http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6219a3.htm?s_cid=mm6219a3_w

Microbes in Pool Filter Backwash as Evidence of the Need for Improved Swimmer Hygiene — Metro-Atlanta, Georgia, 2012

Weekly

May 17, 2013 / 62(19);385-388

Filters physically remove contaminants, including microbes, from water in treated recreational water venues, such as pools. Because contaminants accumulate in filters, filter concentrates typically have a higher density of contamination than pool water. During the 2012 summer swimming season, filter concentrate samples were collected at metro-Atlanta public pools. Quantitative polymerase chain reaction (qPCR) assays were conducted to detect microbial nucleic acid. Pseudomonas aeruginosa was detected in 95 (59%) of 161 samples; detection indicates contamination from the environment (e.g., dirt), swimmers, or fomites (e.g., kickboards). P. aeruginosa detection underscores the need for vigilant pool cleaning, scrubbing, and water quality maintenance (e.g., disinfectant level and pH) to ensure that concentrations do not reach levels that negatively impact swimmer health. Escherichia coli, a fecal indicator, was detected in 93 (58%) samples; detection signifies that swimmers introduced fecal material into pool water. Fecal material can be introduced when it washes off of swimmers’ bodies or through a formed or diarrheal fecal incident in the water. The risk for pathogen transmission increases if swimmers introduce diarrheal feces. Although this study focused on microbial DNA in filters (not on illnesses), these findings indicate the need for swimmers to help prevent introduction of pathogens (e.g., taking a pre-swim shower and not swimming when ill with diarrhea), aquatics staff to maintain disinfectant level and pH according to public health standards to inactivate pathogens, and state and local environmental health specialists to enforce such standards.

During June–August 2012, county (Cobb, DeKalb, Fulton, and Gwinnett) and state environmental health specialists collaborated with CDC to collect filter concentrates at a convenience sample of public pools. The study protocol entailed collecting a 1-liter filter backwash* sample 30 seconds after the start of backwash flow and immediately neutralizing any free chlorine (the form of chlorine that inactivates pathogens), using 2.5 mL of a 10% sodium thiosulfate solution. Additionally, the following data were collected using a standardized form: type of filter media; pool location (i.e., indoor versus outdoor), setting (i.e., membership/club, municipal, or waterpark), and primary patron designation (i.e., adults and children versus primarily children); type of disinfectant used; visible signage instructing patrons not to swim when ill with diarrhea; estimated number of swimmers in the past week; and estimated number of days since last filter backwash. No pool identifiers were collected.

During December 2012–March 2013, nucleic acid was extracted from each sample (1), and qPCR assays (Table 1), were conducted to detect nucleic acid of E. coli, P. aeruginosa, Giardia intestinalis, Cryptosporidium spp., E. coli O157:H7 (a pathogenic toxin–producing E. coli), noroviruses GI and GII, and adenovirus.† Detection of a study microbe was defined as a qPCR cycle threshold§ value <40.

All but one of the pool filters in the study were rapid sand filters; the remaining filter used diatomaceous earth. At least one of the assayed microbes was detected in 121 (75%) of 161 filter backwash samples collected. P. aeruginosa was detected in 95 (59%) samples. E. coli was detected in 93 (58%) samples. P. aeruginosa and E. coli were both detected in 67 (42%) samples. G. intestinalis was detected in two samples. Cryptosporidium spp. were detected in one sample. Neither E. coli O157:H7, norovirus GI, norovirus GII, nor adenovirus was detected in any of the samples. The proportion of samples positive for E. coli significantly (p≤0.05) differed between membership/club and municipal pools (Table 2). The proportion of samples positive for P. aeruginosa significantly differed between venues treated with traditional chlorine products combined with ultraviolet light disinfection versus those treated with saltwater-generated free chlorine.¶ Most (71% [10 of 14]) pools with saltwater-generated free chlorine were located outdoors.

Editorial Note

The detection of E. coli in over half of filter backwash samples indicates that swimmers frequently introduced fecal material into pools and thus might transmit infectious pathogens to others. The risk for transmission and recreational water illness (RWI)** increases if swimmers introduce feces when ill with diarrhea (Box). A single diarrheal contamination incident can introduce 107–108 Cryptosporidium oocysts (2) into the water, a quantity sufficient to cause infection if a mouthful of water from a typical pool is ingested (3). Additionally, each person has an average of 0.14 grams of fecal material on their perianal surface that could rinse into the water (4) if swimmers fail to take a pre-swim shower with soap. The 1) frequent occurrence of fecal contamination of pools documented in this study and 2) marked increase in the incidence of RWI outbreaks, which is driven by the substantially increasing incidence of acute gastrointestinal illness outbreaks associated with pools and caused by pathogens transmitted by the fecal-oral route (particularly the extremely chlorine-tolerant parasite, Cryptosporidium) (5), underscore the need for improved swimmer hygiene (e.g., taking a pre-swim shower and not swimming when ill with diarrhea). This study also found that the proportion of samples positive for E. coli significantly differed between membership/club and municipal pools. This finding might reflect differences in the number of swimmers who are either diapered children or children learning toileting skills.

Additionally, more than half of filter backwash samples were positive for P. aeruginosa. The detection of this ubiquitous microbe could reflect environmental (e.g., dirt or pool fill water), swimmer (e.g., fecal material or skin), or fomite (e.g., kickboards) contamination. Once in a pool, P. aeruginosa inhabits and amplifies in biofilms on moist or submerged surfaces, such as pool walls, plumbing, and filters. Further investigation is needed to better characterize P. aeruginosa contamination of pools and its contributing factors. P. aeruginosa can cause RWI (e.g., otitis externa or dermatitis) outbreaks when adequate disinfection is not consistently maintained (5). The proportion of samples positive for P. aeruginosa significantly differed between venues treated with traditional chlorine products combined with ultraviolet light disinfection versus those treated with saltwater-generated free chlorine. The reason for this association is unclear but might reflect differences in swimmers or pool location, age, or design. Pool operator vigilance (e.g., cleaning, scrubbing surfaces, and maintaining water quality [e.g., disinfectant level and pH]) and enforcement of such public health standards by state and local environmental health specialists can minimize P. aeruginosa amplification and thus prevent a negative impact on swimmer health.

