News Scan for Feb 15, 2018

Salmonella coconut probe over
Valley fever outbreaks

CDC declares coconut-linked Salmonella investigation over

The Centers for Disease Control and Prevention (CDC) said today that a multistate Salmonella outbreak—first announced a month ago—appears to be over after it reached 27 cases in nine states.

Today's update includes two new cases—in California and Washington—since the CDC's first outbreak notice on Jan 16. Six patients required hospitalizations, but no deaths were reported. Also, the most recent illness-onset date is Nov 4, 2017, with the earliest more than a year ago. Patients range in age from 1 to 82 years, with a median age of 15.

Whole-genome sequencing revealed that Salmonella strains infecting outbreak patients were closely related genetically. None, however, were shown to be antibiotic resistant.

On Jan 3, Evershing International Trading Company of San Jose, Calif., recalled all 16-ounce Coconut Tree Brand Frozen Shredded Coconut after Massachusetts officials confirmed Salmonella in the product.

"This outbreak appears to be over," the CDC said. "However, the recalled shredded coconut has a long shelf life and may still be in people’s homes. Consumers unaware of the recall could continue to eat the product and potentially get sick."
Feb 15 CDC notice
Jan 17 CIDRAP News story "
Frozen coconut implicated in new Salmonella outbreak"


Survey of valley fever cases since 1940 highlights environmental exposure

Between 1940 and 2015, officials recorded 47 coccidioidomycosis, or valley fever, outbreaks worldwide that resulted in 1,464 cases, new research published in Emerging Infectious Diseases shows. The vast majority of those cases, 85%, were caused by environmental exposures to soil containing the fungi that causes the disease.

Though valley fever is endemic to the southwestern United States, there have been few attempts to look at overall exposure trends in the literature. The authors of this study searched all medical literature that documented more than 2 human coccidioidomycosis cases (at least 1 lab-confirmed) linked to a common source, event, or activity in space and time, to better understand the environmental risk factors of valley fever infection.

Outbreaks ranged in size from 2 to 379 cases. Two outbreaks (4%) resulting in 582 cases (40%): One occurred after the Northridge earthquake in 1994 in Ventura County, and the other resulted from the "Tempest from Tehachapi" dust storm in 1977, both in California.

Over half of the outbreaks (53%) occurred because of an occupational exposure, usually construction or farming. Military personnel, incarcerated persons, and outdoor workers had the highest risk of infection.

"Over time, outbreak investigations uncovered additional coccidioidomycosis-endemic areas throughout California's Central Valley, Texas, Utah, and areas of Brazil," the authors said. "Outbreak data also suggest that some geographic regions seem particularly well suited for Coccidioides growth and human exposure. For example, the arid hills bordering the southwestern portion of California's Central Valley were the setting for 5 outbreaks within 150 miles of each other."

Each year in the United States, about 10,000 non-outbreak cases of valley fever are recorded, and there are likely hundreds more that go unreported, the authors said. Symptoms are flu-like, including fever, cough, chills, and chest pain. Most cases resolve on their own.
Feb 14 Emerg Infect Dis study

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