherichia coli- bacteria (STEC[1][2]), serotype O104:H4 (Frank et al., 2011). In Germany, between the 1^st of May and the 28^th of June 2011, 838 Haemolytic Uremic Syndrome (HUS) cases and 3 091 STEC cases with diarrhea have been reported, of which 47 persons have died (RKI, 2011).

 

On Friday the 24^th of June, France reported[3] a cluster of patients with bloody diarrhoea, after having participated in an event in the Commune of Bègles near Bordeaux on the 8th of June. As of 28 June, eight cases of bloody diarrhoea and a further eight cases with HUS have been identified. Eleven of these patients, seven women and four men, between 31 and 64 years of age, had attended the same event in Bègles. Infection with E. coli O104:H4 has been confirmed for four patients with HUS.

 

Six of the cases reported having eaten sprouts at the event on the 8^th of June, and leftovers are being analysed. Outbreak investigation revealed that the suspected sprouts of fenugreek, rocket and mustard had been privately produced in small quantities by the organiser of the event from seeds bought at an approved garden centre, and were not imported from the sprout producer implicated in the outbreak in Germany (INVS, 2011). An analytical epidemiological study is ongoing with the persons that attended the event on 8^th of June. Local trace back investigations in France suggested that the seeds for sprouting were distributed to the approved garden centre by a UK based company.

(Continue . . . )

 

After the row last week over the ECDC first printing, then removing the name of the (suspected) supplier of the contaminated seeds (see CIDRAP article), it is interesting to note that none of the links in the supply chain appear to be directly named in this report.

 

The bottom line is that while the number of new cases continues to decline, the potential exists for additional localized outbreaks as potentially contaminated seeds may still be in the pipeline.

 

From the report:

 

The number of Member States that have received parts of the suspected lots is much larger than previously known and it cannot be excluded that other Member States and third countries were supplied. The trace forward operation is becoming complex and widespread and may take weeks.

 

Hence the EFSA’s advise to people: not to grow sprouts for their own consumption and not to eat sprouts or sprouted seeds unless they have been cooked thoroughly.

WHO Europe: EHEC Update & FAQ

 

 

# 5600

 

 

The expanding outbreak of EHEC (or STEC  Shiga-Toxin Producing E. Coli) in Europe has produced an avalanche of news articles and analysis. Most days we are seeing literally scores of updates.

 

Both Crof at Crofsblog and the newshounds at FluTrackers  (see news forum Escherichia coli (E. Coli), Enterohemorrhagic Escherichia Coli (EHEC), Hemolytic-Uremic Syndrome) have been providing outstanding hour-to-hour coverage of this story.

 

Of course, I haven’t been ignoring the crisis.  My coverage, however, has been focused less on the breaking news aspects, and more on research updates (CDC, ECDC, WHO) and background information.

 

Today, an update and a well-done FAQ from WHO Europe.

 

 

EHEC outbreak: Update 6 (04-06-11)

04-06-2011

These are the current figures for the outbreak. Enterohaemorrhagic Escherichia coli (EHEC) and haemolytic uraemic syndrome (HUS) have exclusive notification categories, so case numbers should not overlap. The figures in any rapidly evolving outbreak are provisional, however, and subject to change for a variety of reasons.

• As of 02 June at 15:00 CET, Germany had reported 520 cases of HUS, including 11 fatalalities: 50 more than the previous day. 70% of the cases were in females and 89% in adults aged 20 years or older. 
• As of 02 June 15:00 CET, 1213 cases of EHEC infections (without HUS) had been reported in Germany, 6 of them fatal: 149 more than the previous day. Of those cases, 61% were in females, and 88% in adults aged 20 years or older. Case onset dates for EHEC ranged from 1 to 30 May.
• As of 03 June 18:00 CET, 11 other European countries (see table) had reported a total of 31 HUS (1 fatal) and 70 EHEC cases (0 fatal). 

• In addition, the Centers for Disease Control and Prevention (CDC) in Atlanta, United States of America had previously  published information on two cases of HUS in the United States that were linked to this outbreak.  
• All but 1 of the above HUS and EHEC patients had travelled to or from Germany during the incubation period for infection, typically 3–4 days after exposure (range 2–10 days). An increasing number of cases is laboratory confirmed as EHEC serotype O104:H4.

Since various agencies and news organizations around the world have elected to use different terminology to describe this outbreak, following this story can sometimes be a bit confusing.

 

The World Health Organization has put together a good FAQ (Frequently Asked Questions) file on the outbreak, which may serve to clear up some of the confusion.

 

 

 

Frequently asked questions on the EHEC infection outbreak in Germany

Background

1. What are EHEC and HUS?

Enterohaemorrhagic Escherichia coli (EHEC) is a human pathogenic E. coli bacterium that is able to cause haemorrhagic colitis (bloody diarrhoea), which sometimes develops into haemolytic uraemic syndrome (HUS). HUS is a life-threatening disease that causes kidney damage and is a severe complication of EHEC infection. EHEC is so-called Shigatoxin-producing E. coli (STEC), also known as verocytotoxin-producing E. coli (VTEC). Animals can carry other types of STEC/VTEC in their intestines that are not necessarily pathogenic for humans.