The findings in this report are subject to at least four limitations. First, the pools sampled in this study are a convenience sample of pools in metro-Atlanta, and thus study findings cannot be generalized to pools in metro-Atlanta or beyond. However, the incidence of RWI outbreaks of acute gastrointestinal illness throughout the United States suggests that swimmers frequently introduce fecal material and pathogens into recreational water throughout the country. Second, qPCR results alone cannot be used to determine whether the detected pathogens were viable or infectious or determine the level of swimmer risk; qPCR detects viable microbes as well as those inactivated by disinfection. Of note, no RWI outbreaks associated with pools were detected in Georgia in 2012. Third, pool operators were asked to estimate the number of swimmers in the past week and number of days since last filter backwash; however, the data were deemed unreliable and thus could not be used to characterize the relationship between either of these factors and the detection of microbes in filter backwash samples. Finally, E. coli are found in fecal material from warm-blooded animals, not just humans. However, the E. coli detected in the pool filter backwash samples is most likely of human origin given that swimming is the most popular sport among children (6), over one third of the samples that tested positive for E. coli came from filters of indoor pools, and public outdoor pools are fenced in to limit access.

Swimmers have the power and responsibility to decrease the risk for RWIs by practicing good hygiene. In addition to minimizing the amount of fecal material introduced into recreational water, good swimmer hygiene, through bathroom breaks every 60 minutes and taking a pre-swim shower, minimizes the amount of urine and sweat introduced into the water (Box). Nitrogen in urine and sweat depletes free chlorine by combining with it to form di- and tri-chloramines, which are volatile respiratory and ocular irritants; free chlorine alone, at CDC-recommended concentrations, is not an ocular irritant. This study and others indicate that swimmers frequently introduce fecal material, microbes, urine (7), sweat, and other contaminants (8) into recreational water. Another study suggests that disinfectant level and pH frequently are not properly maintained (9). Together, they all underscore the importance of a strong partnership among the swimming public, aquatics staff, and public health to prevent RWIs. RWI prevention will be optimized when swimmers minimize introduction of pathogens into the water by practicing good hygiene, aquatics staff maintain disinfectant level and pH according to state and local public health standards to inactivate pathogens, and state and local environmental health specialists enforce such standards. This critical partnership depends on maintaining robust state and local pool inspection programs (10) that provide leadership by enforcing public health standards and serving as a healthy swimming resource to aquatics staff and swimming public.

References

1. Hill VR, Kahler AM, Jothikumar N, Johnson TB, Hahn D, Cromeans TL. Multistate evaluation of an ultrafiltration-based procedure for simultaneous recovery of enteric microbes in 100-liter tap water samples. Appl Environ Microbiol 2007;73:4218–25.
2. Goodgame RW, Genta RM, White AC, Chappell CL. Intensity of infection in AIDS-associated cryptosporidiosis. J Infect Dis 1993;167:704–9.
3. Chappell CL, Okhuysen PC, Langer-Curry R, et al. Cryptosporidium hominis: experimental challenge of healthy adults. Am J Trop Med Hyg 2006;75:851–7.
4. Gerba CP. Assessment of enteric pathogen shedding by bathers during recreational activity and its impact on water quality. Quant Microbiol 2000;2:55–68.
5. CDC. Surveillance for waterborne disease outbreaks and other health events associated with recreational water—United States, 2007–2008. MMWR 2011;60(No. SS-12):1–32.
6. US Census Bureau. Recreation and leisure activities: participation in selected sports activities 2009. Washington, DC: US Census Bureau; 2012. Available at http://www.census.gov/compendia/statab/2012/tables/12s1249.pdf .
7. Wiant C. New public survey reveals swimmer hygiene attitudes and practices. Int J Aquat Res Educ 2012;3:201–2.
8. Keuten MGA, Schets FM, Schijven JF, Verberk JQJC, van Dijk JC. Definition and quantification of initial anthropogenic pollutant release in swimming pools. Water Res 2012;46:3682–92.
9. CDC. Violations identified from routine swimming pool inspections—selected states and counties, United States, 2008. MMWR 2010;59:582–7.
10. National Association of County and City Health Officials. Local health department job losses and program cuts: findings from January 2012 survey. Washington, DC: National Association of County and City Health Officials; 2013. Available at http://www.naccho.org/advocacy/upload/overview-report-mar-2012-final.pdf.

http://www.fsis.usda.gov/News_&_Events/NR_051013_01/index.asp

New Study by USDA, FDA Aims to Enhance Food Safety in Retail Delis
Risk Assessment Targets Listeria monocytogenes (Lm

http://www.fsis.usda.gov/PDF/Interagency_RA_Lm_Retail_Report_May2013.pdf

http://www.cdc.gov/ecoli/2013/O121-03-13/index.html

• A total of 35 persons infected with the outbreak strain of Shiga toxin-producing Escherichia coliO121 (STEC O121) have been reported from 19 states.
  • 82% of ill persons are 21 years of age or younger.
  • 31% of ill persons have been hospitalized. Two ill people developed hemolytic uremic syndrome (HUS), a type of kidney failure, and no deaths have been reported.
• CDC and state public health officials are interviewing ill persons to obtain information regarding foods they might have eaten and other exposures in the week before illness.
  • Information available to date indicates that consumption of Farm Rich brand frozen food products is one likely source of infection for the ill persons in this outbreak.
• The outbreak strain of STEC O121 has been identified in two different Farm Rich brand frozen products collected from the homes of two ill persons in Texas and New York.
• On April 4, 2013, Rich Products Corporation expanded its recall to include all Farm Rich, Market Day, and Schwan’s brand frozen food products produced at its Waycross, Georgia plant between July 1, 2011 and March 29, 2013 due to possible contamination with E. coliO121.
  • The recalled products had “Best By” dates ranging from January 1, 2013 to September 29, 2014.
• Consumers should check their freezers for recalled frozen products and not eat them.
• The U.S. Department of Agriculture’s Food Safety Inspection Service and the U.S. Food and Drug Administration are currently conducting investigations to determine the source of product contamination.

