Tuesday, August 25, 2015

CDC Report - Human Plague Cases in Western US

 There have been 11 cases of human plague with 3 deaths.  Cases are based in western US and are associated with the fleas, often those found on squirrels or other rodents.

"Plague circulates among wild rodents and their fleas in rural and semirural areas in the western United States (2). Transmission to humans occurs through the bite of infected fleas, direct contact with infected body fluids or tissues, or inhalation of respiratory droplets from ill persons or animals, including ill domesticated cats and dogs (3). The usual incubation period between exposure and illness onset is 2–6 days."

A 2012 case occurred in Oregon where a man wrestled a dead rat out of a cat's mouth.  From that posting: Yersinia pestis, a gram negative organism, is one of the most pathogenic organisms known. It can infect through lesions in the skin (such as a flea bite) where it infects the lymphnodes and then invades other organs where it causes massive tissue destruction. Gangrene often sets in on the dead tissue. It can also spread through inhalation of infective respiratory particles (pneumonia). Disease is initially characterized by development of one or more inflamed, swollen lymph nodes (buboes), and then chills and fever, lethargy and confusion. Historically, the fatality rate was greater than 50%, but now with antibiotics, it is 16% (below).

CDC - MMWR
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm64e0825a1.htm?s_cid=mm64e0825a1_e
Human Plague — United States, 2015

Early Release
August 25, 2015 / 64(Early Release);1-2
Natalie Kwit, DVM1,2; Christina Nelson, MD2; Kiersten Kugeler, PhD2; Jeannine Petersen, PhD2; Lydia Plante, MSPH3; Hayley Yaglom, MPH3; Vicki Kramer, PhD4; Benjamin Schwartz, MD5; Jennifer House, DVM6; Leah Colton, PhD6; Amanda Feldpausch, MPH7; Cherie Drenzek, DVM7; Joan Baumbach, MD8; Mark DiMenna, PhD9; Emily Fisher, MD1,10; Emilio Debess, DVM10; Danielle Buttke, DVM11; Matthew Weinburke, MPH11; Christopher Percy, MD12; Martin Schriefer, PhD2; Ken Gage, PhD2; Paul Mead, MD2

Since April 1, 2015, a total of 11 cases of human plague have been reported in residents of six states: Arizona (two), California (one), Colorado (four), Georgia (one), New Mexico (two), and Oregon (one). The two cases in Georgia and California residents have been linked to exposures at or near Yosemite National Park in the southern Sierra Nevada Mountains of California. Nine of the 11 patients were male; median age was 52 years (range = 14–79 years). Three patients aged 16, 52, and 79 years died.

Consumer Reports Ground Meat Report - Hype versus True Risk

Consumer reports released a study of pathogenic bacteria found in ground beef titled – How Safe Is Your Ground Beef . The tag line – “If you don’t know how the ground beef you eat was raised, you may be putting yourself at higher risk of illness from dangerous bacteria. You okay with that?”

So Consumer Reports bought 300 packages of ground meat and tested for E. coli (including O157 and six other toxin-producing strains), enterococcus, salmonella, and staphylococcus aureus. Plus they tested for antibiotic resistance.
Results –
· All samples contained indicator organisms – enterococcus and generic E. coli.
· C. perfringens – 20 percent of the samples.
· S. aureus – 10 percent of the samples
· Salmonella – 1 percent
· Beef from conventionally raised cows was more likely to have bacteria overall, as well as bacteria that are resistant to antibiotics, than beef from sustainably raised cows. 18 percent of conventional beef samples were contaminated with superbugs—the dangerous bacteria that are resistant to three or more classes of antibiotics—compared with just 9 percent of beef from samples that were sustainably produced.
· The rest of the article goes on to state why they believe sustainably produced is safer than conventional.

Agree – there are pathogens, namely Salmonella and STEC E. coli, that can be present in meat, and when that meat is ground, these pathogens are distributed throughout. So if you undercook ground meat (aka rare or medium rare), the pathogens, if present, can survive and then may cause illness. So it is important to cook ground meat to 160ºF. and of course, verify with a thermometer.

The fact that ALL samples contained enterococcus and generic E. coli shows that ground meat is not sterile and because the indicators are present, we know that there is always the likelihood of pathogens being present. But it is important to point out, there was a very low levels of Salmonella and that no pathogenic E. coli were able to be isolated from their samples.

The study also looked at the prevalence (absence vs presence) for S. aureus and C. perfrigens as a indicator of safety.   First, these organisms only cause illness when the numbers are exceedingly high, so just being present is not as important as the number. These organisms are commonly found in the environment and in food at low numbers that have no health effect. Humans have a high prevalence of S. aureus in their nasal passage and C. perfringens in their intestines.

The antibiotic resistance numbers were not clear cut in that there are many variables. This is not anything different than has been found before.   However, the prevalence of the two most important pathogens in beef related illnesses (STEC E.coli and Salmonella) were too low, so nothing could be said with regard to that.   And there was no differentiation on which antibiotics (those used for humans, those used for animals, and those not really used).   

