Global & Disaster Medicine

Archive for the ‘Food-borne diseases’ Category

People infected with the outbreak strain of Salmonella Carrau, by state of residence, as of April 12, 2019 (n=93).

Map of United States - People infected with the outbreak strain of Salmonella, by state of residence, as of April 12, 2019

Epi curve of people infected with the outbreak strain of Salmonella, by date of illness onset, as of April 12, 2019

People infected with the outbreak strain of Salmonella Carrau, by date of illness onset*

 

Photo of packages of pre-cut melon on shelves.


France: 4 dead and 15 in ICU after a presumed food poisoning at a retirement home

Sun

‘…….”Prosecutors have been informed that there is a strong suspicion of food poisoning,” said deputy mayor Frederic Pasian.

“The residents all had symptoms at around 8pm – an hour and a half after their meal,” Mr Passian added, saying many were “vomiting and displaying other serious symptoms related to their meal.”…..’


CDC: 3 Types of Post-Disaster Poisonings

CDC

National Poison Prevention Week (March 17-23) was started in 1962 to encourage Americans to “learn of the dangers of accidental poisoning and to take such preventive measures as are warranted by the seriousness of the danger.” Fifty-seven years later, those threats—and probably some new ones—to personal and public health persist. They can also be prepared for and—in many cases—prevented.

Here are three types of post-disaster poisonings that you should be aware of, and three ways to prepare your health for each.

Carbon monoxide poisoning

Carbon monoxide (or CO) is a silent killer. You can’t see it, smell it, or taste it; yet, there it is any time you burn gasoline, natural gas, charcoal, or kerosene in a car, generator, furnace, grill, or space heater.

A portable generator placed outside and in a dry area on the ground.

Unintentional, non-fire related carbon monoxide (or CO) poisoning takes the lives of at least 430 people and sends another 50,000 people to the emergency department in the U.S. every year. Occurrences of accidental poisonings only increase when—in the aftermath of a disaster or emergency—people try to generate power or warmth or to cook.

Articles detailing the personal health threat posed by CO in the aftermath of hurricanes have appeared in the pages of the Morbidity and Mortality Weekly Report for decades–Hurricane Sandy in 2012, Hurricane Ike in 2008, Hurricane Katrina in 2005, and hurricanes Charley, Frances, Ivan, and Jeanne in 2004. Most recently, 16 of the 129 deaths in in Florida, Georgia, and North Carolina related to Hurricane Irma in 2017, were CO poisonings.

Here are three ways you can prepare for and prevent CO poisoning after a disaster.

  1. Learn how to use a back-up generator safely. Place generators outside, in a dry area, and at least 20 feet from any door, window, or vent. Never run a generator inside your home or garage, even if doors and windows are open.
  2. Install battery-powered or battery backed-up CO detectors in your home. The U.S. Fire Administration recommends that you test your devices at least once a month. Change the batteries in your CO detectors every six months. If your detector alarms, go outside for fresh air and call 911.
  3. Know the symptoms of CO poisoning. The most common symptoms of CO poisoning are headache, dizziness, weakness, upset stomach, vomiting, chest pain, and confusion.

Medication poisoning

Medications are, for the most part, safe when used as prescribed and dosed as directed on the label, but there is the risk of an adverse drug event anytime you bring a medicine into the house. In the wrong hands, medicines are dangerous. More often than anyone would like, the wrong hands belong to kids. About 60,000 young children are taken to emergency rooms each year because they got into medicines.

The threat of medication poisoning in kids and adults is also there in an emergency evacuation when families are forced from their homes and into a shelter, a hotel, or the home of a friend or family. Under stressful circumstances and in unfamiliar surroundings, people can forget to practice safe medication use and storage.

Here are three ways you can prepare for and prevent medication poisoning after a disaster.