http://www.phac-aspc.gc.ca/efwd-emoha/efbi-emoa-eng.php

Estimates of Food-borne Illness in Canada

The Public Health Agency of Canada estimates that each year roughly one in eight Canadians (or four million people) get sick due to domestically acquired food-borne diseases. This estimate provides the most accurate picture yet of which food-borne bacteria, viruses, and parasites (“pathogens”) are causing the most illnesses in Canada, as well as estimating the number of food-borne illnesses without a known cause.

In general, Canada has a very safe food supply; however, this estimate shows that there is still work to be done to prevent and control food-borne illness in Canada, to focus efforts on pathogens which cause the greatest burden and to better understand food-borne illness without a known cause.

About the estimates of food-borne illness in Canada

Findings

The Public Health Agency of Canada estimates that each year roughly one in eight Canadians (or four million people) get sick with a domestically acquired food-borne illness.

The Agency has estimates for two major groups of food-borne illnesses:

• Known food-borne pathogens: There are 30 pathogens known to cause food-borne illness. Many of these pathogens are tracked by public health systems that monitor cases of illness.
• Unspecified agents: Because you can’t “monitor” what is not yet identified, estimates for this group of agents were developed by first looking at the health effects or symptoms that they are most likely to cause—acute gastrointestinal illness (AGI) (i.e. vomiting and diarrhea). Unspecified agents were defined as: agents with insufficient data to estimate agent-specific burden; known agents not yet identified as causing food-borne illness; microbes, chemicals, or other substances known to be in food whose ability to cause illness is unproven; and agents not yet identified.

To estimate the total number of food-borne illnesses, the Agency estimated the number of illnesses caused by both known food-borne pathogens and unspecified agents.

Table 2. Top four pathogens causing domestically acquired food-borne illnesses in Canada, circa 2006

Pathogen	Estimated annual number of illnesses (90% credible interval)	%
Norovirus	1,047,733 (679,576 – 1,434,048)	65
Clostridium perfringens	176, 963 (95,225 – 270,160)	11
Campylobacter spp.	145,350 (95,686 – 212,971)	8
Salmonella, nontyphoidal	87,510 (58,832 – 125,525)	5
Subtotal		89

Journal publication

The full article entitled “Estimates of the Burden of Food-borne Illness in Canada for 30 Specified Pathogens and Unspecified Agents, circa 2006” is published in the journal Foodborne Pathogens and Diseases.

If you would like a copy of the article in either English or French please contact: enteric.surveillance.entérique@phac-aspc.gc.ca.

Methods and Data Sources

Surveillance and Data Systems

Many surveillance systems are used in Canada to provide information about the occurrence of food-borne illness. Most of the Agency’s surveillance systems rely on data from provincial/territorial and local public health ministries/units/authorities. Systems focus on specific pathogens likely to be transmitted through food to detect outbreaks, monitor trends and risk factors.

Each surveillance system plays a role in detecting and preventing food-borne illness and outbreaks.

Under-reporting and under-diagnosis

In general, to be captured in a Canadian surveillance system a sick individual must: seek care; have a sample (stool, urine or blood) requested; and submit a sample for testing. In addition, the sample must be tested with a test capable of identifying the causative agent; and finally the positive test result must be reported to the surveillance system (Figure 1). Surveillance systems only capture a small portion of total illnesses given all these necessary steps (i.e. there is under-diagnosis and under-reporting taking place).

Figure 1 Burden of illness pyramid

Text Equivalent – Figure 1

Methodological Approaches

Estimating Canadian food-borne illnesses for 30 known food-borne pathogens

Two main methods were used to estimate the number of Canadian food-borne illnesses for the Listing of 30 known pathogens.

The first approach:

For each pathogen with surveillance data, we used data from various surveillance systems and corrected for under-reporting and under-diagnosis. We then multiplied the adjusted number by the proportion of illnesses acquired in Canada (that is, not acquired during international travel) and the proportion transmitted by food, to estimate the number of illnesses that are domestically acquired and food-borne (Figure 2).

The second approach:

For common pathogens that are not part of standard surveillance, we estimated the number of Canadians who would experience symptoms (e.g. diarrheal illness) and the proportion of those symptoms that is related to the particular pathogen. We then multiplied this number by the proportion of illnesses acquired in Canada and the proportion transmitted by food, to yield an estimated number of illnesses that are domestically acquired and food-borne (Figure 3).

Alternative approaches were used to estimate illnesses where suitable data from surveillance or data on proportion of symptoms attributed to the pathogen were not available.

Then, the estimates for each of the pathogens were added together to arrive at an overall pathogen specific total. An uncertainty model to generate a point estimate and 90% credible interval (i.e. upper and lower limits that account for variability and uncertainty of the data) was used.

Figure 2^{Figures 2 and 3 – Footnote *} First approach: For pathogens where laboratory-confirmed cases were scaled up

Text Equivalent – Figure 2

Figure 3^{Figures 2 and 3 – Footnote *} Second approach: For pathogens where Canadian population was scaled down

Text Equivalent – Figure 3

Footnote *

Probability distributions were used to model uncertainty in each data inputs. Point estimates were bounded by a 90% credible interval.