Unlike studies that are published in peer-reviewed journals, this study is not peer reviewed.  Also, it would have been better to look at numbers for S. aureus and C. perfringens rather than prevalence.

The other issue is determining what is more sustainable....that is, what provides the lowest carbon footprint while being able to feed a growing population.

Take home– if you want to buy organic or grass fed beef because you think it tastes better, great....if you are willing and able to pay the higher price.  But saying it is safer based upon these results may be more hype than true risk.  But of course the main stream media will push the hype.

Regardless, it is important to cook ground meat to the proper temperature and to handle it properly.

Monday, August 24, 2015

Coriander Powder Recalled Due to Sample Testing Positive for Salmonella

A New Jersey company is recall 14.1 oz containers of coriander powder after FDA testing found a sample positive for Salmonella.  No injuries have been reported.


FDA Recall Notice
http://www.fda.gov/Safety/Recalls/ucm459332.htm
Chetak New York L.L.C. Recalls 14.1 oz. Jar of "Deep Coriander Powder" Because of Possible Health Risk

Contact:  Consumer: 1-973-835-1906

FOR IMMEDIATE RELEASE – August 20, 2015 – Edison, NJ – Chetak New York L.L.C. of Edison, NJ is recalling 300 jars of 14.1 oz "Deep Coriander Powder", Lot# LE15152, because they have the potential to be contaminated with Salmonella, an organism which can cause serious and sometimes fatal infections in young children, frail or elderly people, and others with weakened immune systems. Healthy persons infected with Salmonella often experience fever, diarrhea (which may be bloody), nausea, vomiting and abdominal pain. In rare circumstances, infection with Salmonella can result in the organism getting into the bloodstream and producing more severe illnesses such as arterial infections (i.e. infected aneurysms), endocarditis and arthritis.

The recalled "Deep Coriander Powder" jars were distributed nationwide in retail store from July 30, 2015 to August 13, 2015. The product comes in a 14.1oz clear plastic jar marked with the UPC number on the rear of the package. The lot number can be located on the bottom of the jar.

Friday, August 14, 2015

Report on Antimicrobial Resistance in Salmonella and Campylobacter

The FDA released its 2012-2013 National Antimicrobial Resistance Monitoring System (NARMS) Integrated Report.  The results are mostly encouraging.  From the report:
  1. About 80% of human Salmonella isolates are not resistant to any of the tested antibiotics.
  2.  Salmonella multi-drug resistance (resistance to three or more classes of antibiotics) in human, cattle, and chicken isolates has not changed (~10%) in the last decade, and the numbers of multi-drug resistant Salmonella isolates in retail chicken have gone down (~3%).   
  3. But two types of Salmonella do show some increases.  Multidrug resistance (MDR) in human isolates of a common Salmonella serotype (l 4,[5],12:i:-) continues to rise. Resistance has more than doubled from 18% in 2011 to 46% in 2013.  And anincrease in MDR and ceftriaxone resistance was also observed in Salmonella serotype Dublin isolated from cattle and human sources.
  4. Campylobacter jejuni resistance to the fluoroquinolone ciprofloxacin, the most common antibiotic used to treat human C. jejuni illness, was at its lowest level in retail chicken to date (11%).
 FDA News Release
FDA Releases 2012 and 2013 NARMS Integrated Annual Report; Finds Some Improvement in Antibiotic Resistance Trends in Recent Years
August 11, 2015
The U.S. Food and Drug Administration has released its 2012-2013 National Antimicrobial Resistance Monitoring System (NARMS) Integrated Report. This report replaces FDA’s annual NARMS Executive Summary report and highlights antimicrobial resistance patterns in bacteria isolated from humans, retail meats, and animals at slaughter. Specifically, the report focuses on major foodborne pathogens that are resistant to antibiotics that are considered important to human medicine, and on multidrug resistant pathogens (described as resistant to three or more classes of antibiotics).

Sprouter Issues Third Recall Notice Due to Listeria

A Virginia company has issued a recall for soybean sprouts and mung bean sprouts after the samples of the product were found to be positive.  The testing was conducted by Virginia Laboratory Services.

This is the third recall issued by this producer, with earlier recalls coming in May and June.  Do you think they have a problem?  One could also wonder what was required of this company before they were allowed to begin producing again.

Further, this shows how Listeria can be difficult to eliminate once it becomes established.


FDA Recall Notice
http://www.fda.gov/Safety/Recalls/ucm458037.htm
Good Seed Inc. Recalls Soybean Sprouts & Mung Bean Sprouts Due To A Possible Health Risk

Contact:  Consumer:  (703) 392-0075

FOR IMMEDIATE RELEASE – August 3, 2015 – Springfield, VA – Good Seed Inc. of Springfield, VA is voluntarily recalling all packages of soybean sprouts and mung bean sprouts because they have the potential to be contaminated with Listeria monocytogenes, an organism which can cause serious and sometimes fatal infections to individuals with weakened immune systems. Although healthy individuals may suffer only short term symptoms such as high fever, severe headache, stiffness, nausea, abdominal pain and diarrhea, Listeria infection can cause miscarriages and stillbirths among pregnant women.

