CDC Report - 2017 Norovirus Outbreak Highlights the Need for Facility Controls

In CDC MMWR, a report discusses an outbreak of Norovirus that occurred at an Nebraska Event Center in 2017.  This outbreak continued for over two weeks with 159 people suffering from norovirus infection (three confirmed and 156 probable).  In the period of  the outbreak, October 27–November 18, 2017, nine events were held at the facility.  Two issues were cited...improper decontamination of facilities after the onsite of initial illness at the facility and then allowing people to come back to work too soon after being ill.

"The investigation revealed a public vomiting episode at the facility on October 27 and at least one employee involved with preparing and serving food who returned to work <24 hours after symptom resolution, suggesting that a combination of contaminated environmental surfaces and infected food handlers likely sustained the outbreak."

Norovirus is an issue in these settings when someone has become ill because:

1. The virus is highly contagious, requiring only a small amount of virus to be present in order to cause illness (infectious dose capable of causing infection with as few as 18–2,800 virus particles) 
2. Infected people shed a large numbers of virus particles, even those with asymptomatic infections. 
3. Norovirus is resistant to many common commercial disinfectants and is able to persist on environmental surfaces for up to 2 weeks or longer.

Strict controls are needed when someone onsite becomes ill.  The area must be completely disinfected and anyone exposed must be excluded from the workplace.

CDC MMWR
https://www.cdc.gov/mmwr/volumes/68/wr/mm6828a2.htm
Successive Norovirus Outbreaks at an Event Center — Nebraska, October–November, 2017
Weekly / July 19, 2019 / 68(28);627–630
Rebecca J. Free, MD1,2; Bryan F. Buss, DVM2,3; Samir Koirala, MBBS2; Monica Ulses4; Anna Carlson, PhD2; Brianna Loeck, MPH2; Tom Safranek, MD2 (View author affiliations)

Outbreak of E. coli O103 - 73 Cases, Source Still Unknown

CDC is investigating an ongoing outbreak of E. coli O103 infection.  To this point, 72 people have become ill in 5 different states.  Eight people have been hospitalized.  While the primary symptom is bloody diarrhea, the infection can progress to cause damage to the kidney, or HUS.  This is a severe complication with loss of kidney function.  There have not been any cases progressing to HUS.

No source has been identified yet.  Historically, outbreaks such as this have been linked to leafy greens such as romaine or spinach, undercooked ground meat, sprouts, and raw flour.

https://www.cdc.gov/media/releases/2019/s0405-multistate-outbreak-e-coli.html
CDC Investigation Notice: Multistate Outbreak of E. coli O103 Infections

April 5, 2109

CDC - Surveillance study on the cause of reported foodborne Outbreaks

CDC issued a surveillance study on the cause of reported foodborne Outbreaks.

• During 2009–2015, FDOSS received reports of 5,760 outbreaks, resulting in 100,939 illnesses, 5,699 hospitalizations, and 145 deaths 
• Where a single agent was confirmed (in 2,953 outbreaks) with a single confirmed etiology, 

1. Norovirus was the most common cause of outbreaks (1,130 outbreaks [38%]) and outbreak-associated illnesses (27,623 illnesses [41%]). 
2. Salmonella was the second most common single confirmed etiology reported, with 896 outbreaks (30%) and 23,662 illnesses (35%)
3. Shiga toxin-producing Escherichia coli (STEC) (191 outbreaks [6%]), 
4. Campylobacter (155 [5%]), 
5. Clostridium perfringens (108 [4%]), 
6. Scombroid toxin (95 [3%]), 
7. Ciguatoxin (80 [3%]), 
8. Staphylococcus aureus (35 [1%]), 
9. Vibrio parahaemolyticus (35 [1%]), and 
10. Listeria monocytogenes (35 [1%]). 