Listing of 30 known pathogens by estimation method

Pathogens for which laboratory-confirmed illnesses were scaled up

National reportable disease data

• Brucella spp.
• Campylobacter spp.
• Clostridium botulinum
• Cryptosporidium spp.
• Cyclospora cayetanensis
• VTEC O157
• Giardia sp.
• Hepatitis A
• Salmonella spp., nontyphoidal
• Salmonella Typhi
• Shigella spp
• Vibrio cholera
• Vibrio spp., other
• Vibrio vulnificus

Provincial reportable disease data

• Trichinella spp.
• Listeria monocytogenes
• Vibrio parahaemolyticus
• Yersinia enterocolitica

Pathogens for which Canadian population scaled down

• Adenovirus
• Astrovirus
• Norovirus
• Rotavirus
• Sapovirus
• Toxoplasma gondii
• Clostridium perfringens

Other methods

• E. coli, other diarrheagenic
• ETEC
• VTEC non-O157
• Bacillus cereus
• Staphylococcus aureus

Estimating Canadian food-borne illnesses for unspecified agents

Unspecified agents that cause acute gastrointestinal illness fall into four general categories:

• Agents with insufficient data to estimate agent-specific burden
• Known agents not yet recognized as causing food-borne illness
• Microbes, chemicals, or other substances known to be in food that could at some time be shown to cause illness Agents not yet described
• Agents not yet described

To estimate food-borne illnesses from unspecified agents, we used symptom-based data from surveys to estimate the total number of episodes of acute gastrointestinal illnesses (AGI) and then subtracted the number of illnesses accounted for by known AGI pathogens. We then multiplied this number by the proportion of domestically acquired illnesses and of illnesses attributable to food, just as we did for the known agents. Finally, as with the known-pathogens estimate, we used an uncertainty model to generate a point estimate and 90% credible interval (upper and lower limits) (Figure 4).

Food-borne illnesses due to chemicals that cause acute gastrointestinal illness are included in the estimate of illnesses due to unspecified agents. However, chemicals or unspecified agents that do not cause acute gastrointestinal illness are not included in the estimates.

Figure 4^{Figures 4 – Footnote *} Approach for unspecified agents

Text Equivalent – Figure 4

Footnote *

Probability distributions were used to model uncertainty in each data input. Point estimates were bounded by a 90% credible interval.

Footnote **

Estimated proportions were based on 25 known pathogens that cause acute gastrointestinal illness. Five pathogens were not included because their primary symptoms are not acute gastrointestinal illness.

Improvements to previous estimates

The Agency’s 2013 estimates of illnesses from food-borne diseases in Canada are more accurate than the estimates published in 2008 of 11 million episodes of food-borne illness each year based on better data and methodologies. The 2008 estimates used values from earlier United States Centers for Disease Control and Prevention estimates applied to a Canadian estimate of the average number of episodes of acute gastrointestinal illness per person occurring each year. In addition, the methodology used for the 2013 estimates is different from that used in 2008. As a result of these differences, no strict side-by-side comparison can be made between the two sets of estimates. The 2013 estimates do not mean that there is less food-borne illness occurring, but rather, that more accurate estimates are now possible.

The 2013 estimates of illnesses from food-borne disease in Canada reflect improvements in methodology since 2008. Perhaps most importantly, these new estimates identify and rank the most important bacteria, viruses and parasites (“pathogens”) responsible for causing food-borne illness. These more specific estimates can further inform policy and regulatory priorities to prevent future illnesses.

The following list highlights the major differences in data and methodology between the new estimates and those published in 2008, and how they affect the estimates of illnesses from food-borne diseases in Canada.

Differences between 2008 and 2013 methodology

2008

• Included international travel-related illnesses.
• Did not estimate illness for individual pathogens.
• Utilised 1.3 episodes per person/year based on the following AGI case definition: any diarrhea or vomiting in the past 28 days excluding those with chronic conditions.
• 36% = Proportion applied to rate of acute gastrointestinal illness (known pathogens and the unspecified agents included) estimated to be food-borne (based on the US 1999 estimates).
• Uncertainty and variability of each input was not calculated.

2013

• Excluded international travel-related illnesses.
• Estimates of illness for 30 known pathogens.
• Pathogen-specific multipliers used to adjust for under-reporting and under-diagnosis.
• Pathogen specific proportion domestically acquired and food-borne applied.
• Utilised 0.63 episodes per person/year based on the following AGI case definition: 3 or more loose stools in 24 hours or any vomiting in the past 28 days excluding those with chronic conditions, or concurrent symptoms of coughing, sneezing, sore throat or runny nose.
• 20% = Proportion of the unspecified agents estimated to be food-borne (based on pathogen specific information on proportion food-borne).
• The Agency used many data sources, with varying degrees of reliability, to determine the estimates of food-borne illnesses. For each estimate, a formula was used to account for the cumulative effect of uncertainty and variability of the data inputs.

Effects of Difference

• 2013 estimate focused on food-borne illnesses acquired in Canada: 2013 estimates were limited to food-borne illnesses that were acquired in Canada, which reduced the number of food-borne illnesses in 2013 vs. 2008.
• 2013 estimated number of illnesses caused by known pathogens: more accurate: Utilising specific multipliers and proportion domestically acquired and food-borne for the 30 known pathogens yielded more accurate estimates for each known pathogen and, ultimately, greater accuracy in the overall estimate of food-borne illness.
• 2013 estimate of acute gastrointestinal illnesses (AGI): more precise: A more specific case definition for AGI was used to be more precise in the estimate and to minimize the chance of estimating illness that was not infectious (i.e. related to chronic illnesses such as Crohn’s disease) and not truly gastrointestinal (i.e. symptoms related to a respiratory infection). The impact of this is a lower overall estimate in 2013 vs. 2008.
• 2013 estimate used a smaller proportion of unspecified AGI determined to be food-borne: Reduced the number of food-borne illnesses in 2013 vs. 2008.
• 2013 estimate accounted for uncertainty: The results were upper and lower 90% credible limits, (i.e. a 90% credible interval). This means that 90% of the time the true value of the estimate falls within the upper and lower values.

Although we cannot compare these estimates to determine trends, we can turn to other data sources for information about trends in some important infections that are transmitted commonly through food.

