Global & Disaster Medicine

Archive for the ‘Food-borne diseases’ Category

French baby milk formula maker Lactalis has ordered a global product recall over fears of salmonella contamination because 26 infants in the country have become sick since early December.

BBC

“…..Lactalis is one of the world’s biggest dairy producers. Company spokesman Michel Nalet told AFP “nearly 7,000 tonnes” of production may have been contaminated….”


CDC recommendations to healthcare providers treating patients in Puerto Rico and USVI, as well as those treating patients in the continental US who recently traveled in hurricane-affected areas during the period of September 2017 – March 2018.

CDC

Advice for Providers Treating Patients in or Recently Returned from Hurricane-Affected Areas, Including Puerto Rico and US Virgin Islands

Distributed via the CDC Health Alert Network
October 24, 2017, 1330 ET (1:30 PM ET)
CDCHAN-00408

Summary
The Centers for Disease Control and Prevention (CDC) is working with federal, state, territorial, and local agencies and global health partners in response to recent hurricanes. CDC is aware of media reports and anecdotal accounts of various infectious diseases in hurricane-affected areas, including Puerto Rico and the US Virgin Islands (USVI). Because of compromised drinking water and decreased access to safe water, food, and shelter, the conditions for outbreaks of infectious diseases exist.

The purpose of this HAN advisory is to remind clinicians assessing patients currently in or recently returned from hurricane-affected areas to be vigilant in looking for certain infectious diseases, including leptospirosis, dengue, hepatitis A, typhoid fever, vibriosis, and influenza. Additionally, this Advisory provides guidance to state and territorial health departments on enhanced disease reporting.

 

Background
Hurricanes Irma and Maria made landfall in Puerto Rico and USVI in September 2017, causing widespread flooding and devastation. Natural hazards associated with the storms continue to affect many areas. Infectious disease outbreaks of diarrheal and respiratory illnesses can occur when access to safe water and sewage systems are disrupted and personal hygiene is difficult to maintain. Additionally, vector borne diseases can occur due to increased mosquito breeding in standing water; both Puerto Rico and USVI are at risk for outbreaks of dengue, Zika, and chikungunya.

Health care providers and public health practitioners should be aware that post-hurricane environmental conditions may pose an increased risk for the spread of infectious diseases among patients in or recently returned from hurricane-affected areas; including leptospirosis, dengue, hepatitis A, typhoid fever, vibriosis, and influenza. The period of heightened risk may last through March 2018, based on current predictions of full restoration of power and safe water systems in Puerto Rico and USVI.

In addition, providers in health care facilities that have experienced water damage or contaminated water systems should be aware of the potential for increased risk of infections in those facilities due to invasive fungi, nontuberculous Mycobacterium species, Legionella species, and other Gram-negative bacteria associated with water (e.g., Pseudomonas), especially among critically ill or immunocompromised patients.

Cholera has not occurred in Puerto Rico or USVI in many decades and is not expected to occur post-hurricane.

 

Recommendations

These recommendations apply to healthcare providers treating patients in Puerto Rico and USVI, as well as those treating patients in the continental US who recently traveled in hurricane-affected areas (e.g., within the past 4 weeks), during the period of September 2017 – March 2018.

  • Health care providers and public health practitioners in hurricane-affected areas should look for community and healthcare-associated infectious diseases.
  • Health care providers in the continental US are encouraged to ask patients about recent travel (e.g., within the past 4 weeks) to hurricane-affected areas.
  • All healthcare providers should consider less common infectious disease etiologies in patients presenting with evidence of acute respiratory illness, gastroenteritis, renal or hepatic failure, wound infection, or other febrile illness. Some particularly important infectious diseases to consider include leptospirosis, dengue, hepatitis A, typhoid fever, vibriosis, and influenza.
  • In the context of limited laboratory resources in hurricane-affected areas, health care providers should contact their territorial or state health department if they need assistance with ordering specific diagnostic tests.
  • For certain conditions, such as leptospirosis, empiric therapy should be considered pending results of diagnostic tests— treatment for leptospirosis is most effective when initiated early in the disease process. Providers can contact their territorial or state health department or CDC for consultation.
  • Local health care providers are strongly encouraged to report patients for whom there is a high level of suspicion for leptospirosis, dengue, hepatitis A, typhoid, and vibriosis to their local health authorities, while awaiting laboratory confirmation.
  • Confirmed cases of leptospirosis, dengue, hepatitis A, typhoid fever, and vibriosis should be immediately reported to the territorial or state health department to facilitate public health investigation and, as appropriate, mitigate the risk of local transmission. While some of these conditions are not listed as reportable conditions in all states, they are conditions of public health importance and should be reported.

