Food Outbreak Scan for May 22, 2014

News brief

Two-state E coli outbreak linked to raw sprouts

An outbreak of Escherichia coli O121 infections in Washington and Idaho has been linked to raw clover sprouts, the Centers for Disease Control and Prevention (CDC) and state health officials announced.

The outbreak involves 7 confirmed and 3 suspected cases, with 5 cases in Spokane County, 2 in King County—both in Washington—and 3 in Kootenai County, Idaho, the Washington State Department of Health (WSDH) said in a news release yesterday.

Five patients required hospitalization, but no deaths have been reported, the CDC said in an update today. Two of the hospitalized patients are from Idaho, the Idaho Department of Health and Welfare (IDHW) said in an update yesterday. The CDC said nine of the patients are women.

Initial investigations indicated a "strong link" to eating raw clover sprouts produced by Evergreen Fresh Sprouts, LLC, of Moyie Springs, Idaho, the WSDH said.

"We advise people not to eat raw clover sprouts from Evergreen Fresh Sprouts until further notice," said Washington State Health Officer Kathy Lofy, MD, according to a WSDH news release. "If you have these products at home, you should throw them out."

The sprouts were eaten in sandwiches served at several restaurants, including Jimmy John's Gourmet Sandwiches, Pita Pit, and Daanen's Deli, the WSDH said. The restaurants in which patients reported eating the sprouts have voluntary suspended serving sprouts, the agency added.

In 2011 Evergreen Fresh Sprouts was involved in a five-state, 25-case Salmonella outbreak caused by contaminated alfalfa sprouts and spicy sprouts, according to the CDC.
May 22 CDC report
May 21 WSDH news release
May 21 IDHW update
Jul 6, 2011, CDC final notice on previous outbreak

FSIS provides more details on large E coli–related beef recall

Yesterday the US Department of Agriculture's (USDA's) Food Safety and Inspection Service (FSIS) clarified that ground beef linked to a four-state outbreak of E coli O157:H7 illness was distributed nationally, not just to a handful of states, and released a list of some of the retailers involved.

In an updated notice, the FSIS said that 1.8 million pounds of ground beef products from Wolverine Packing Company of Detroit "were shipped to distributors for restaurant and retail use nationwide." The beef was produced between Mar 31 and Apr 18.

At least 11 people have been sickened in the outbreak: 5 in Michigan, 4 in Ohio, and 1 each in Massachusetts and Missouri, the CDC said in a May 19 update. The FSIS said in its updated notice that it was first notified of E coli outbreak cases on May 8.

Also yesterday, the FSIS released a list of retailers that the agency believes received the recalled ground beef. The list includes Gordon Food Service Marketplace, Surf N Turf Market, Giorgio's Italian Deli, M Sixty Six General Store, and Buchtel Food Market.

"This list may not include all retail locations that have received the recalled product or may include retail locations that did not actually receive the recalled product," the FSIS said and urged consumers to use the product-specific identification information that it provides in its recall notice.

In addition, Brian Ronholm, acting under secretary for food safety, provided outbreak details in a USDA blog post. He clarified outbreak details for consumers, such as how the FSIS determined how much product should be involved in a recall.
May 21 FSIS updated notice
May 19 CDC outbreak update
May 21 FSIS list of retailers
May 21 USDA blog post

Identifying outbreak cases via online food reviews

New York City researchers recently identified three previously unreported foodborne disease outbreaks through a business review Web site but warned that the process was resource-intensive, according to their report today in Morbidity and Mortality Weekly Report (MMWR).

Scientists from the New York City Department of Health and Mental Hygiene (DOHMH) and Columbia University used a software program to identify 893 reviews of about 294,000 on the Yelp review site from Jul 1, 2012, through Mar 31, 2013, that might describe food-related outbreaks and required further review by an epidemiologist. Of those 893 reviews, 468 described a recent event consistent with foodborne disease.

A total of 339 reviews that indicated only one person became ill and had no scombroid poisoning or severe neurologic symptoms were excluded, leaving 129 reviews that required further investigation. Of the 129 reviews, 27 reviewers (21%) completed a telephone interview.

From those interviews the investigators identified three outbreaks that met DOHMH outbreak criteria. They involved 16 cases not previously reported to the agency.

The authors conclude, "By incorporating website review data into public health surveillance programs, health departments might find additional illnesses and improve detection of foodborne disease outbreaks in the community."