Trends

Data from the Canadian Notifiable Disease Surveillance System (CNDSS) and National Enteric Surveillance Program (NESP) provide the best measures of disease trends. Although these systems include only a portion of the pathogens that make up the estimates, it does allow us to see changes over time for these important food-borne pathogens.

According to these systems some food-borne illnesses have dropped substantially over the past decade, but infections caused by one of the most common pathogens – Salmonella have not declined.

Trends in food-borne illness for 2011 compared to the 1998-2000 baseline period:

• No significant change in the rate of Salmonella infection (NESP).
• 35% decrease (95%CI 33-36%) in the rate of campylobacteriosis (CNDSS)
• 68% decrease (95%CI 65-71%) in the number of O157 Verotoxigenic Escherichia coli (VTEC) infections (NESP)
• 27% decrease (95%CI 22-32%) in the rate of shigellosis (CNDSS)

Other important pathogens commonly transmitted through food (e.g. norovirus, Clostridium perfringens, Toxoplasma gondii) are not tracked in part because they cause mild symptoms of short duration and because of current limitations in laboratory capacity and techniques. Common prevention measures (e.g. safe food handling) that would decrease illness caused by tracked pathogens would also decrease illness caused by pathogens not currently being tracked.

Figure 5 Relative rates of laboratory-confirmed infections with Campylobacter, VTEC O157, Salmonella, and Shigella compared with 1998–2000 rates, by year, 2001–2011, CNDSS and NESP

Text Equivalent – Figure 5

Comparison to US methodology and results

Canada used similar methodologies as the United States Centre for Disease Control and Prevention (US-CDC) for estimating the burden of food-borne illness in their country.

Findings

The overall total estimate (specified and unspecified agents) for Canada is slightly less than the US-CDC estimate with approximately one in eight Canadians compared to the US-CDC estimate of one in six Americans, experiencing food-borne illness per year.

Top 4 Pathogens contributing to total domestic food-borne illness in:

Canada

• Norovirus
• Clostridium perfringens
• Campylobacter spp
• Salmonella spp., non-typhoidal

The United States

• Norovirus
• Salmonella spp., non-typhoidal
• Clostridium perfringens
• Campylobacter spp.

Methods

Canada

• Inclusion of adenovirus and exclusion of Mycobacterium bovis and Streptococcus Group A (pathogens excluded are not relevant to Canada’s domestic food supply).
• Incorporated duration of illness and bloody diarrhea to define severe cases for some pathogens.
• Ratio of Bacillus cereus and Staphylococcus aureus to Clostridium perfringens using reported provincial data was applied to the estimate obtained through the population incidence of Clostridium perfringens from UK study.
• Estimated rotavirus, astrovirus and sapovirus for the total population.
• Included illnesses due to viruses for the total population as part of specified pathogen estimate.

The United States

• Did not include adenovirus but did include Mycobacterium bovis and Streptococcus Group A.
• Included only bloody diarrhea in definition of severe cases for some pathogens.
• Used data from outbreak reporting system and then applied an outbreak to sporadic ratio for Bacillus cereus, Staphylococcus aureus and Clostridium perfringens.
• Estimated rotavirus, astrovirus and sapovirus for < 5 years of age only.
• Illnesses related to viruses for those greater than 5 years of age are included in the unspecified agents’ estimate.

Effects of Methods

• Pathogens causing food-borne illness included in the estimate: Minimal impact to differences in overall estimates.
• Canadian definition of severity of illness included duration: Results in a higher proportion of cases being considered severe, and ultimately in a lower estimate of under-diagnosis in Canada compared to the United States.
• Approach to estimating bacterial food-borne toxins: Different approaches therefore difficult to compare the effect.
• Viruses calculated for total population: Reduced the number of cases in the unspecified portion as these were now part of the number of viruses estimated within the specified pathogens portion for Canada compared to the United States. Results in a lower total food-borne estimate for Canada compared to the US as these viruses have a low proportion food-borne.
• Unspecified agents: Reduced the number of cases estimated in the unspecified portion (60% of total) compared to the US (80% of total). Also reduces proportion food-borne (20%) compared to US (25%) applied to AGI caused by unspecified agents

Additional Information

• Food Safety – Public Health Agency of Canada
• Food Safety Videos
• Anatomy of a Food-borne Illness Outbreak
• Prevention and Education: Safe food handling and preparation
• FoodSafety.gc.ca

Percentage Change in 2012 compared with 2006-2008: Campylobacter - 14% increase, E. coli O157 – no change, Listeria – no change, Salmonella – no change, Vibrio – 43% increase, Yersinia – no change

2012 rate per 100,000 Population: Campylobacter - 14.30, E. coli O157 – 1.12, Listeria – 0.25, Salmonella – 16.42, Vibrio – 0.41, Yersinia – 0.33

2020 target rate per 100,000 Population: Campylobacter - 8.5, E. coli O157 – 0.6, Listeria – 0.2, Salmonella – 11.4, Vibrio – 0.2, Yersinia – 0.3

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6215a2.htm?s_cid=mm6215a2_e

Incidence and Trends of Infection with Pathogens Transmitted Commonly Through Food — Foodborne Diseases Active Surveillance Network, 10 U.S. Sites, 1996–2012

Weekly

April 19, 2013 / 62(15);283-287

Foodborne diseases are an important public health problem in the United States. The Foodborne Diseases Active Surveillance Network* (FoodNet) conducts surveillance in 10 U.S. sites for all laboratory-confirmed infections caused by selected pathogens transmitted commonly through food to quantify them and monitor their incidence. This report summarizes 2012 preliminary surveillance data and describes trends since 1996. A total of 19,531 infections, 4,563 hospitalizations, and 68 deaths associated with foodborne diseases were reported in 2012. For most infections, incidence was highest among children aged <5 years; the percentage of persons hospitalized and the percentage who died were highest among persons aged ≥65 years. In 2012, compared with the 2006–2008 period, the overall incidence of infection† was unchanged, and the estimated incidence of infections caused by Campylobacter and Vibrio increased. These findings highlight the need for targeted action to address food safety gaps.