  1. Keep all prescription medications and over-the-counter medicines and vitamins, including your emergency supply, Up and Away and out of the reach and sight of children and pets—this includes medicines in suitcases, purses, and “grab and go” bags.
  2. Create an Emergency Action Plan that includes important contact information, such as phone numbers for your physician, pediatrician, pharmacist, veterinarian, and the Poison Control Center: 800-222-1222.
  3. Properly dispose of unused, expired, or contaminated medicines in your medicine cabinet and emergency supply. Discard medications that touched floodwater or have changed in appearance or smell. Contact a pharmacist or healthcare provider if you are unsure about a drug’s safety.

Food poisoning

How to clean and sanitize surfaces that do not soak up water and that may have touched floodwater

Food poisoning symptoms may range from mild to severe and may differ depending on the germ you swallowed. Eating or drinking something contaminated by floodwater, for example, can cause diarrheal disease, such as E. coli or Salmonella infection.

Prolonged power outages can also affect food safety. Perishable foods, such as meats, seafood, and dairy, are unsafe to eat after being in your refrigerator when the power has been off for 4 hours or more. Researchers have identified more than 250 foodborne diseases that can cause a variety of symptoms. Some of the most common symptoms are nausea, vomiting, diarrhea, and stomach cramps.

Here are three ways you can prepare for and prevent food poisoning after a disaster.

  1. When in doubt, throw out any food that may not be safe to eat. That includes foods that have an unusual or unintended odor, color, or texture, foods that may have touched floodwater, and perishable foods that have not been refrigerated properly due to power outages. Never taste food to determine its safety. Food can make you sick even if it looks, smells, and tastes normal.
  2. Throw away wooden cutting boards, baby bottle nipples, and pacifiers if they have come into contact with floodwaters; you cannot properly sanitize them. Clean and sanitize all surfaces in your kitchen, including cutlery and countertops, that come into contact with food.
  3. Handwashing with soap and water is one of the most important practical skills you can learn (and teach to others) to avoid getting sick and spreading germs at all times, including before you handle food—disaster or not. The germs that cause foodborne illnesses can survive in many places around your kitchen, including your hands, utensils, and cutting boards.

Learn more ways to prepare your health for a disaster or an emergency at www.cdc.gov/cpr/prepyourhealth.


At least 133 people have died and more than 200 others have been hospitalized after consuming tainted alcohol in India

CNN

“…..Homemade alcohol is typically brewed in villages before being smuggled into cities, where it sells for about 10 cents a glass — about a third the price of legally brewed liquor…….

Country-made liquor often contains toxic methanol, which can make people feel inebriated. However, even a very small amount can be toxic. Methanol poisoning can cause confusion, dizziness, drowsiness, headaches and the inability to coordinate muscle movements…..”

Human Brucella abortus RB51 Infections and the Consumption of Unpasteurized Domestic Dairy Products — United States, 2017–2019.

Negrón ME, Kharod GA, Bower WA, Walke H. Notes from the Field: Human Brucella abortus RB51 Infections Caused by Consumption of Unpasteurized Domestic Dairy Products — United States, 2017–2019. MMWR Morb Mortal Wkly Rep 2019;68:185. DOI: http://dx.doi.org/10.15585/mmwr.mm6807a6.

“……Since August 2017, CDC has confirmed three cases of brucellosis attributed to Brucella abortus cattle vaccine strain RB51 (RB51). Each case was associated with consumption of domestically acquired unpasteurized (raw) milk products (1). Patient symptoms varied and included fever, headache, overall malaise, and respiratory symptoms. In total, at least eight persons met the probable case definition of a clinically compatible illness epidemiologically linked to a shared contaminated source …..”


Enteroinvasive Escherichia coli Outbreak Associated at a Potluck in North Carolina

Herzig CT, Fleischauer AT, Lackey B, et al. Notes from the Field: Enteroinvasive Escherichia coli Outbreak Associated with a Potluck Party — North Carolina, June–July 2018. MMWR Morb Mortal Wkly Rep 2019;68:183–184. DOI: http://dx.doi.org/10.15585/mmwr.mm6807a5.

The figure is a histogram, an epidemiologic curve showing the number of enteroinvasive Escherichia coli cases, by reported date and period of symptom onset in North Carolina during June 30–July 2, 2018.

