News Scan for Dec 19, 2013

Salmonella outbreak grows
Botulism in Texas
Q fever lessons

Foster Farms–linked Salmonella case count rises to 416

The multistate outbreak of Salmonella Heidelberg linked to chicken from producer Foster Farms in California has now sickened 416 people in 23 states and Puerto Rico, according to an update today from the Centers for Disease Control and Prevention (CDC). The last-reported case count was 389 on Nov 19.

The majority of cases (74%) have occurred in California. Of the 27 newly reported cases, 22 have been from California, followed by Arizona and Colorado with 2 each and Washington with 1.

Illness-onset dates for patients with information available range from Mar 1 to Dec 1 of this year. Patient ages range from 1 to 93 years, with a median of 19. Hospitalization has been necessary in 39% of 340 cases with information available, and there have been no deaths.

The three Foster Farms facilities made substantive changes in slaughter and processing methods after the outbreak began that allowed them to continue operations, according to an Oct 17 notice from the US Department of Agriculture.

The CDC notes that illnesses occurring after Nov 17 may not have been reported yet because of lag time between onset and reporting. The agency also cautions that more cases may occur because consumers purchased the tainted chicken and froze it for later use.
Dec 19 CDC update
Last CIDRAP News scan (Nov 20) on the outbreak


Botulism cases in Texas linked to fermented vegetables

Four cases of botulism in Amarillo, Tex., have been linked to homemade turshi, a traditional Middle Eastern dish made of fermented vegetables, according to Amarillo city officials.

All four patients were hospitalized, but two have been released, the city said in a Dec 17 press release. The identification of the first case on Dec 9 sparked an investigation by city health and environmental officials, the Texas Department of State Health Services, and the CDC.

Investigators learned that two patients from each of two households had eaten turshi over several weeks and that the dish had been prepared in one of the households, according to the release.

"Investigators believe that during the fermentation phase of preparation lasting several weeks, conditions were ideal for bacteria growth and botulinum toxin production," the release said. "Because the food was consumed weeks ago, none of the turshi was available for testing. No commercial food product or restaurant has been linked to the outbreak."

Officials said no commercially available turshi was implicated in the outbreak and there was no indication of a threat to the public.

The statement also said that tests of clinical and environmental samples in the investigation were negative, but testing was continuing.

Deree Duke, head of the city's Department of Environmental Health, told the Amarillo Globe-News that the cases were clinically confirmed. He said low levels of botulinum toxin can be hard to detect, especially when there is a considerable delay between onset of symptoms and testing.
Dec 17 City of Amarillo press release
Dec 17 Amarillo Globe-News story


Multistate 2011 Q fever outbreak had high rate of symptomatic cases

The first reported US multistate outbreak of Q fever, in 2011, involved 21 people, with an unusually high percentage of them having symptoms, according to results of a cross-sectional investigation published yesterday in Vector-Borne and Zoonotic Diseases.

Investigators queried people associated with the index goat farm in Washington state as well as 16 other farms that bought goats from the index farm or housed goats at the index farm for breeding.

Of 109 people contacted, 21 (19%) from Washington or Montana met the outbreak case definition and had a Coxiella burnetii phase 2 immunoglobulin G titer of 1:128 or greater by immunofluorescence assay. Of the case-patients, 15 (71%) were symptomatic. The authors said a typical symptomatic rate is about half of patients.

Evidence of C burnetii infection was detected in all 17 goat herds sampled (13 in Washington, 3 in Montana, and 1 in Oregon) by polymerase chain reaction, enzyme-linked immunosorbent assay, or both.

Goat-specific Q fever risk factors included direct contact with a newborn goat, exposure to a dead or weak newborn, living on a property with goats, and direct contact with "birth/afterbirth products."

The authors said that after their investigation Washington and Montana implemented a herd management plan to encourage best disease-control practices, reduce the possibility of future outbreaks, and promote communication between public health and agriculture officials.
Dec 18 Vector Borne Zoonotic Dis abstract

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