 

For More Information


CDC: 14 new Salmonella cases tied to papayas. The case total now stands at 235, with 78 hospitalizations and 2 deaths (1 in New York and 1 in California).

CDC1

Photo of a papaya cut open

People infected with the outbreak strains of Salmonella, by state of residence, as of September 11, 2017

CDC2

People infected with the outbreak strains of Salmonella Newport & Infantis, by state of residence, as of September 11, 2017

CDC3

People infected with the outbreak strain of Salmonella Urbana, by state of residence, as of September 11, 2017


CDC: Raw milk from the K-Bar Dairy in Paradise, Texas, tested positive for Brucella RB51, a rare bacterium that can cause serious illness.

CDC

“People who consumed raw milk or raw milk products from one Texas dairy should contact their health care provider immediately, warn health investigators from the Centers for Disease Control and Prevention (CDC) and the Texas Department of State Health Services (DSHS). Raw milk from the K-Bar Dairy in Paradise, Texas (northwest of Fort Worth), tested positive for a rare but potentially serious bacteria known as Brucella RB51.
CDC advises that people who consumed raw milk or milk products from the K-Bar Dairy between June 1 and Aug. 7, 2017, should get antibiotic treatment to avoid the risk of lifelong, chronic infections. Initially, people with brucellosis experience fever, sweats, aches and fatigue. If not treated, Brucella RB51 infection can result in long-term complications, like arthritis;  heart problems; enlargement of the spleen or liver; and, in rare cases, nervous system problems,  like meningitis RB51 can cause severe illness in people with weakened immune systems and miscarriages in pregnant women…..”

Glass of milk sitting on grass


Salmonella Kiambu Infections Linked to Yellow Maradol Papayas: 47 ill in 12 States & 1 Death

CDC

People infected with the outbreak strain of Salmonella Kiambu, by state of residence, as of July 21, 2017

What are the signs and symptoms of Salmonella infection?

Most people infected with Salmonella develop the following signs and symptoms 12-72 hours after being exposed to the bacteria:

  • Diarrhea
  • Fever
  • Abdominal cramps

How long does the illness last?

  • The illness usually lasts 4 to 7 days, and most people recover without treatment.
  • In some people, the diarrhea may be so severe that the patient needs to be hospitalized. Salmonella infection may spread from the intestines to the bloodstream and then to other places in the body.
  • In rare cases, Salmonella infection can cause death unless the person is treated promptly with antibiotics.

Who is more likely to have a severe illness?

  • Children younger than 5 years
  • Adults older than 65
  • People with weakened immune systems

More information about Salmonella and steps people can take to reduce their risk of infection with Salmonella in general can be found on the CDCSalmonella(https://www.cdc.gov/salmonella/general/index.html) website.

Advice to Consumers, Restaurants, and Retailers

Photo of a papaya cut open

Yellow Maradol Papaya: Maradol papayas are a large, oval fruit that weighs 3 or more pounds, with green skins that turn yellow when the fruit is ripe. The flesh inside the fruit is salmon-colored.

CDC recommends that consumers not eat, restaurants not serve, and retailers not sell yellow Maradol papayas until we learn more.

  • If you aren’t sure if the papaya you bought is a yellow Maradol papaya, you can ask the place of purchase. Restaurants and retailers can ask their supplier.
  • When in doubt, don’t eat, sell, or serve them and throw them out.
  • Wash and sanitize countertops as well as drawers or shelves in refrigerators where papayas were stored.

Contact a healthcare provider if you think you got sick from eating contaminated papaya.

  • Most people infected with Salmonella develop the following signs and symptoms 12-72 hours after being exposed to the bacteria:
    • Diarrhea
    • Fever
    • Abdominal cramps

 

 


Grilling safely: CDC

 

Get Ready to Grill Safely

important to keep meat, fish and poultry separated from other food in the grocery cart and shopping bags.keep meat, poultry, and seafood refrigerated until ready to grill wash hands with soap before and after handling raw meat, poultry, and seafood. Also, wash work surfaces, utensils, and the grill before and after cooking. Cook to correct temperature 145 for beef, pork, lamb, veal, fish. 160 F for hamburgers and other ground meat. 165 F for poultry throw out marinades and sauces that have touches raw meat juices, and put cooked meat on a clean plate.

Food poisoning peaks in the summer months when warmer temperatures cause foodborne germs to flourish. Follow these steps for a safe and enjoyable grilling season.

Separate

When shopping, pick up meat, poultry, and seafood last, right before checkout. Separate them from other food in your shopping cart and grocery bags. To guard against cross-contamination, put packages of raw meat and poultry into individual plastic bags.