“On July 2, 2018, the North Carolina Division of Public Health was notified that approximately three dozen members of an ethnic Nepali refugee community had been transported to area hospitals for severe gastrointestinal illness after attending a potluck party on June 30. The North Carolina Division of Public Health partnered with the local health department and CDC to investigate the outbreak, identify the cause, and prevent further transmission. The investigation included molecular-guided laboratory testing of clinical specimens by CDC, which determined that this was the first confirmed U.S. outbreak of enteroinvasive Escherichia coli (EIEC) in 47 years.

A case was defined as the occurrence of diarrhea, vomiting, or fever ≥101°F (38.3°C) in a person who consumed food served at the party. Cases were identified through medical record review and retrospective cohort investigation with convenience sampling of party attendees. Among approximately 100 attendees, 52 met the case definition. Median age was 31 years (range = 3–76 years); 28 (54%) were hospitalized, including 13 (25%) with sepsis, and eight (15%) who were admitted to an intensive care unit. All patients recovered, and no secondary cases were identified.

Forty-nine persons, including 35 who were ill, were interviewed using a questionnaire to ascertain symptoms, recent travel, and food exposures. Participants also were provided with hand hygiene guidance. Among the 35 ill persons, 30 (86%) reported symptom onset on July 1, the day after the event (Figure). Median interval between eating and symptom onset was 20.5 hours (range = 1–45.5 hours). Overall, 33 (94%) ill persons experienced diarrhea, including 27 (77%), 19 (54%), and two (6%) who reported diarrhea that was watery, mucoid, or bloody, respectively. Thirty-two (91%) ill persons reported fever.

Participants reported eating chicken curry, vegetable curry, rice, lentil soup, fried bread, cold and hot salads, and cake; no imported foods were reported. No single food item was statistically significantly associated with illness; however, 37 persons reported eating chicken curry, and those who did had a 47% higher risk for illness than those who did not (risk ratio = 1.47; 95% confidence interval = 0.76–2.83). No food was available for testing…..”


Ontario, Canada: Listeria monocytogenes Associated with Pasteurized Chocolate Milk

EID

Hanson H, Whitfield Y, Lee C, Badiani T, Minielly C, Fenik J, et al. Listeria monocytogenes Associated with Pasteurized Chocolate Milk, Ontario, Canada. Emerg Infect Dis. 2019;25(3):581-584. https://dx.doi.org/10.3201/eid2503.180742

Outbreak cases of listeriosis (n = 34) by onset week and year, Ontario, Canada, November 2015–August 2016. Data were obtained from the Ontario Ministry of Health and Long-Term Care, integrated Public Health Information System database, extracted by Public Health Ontario, August 16, 2016. One case with an onset date during January 2016 occurred in week 52 of 2015 (according to the Public Health Agency of Canada epidemiologic week calendar). *Neonatal case-patient with symptom onset on April 4, 20

Figure 1. Outbreak cases of listeriosis (n = 34) by onset week and year, Ontario, Canada, November 2015–August 2016. Data were obtained from the Ontario Ministry of Health and Long-Term Care, integrated Public Health Information System database, extracted by Public Health Ontario, August 16, 2016. Weeks are defined according to the Public Health Agency of Canada epidemiologic week calendar. *Neonatal case-patient with symptom onset on April 4, 2016 (week 14), and illness most likely caused by mother-to-child transmission. **Asymptomatic case-patient from whom a specimen was collected on July 13, 2016, and exposure occurred before June 27, 2016 (week 28).

Bags of pasteurized chocolate milk as sold in Canada, with outer bag containing brand information removed. A bag of milk similar to these, found at the home of 1 case-patient during investigation of an outbreak of Listeria monocytogenes infection associated with pasteurized chocolate milk in Ontario, Canada, was found to be contaminated with the same strain obtained from infected patients.

Figure 2. Bags of pasteurized chocolate milk as sold in Canada, with outer bag containing brand information removed. A bag of milk similar to these, found at the home of 1 case-patient during investigation of an outbreak of Listeria monocytogenes infection associated with pasteurized chocolate milk in Ontario, Canada, was found to be contaminated with the same strain obtained from infected patients.

