Wednesday, October 21, 2015

California Restaurant Source of Shigella - Number of Cases Continues to Climb

UPDATE (10/23/15)- Within a few days, the number of Shigella cases linked to a California restaurant continues to climb.  Reports now have the number at 110 cases in 4 different California Counties.

A California restaurant is being held responsible for up to 80 people becoming infected with Shigella with about a dozen becoming hospitalized.  Because this is a highly contagious bacterial infection, a number of secondary infections are beginning to arise. (People who are contracting the disease from someone who ate at the restaurant).
Shigella causes severe diarrhea, sometimes bloody, as well as fever and abdominal pain. Symptoms will occur within a day or two after infection and will last 5 to 7 days.  It is highly infectious, only requiring less than 20 cells to cause infection.  It spreads through contact with food or person to person which can be problematic when someone has profuse diarrhea and does not wash their hands or washes their hand insufficiently. 
Glove usage handling ready-to-eat foods would help...but that is not a law in CA.  In 2014, California repealed the law requiring glove usage to prevent bare hand contact with ready-to-eat food.

Getting sick workers to stay home is another issue.  Many people will still go to work even if they are ill.
Rod-shaped, drug-resistant Shigella bacteria 

Channel 7 ABC News
Shigella outbreaks spreads to 4 Bay Area counties, 110 suspected cases
By David Louie
Thursday, October 22, 2015 10:51AM
SAN JOSE, Calif. (KGO) --
The Shigella outbreak linked to a South Bay seafood restaurant has now grown to 110 suspected cases and has spread to a total of four Bay Area counties.

Mariscos San Juan, a popular restaurant in San Jose, was closed down over the weekend following dozens of people's reporting diarrhea and fever after eating there. Public health officials believe it to be Shigella, a form of bacteria that is highly infectious.

Of the reported 110 suspected Shigella cases, 92 are in Santa Clara County and the 18 others in Santa Cruz, Alameda and San Mateo counties.

Meissner was masking how he felt after winding up in the emergency room for seven hours at O'Connor Hospital Saturday night. He developed a 105 degree fever and other symptoms consistent with Shigella after eating a ceviche tostada the day before at Mariscos San Juan #3 on North 4th Street in San Jose.

"It is an extremely high fever, really bad chills, extremely bad cramping, constant running to the bathroom, nausea, vomiting, dizziness," he explained.

The cause of the outbreak is still under investigation, but is slowed by the fact some restaurant employees have not yet turned in stool samples for testing. County health officers believe the reason may be secondary infections as the highly contagious bacteria spreads.

This is believed to be the largest outbreak of Shigella to occur in Santa Clara County.

In 2000, more than 220 people got sick from Shigella bacteria at a Mexican restaurant in Redwood City that is no longer in business.

More lawsuits are expected in the San Jose outbreak.

According to the CDC, the symptoms of Shigella include diarrhea, fever and stomach cramps starting a day or two after being exposed to the bacteria. The symptoms usually go away in 5-10 days. Shigella can be stopped by frequent and careful hand-washing with soap. Click here for further details on Shigella from the CDC.

Meanwhile, a lawsuit was filed by the dean of students at a local high school who's been a customer at the restaurant for a couple years. Greg Meissner went to the restaurant on Friday for take-out. By the next day, he was taken down by Shigella.

San Jose Mercury News
San Jose restaurant food poisoning: More than 80 sick after outbreak at Mariscos San Juan
By Joe Rodriguez
Posted: 10/20/2015 08:37:46 AM PDT
SAN JOSE -- Santa Clara County health officials Tuesday said up to 80 people have been sickened and 12 required intensive care treatment at hospitals after contracting Shigella, an easily transmittable bacteria, traced to a downtown seafood eatery, and they feared more than 100 other people could become infected over the next few days.