2. Surely E. coli is very common, so why the concern?

Yes, E. coli is a common bacterium that is found in the intestines of humans and warm-blooded animals. Nevertheless, this particular strain, a rare serotype of EHEC (namely E. coli O104:H4), is severe, and has caused much illness and some deaths in Germany. Cases have also occurred in 11 other countries, all of whom had travel links to, or residence in, Germany, except for one case still under investigation. This is a significant outbreak of HUS. It is affecting mostly women and mostly people over 20 years of age, which is unusual. As the source of the outbreak has not been found, it is difficult to say how long it will last.

3. Is this unique?

The serotype of EHEC, O104:H4, isolated from cases in the EHEC infection outbreak in Germany, is a rare one, seen in humans before but never in an EHEC outbreak. This has been confirmed by the WHO Collaborating Centre for Reference and Research on Escherichia and Klebsiella, the Statens Serum Institut in Denmark. The molecular/genetic features of this pathogen are important in helping authorities to identify cases in other countries that could be associated with the outbreak in Germany and to identify the source of the outbreak. While epidemiological and laboratory investigations continue, the source of the outbreak still remains unknown.

4. How would you describe the EHEC outbreak currently happening in Germany?

Germany is experiencing a significant outbreak of EHEC, a highly pathogenic bacterium subgroup of STEC. A minority of cases are presenting complications with HUS, a life-threatening disease characterized by acute kidney failure (uraemia), haemolytic anaemia, and a low platelet count (thrombocytopenia).

5. When was the last EHEC outbreak?

Every year there are EHEC outbreaks in different parts of the world including Europe, sometimes involving HUS and even deaths, but the number of affected people is very much lower than what Germany is now experiencing. In 1996, the world’s biggest recorded outbreak was registered in Japan and included over 10 000 infected cases.

6. How many countries are involved in the current outbreak?

Cases have now been notified from 11 countries in addition to Germany: Austria, the Czech Republic, Denmark, France, the Netherlands, Norway, Spain, Sweden, Switzerland, the United Kingdom and the United States of America. These are typically people who have recently visited northern Germany or, in one case, had contact with a visitor from northern Germany who was an EHEC case.

7. Do people outside Germany need to worry?

Most of the cases are linked to the northern part of Germany, and investigations are taking place to define the exact geographical areas where transmission is occurring. There is no indication so far of confirmed domestic or secondary infection in other countries.

CDC Health Advisory (HAN) On Shiga-Toxin Producing E. Coli 0104

 

 

# 5599

 

 

The CDC’s Health Alert Network (HAN) is designed to ensure that communities, agencies, health care professionals, and the general public are able to receive timely information on important public health issues.

 

You can sign up for HAN messages, and scores of other CDC and HHS email notifications, by going to the CDC - Quick Subscribe GovDelivery page.

 

There are 4 types of HAN releases.

Health Alert

Conveys the highest level of importance; warrants immediate action or attention.

Health Advisory

Provides important information for a specific incident or situation; may not require immediate action.

Health Update

Provides updated information regarding an incident or situation; unlikely to require immediate action.

Info Service
Provides general information that is not necessarily considered to be of an emergent nature.

 

Today we have a HAN ADVISORY on the outbreak of EHEC or Shiga-Toxin producing E. Coli in Europe, with instructions for Health Care providers to be on the lookout of possible symptoms in travelers returning from Europe.

 

As of May 31st, the CDC has been made aware of 3  cases of HUS among travelers who recently entered the United States after leaving Germany.

 

While most of the information below is of greatest interest to clinicians, this illustrates that in today’s highly mobile society, even an outbreak of a food borne illness can impact countries oceans apart.

 

 

 

This is an official

CDC HEALTH ADVISORY

Distributed via Health Alert Network
June 3, 2011, 9:30 a.m. EST
CDCHAN-00322-ADV-N

Notice to Health Care Providers — Shiga Toxin-producing E. coli O104 (STEC O104:H4) Infections in U.S. Travelers Returning from Germany

 

CDC is monitoring a large outbreak of Shiga toxin-producing Escherichia coli O104:H4 (STEC O104:H4) infections ongoing in Germany. The responsible strain shares virulence characteristics with enteroaggregative E. coli (EAEC). As of May 31, 2011, the Robert Koch Institute (RKI) reported 470 patients with hemolytic uremic syndrome, or HUS (a severe condition associated with STEC infection that can lead to kidney failure), and nine deaths. The strain of STEC that is causing this illness, STEC O104:H4 is very rare. The illness that it causes is similar to that caused by E. coli O157:H7 or STEC O157:H7, which is also a Shiga toxin-producing E. coli.

 

CDC is not aware of any cases of STEC O104:H4 infection ever being previously reported in the United States. However, as of May 31, 2011, three cases of HUS in the United States have been reported in persons who recently traveled to Hamburg, Germany. CDC is working with state health departments to learn more about these suspected cases and obtain bacterial isolates for further characterization.