 


Why is there a decline in Salmonella infections in NYC restaurants?

Restaurant Inspection Letter Grades and Salmonella Infections, New York, New York, USA PDF Version[PDF – 506 KB – 5 pages]

M. J. Firestone and C. W. Hedberg
EID
Volume 24, Number 12—December 2018
Rates of Salmonella infection in the United States have not changed over the past 20 years. Restaurants are frequent settings for Salmonella outbreaks and sporadic infections. Few studies have examined the effect of posting letter grades for restaurant inspections on the incidence of foodborne illness. We compared Salmonella infection rates in New York, New York, USA (NYC), with those in the rest of New York state before and after implementation of a letter grade system for restaurant inspections in NYC. We calculated a segmented regression model for interrupted time series data. After implementation of letter grading, the rate of Salmonella infections decreased 5.3% per year in NYC versus the rest of New York state during 2011–2015, compared with the period before implementation, 2006–2010. Posting restaurant inspection results as letter grades at the point of service was associated with a decline in Salmonella infections in NYC and warrants consideration for broader use.
                                                        

Now, 52 people have been infected with E. coli in this Romaine lettuce outbreak

Epi curve of people infected with the outbreak strain of E. coli, by date of illness onset, as of December 6, 2018

At A Glance

 


Reports of 11 more Escherichia coli O157:H7 illnesses linked to the Romaine lettuce outbreak.

CDC

Based on new information, CDC is narrowing its warning to consumers. CDC is advising that U.S. consumers not eat and retailers and restaurants not serve or sell any romaine lettuce harvested from the Central Coastal growing regions of northern and central California. If you do not know where the romaine is from, do not eat it.

Map of United States - People infected with the outbreak strain of E. coli, by state of residence, as of November 26, 2018

  • Romaine lettuce products will be labeled with a harvest location by region. It may take some time before these labels are available.
    • If the romaine lettuce is not labeled with a harvest growing region, do not buy, serve, sell, or eat it.
  • Check bags or boxes of romaine lettuce for a label indicating where the lettuce was harvested. Romaine lettuce labeled with a harvest region outside of the Central Coastal growing regions of northern and central California (such as the desert growing region near Yuma, the California desert growing region near Imperial County and Riverside County, the state of Florida, and Mexico) is not linked to this outbreak.
  • If you do not know where your romaine lettuce was harvested, do not eat it and throw it away.
    • This advice includes all types or uses of romaine lettuce, such as whole heads of romaine, hearts of romaine, and bags and boxes of precut lettuce and salad mixes that contain romaine, including baby romaine, spring mix, and Caesar salad.
    • If you do not know if the lettuce is romaine or whether a salad mix contains romaine, do not eat it and throw it away.
    • Wash and sanitize drawers or shelves in refrigerators where romaine was stored. Follow these five steps to clean your refrigerator.
  • Restaurants and retailers should check the label on bags or boxes of romaine lettuce, or ask their suppliers about the source of their romaine lettuce.
    • Do not sell or serve any romaine lettuce harvested from the Central Coastal growing regions of northern and central California.
    • If you do not know where your romaine lettuce was harvested, do not sell or serve it.
  • Hydroponically or greenhouse-grown romaine lettuce has not been linked to this outbreak.
  • Take action if you have symptoms of an E. coli infection:
    • Talk to your healthcare provider.
    • Write down what you ate in the week before you started to get sick.
    • Report your illness to the health department.
    • Assist public health investigators by answering questions about your illness.

Advice to Clinicians

  • Antibiotics are not recommended for patients with E. coli O157 infections. Antibiotics are also not recommended for patients in whom E.coli O157 infection is suspected, until diagnostic testing rules out this infection.
  • Some studies have shown that administering antibiotics to patients with E. coli O157 infections might increase their risk of developing hemolytic uremic syndrome (a type of kidney failure), and the benefit of antibiotic treatment has not been clearly demonstrated.

Latest Outbreak Information

Illustration of a megaphone.