They noted, however, "The system required substantial resources; in addition to programming expertise, staff members were needed to read reviews, send e-mails, interview reviewers, and perform follow-up inspections." They said the DOHMH is working to refine the project.
May 23 MMWR report

News Scan for May 22, 2014

News brief

H7N9 sickens two from Anhui province

Two new H7N9 influenza infections were reported in China today, both from Anhui province, according to a health department statement translated and posted by FluTrackers, an infectious disease news message board.

Both patients are men, ages 69 and 58, who are hospitalized in critical condition. The cases are the second and third to be reported in Anhui province this week and lift its overall number of H7N9 cases to 14.

The two new cases increase the H7N9 outbreak total to 445 cases. So far 309 infections have been reported during the outbreak's current second wave, compared with 136 in the first last spring.

In other developments, the World Health Organization (WHO) today provided more details about four H7N9 cases reported in China on May 19, three from Guangdong province and one from Jiangsu province.

All of the patients are men, and their ages range from 37 to 86. Three are in critical condition, and one has a mild illness. Illness onsets range from Apr 20 to May 12, and hospital admission dates range from Apr 25 to May 12.

All four had a history of exposure to live poultry.
May 22 FluTrackers thread
FluTrackers human H7N9 case count
May 22 WHO statement

Indonesian tot dies from H5N1

A 2-year-old boy died of H5N1 avian flu in Indonesia last month, the WHO said in an update posted yesterday.

The boy, from Central Java, first had symptoms on Apr 10, was hospitalized Apr 13, and died Apr 20, the WHO said in its most recent "Influenza at the Human-Animal Interface" report, dated May 5. "In the weeks before disease onset of the child, some backyard chickens died around the house," the report said.

The boy's death represents the first case of H5N1 this year in Indonesia, a country that has seen as many as 55 confirmed cases in a year (in 2006), but last year reported only 3.

In the report, the WHO placed the global number of lab-confirmed H5N1 cases since 2003 at 665, 392 of which have been fatal. That number represents 15 new cases and 6 newly reported deaths since the agency last updated its case count, on Jan 24.

The 15 cases not included in the WHO's Jan 24 count reflect 9 in Cambodia, 3 in Egypt, and 1 each in Canada, Vietnam, and China, according to previous news reports. In addition, Hong Kong officials on Feb 25 reported an H5 infection in a child in mainland China but did not issue a follow-up report about the specific strain.
May 5 WHO report
Jan 24 WHO global case count

Valley fever in Washington shows fungus has moved north

Three cases of valley fever (coccidiodomycosis) in Washington state led to the discovery of the disease-causing fungus there, far north of its recognized range in the US Southwest, according to a new report.

Valley fever is caused by inhaling spores of the soil-dwelling fungi Coccidioides immitis or Coccidoides posadasii, notes an article today in Morbidity and Mortality Weekly Report (MMWR). The disease is endemic in the Southwest and in hot, arid regions of Central and South America. US cases reported in 2012 totaled 17,802.

Three valley fever cases in south-central Washington in 2010 and 2011 appeared to be locally acquired, because the patients had not traveled recently to areas where the disease is endemic, the report says.

No reliable test for soil-dwelling Coccidoides was available when the cases were first investigated in late 2010, but investigators took and preserved soil samples from sites where the patients had been active. In 2013 the samples were sent to the Centers for Disease Control and Prevention (CDC), where a new polymerase chain reaction test developed by the Translational Genomics Research Institute was used to detect Coccidoides DNA in 6 of 22 samples.

Viable C immitis was then isolated from four of the six samples, and whole-genome sequencing showed that the strain was identical to C immitis from one of the patients, the report says. "This is new direct evidence that the infections were acquired in Washington and that C. immitis exists in this environment clearly outside the recognized endemic area," it states.
May 23 MMWR article

WHA approves hepatitis control resolution

The World Health Assembly (WHA) today approved a resolution to improve the control of hepatitis, a disease that's responsible for 1.4 million global deaths each year, with an estimated 500 million people each year living with chronic infections, the WHO said today in a statement.

Today's resolution underscores the importance of expanding hepatitis A and B vaccinations and shoring up infection control practices in healthcare settings. It also notes the importance of steps to protect groups such as those who inject drugs by improving their access to testing and treatment. The action also acknowledges the need to improve screening, because most people with chronic hepatitis B and C don't know they're infected.

WHA members said they would consider a host of measures to improve access to quality, affordable tests and treatments while keeping in mind intellectual property rights. They asked the WHO secretary to help countries develop and track the progress of hepatitis control programs.

The WHA is the decision-making group of the WHO, held each year in Geneva. About 3,000 participants help set policy decisions on issues such as disease prevention, monitoring health improvement progress, and the WHO's budget. The meeting started May 19 and goes through May 24.
May 22 WHO statement