"It's very, very infectious," Public Health Director Sara Cody said during a news conference. "It doesn't take very much for this bacteria to spread."
Shigella can be very serious and, in rare cases, fatal, county officials said.
Health authorities on Sunday shut down Mariscos San Juan, a Mexican seafood restaurant in downtown San Jose that appears to be the only source of this outbreak. They have since been trying to alert people who ate there last Friday and Saturday and may be vulnerable to the microbe, which causes severe fever, diarrhea and stomach pain and can be spread quickly to others.
Symptoms can take as long as a week to appear, but most often begin one to four days after infection.
"I've never been this sick," said Erika Funes, a San Jose mother of two who lunched at Mariscos San Juan on Friday. It was her first visit to the restaurant. After her temperature shot up to 105.2 degrees that night, a relative drove her to the emergency room at O'Connor Hospital in west San Jose.
"I'm feeling better now, but I still have some stomach pain," she said on Tuesday, "My main concerns are my two little ones at home. I don't want them to get infected."
Funes said she ended up at O'Connor twice -- before doctors knew exactly what they were dealing with and again after the Shigella outbreak had become known. Cody said victims wound up at several hospitals in the region. All are expected to recover.
Cody said the virulence of Shigella bacteria can vary, but that this strain is of "a garden variety" that is treatable with antibiotics.
Even so, she said, it could be harmful to the people with weak immune systems, including sickly children and elderly adults. None of the victims known by Tuesday morning included children, she said. By Tuesday evening, 15 infections had been confirmed as Shigella.
Some of the 80 cases included people who did not eat at the restaurant, but were infected later, probably by customers who had.
"We're beginning to see a small wave of secondary infections," Cody said, adding that Shigella travels quickly because it takes only 10 to 20 bacteria to infect someone. To help control the spread of this disease, county officials said people should carefully wash their hands with soap and water, and those who are ill should not prepare or handle food for others.
Health officials suspect the disease was spread by a contaminated food handler, but said "all possible sources of contamination are currently being investigated." A local hospital alerted the department to about five cases on Saturday, and the county closed the restaurant Sunday after officials determined that dozens of customers who ate there had come down with symptoms.
Mariscos San Juan owner Sergio Becerra Cruz was unavailable for comment Tuesday. He has two other restaurants of the same name on Willow Street and Senter Road in San Jose, where health inspectors found nothing wrong or suspicious. They remain open. County officials Tuesday said the Fourth Street Mariscos would remain closed "until the safety of the public can be assured."
Michael Balliet, head of the county consumer protection division, said the downtown restaurant was cited for one major health code violation in early August for using improper methods to cool shrimp tacos. The restaurant corrected the method the same day.
Dr. George Han, the county's lead investigator in the Mariscos San Juan outbreak, said infected kitchen workers typically transmit the bacteria to food after not washing their hands properly, and then customers ingest the microbe through the food.
In 2000, health officials blamed salsa contaminated with Shigella for the death of one woman and the sickness of more than 100 other people who ate at Viva Mexico, a popular Mexican restaurant in Redwood City. The owners renamed it and paid $55,000 in fines to county authorities.
The relatively simple method of infection is what worries Santa Clara County health officials. Han said the number of infections could rise to 100 or more within days.
County officials urged anyone who ate at the Fourth Street Mariscos on Friday or Saturday to seek medical attention if they become ill.
"If we can stop the spread," Han said, "hopefully this could all end this week."
Mercury News Staff Writer Mark Gomez contributed to this report. Contact Joe Rodriguez at
CDC Website
Shigellosis is a diarrheal disease caused by a group of bacteria called Shigella. Shigella causes about 500,000 cases of diarrhea in the United States annually 1. There are four different species of Shigella:
  • Shigella sonnei (the most common species in the United States)
  • Shigella flexneri
  • Shigella boydii
  • Shigella dysenteriae
S. dysenteriae and S. boydii are rare in the United States, though they continue to be important causes of disease in the developing world. Shigella dysenteriae type 1 can cause deadly epidemics 2.
Symptoms of shigellosis typically start 1–2 days after exposure and include:
  • Diarrhea (sometimes bloody)
  • Fever
  • Abdominal pain
  • Tenesmus (a painful sensation of needing to pass stools even when bowels are empty)
In persons with healthy immune systems, symptoms usually last about 5 to 7 days. Persons with diarrhea usually recover completely, although it may be several months before their bowel habits are entirely normal. Once someone has had shigellosis, they are not likely to get infected with that specific type again for at least several years. However, they can still get infected with other types of Shigella.
Possible complications from Shigella infections include:
  • Post-infectious arthritis. About 2% of persons who are infected with Shigella flexneri later develop pains in their joints, irritation of the eyes, and painful urination. This is called post-infectious arthritis. It can last for months or years, and can lead to chronic arthritis. Post-infectious arthritis is caused by a reaction to Shigella infection that happens only in people who are genetically predisposed to it 2.
  • Blood stream infections. Although rare, blood stream infections are caused either by Shigella organisms or by other germs in the gut that get into the bloodstream when the lining of the intestines is damaged during shigellosis. Blood stream infections are most common among patients with weakened immune systems, such as those with HIV, cancer, or severe malnutrition 2.
  • Seizures. Generalized seizures have been reported occasionally among young children with shigellosis, and usually resolve without treatment. Children who experience seizures while infected with Shigella typically have a high fever or abnormal blood electrolytes (salts), but it is not well understood why the seizures occur 2.
  • Hemolytic-uremic syndrome or HUS. HUS occurs when bacteria enter the digestive system and produce a toxin that destroys red blood cells. Patients with HUS often have bloody diarrhea. HUS is only associated with Shiga-toxin producing Shigella, which is found most commonly in Shigella dysenteriae 2.
Shigella germs are present in the stools of infected persons while they have diarrhea and for up to a week or two after the diarrhea has gone away. Shigella is very contagious; exposure to even a tiny amount of contaminated fecal matter—too small to see-- can cause infection. Transmission of Shigella occurs when people put something in their mouths or swallow something that has come into contact with stool of a person infected with Shigella. This can happen when:
  • Contaminated hands touch your food or mouth. 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. Hands can also become contaminated with Shigella while changing the diaper of an infected child or caring for an infected person.
  • Eating food contaminated with Shigella. Food may become contaminated if food handlers have shigellosis. Produce can become contaminated if growing fields contain human sewage. Flies can breed in infected feces and then contaminate food when they land on it.
  • Swallowing recreational (for example lake or river water while swimming) or drinking water that was contaminated by infected fecal matter.
  • Exposure to feces through sexual contact.
LA Times
California Legislature repeals glove law for food handlers

California lawmakers have pulled an about-face on a controversial change to the state's health code that bans restaurant workers from touching food with their bare hands and requires chefs and bartenders to wear gloves.