At A Glance

Photo of romaine lettuce in a wood bowl.

  • Since the last update on November 20, an additional 11 ill people have been included in this investigation.
  • Forty-three people infected with the outbreak strain of Shiga toxin-producing E. coli O157:H7 have been reported from 12 states.
    • Illnesses started on dates ranging from October 8, 2018 to October 31, 2018.
    • Sixteen people have been hospitalized, including one person who developed hemolytic uremic syndrome, a type of kidney failure. No deaths have been reported.
  • The Public Health Agency of Canada has identified ill people infected with the same DNA fingerprint of E. coli O157:H7 bacteria in Canada.
  • Epidemiologic and traceback evidence from the United States and Canada indicates that romaine lettuce harvested from the Central Coastal growing regions of northern and central California is a likely source of the outbreak.
  • Ill people in this outbreak were infected with E. coli bacteria with the same DNA fingerprint as the E. coli strain isolated from ill people in a 2017 outbreak linked to leafy greens in the United States and to romaine lettuce in Canada. The current outbreak is not related to a spring 2018 multistate outbreak of E. coli O157:H7 infections linked to romaine lettuce.
  • CDC is advising that consumers not eat any romaine lettuce harvested from the Central Coastal growing regions of northern and central California. No common grower, supplier, distributor, or brand of romaine lettuce has been identified.
  • This investigation is ongoing, and CDC will provide more information as it becomes available.

Symptoms of E. coli Infection

Illustration of a person with stomach pain.
  • People usually get sick from Shiga toxin-producing E. coli (STEC) 2–8 days (average of 3–4 days) after swallowing the germ.
  • Some people with a STEC infection may get a type of kidney failure called hemolytic uremic syndrome (HUS).
  • E. coli infection is usually diagnosed by testing a stool sample.
  • Antibiotics are not recommended for patients with suspected E. coli infections until diagnostic testing can be performed and E. coli infection is ruled out. Some studies have shown that administering antibiotics to patients with E. coli infections might increase their risk of developing HUS, and a benefit of treatment has not been clearly demonstrated.
  • For more information, see Symptoms of E. coli Infection.

Investigation Details

November 26, 2018

CDC, public health and regulatory officials in several states, Canada, and the FDA are investigating a multistate outbreak of Shiga toxin-producing Escherichia coli O157:H7 (E. coli O157:H7) infections.

As of November 26, 2018, 43 people infected with the outbreak strain of E. coli O157:H7 have been reported from 12 states. A list of the states and the number of cases in each can be found on the Map of Reported Cases page.

Illnesses started on dates ranging from October 8, 2018 to October 31, 2018. Ill people range in age from 1 to 84 years, with a median age of 25. Sixty-nine percent of ill people are female. Of 38 people with information available, 16 (42%) have been hospitalized, including one person who developed hemolytic uremic syndrome, a type of kidney failure. No deaths have been reported.

Illnesses that occurred after October 31, 2018, might not yet be reported due to the time it takes between when a person becomes ill with E. coli infection and when the illness is reported. This takes an average of two to three weeks.

Investigation of the Outbreak

Epidemiologic and traceback evidence indicates that romaine lettuce from the Central Coastal growing regions of northern and central California is a likely source of this outbreak.

In interviews, ill people answered questions about the foods they ate and other exposures in the week before they became ill. Twenty-two (88%) of 25 people interviewed reported eating romaine lettuce. This percentage is significantly higher than results from a survey[PDF – 787 KB] of healthy people in which 47% reported eating romaine lettuce in the week before they were interviewed. Ill people reported eating different types of romaine lettuce in several restaurants and at home.

Preliminary traceback information from the FDA indicates that ill people in this outbreak ate romaine lettuce harvested from the Central Coastal growing regions of northern and central California. At this time, no common grower, supplier, distributor, or brand of romaine lettuce has been identified. CDC is advising that consumers not eat and restaurants and retailers not sell any romaine lettuce from the Central Coastal growing regions of northern and central California.

This investigation is ongoing, and CDC will provide more information as it becomes available.


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