 

CDC has recommended that any person who has recently traveled to Germany and has signs or symptoms of STEC infection, or HUS, should seek medical care and let the medical provider know about the outbreak of STEC infections in Germany and the importance of being tested for STEC infection.

 

Symptoms of STEC infection include severe stomach cramps, diarrhea (which is often bloody) and vomiting. If there is fever, it usually is not very high. Most people get better within 5–7 days, but some patients go on to develop HUS, usually about a week after the diarrhea starts. 

 

(Continue . . . )

Report: EHEC Outbreak From New E. Coli Strain

 

 

 

# 5594

 

 

It is being widely reported this morning by the International press that Chinese scientists at the Beijing Genomics Institute, after completing the sequencing the genome of the E. Coli bacterium responsible for the massive outbreak of food poisoning in Germany, have pronounced it to be a `new strain’.

 

E.coli outbreak in Europe caused by new toxic strain - Reuters

WHO says E.coli strain never seen before – SwissInfo.Ch

E coli outbreak: WHO says bacterium is a new strain – The Guardian

 

Excerpts from the press release from the Beijing Genomics Institute follows:

 

 

BGI Sequences Genome of the Deadly E. Coli in Germany and Reveals New Super-Toxic Strain

2011-06-02 15:28:36

Sequence analysis indicated this bacterium is an EHEC serotype O104 E. coli strain; however, this is a new serotype — not previously involved in any E. coli outbreaks.

 

Comparative analysis showed that this bacterium has 93% sequence similarity with the EAEC 55989 E. coli strain, which was isolated in the Central African Republic and known to cause serious diarrhea. This new strain of E. coli, however, has also acquired specific sequences that appear to be similar to those involved in the pathogenicity of hemorrhagic colitis and hemolytic-uremic syndrome.

 

The acquisition of these genes may have occurred through horizontal gene transfer. The analysis further showed that this deadly bacterium carries several antibiotic resistance genes, including resistance to aminoglycoside, macrolides and Beta-lactam antibiotics: all of which makes antibiotic treatment extremely difficult.

 

According to a number of press reports this morning, Hilde Kruse, a food safety expert at the World Health Organization  has confirmed with The Associated Press that "this is a unique strain that has never been isolated from patients before", and that - the new strain has "various characteristics that make it more virulent and toxin-producing.”

 

The source of this contamination, and how (and where) this new strain may have evolved, remains a mystery.

CDC Statement On Europe’s EHEC (STEC) Outbreak

 

 

 

# 5592

 

 

 

While the Robert Koch Institute (RKI) in Germany has the lead on the investigation of the large outbreak of Shiga toxin-producing E. coli  STEC O104, the CDC is naturally following the events there closely. 

 

Earlier today the CDC released a statement outlining what is currently known about the outbreak, along with a brief Q&A section that addresses some common questions the public may have.

 

I’ll not reprint the entire statement, but you are encouraged to follow the link to read it in its entirety. 

 

 

For Immediate Release: June 1, 2011
Contact: CDC Media Relations
(404) 639-3286

CDC Statement on Outbreak of STEC O104:H4 infections in Germany

CDC is following a large outbreak of Shiga toxin-producing E. coli O104, or STEC O104, infections currently going on in Germany. As of May 31, 2011, the Robert Koch Institute (RKI), Germany's disease control and prevention agency, has confirmed six deaths and 373 patients with hemolytic uremic syndrome, or (HUS) (kidney failure), a life-threatening complication of E. coli infections.

 

To date, no confirmed cases of STEC O104 infections have been reported in U.S. travelers to Europe. Two cases of HUS in the United States have been reported in persons with recent travel to Hamburg, Germany. CDC is working with state health departments to learn more about these two cases and to identify others. CDC has been in contact with the German public health authorities at RKI. We have alerted state health departments in the United States of the ongoing outbreak. We have also requested that they report to CDC any cases in which people have either HUS or Shiga toxin-positive diarrheal illness, with illness onset during or after travel to Germany since April 1, 2011.

 

The strain of STEC causing illness, STEC O104:H4, is very rare. CDC is not aware of any cases of STEC O104:H4 infection ever being reported in United States. Any person with recent travel to Germany with signs or symptoms of STEC infection or HUS, should seek medical care and let the medical provider know about the outbreak of STEC infections in Germany and the importance of being tested. Symptoms of STEC infection include severe stomach cramps, diarrhea, which is often bloody, and vomiting. If there is fever, it usually is not very high. Most people get better within 5–7 days, but some patients go on to develop HUS—usually about a week after the diarrhea starts. Symptoms of HUS include decreased frequency of urination, feeling very tired, and losing pink color to skin and membranes due to anemia.

(Continue . . . )

 

 

For some of the best day-to-day coverage of this story, I would direct my readers to Crof at Crofsblog, who has been spending a lot of time finding and translating news items from the German Press.

 

For now, the source of this rare form of E. coli remains a mystery, and the number of cases continues to grow.