News Scan for Apr 29, 2016

Listeria in Dole facility
Flu retreat resumes
Wisconsin Elizabethkingia developments
Fecal transplant compatibility
Tdap vaccine effectiveness

FDA: Dole kept salad facility running for 18 months after Listeria surfaced

Federal inspection records obtained by Food Safety News (FSN) show that Dole kept a salad processing plant in Ohio operating for about 18 months after finding Listeria contamination there, until an outbreak was traced to the facility in January of this year.

The information was in Food and Drug Administration records (FDA) obtained by FSN under a Freedom of Information Act (FOIA) request. FSN published a story on the records and posted them today. The listeriosis outbreak involved 33 cases and 4 deaths, including 19 cases and 1 death in the United States and 14 cases with 3 deaths in Canada. All the patients were hospitalized.

The FDA report says the company found Listeria in environmental samples from the Springfield, Ohio, plant nine times between July 2014 and December 2015. The company suspended production at the plant on Jan 21, 2016, after a random test by state officials found a bagged salad from the facility contained L monocytogenes, the FSN story noted.

DNA fingerprinting linked the Listeria isolate in the salad to the outbreak, the story noted. It said US and Canadian investigators had been trying to find the cause of the outbreak since September 2015.

Dole announced the limited resumption of production at the plant on Apr 22, saying US and Canadian officials had completed their investigations there.

In a press release today addressing media reports on the FDA's observation reports, Dole said FDA item covers problems the company has corrected and that it has been working with the agency and other authorities to improve testing, sanitation, and other procedures, which led to the plant reopening.

The US Department of Justice (DOJ) is doing its own investigation and has contacted Dole, and the company said it will also be cooperating with the DOJ to answer questions and address any concerns.
Apr 29 FSN story
FDA inspection report obtained by FSN
Mar 31 CIDRAP News item on the outbreak
Apr 22 Dole press release
Apr 29 Dole press release


Flu activity in US resumes its slow retreat

Influenza activity resumed its reluctant springtime decline across the United States last week, after hesitating a week earlier, according to the weekly update from the Centers for Disease Control and Prevention (CDC).

The estimated share of clinic visits prompted by influenza-like illness (ILI) sank to 2.0%, just below the national baseline of 2.1%. The previous week’s number was right at the baseline.

New Jersey was the only state reporting high ILI activity, the same as a week earlier. Moderate activity was reported in Arizona, Arkansas, and Puerto Rico; a week earlier, only Minnesota and Puerto Rico were in that category.

Flu cases were still said to be geographically widespread last week in 13 states and Puerto Rico, a tiny improvement from the 14 states and Puerto Rico reporting that status the previous week.

The CDC said four more flu-related deaths in children were reported, compared with six a week earlier, raising the season total to 60. One death was attributed to influenza B, two to type A viruses that were not subtyped, and one to a virus that was not typed.

In the 122 Cities Mortality Reporting System, 6.7% of deaths were attributed to pneumonia and flu, which was down from 7.7% a week earlier and below the week’s epidemic threshold of 7.0%.

Also, labs tested fewer respiratory specimens and found fewer flu viruses in them last week: 12.5% of 14,806 samples tested positive, versus 14.0% of 18,188 the previous week.

The cumulative rate of flu-related hospitalizations inched up to 29.8 per 100,000 people last week, compared with 28.4 the previous week. The rate for seniors was 79.6, up from 75.0 a week earlier.
Apr 29 CDC FluView update
Past FluView
reports page


Wisconsin probes more Elizabethkingia cases, including one in a newborn

Wisconsin health officials are investigating two more Elizabethkingia anopheles infections, according to a health department update, and a media outlet reported yesterday that an infection has been detected in a baby in the neonatal intensive care unit at a Milwaukee hospital.

The Wisconsin Department of Health Services (WDHS) said as of Apr 27 it had received a total of 65 reports, with 59 of them confirmed, 2 under investigation, and 4 possible cases. Nineteen deaths have been reported, 18 in confirmed cases and 1 among the possible cases. Patients are from 12 Wisconsin counties.