• Listeria, Salmonella, and STEC were the most common causes of hospitalizations (82%) and deaths (82%) reported among persons in outbreaks with a single confirmed etiology.
• Salmonella and STEC were two of the most common causes of large outbreaks.
• Restaurants accounted for the largest percentage followed by Catering, Private Home, and then Institutional.
• The food categories responsible for the most outbreak-associated illnesses were chicken (3,114 illnesses [12%]), pork (2,670 [10%]), and seeded vegetables (2,572 [10%]).
• The pathogen-food category pairs that caused the most outbreak-associated illnesses were Salmonella in eggs (2,422 illnesses), Salmonella in seeded vegetables (2,203), and Salmonella in chicken (1,941

Limitation of analysis:

1. "Because CDC’s foodborne outbreak surveillance is dynamic and agencies can submit, update, or delete reports at any time, the results of this analysis might differ slightly from previous or future reports". 
2. "Not all outbreaks are identified and the majority of foodborne illnesses occur outside the context of a recognized outbreak. The degree to which the food vehicles, etiologies, and locations implicated in outbreaks represent the vehicles, etiologies, and locations of sporadic foodborne illness is unknown." 
3. "Some outbreaks have an unknown food vehicle, an unknown etiology, or both, and analyses and conclusions drawn from outbreaks with an identified food vehicle and confirmed etiology might not be representative of all outbreaks." 
4. "Pathogens that are not known to cause illness sometimes are reported as a confirmed or suspected etiology."

https://www.cdc.gov/mmwr/volumes/67/ss/ss6710a1.htm?s_cid=ss6710a1_e
Surveillance for Foodborne Disease Outbreaks — United States, 2009–2015
Surveillance Summaries / July 27, 2018 / 67(10);1–11

CDC: 4/25 Update on E. coli Outbreak Associated with Romaine Lettuce

There are now 84 cases of E. coli infection with 42 hospitalizations related to the romaine lettuce from Yuma AZ.  Cases have occurred in 19 different states.   CDC recommends against eating any form of romaine lettuce unless you can verify that it is from an area other than Yuma.

How hard is it to determine where your romaine is from?  Probably not easy. 
Unfortunately, this will be a big impact on all those who farm or process romaine.

https://www.cdc.gov/ecoli/2018/o157h7-04-18/index.html
Multistate Outbreak of E. coli O157:H7 Infections Linked to Romaine Lettuce

CDC MMWR: 2016-2017 Outbreak of Salmonella Outbreak from Undercooked Ground Beef

A CDC MMWR article details the investiation into a 2016-2017 Salmonella outbreak associated with ground beef.  "Contaminated ground beef was the likely source of a protracted outbreak of 106 Salmonella Newport infections, 42 hospitalizations, and one death in 21 states during October 2016–July 2017. While no direct link was found, whole genome sequencing suggests dairy cows were the ultimate outbreak source."

Traceback to an individual farm or processing lot was not possible.  "In the current outbreak, as has been observed in previous outbreaks, ground beef purchases traced back to numerous lots and slaughter/processing establishments (6). One possible explanation is that dairy cows carrying a high Salmonella load that overwhelmed antimicrobial interventions could have gone to multiple slaughter/processing establishments (7), resulting in contamination of multiple brands and lots of ground beef. This might explain the reason for failure to identify a single, specific source of contaminated ground beef."

CDC MMWR
https://www.cdc.gov/mmwr/volumes/67/wr/mm6715a2.htm?s_cid=mm6715a2_e
Protracted Outbreak of Salmonella Newport Infections Linked to Ground Beef: Possible Role of Dairy Cows — 21 States, 2016–2017
Weekly / April 20, 2018 / 67(15);443–446
Katherine E. Heiman Marshall, MPH1; Mackenzie Tewell, MPH2; Selam Tecle, MPH3; Molly Leeper, MPH1; Jennifer Sinatra, DVM4; Bonnie Kissler, MPH4; Adrienne Fung, MPH5; Kerri Brown, MSPH6; Darlene Wagner, PhD1; Eija Trees, PhD1; Kelley B. Hise, MPH1; Vishnu Chaturvedi, PhD7; Linda K. Schlater, DVM8; Brenda R. Morningstar-Shaw, MS8; Laura Whitlock, MPH1; Kristin Holt, DVM4; Karen Becker, DVM4; Megin Nichols, DVM1; Ian T. Williams, PhD1; Michael Jhung, MD1; Matthew E. Wise, PhD1; Laura Gieraltowski, PhD1 (View author affiliations)

