News Scan for Dec 19, 2014

More polio-like illnesses
Federal food safety shortfalls
Crypto in emergency workers

CDC reports 8 more polio-like illnesses, 3 EV-D68 cases

The national count for acute flaccid myelitis (AFM), an unexplained polio-like illness in children, has increased by 8, to 102 cases in 34 states, the Centers for Disease Control and prevention (CDC) reported yesterday.

In addition, the CDC reported three more cases of enterovirus D68 (EV-D68) respiratory infection, which may be related to AFM. The new total is 1,152 cases since August in 49 states and the nation's capital.

Earlier this month, a CDC official said that close to half of the AFM patients to that point had tested positive for EV-D68 in nasal or stool samples, suggesting a likely link between the two conditions. But the connection was not certain, because the virus had not been found in any cerebrospinal fluid samples, which would signal infection in the nervous system.

CDC spokeswoman Jeanette St. Pierre said today that the agency has no new findings to report in its investigation of the causes of the myelitis cases.

EV-D68, which was rare until recently, has been the most common enterovirus identified in the United States this year, according to the CDC. It typically triggers cold-like symptoms but can cause a severe respiratory illness, almost exclusively in children, many of whom have asthma.
CDC update on AFM cases
CDC update on EV-D68
Related Dec 12 CIDRAP News item


Report describes lack of federal food safety coordination

Greater interagency collaboration is needed at the federal level to coordinate food safety practices and performance, according to a Government Accountability Office (GAO) report issued yesterday.

The GAO evaluated how the US Department of Agriculture (USDA) and the Department of Health and Human Services (HHS) have implemented the 2010 Government Performance and Results Modernization Act (GPRAMA) across food safety programs. The report revealed shortfalls in two main areas: documentation of collaborative effort and broad-based coordination of goals and activities across the 15 federal agencies responsible for food safety.

The GAO found that USDA and HHS planning documents did not describe relevant cross-agency food safety efforts and could not be reconciled across individual programs, even though several inter-agency efforts are active (eg, the National Antimicrobial Resistance Monitoring System and the Food Emergency Response Network). In a review of strategic plans, the GAO found that individual agencies did not provide specifics about their food safety goals and partners.

Although the Office of Management and Budget was tasked to develop a government-wide food safety performance plan in 2011, no action on this front has been taken, the report says. The Food Safety Working Group, which was moving toward drafting centralized performance measures, stopped meeting 3 years ago. The GAO recommends that Congress formalize the performance plan by statute and reinstate the working group.

HHS's Food and Drug Administration (FDA) and the USDA's Food Safety and Inspection Service (FSIS) have implemented collaborative efforts focused on specific topics, such as tracking outbreak sources and monitoring chemical residues on food. Despite these gains, no centralized interagency program allows federal agencies to define and reach agreements on performance goals.

Interviews GAO conducted with federal food safety experts revealed that 10 out of 12 officials believed that a centralized and collaborative food safety performance mechanism is necessary, maintaining that it will foster accountability, diversity of opinion, and public trust.
Dec 18 GAO report
Dec 18 GAO
report summary


Cryptosporidiosis hit first responders after cattle-truck crash

Confirmed or probable cryptosporidiosis developed in 6 of 15 law enforcement and volunteer emergency workers who responded during an April 2013 storm in Kansas to the rollover of a cattle truck carrying young calves, says a report in today's issue of Morbidity Mortality Weekly Report. The account is billed as the first report of emergency responders contracting the disease solely through direct contact with animals and their feces.

The tractor-trailer was carrying 350 pre-weaned Holstein steer calves less than 10 days of age under crowded conditions. Many of the surviving calves had to be carried from the wrecked truck or immediate surroundings to cattle and horse trailers for further transport. According to the MMWR article, "Responders noted that most of the calves had scours" (diarrhea).

The Kansas Department of Health and Environment investigated the accident after it was notified by the local health department of two confirmed cases of cryptosporidiosis in workers who had been at the accident scene. During questioning of the 13 remaining accident responders, 4 more reported having diarrhea and either abdominal cramping, vomiting, or anorexia within 10 days after the accident, and so were considered probable cases.

Bivariate analysis showed ill responders were more likely than responders who stayed healthy to have carried calves (relative risk [RR], 3.0) and to have come in contact with fecal matter (RR, 4.5). Responders who returned from the accident to places without power (due to the storm) were more likely to have become ill than those returning to places with power, presumably because they did not have hot water and were not able to properly wash their hands and decontaminate equipment and clothing.

According to the article, scours is common in young calves, with pre-weaned calves most likely to be infected with Cryptosporidium species. Very young steer calves being transported away from dairy operations may be deprived of colostrum, and stressful conditions can increase shedding of pathogens. The stressful conditions in the truck as well as during and after the accident "might have led to an increased probability of pathogen transmission," says the article.

The outbreak points to the need for people handling calves, including emergency responders, to be educated about the potential for zoonotic transmission of Cryptosporidium and other pathogens, says the article.
Dec 19 MMWR article

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