Meanwhile, Children's Hospital of Wisconsin yesterday confirmed the Elizabethkingia infection in the baby, which appears to be the first involving a child, the Milwaukee Journal Sentinel reported. Most of the other infections are in seniors who have chronic underlying health conditions.

The hospital said the baby's illness isn't serious and that the bacteria isn't easily transmitted from person to person.

Illinois recently reported a case matching the Wisconsin outbreak strain, and last week reported 10 more cases involving a strain different from Wisconsin's. Michigan has also reported a case. The US Centers for Disease Control and Prevention (CDC) said it has received reports of 61 confirmed cases from the three states so far, 20 of them fatal.

E anopheles can be found in soil and other environmental sources and has been linked to opportunistic infections. So far the source of the outbreak isn't known. The organism is usually antibiotic-resistant, but the Wisconsin strain is susceptible to some drugs.
Apr 27 WDHS update
Apr 28 Journal Sentinel
CDC Elizabethkingia outbreak


Donor-host compatibility boosts fecal transplant effectiveness

Genetic compatibility of bacterial strains between fecal microbiota transplantation (FMT) donors and recipients may be the key to building diverse, co-existing gut bacteria in people with an array of digestive tract disorders, according to a study today in Science.

Researchers led by the European Molecular Biology Laboratory sequenced 55 fecal samples from 10 people with metabolic syndrome, five of whom received allogenic FMTs and a placebo group of five people who received autologous FMTs. None of the recipients had used antibiotics or other medications in the 3 months before transplantation.

The group that received allogenic FMTs demonstrated significant co-existence of donor and host gut bacterial strains, with 69.3% of donor-specific strains retained 2 days after transplant and 37.6% retained 90 days later. People who received an autologous transplant (ie, a transplant from themselves) had a 9.5% rate of variation, suggesting some possible benefit from the transfer process, the authors said.

Strain compatibility between recipients and donors likely played a significant role in building diverse gut bacteria. Three people who received allogenic FMTs from the same donor had drastically different rates of strain co-existence (46.1%, 56.6%, and 12%) after 90 days. Donor strains were more likely colonize the digestive tract if their species were already present, which could aid in matching donors with recipients and replacing antibiotic-resistant bacteria with susceptible strains, the authors said.

Further study is needed to determine the effect of microbial resilience in the digestive tract and individual immune response to FMT and strain compatibility, the authors said, adding that "A 'one-stool-fits-all' model currently supported by standardized donor stool banks may not be clinically appropriate."
Apr 29 Science study


Tdap vaccine moderately effective in school pertussis outbreak

Effectiveness of the tetanus, diphtheria, and pertussis (Tdap) vaccine was 68.5% in two Maine schools during a 2011 pertussis outbreak and did not appear to wane over time, according to a Mar 31 retrospective cohort study in Vaccine.

Researchers led by the US Centers for Disease Control and Prevention (CDC) evaluated Tdap vaccine effectiveness (VE) in 314 students attending one of two schools in Maine's rural Penobscot County. Students were between 11 and 19 years old during an Aug 15 to Nov 26, 2011, pertussis outbreak.

Among 118 students at School A and 196 students at School B, pertussis attack rates were 11.9% (14 students) and 7.7% (15 students), respectively. Slightly more than half (51%) of students in both schools had received Tdap immunization, and 25% were vaccinated during or following the outbreak. Most cases (80%) in both schools occurred in students vaccinated less than 36 months before the outbreak began, the authors said.

VE was 70.4% in School A and 65.2% in School B, for an overall VE of 68.5%. VE was comparable in larger samples of students who were unvaccinated or partially vaccinated (63.3% in 344 students) or lacked documentation of immunization status. (64.9% in 343 students), the authors said.

The authors said that Tdap vaccination appeared to be "moderately effective" in preventing pertussis and showed little evidence of waning over time, noting that VE was comparable 2 years prior to and 2 years after the pertussis outbreak (68.5% vs. 71.5%).

Lack of waning may be attributable to older children having been vaccinated with whole-cell pertussis vaccine in Tdap formulation, rather than with the acellular pertussis vaccine currently used, the authors said.
Mar 31 Vaccine study

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