CDC Reports Ongoing Outbreak E. coli STEC Infections with 17 Cases So Far, Food Not Yet Identified

The CDC reports that there is an ongoing outbreak of E. coli O157:H7 infections.  To date, there have been 17 cases in 7 states, with those states located across the country.  A source food or establishment has not yet been identified.
Connecticut  2
Idaho  4
Missouri  1
New Jersey  6
Ohio  1
Pennsylvania  2
Washington  1
Total  17

While finding the source in this type of cross-country outbreak is probably not easy, the ability to track and match the bacterial strains for each of the cases is incredible, especially when you consider that many of the states only have one or two cases.

https://www.cdc.gov/ecoli/2018/o157h7-04-18/index.html
Investigation Notice: Multistate Outbreak of E. coli O157:H7 Infections
Posted April 10, 2018 6:00 PM EST

CDC Report - Two Outbreaks of Trichinosis Linked to Consumption of Walrus Meat

If you ever have the opportunity to eat walrus meat, make sure it is cooked well.  There were two recent outbreaks of trichinosis or trichinellosis (five cases each) in Alaska that were associated with consumption of walrus meat.  The disease is caused by the parasite trichinella and is acquired when the larvae of the worm in ingested when consuming contaminated meat of animals including bear, cougar, wild boar and walruses.  Domestic pigs were once a source, but not really any more since controls were put in place by the industry to improve farming conditions.

Initial infection leads to nausea, diarrhea, vomiting, fatigue, fever, and abdominal discomfort. This is followed within a few weeks by headaches, fevers, chills, cough, swelling of the face and eyes, aching joints and muscle pains, as the larvae get into the blood stream and start to encyst into the muscles.. "If the infection is heavy, patients may experience difficulty coordinating movements, and have heart and breathing problems. In severe cases, death can occur."

Cooking wild meat to an internal temperature of 160ºF will take care of the issue.  Canning wild meat is another alternative to consider.

CDC - MMWR
https://www.cdc.gov/mmwr/volumes/66/wr/mm6626a3.htm?s_cid=mm6626a3_e
Two Outbreaks of Trichinellosis Linked to Consumption of Walrus Meat — Alaska, 2016–2017

CDC Reports on a 2016 Salmonella Outbreak Related to Peppers

CDC released a report detailing a 2016 Salmonella outbreak related to peppers.  This is the first time this report has been issued.  Investigators had difficulties in determining the type of pepper as well as the source of the pepper.  Because the lack of 'actionable' information, no warning was issued to consumers.

In June 2016, PulseNet identified a cluster of 16 Salmonella Anatum infections with an indistinguishable [unique] pulsed-field gel electrophoresis (PFGE) pattern from four states.  Thirty-two patients in nine states were identified with illness onsets from May 6–July 9, 2016.  The combined evidence indicated that fresh hot peppers were the likely source of infection; however, a single pepper type or source farm was not identified.  Much of this related to different foods people ate, whether specific peppers were included in salsa recipes, etc.   The only link was related to testing in in April 2016, the same PFGE pattern had been uploaded to PulseNet from an isolate obtained from an Anaheim pepper, a mild to medium hot pepper.

This demonstrates the challenges posed by our food system, especially for produce items like peppers that are used primarily as an ingredient in many different foods, such as salsa.  Cross contamination from the peppers to other items may muddy the investigation.

 
CDC MMWR
https://www.cdc.gov/mmwr/volumes/66/wr/mm6625a2.htm
Multistate Outbreak of Salmonella Anatum Infections Linked to Imported Hot Peppers — United States, May–July 2016
Weekly / June 30, 2017 / 66(25);663–667
Rashida Hassan, MSPH1; Joshua Rounds, MPH2; Alida Sorenson, MPH3; Greg Leos, MPH4; Jeniffer Concepción-Acevedo, PhD1; Taylor Griswold, MS1; Adiam Tesfai, PhD5; Tyann Blessington, PhD5; Cerise Hardy, MPH5; Colin Basler, DVM1 (View author affiliations)

CDC Releases Surveillance Data for Foodborne Illnesses 2013 - 2016

CDC released surveillance data for foodborne diseases for the period 2013 to 2016.  This covers 10 sites in the US and is used to compare incident levels over time.