FoodNet conducts active, population-based surveillance for laboratory-confirmed infections caused by Campylobacter, Cryptosporidium, Cyclospora, Listeria, Salmonella, Shiga toxin–producing Escherichia coli (STEC) O157 and non-O157, Shigella, Vibrio, and Yersinia in 10 sites covering 15% of the U.S. population (48 million persons in 2011).§ FoodNet is a collaboration among CDC, 10 state health departments, the U.S. Department of Agriculture’s Food Safety and Inspection Service (USDA-FSIS), and the Food and Drug Administration (FDA). Hospitalizations occurring within 7 days of specimen collection date are recorded, as is the patient’s vital status at hospital discharge, or at 7 days after the specimen collection date if the patient was not hospitalized. All hospitalizations and deaths that occurred within a 7-day window are attributed to the infection. Surveillance for physician-diagnosed postdiarrheal hemolytic uremic syndrome (HUS), a complication of STEC infection characterized by renal failure, is conducted through a network of nephrologists and infection preventionists and by hospital discharge data review. This report includes 2011 HUS data for persons aged <18 years.

Incidence was calculated by dividing the number of laboratory-confirmed infections in 2012 by U.S. Census estimates of the surveillance population area for 2011.¶ A negative binomial model with 95% confidence intervals (CIs) was used to estimate changes in incidence from 2006–2008 to 2012 and from 1996–1998 to 2012 (1). The overall incidence of infection with six key pathogens for which >50% of illnesses are estimated to be foodborne (Campylobacter, Listeria, Salmonella, STEC O157, Vibrio, and Yersinia) was calculated (2). Trends were not assessed for Cyclospora because data were sparse, or for STEC non-O157 because of changes in diagnostic practices. For HUS, changes in incidence from 2006–2008 to 2011 were estimated.

Incidence and Trends

In 2012, FoodNet identified 19,531 laboratory-confirmed cases of infection (Table 1). The number of infections and incidence per 100,000 population, by pathogen, were as follows: Salmonella (7,800; 16.42), Campylobacter (6,793; 14.30), Shigella (2,138; 4.50), Cryptosporidium (1,234; 2.60), STEC non-O157 (551; 1.16), STEC O157 (531; 1.12), Vibrio (193; 0.41), Yersinia (155; 0.33), Listeria (121; 0.25), and Cyclospora (15; 0.03). As usual, the highest reported incidence was among children aged <5 years for Cryptosporidium and the bacterial pathogens other than Listeria and Vibrio, for which the highest incidence was among persons aged ≥65 years (Table 2).

Among 6,984 (90%) serotyped Salmonella isolates, the top three serotypes were Enteritidis, 1,238 (18%); Typhimurium, 914 (13%); and Newport, 901 (13%). Among 183 (95%) Vibrio isolates with species information, 112 were V. parahaemolyticus (61%), 25 were V. vulnificus (14%), and 20 were V. alginolyticus (11%). Among 496 (90%) serogrouped STEC non-O157 isolates, the most common serogroups were O26 (27%), O103 (23%), and O111 (15%). Among 2,318 (34%) Campylobacter isolates with species information, 2,082 (90%) were C. jejuni, and 180 (8%) were C. coli.

The estimated incidence of infection was higher in 2012 compared with 2006–2008 for Campylobacter (14% increase; confidence interval [CI]: 7%–21%) and Vibrio (43% increase; CI: 16%–76%) and unchanged for other pathogens (Figure 1). In comparison with 1996–1998, incidence of infection was significantly lower for Campylobacter, Listeria, Shigella, STEC O157, and Yersinia, whereas the incidence of Vibrio infection was higher (Figure 2). The overall incidence of infection with six key pathogens** transmitted commonly through food was lower in 2012 (22% decrease; CI: 11%–32%) compared with 1996–1998 and unchanged compared with 2006–2008.

The incidence of infections with specific Salmonella serotypes in 2012, compared with 2006–2008, was lower for Typhimurium (19% decrease; CI: 10%–28%), higher for Newport (23% increase; CI: 1%–50%), and unchanged for Enteritidis. Compared with 1996–1998, the incidence of infection was significantly higher for Enteritidis and Newport, and lower for Typhimurium.

Among 63 cases of postdiarrheal HUS in children aged <18 years (0.57 cases per 100,000 children) in 2011, 33 (52%) occurred in children aged <5 years (1.09 cases per 100,000). Compared with 2006–2008, the incidence was significantly lower for children aged <5 years (44% decrease; CI: 18%–62%) and for children aged <18 years (29% decrease; CI: 4%–47%).

Hospitalizations and Deaths

In 2012, FoodNet identified 4,563 hospitalizations and 68 deaths among cases of infection with pathogens transmitted commonly through food (Table 1). The percentage of patients hospitalized ranged from 15% for Campylobacter to 96% for Listeria infections. The percentage hospitalized was greatest among those aged ≥65 years for STEC O157 (67%), Vibrio (58%), Salmonella (55%), Cyclospora (50%), Shigella (41%), STEC non-O157 (34%), Cryptosporidium (33%), and Campylobacter (31%). At least 95% of patients with Listeria infection in each age group†† with cases were hospitalized. The percentage of patients who died ranged from 0% for Yersinia and Cyclospora to 11% for Listeria infections. The percentage that died was highest among persons aged ≥65 years for Vibrio (6%), Salmonella (2%), STEC O157 (2%), Cryptosporidium (1%), Shigella (1%), and Campylobacter (0.2%).