The Senate voted 32 to 0 Thursday to repeal the law that went into effect Jan. 1. The measure was previously approved by the Assembly.

A sweeping backlash against the glove law helped propel efforts to quash the bare-hand ban, which was intended to curb food-borne illnesses.

"After that bill was enacted a vast number of our local restaurants and bars raised very serious questions about the prohibition," Sen. Kevin de León (D-Los Angeles) told his colleagues in Sacramento. He noted that the proposed repeal, AB 2130, would return previous language to the health code that says employees should "minimize" bare-handed contact with food.

It's a coup for restaurant industry workers who petitioned in support of a repeal, arguing that hand washing is as effective as wearing gloves, without the added cost or environmental effects of what would amount to millions of discarded gloves.
After that bill was enacted a vast number of our local restaurants and bars raised very serious questions about the prohibition.- Sen. Kevin de León

De León said the bill had to be approved Thursday so Gov. Jerry Brown would have time to sign it before local health agencies begin enforcing it, following a six-month grace period, on Tuesday.

Assemblyman Richard Pan (D-Sacramento), who introduced the bill, said he was confident the governor would sign the repeal measure.

The ban applies to bartenders, who often use bare hands to prepare and garnish cocktails.

"It was going to cost bars a lot of money, not just in the number of gloves," said bartender Joshua Miller of Alameda, Calif. "Having to change gloves constantly slows down service, and for a busy bar, time is money. Yet nobody outside of the corporate bar and restaurant community knew anything about it.
This law would have made people less safe because of a false sense of security.- Iso Rabins

"My initial reaction was, 'Where do I sign the petition [against it]?' But there wasn't one," said Miller, who in February created a petition opposing the law on

His petition and one started by Iso Rabins, founder of a business incubator for food makers in San Francisco, garnered more than 19,000 signatures combined.

"This law would have made people less safe because of a false sense of security. You're less aware of your hands being dirty and more likely to engage in risky behavior. You touch chicken, touch the trash, touch something else," Rabins said.

Food safety experts say hand washing doesn't occur enough in general, whether workers are bare-handed or wearing gloves. A study by the Centers for Disease Control on hand washing and hygiene behavior in restaurants found that workers who wore gloves were less likely than those not using gloves to wash their hands when they should.

"The good thing that came out of this is awareness," said Mary FitzGerald of Safe & Sound Food Safety Consultants. "There should be more emphasis on training and not whether you use gloves or not. It's something that everybody's not doing enough of."

Legislators may yet revisit the issue.

"It is the industry standard in restaurants to prioritize cleanliness when handling food, and the repeal of the glove law will still emphasize these standards," Assemblyman Pan said. "Unfortunately the focus from last year's law was just on gloves, and until we repeal the glove law we can't have a meaningful stakeholder discussion on food safety in the restaurant industry."

Los Angeles chefs who spoke vehemently against the law said they were relieved by the impending repeal.

Neal Fraser, the chef behind several L.A. restaurants including the soon-to-open Redbird at Vibiana, said Thursday of the repeal legislation, "I think it's a good thing, it's a very amazing thing. It's especially good for the environment.

"And do I think that not wearing gloves and washing hands is better than wearing gloves and not washing your hands? Absolutely."

Many cooks who already use gloves will continue to do so.

"The Subways of the world already have internal corporate policies in place requiring glove use," said Jordan R. Bernstein, an attorney at Michelman & Robinson in Encino, who works with restaurant clients and has publicly opposed the law. "This was a quick-trigger attempt by the Legislature to fix a problem but without actually analyzing the issues."

At Sushi Gen in Little Tokyo, chef Toshiaki Toyoshima and his kitchen staff have been wearing gloves since January, despite the enforcement grace period, to get used to shaping sushi with gloved fingers.

"We get so many calls complaining about the gloves," said Toyoshima, who is also vice president of the Japanese Restaurant Assn. of Southern California. "Many sushi chefs will be happy."
Twitter: @bettyhallock

Patrick McGreevy in Sacramento contributed to this report.

1 comment:

  1. Thanks for the information dear!! I was also thinking to book this restaurant for my official Christmas party but the corporate event planning firm I hired for this event suggested me other restaurants that are much affordable and provide better services than this one. So I would book one of those party places.