One important point made is that testing for pathogens is changing, where lab facilities are using more culture independent diagnotic tests or CIDTs.  With CIDT's they look for markers and do not isolate the organism.  According to the report - CIDTs complicate the interpretation of FoodNet surveillance data because pathogen detection could be affected by changes in health care provider behaviors or laboratory testing practices

• Health care providers might be more likely to order CIDTs because these tests are quicker and easier to use than traditional culture methods, a circumstance that could increase pathogen detection 
• Pathogen detection could also be increasing as clinical laboratories adopt DNA-based syndromic panels, which include pathogens not often included in routine stool culture  
• CIDTs do not yield isolates, which public health officials rely on to distinguish pathogen subtypes, determine antimicrobial resistance, monitor trends, and detect outbreaks.

So basically, year to year numbers may be more difficult to interpret because testing is easier, especially for pathogens that were more difficult to grow or were not normally considered.  So while it looks like the incidence to certain pathogens are increasing, that is probably not the case.

CDC MMWR

https://www.cdc.gov/mmwr/volumes/66/wr/mm6615a1.htm?s_cid=mm6615a1_e
Incidence and Trends of Infections with Pathogens Transmitted Commonly Through Food and the Effect of Increasing Use of Culture-Independent Diagnostic Tests on Surveillance — Foodborne Diseases Active Surveillance Network, 10 U.S. Sites, 2013–2016
Weekly / April 21, 2017 / 66(15);397–403

CDC Report on 2015 Salmonella Outbreak Associated with Truffle Oil

CDC issued a report on a 2015 outbreak of Salmonella Enteritidis associated with a Washington DC restaurant.  There were 159 reported cases.  Truffle oil was the most likely source based on the epidemiological investigation, but the organism was not isolated from the oil itself.   "Six food items were significantly associated with case status (Table 2), three of which (beef carpaccio, truffle mushroom croquette, and truffle risotto) contained truffle oil. When all truffle oil–containing items were combined into a single variable, including the three that were individually significant, consumption of a truffle oil–containing item was reported by 89% of case-patients compared with 57% of control subjects (p<0.001)."

While this Salmonella strain is normally associated with poultry and eggs, it was unusual that truffle oil was the likely source.  And being a common pathogen, the report indicates that "Timely engagement of the public, health care providers, and local and federal public health officials, is particularly critical for early recognition of outbreaks involving common foodborne pathogens, such as Salmonella Enteritidis"  Basically, by really looking hard, investigators were able to determine that something different was going on, and in doing so, were able to determine the restaurant was involved.  At that point, they closed the establishment thus preventing additional cases that would have most definitely occurred.

As far as testing "Truffle fries sampled from the deep fryer and uncooked truffle mushroom croquettes were among the samples collected on September 10; a truffle oil sample was collected on September 14."  "DCPHL tested the truffle fries, which screened positive for Salmonella by using polymerase chain reaction (PCR), but Salmonella was not isolated during confirmatory testing. All other food and environmental samples were negative for Salmonella."

Another outbreak in the same restaurant chain indicated the issue may have originated in a NY commissary where the oil originated (but not sure if made there).  It seems the commissary had gone through purge and sanitize procedure, so nothing was found there when investigators inspected that operation.

So before we throw truffle oil on the list per se, there should be additional information as to where it was made.  This may be more of a commissary issue that a truffle issue.

CDC - MMWR
https://www.cdc.gov/mmwr/volumes/66/wr/mm6610a4.htm?s_cid=mm6610a4_e
Investigation of Salmonella Enteritidis Outbreak Associated with Truffle Oil — District of Columbia, 2015
Weekly / March 17, 2017 / 66(10);278–281

CDC Report - Outbreaks Associated with Imported Food

A report in Emerging Infectious Diseases investigated outbreaks associated imported foods.  "The proportion of US food that is imported is increasing; most seafood and half of fruits are imported. We identified a small but increasing number of foodborne disease outbreaks associated with imported foods, most commonly fish and produce. New outbreak investigation tools and federal regulatory authority are key to maintaining food safety."