Reported by

Debra Gilliss, MD, California Dept of Public Health. Alicia B. Cronquist, MPH, Colorado Dept of Public Health and Environment. Matthew Cartter, MD, Connecticut Dept of Public Health. Melissa Tobin-D’Angelo, MD, Georgia Dept of Public Health. David Blythe, MD, Maryland Dept of Health and Mental Hygiene. Kirk Smith, DVM, Minnesota Dept of Health. Sarah Lathrop, PhD, Univ of New Mexico. Shelley Zansky, PhD, New York State Dept of Health. Paul R. Cieslak, MD, Oregon Health Authority. John Dunn, DVM, Tennessee Dept of Health. Kristin G. Holt, DVM, Food Safety and Inspection Svc, US Dept of Agriculture. Susan Lance, Center for Food Safety and Applied Nutrition, Food and Drug Admin. Stacy M. Crim, MPH, Olga L. Henao, PhD, Mary Patrick, MPH, Patricia M. Griffin, MD, Robert V. Tauxe, MD, Div of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC. Corresponding contributor: Stacy M. Crim, scrim@cdc.gov, 404-639-2257.

Editorial Note

In 2012, the incidence of infections caused by Campylobacter and Vibrio increased from the 2006–2008 period, whereas the incidence of infections caused by Cryptosporidium, Listeria, Salmonella, Shigella, STEC O157, and Yersinia was unchanged. These findings highlight the need to continue to identify and address food safety gaps that can be targeted for action by the food industry and regulatory authorities.

After substantial declines in the early years of FoodNet surveillance, the incidence of Campylobacter infection has increased to its highest level since 2000. Campylobacter infections are more common in the western U.S. states and among children aged <5 years (3). Although most infections are self-limited, sequelae include reactive arthritis and Guillain-Barré syndrome.§§ Associated exposures include consumption of poultry, raw milk, produce, and untreated water, and animal contact (4,5).

Declines in U.S. campylobacteriosis during 1996–2001 might have been related to measures meat and poultry processors implemented to comply with the Pathogen Reduction and Hazard Analysis and Critical Control Points (HACCP) systems regulations issued by USDA-FSIS in the late 1990s.¶¶ In 2011, USDA-FSIS issued new Campylobacter performance standards for U.S. chicken and turkey processors.*** Continued FoodNet surveillance can help to assess the public health impact of these standards and other changes. Detailed patient exposure information coupled with information on strain subtypes could help in assessing the relative contribution of various sources of infection and the effectiveness of control measures.

Although a significant increase was observed in reported Vibrio infections, the number of such infections remains low (6). Vibrios live naturally in marine and estuarine waters, and many infections are acquired by eating raw oysters (7). These infections are most common during warmer months, when waters contain more Vibrio organisms. Infections can be prevented by postharvest treatment of oysters with heat, freezing, or high pressure (8), or by thorough cooking. Persons who are immunocompromised or have impaired liver function should be informed that consuming raw seafood carries a risk for severe Vibrio infection. Vibrios also cause wound and soft-tissue infections among persons who have contact with water; for example, Vibrio alginolyticus typically causes ear infection (9).

The decrease in incidence of HUS in 2011 compared with 2006–2008 mirrors the decrease in the incidence of STEC O157 infection observed in 2011. The incidence of STEC O157 infection, which had declined since 2006, was no longer decreasing in 2012, and now exceeds the previously met Healthy People 2010 target of one case per 100,000 persons. The continued increase in STEC non-O157 infections likely reflects increasing use by clinical laboratories of tests that detect these infections.

FoodNet surveillance relies on isolation of bacterial pathogens by culture of clinical specimens; therefore, the increasing use of culture-independent tests for Campylobacter and STEC might affect the reported incidence of infection (10). Data on persons with only culture-independent evidence of infection suggests that in 2012, the number of laboratory-identified Campylobacter cases could have been 9% greater and the number of STEC (O157 and non-O157) cases 7%–19% greater than that reported (CDC, unpublished data, 2013). The lack of recent decline in STEC O157 incidence is of concern; continued monitoring of trends in the incidence of HUS and use of culture-independent testing might aid in interpreting future data on STEC O157 incidence.

The findings in this report are subject to at least four limitations. First, health-care–seeking behaviors and other characteristics of the population in the surveillance area might affect the generalizability of the findings. Second, many infections transmitted commonly through food (e.g., norovirus infection) are not monitored by FoodNet because these pathogens are not identified routinely in clinical laboratories. Third, the proportion of illnesses transmitted by nonfood routes differs by pathogen, and the route cannot be determined for individual, nonoutbreak-associated illnesses and, therefore, the data provided in this report do not exclusively relate to infections from foodborne sources. Finally, in some cases counted as fatal, the infection with the enteric pathogen might not have been the primary cause of death.

Most foodborne illnesses can be prevented. Progress has been made in decreasing contamination of some foods and reducing illness caused by some pathogens, as evidenced by decreases in earlier years. In 2010, FDA passed the Egg Safety Rule,††† designed to decrease contamination of shell eggs with Salmonella serotype Enteritidis. In 2011, USDA-FSIS tightened its performance standard for Salmonella contamination to a 7.5% positive rate for whole broiler chickens.§§§ Finally, the Food Safety Modernization Act of 2011 gives FDA additional authority to improve food safety and requires CDC to strengthen surveillance and outbreak response.¶¶¶ Collection of comprehensive surveillance information further supports reductions in foodborne infections by helping to determine where to target prevention efforts, supporting efforts to attribute infections to sources, guiding implementation of measures known to reduce food contamination, and informing development of new measures. Because consumers can bring an added measure of safety during food storage, handling, and preparation, they are advised to seek out food safety information, which is available online.****

Acknowledgments

Workgroup members, Foodborne Diseases Active Surveillance Network (FoodNet), Emerging Infections Program; communications team, Div of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Diseases, CDC.