Chill

Keep meat, poultry, and seafood refrigerated until ready to grill. When transporting, keep below 40°F in an insulated cooler.

Clean

Wash your hands with soap before and after handling raw meat, poultry, and seafood. Wash work surfaces, utensils, and the grill before and after cooking.

Check your grill and tools

Use a moist cloth or paper towel to clean the grill surface before cooking. If you use a wire bristle brush, thoroughly inspect the grill’s surface before cooking. Wire bristles from grill cleaning brushes may dislodge and stick into food on the grill.

Don’t cross-contaminate

Throw out marinades and sauces that have touched raw meat juices, which can spread germs to cooked foods. Use clean utensils and a clean plate to remove cooked meat from the grill.

Cook

Use a food thermometer to ensure meat is cooked hot enough to kill harmful germs. When smoking, keep temperatures inside the smoker at 225°F to 300°F to keep meat a safe temperature while it cooks.

  • 145°F – whole cuts of beef, pork, lamb, and veal (stand-time of 3 minutes at this temperature)
  • 145°F – fish
  • 160°F – hamburgers and other ground beef
  • 165°F – all poultry and pre-cooked meats, like hot dogs

Smoking:

After Grilling:

  • 140°F or warmer – until it’s served

Refrigerate

Divide leftovers into small portions and place in covered, shallow containers. Put in freezer or fridge within two hours of cooking (one hour if above 90°F outside).

Learn More:

 


People infected with the outbreak strains of Salmonella, by state of residence, as of May 25, 2017 (n=372)

CDC

People infected with the outbreak strains of Salmonella, by state of residence, as of May 25, 2017 (n=372)

Posted June 1, 2017 2:45PM ET

Outbreak Advisory

8
Outbreaks
372
Cases
47
States
71
Hospitalizations
  • CDC, many state departments of health and agriculture, and the U.S. Department of Agriculture’s Animal and Plant Health Inspection Service are investigating eight multistate outbreaks of human Salmonella infections linked to contact with live poultry in backyard flocks.
    • These outbreaks are caused by several kinds of Salmonella bacteria: Salmonella Braenderup, Salmonella Enteritidis, Salmonella Hadar, Salmonella I 4,[5],12:i-, Salmonella Indiana, Salmonella Infantis, Salmonella Mbandaka, and Salmonella Typhimurium.
  • As of May 25, 2017, 372 people infected with the outbreak strains of Salmonella have been reported from 47 states.
    • Illnesses started on dates ranging from January 4, 2017 to May 13, 2017.
    • 71 ill people have been hospitalized, and no deaths have been reported.
    • 36% of ill people are children younger than 5 years.
  • Epidemiologic, traceback, and laboratory findings link the eight outbreaks to contact with live poultry, such as chicks and ducklings, which come from several hatcheries.
    • In interviews, 190 (83%) of 228 ill people reported contact with live poultry in the week before illness started.
    • People reported purchasing live baby poultry from several sources, including feed supply stores, websites, hatcheries, and from relatives.
  • Contact with live poultry and the areas where they live and roam can make people sick with Salmonella infections. Chicks, ducklings, and other live poultry that look healthy and clean can still carry Salmonella bacteria.
  • Outbreaks(https://www.cdc.gov/eid/article/22/10/15-0765_article) linked to contact with live poultry have increased in recent years as more people keep backyard flocks. In 2016(https://www.cdc.gov/salmonella/live-poultry-05-16/), a record number of illnesses were linked to contact with backyard poultry.

CDC: Unpasteurized milk, consumed by only 3.2% of the population, and cheese, consumed by only 1.6% of the population, caused 96% of illnesses caused by contaminated dairy products.

CDC

Costard S, Espejo L, Groenendaal H, Zagmutt FJ. Outbreak-related disease burden associated with consumption of unpasteurized cow’s milk and cheese, United States, 2009–2014. Emerg Infect Dis. 2017 Jun [date cited]. https://dx.doi.org/10.3201/eid2306.151603

DOI: 10.3201/eid2306.151603


A dodgy batch of smelly French cheese has been blamed for a 300-student mass food poisoning outbreak at schools in Normandy.

The Independent

“…..The children began to suffer headaches, vomiting and stomach aches after eating the cheese at 54 different primary schools and nurseries on 27 April…..”

 


Multistate Outbreak of Shiga toxin-producing Escherichia coli O157:H7 Infections Linked to I.M. Healthy Brand SoyNut Butter

CDC

image of bowl of flour

At A Glance

  • Case Count: 29
  • States: 12
  • Deaths: 0
  • Hospitalizations: 12

Case Count Map: People infected with the outbreak strain of E. coli O157:H7, by state of residence, as of March 28, 2017


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