Emerging Infectious Diseases
Volume 23, Number 3—March 2017
https://wwwnc.cdc.gov/eid/article/23/3/16-1462_article
Dispatch
Outbreaks of Disease Associated with Food Imported into the United States, 1996–2014
L. Hannah Gould , Jennifer Kline, Caitlin Monahan, and Katherine Vierk
Author affiliations: Centers for Disease Control and Prevention, Atlanta, Georgia, USA (L.H. Gould, J. Kline); US Food and Drug Administration, College Park, Maryland, USA (C. Monahan, K. Vierk)
Highlight and copy the desired format. EID Gould L, Kline J, Monahan C, Vierk K.

Pulsenet - Tracking of Foodborne Disease

The US surveillance system for tracking foodborne illnesses, or PulseNet, is 20 years old.  Through time, the technology has improved and its reach is now global. 

In the US, the system is comprised by a network of 83 laboratories linked to the CDC in Atlanta.  Using genetic identification technology, including Whole Genome Sequencing or WGS, it can identify outbreak clusters through matching bacterial isolates involved in cases.  This information is then used to help identify the source of the outbreak.

This article in EMBO is a nice summary of Pulsenet and how it has impacted food safety.

EMBO Reports
http://onlinelibrary.wiley.com/doi/10.15252/embr.201643128/full
Future challenges for tracking foodborne diseases

PulseNet, a 20-year-old US surveillance system for foodborne diseases, is expanding both globally and technologically

Authors - Efrain M Ribot and Kelly B Hise
Centers for Disease Control and Prevention, Atlanta, GA, USA
First published: 19 September 2016Full publication history

CDC Finalizes Investigation on E. coli (STEC O121) in Flour

CDC issued the final report on the E. coli STEC outbreak associated with flour.  The recall of the product was issued in May and then expanded in July.   While CDC expects more cases over time (as people may still have and use recalled flour), there have been 63 cases to date with 17 hospitalizations with one case of HUS (hemolytic uremic syndrome).

 

 Dough is meant for cooking, not eating raw or playing with.  Unfortunately, there are those out there who will continue to eat raw dough (you know who you are).  But please don't pass this habit onto the youth.  One, they are at higher risk.  Two, if you are willing to get sick, then fine, but let's not make a new generation of raw dough eaters.  

  

CDC Outbreak Update

https://www.cdc.gov/ecoli/2016/o121-06-16/index.html

Multistate Outbreak of Shiga toxin-producing Escherichia coli Infections Linked to Flour (Final Update)

Posted September 29, 2016 12:45PM EST

Concern for Zika Virus - Mosquito transmitted disease of South and Central America

The Zika virus is a growing concern as it spreads throughout South and Central America as well as the Pacific Islands.  The mosquito is the primary vector.  While for most people, the symptoms of the viral infection are mild , there is a concern for pregnant women who become infected in that it may lead to microcephaly, a rare neurological condition in which an infant's head is significantly smaller which is associated with incomplete brain development.  Yikes.  (But this has not yet been totally proven.)

Cases of infection in the US have been seen in those who have traveled to areas where the virus is present.

Damn mosquitos...West Nile Virus was bad enough, now we got something else to worry about.  Mosquitos also carry other diseases including Chikungunya, dengue, yellow fever and malaria.

 

CDC Website

Zika Virus

http://www.cdc.gov/zika/index.html/

 

Zika virus is spread to people through mosquito bites. The most common symptoms of Zika virus disease are fever, rash, joint pain, and conjunctivitis (red eyes). The illness is usually mild with symptoms lasting from several days to a week. Severe disease requiring hospitalization is uncommon.

 

Outbreaks of Zika have occurred in areas of Africa, Southeast Asia, the Pacific Islands, and the Americas. Because the Aedes species mosquitoes that spread Zika virus are found throughout the world, it is likely that outbreaks will spread to new countries. In December 2015, Puerto Rico reported its first confirmed Zika virus case. Locally transmitted Zika has not been reported elsewhere in the United States, but cases of Zika have been reported in returning travelers.

CDC - Multistate Foodborne Outbreaks — United States, 2010–2014

In MMWR, the CDC published an analysis of data in the Foodborne Disease Outbreak Surveillance System from 2010 - 2014. The document can be found here.