MMWR - Outbreaks Associated with Drinking Water - 2011-2012

 We generally regard drinking water safe, and rightfully so.  For the amount of water that is consumed each day, there have been relatively few issues.  An MMWR article reports that in the two year period reviewed, 2011-2012, there have been 32 water related outbreaks resulting in 431 cases of illness, 102 hospitalizations, and 14 deaths.

The biggest culprit was Legionella and this was primarily related to drinking water in hospitals affecting at-risk patients.  While we hear of Legionella in air conditioning systems, such as the current issue in NY where over 100 have become ill and 12 have died (Legionella grows in the cooling water systems and then is inhaled through the water vapors), evidently Legionella is an issue in hospitals (along with other HAIs (hospital acquired infections) including Clostridium difficile, MRSA, etc).  "Legionella outbreaks are particularly challenging to prevent and control, in part because the organism lives and multiplies in building plumbing systems, which usually fall outside water utility and regulatory oversight (6,7). One Legionella outbreak occurred in a hotel that used point-of-entry water filters, which effectively dechlorinated all water entering the building, and illustrates the importance of maintaining sufficient residual disinfectant in plumbing systems."

EPA has a publication on Legionella in drinking water.

The other issue was non-community water systems.  "All five noncommunity outbreaks originated from groundwater sources. Specifically, four occurred in outdoor camp or work settings where a source spring was contaminated directly or by inflow from a stream, and the fifth occurred at a meeting facility where a well was contaminated with septic tank overflow."  In these cases, Norovirus, non-Legionella bacteria, and Giardia (a parasite) were responsible.   (You are probably wondering how you ever made it through summer camp as a kid considering the pond water where you swam and that nasty spigot you drank from....and you are also then wondering why your parents sent you there.)

Here, an elk enjoys a drink of water from a spigot used for filling water bottles at Grand Canyon National Park (photo courtesy of Nika Bucknavage).


CDC MMWR
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6431a2.htm?s_cid=mm6431a2_e
Surveillance for Waterborne Disease Outbreaks Associated with Drinking Water — United States, 2011–2012

Weekly
August 14, 2015 / 64(31);842-848
Karlyn D. Beer, PhD1,2; Julia W. Gargano, PhD2; Virginia A. Roberts, MSPH2; Vincent R. Hill, PhD2; Laurel E. Garrison, MPH3; Preeta K. Kutty, MD3; Elizabeth D. Hilborn, DVM4; Timothy J. Wade, PhD4; Kathleen E. Fullerton, MPH2; Jonathan S. Yoder, MPH, MSW2

Advances in water management and sanitation have substantially reduced waterborne disease in the United States, although outbreaks continue to occur (1). Public health agencies in the U.S. states and territories* report information on waterborne disease outbreaks to the CDC Waterborne Disease and Outbreak Surveillance System (http://www.cdc.gov/healthywater/surveillance/index.html). For 2011–2012, 32 drinking water–associated outbreaks were reported, accounting for at least 431 cases of illness, 102 hospitalizations, and 14 deaths. Legionella was responsible for 66% of outbreaks and 26% of illnesses, and viruses and non-Legionella bacteria together accounted for 16% of outbreaks and 53% of illnesses. The two most commonly identified deficiencies† leading to drinking water–associated outbreaks were Legionella in building plumbing§ systems (66%) and untreated groundwater (13%). Continued vigilance by public health, regulatory, and industry professionals to identify and correct deficiencies associated with building plumbing systems and groundwater systems could prevent most reported outbreaks and illnesses associated with drinking water systems.

Cyclospora Update - 457 reported cases

As of August 11, 2015, CDC is reporting that there have been 457 cases of Cyclospora infection.  Cilantro has been identified as a potential source.
 
   
CDC News Release
Cyclosporiasis Outbreak Investigations — United States, 2015
 
Last Updated August 11, 2015 4:00 PM EDT
 
Read the related statement from the U.S. Food and Drug Administration
Cyclospora cayetanensis is a single-celled parasite that causes an intestinal infection called cyclosporiasis.
  • As of August 10, 2015 (3pm EDT), CDC had been notified of 457 ill persons with confirmed Cyclospora infection from 29 states in 2015.
  • Most of these persons—275 (60%) of 457—experienced onset of illness on or after May 1, 2015, and did not have a history of international travel within 2 weeks before illness onset. These 275 persons were from the following 22 states: Arkansas (2), California (2), Connecticut (3), Florida (11), Georgia (22), Illinois (6), Iowa (1), Kansas (2), Maryland (1), Massachusetts (9), Michigan (2), Missouri (1), Montana (3), Nebraska (1), New Jersey (6), New Mexico (1), New York (excluding NYC) (8), New York City (21), Texas (157), Utah (1), Virginia (3), Washington (2), and Wisconsin (10).