What were the important results:

• During this 5-year period, 120 multistate foodborne disease outbreaks (with identified pathogen and food or common setting) were reported to CDC.
• These multistate outbreaks accounted for 3% (120 of 4,163) of all reported foodborne outbreaks, but were responsible for 11% (7,929 of 71,747) of illnesses, 34% (1,460 of 4,247) of hospitalizations, and 56% (66 of 118) of deaths associated with foodborne outbreaks. [Listeria accounted for the largest percentage of deaths - 86%]
• Salmonella (63 outbreaks), Shiga toxin-producing E. coli (34), and Listeria monocytogenes (12) were the leading pathogens.
• Fruits (17), vegetable row crops (15), beef (13), sprouts (10), and seeded vegetables (nine) were the most commonly implicated foods.
• Imported foods were linked to 18 multistate outbreaks.

It is interesting to read the headlines that follow this release.
Big and deadly: Major foodborne outbreaks spike sharply (Washington Post) goes on to say that major foodborne outbreaks in the United States have more than tripled in the last 20 years.
Well, our improvement in being able to see outbreaks has improved in the last twenty years.  With Pulsenet, CDC can work with states to find outbreaks.  This system came online 20 years ago and has continued to improve, especially with the development of whole genome sequencing.  So of course we see more outbreaks than we saw 20 years ago, but that does not mean they didn't exist.  And if you had to guess, you would say that there were more 20 years ago then there are today.

CDC Announcement - October 15th is Global Handwashing Day

While many may scoff, or even mock, those federal officials for putting such effort into creating a 'day' for such a menial task as handwashing, perhaps this is an opportunity to remind all those who handle food of the importance of handwashing.  You may even want to go as far as having a handwashing retraining event....A Handwashing Celebration Extravaganza!

SHOW US THOSE CLEAN HANDS!


CDC News Release
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6439a10.htm?s_cid=mm6439a10_e
Announcement: Global Handwashing Day — October 15, 2015
Weekly
October 9, 2015 / 64(39);1124

October 15, 2015, marks the 8th annual Global Handwashing Day. This observance increases awareness and understanding of handwashing with soap as an effective and affordable way to prevent disease around the world.

CDC MMWR - An Increase in Strongyloidiasis Cases in LA

According to CDC's MMWR weekly report, there has been an increase in the number of cases of Strongyloidiasis in LA County, California.  While there were none in 2012, there were 14 cases in 2013 and 29 cases in 2014.

So what the heck is strongyloidiasis?  Just because you wanted to know.......

So, there you are out tending your garden (or whatever they do in LA where one has their hands in the soil), and this little parasitic worm burrows into your skin and then finds its way to your intestines where it creates a never-ending maternity ward for more parasitic worms.  Isn't that a pleasant thought.

Strongyloidiasis is a disease caused by a nematode, or a roundworm, in the genus Strongyloides. While there are a number of species of this roundworm that can infect birds, reptiles and such, Strongyloides stercoralis is the primary species that infects humans. The larvae are only about 1.5mm in length and are found in the soil. "When the larvae come in contact with skin, they are able to penetrate it and migrate through the body, eventually finding their way to the small intestine where they burrow and lay their eggs and these eggs hatch into larvae in the intestine. Most of these larvae will be excreted in the stool, but some of the larvae may molt and immediately re-infect the host either by burrowing into the intestinal wall, or by penetrating the perianal skin. This characteristic of Strongyloides is termed auto-infection. The significance of auto-infection is that unless treated for Strongyloides, persons may remain infected throughout their lifetime."
"The majority of people infected with Strongyloides are without symptoms. Those who do develop symptoms tend to have non-specific, or generalized complaints. Some people develop abdominal pain, bloating, heartburn, intermittent episodes of diarrhea and constipation, a dry cough, and rashes. Rarely people will develop arthritis, kidney problems, and heart conditions."

"In the United States, Strongyloides has classically been associated with uniformed-service veterans who returned from tropical regions such as Southeast Asia and the South Pacific during World War II. Small domestic studies have shown locations of infection in rural Appalachia. The highest rates in the United States have been documented in immigrant populations."



CDC - MMWR
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6433a8.htm?s_cid=mm6433a8_e
Increase in Reports of Strongyloides Infection — Los Angeles County, 2013–2014
Weekly
August 28, 2015 / 64(33);922-923
Curtis Croker, MPH1; Rosemary She, MD2

During the 1990s, reports of infection with the nematode (roundworm) Strongyloides stercoralis submitted to the Los Angeles County Department of Public Health (LACDPH) ranged from 40 to 50 per year, but by 2000, reports had decreased to five per year; in 2006, Strongyloides infection was removed from the LACDPH reportable disease list. Currently, it is only reported at the discretion of Los Angeles County clinicians and laboratories as an unusual disease occurrence. LACDPH currently only monitors case counts and does not investigate reported Strongyloides cases. During 2013–2014, an increase in Strongyloides cases occurred, with 43 cases reported.

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.

Decreases in the Rates of Foodborne Illness....States Reporting Less?

A decrease in the number of reported foodborne illnesses cases....could that mean our food safety systems are improving.....not according to CSPI....they suggest  that states are reporting less.  Certainly there are differences in state-to-state variability, but one would probably think that variation would exist year-to-year.  However, taking that variation into account, decreases or increases year-to-year across all the states should say something about overall trends.



Center for Science in the Public Interest
http://cspinet.org/new/201506081.html
States Vary Widely at Reporting Foodborne Illness Outbreaks to CDC

June 8, 2015

States vary widely in how well they detect, investigate, and report outbreaks of foodborne illness, according to a new 50-state analysis from the nonprofit Center for Science in the Public Interest. And states are reporting fewer outbreaks to the Centers for Disease Control and Prevention. From 2009 to 2012, the average number of reported foodborne outbreaks decreased by about one-third compared to the six preceding years, according to the report, All Over the Map: A 10-Year Review of State Outbreak Reporting.

CSPI found widely different outbreak reporting rates even among adjacent states with similar populations. Florida, for instance, reported five times the number of outbreaks as Alabama when controlled for population, and Maryland reported four times the number of outbreaks as West Virginia. A high outbreak reporting rate actually can prevent illnesses, as it indicates state and local public health officials are looking for outbreaks and are more likely to identify contaminated foods or offending restaurants.

CDC Release 2013 Foodborne Illness Report

CDC released 2013 Report – Surveillance for Foodborne Disease Outbreaks United States. 2013: Annual Report.  http://www.cdc.gov/foodsafety/pdfs/foodborne-disease-outbreaks-annual-report-2013-508c.pdf

 

The main findings as listed in the report:

• In 2013, 818 foodborne disease outbreaks were reported, resulting in 13,360 illnesses, 1,062 hospitalizations, 16 deaths, and 14 food recalls. 
• Outbreaks caused by Salmonella increased 39% from 2012 (113) to 2013 (157). Outbreak-associated hospitalizations caused by Salmonella increased 38% from 2012 (454) to 2013 (628). 
• Fish (50 outbreaks), mollusks (23), chicken (21), and dairy (21, with 17 due to unpasteurized products) were the most common single food categories implicated in outbreaks.
• As reported in previous years, restaurants (433 outbreaks, 60% of outbreaks reporting a single location of preparation), specifically restaurants with sit-down dining 351, 49%), were the most commonly reported locations of food preparation. 

 

818 foodborne outbreaks impacting 13360 people. Not too bad when you consider there are 320 million people in the US eating hopefully 3 meals a day, 365 days/year...not bad unless you are one of those poor souls who happens to get ill, then really bad is what you are feeling.  And if you take the 48,000,000 as the real number for number of cases, then the vast majority of cases must not be reported. 

 

Salmonella is tops among bacteria, but Norovirus is still the leading etiological agent. I know we like to blame those commercially processed foods, but in the end, a restaurant or a banquet hall is a more likely place for contracting illness. For foods, seafood and mollusks…and there are a lot of cases due to mollusks especially if we could see the rate (number of cases/number of people eating). So if you can combinine a few of these…how about eating fish or mollusks (ie raw oysters) in a restaurant?  

 

As far as rates of foodborne illness per state, the average was 3.3 outbreaks per million people. Nice to see that our fair state of PA rates below this average. Ohio and Minnesota, not so good.