References

1. Henao OL, Scallan E, Mahon B, Hoekstra RM. Methods for monitoring trends in the incidence of foodborne diseases: Foodborne Diseases Active Surveillance Network 1996–2008. Foodborne Pathog Dis 2010;7:1421–6.
2. Henao OL, Crim SM, Hoekstra RM. Calculating a measure of overall change in the incidence of selected laboratory-confirmed infections with pathogens transmitted commonly through food, Foodborne Diseases Active Surveillance Network (FoodNet), 1996–2010. Clin Infect Dis 2012;54(Suppl 5):S418–20.
3. Samuel MC, Vugia DJ, Shallow S, et al. Epidemiology of sporadic Campylobacter infection in the United States and declining trend in incidence, FoodNet 1996–1999. Clin Infect Dis 2004;38(Suppl 3):S165–74.
4. Friedman CR, Hoekstra RM, Samuel M, et al. Risk factors for sporadic Campylobacter infection in the United States: a case-control study in FoodNet sites. Clin Infect Dis 2004;38(Suppl 3):S285–96.
5. Taylor EV, Herman KM, Ailes EC, et al. Common source outbreaks of Campylobacter infection in the USA, 1997–2008. Epidemiol Infect 2012;15:1–10 [Epub ahead of print].
6. Newton A, Kendall M, Vugia DJ, Henao OL, Mahon BE. Increasing rates of vibriosis in the United States, 1996–2010: review of surveillance data from 2 systems. Clin Infect Dis 2012;54(Suppl 5):S391–5.
7. Altekruse SF, Bishop RD, Baldy LM, et al. Vibrio gastroenteritis in the US Gulf of Mexico region: the role of raw oysters. Epidemiol Infect 2000;124:489–95.
8. DePaola A, Jones JL, Noe KE, Byars RH, Bowers JC. Survey of postharvest-processed oysters in the United States for levels of Vibrio vulnificus and Vibrio parahaemolyticus. J Food Prot 2009;72:2110–3.
9. Dechet AM, Yu PA, Koram N, Painter J. Nonfoodborne Vibrio infections: an important cause of morbidity and mortality in the United States, 1997–2006. Clin Infect Dis 2008;46:970–6.
10. Cronquist AB, Mody RK, Atkinson R, et al. Impacts of culture-independent diagnostic practices on public health surveillance for bacterial enteric pathogens. Clin Infect Dis 2012;54(Suppl 5):S432–9.

http://www.cidrap.umn.edu/cidrap/content/influenza/avianflu/news/apr0913cdc.html

CDC activates emergency center over H7N9

Robert Roos News Editor

Apr 9, 2013 (CIDRAP News) – “The US Centers for Disease Control and Prevention (CDC) activated its Emergency Operations Center (EOC) in Atlanta yesterday to support the response to the H7N9 influenza outbreak in China, CDC officials said in an e-mailed statement today.

The EOC was activated at level 2, the second of three levels. Level 1, the highest, signals an agency-wide response. “This is a limited activation that allows for the use of additional resources and staff to meet the technical needs of a public health response,” the agency said…………”

Public Health Responses Supported by CDC’s Emergency Operations Center (EOC)

EOC Responses Since 2001

• 2011: Japan Earthquake and Tsunami
• 2010: New Hampshire Anthrax; Haiti Earthquake, Deepwater Horizon Oil Spill, Haiti Cholera Outbreak
• 2009: Salmonella typhimurium outbreak; Presidential Inauguration; H1N1 Influenza
• 2008: Satellite intercept; Salmonella and E. coli outbreaks; Hurricane Dolly; Tropical Storm Edouard; Hurricanes Gustav, Hanna, and Ike
• 2007: XDR/MDR TB Patient; Hurricane Dean
• 2006: Mumps; Tropical Storm Ernesto; E. coli outbreaks, Botulism Outbreak, Mycoplasma Pneumonia
• 2005: Presidential Inauguration, Marburg virus; Hurricanes Katrina, Rita, and Wilma
• 2004: Avian Influenza, BioWatch, Influenza vaccine shortage; Guam typhoon; Ricin; Citites Readiness Initiative, G8 Summit; Summer Olympics; Democratic National Convention; Republican National Convention; Hurricanes Charley, Frances, Ivan, and Jeanne; West Nile Virus; Tsunami
• 2003: Columbia Space Shuttle Disaster; SARS; Monkeypox; Northeast blackout; Hurricane Isabel; Domestic Influenza; California wildfires; Ricin; Tularemia; Anthrax; BSE (Mad Cow Disease)
• 2001: World Trade Center Attacks; Anthrax Attacks

http://www.fsis.usda.gov/News_&_Events/Recall_025_2013_Expanded/index.asp

New York Firm Recalls Additional Frozen Mini Meals And Other Snack Products Due To Possible E. Coli O121 Contamination

Congressional and Public Affairs (202) 720-9113 Richard J. McIntire For FDA inquiries, contact: Patricia El-Hinnawy (301) 796-4763 Editor’s Note April 4, 2013: Details of this recall were updated April 4, 2013 to reflect the approximate amounts, additional products and slight changes in health investigation information. WASHINGTON, Apr. 4, 2013 – Rich Products Corporation, a Buffalo, N.Y. firm, is expanding its recall of various heat treated, not fully cooked frozen mini meals and snack items to more than 10.5 million pounds because they may be contaminated with E. coli O121, the U.S. Department of Agriculture’s Food Safety and Inspection Service (FSIS) announced today. The expanded recall covers all products produced at the company’s Waycross, Ga. plant with “Best by” dates ranging from January 1, 2013 to September 29, 2014. The following FSIS-regulated products are subject to the expanded recall: Retail products– 21-oz. bags of Farm Rich mini bacon cheeseburgers, UPC code 0 41322 35622 2 1-lb. bags of Schwan’s mini meatball sandwiches, UPC code 0 72180 55312 6 18-oz. bags of Farm Rich mini quesadillas, UPC code 0 41322 35611 6, case code 1 00 41322 35631 1 18-oz. bags of Farm Rich mini quesadillas, UPC code 0 41322 35635 2, case code 1 00 41322 35635 9 20-oz. bags of Farm Rich mini quesadillas, UPC code 0 41322 35611 6, case code 1 00 41322 35611 3 21-oz. bags of Farm Rich Philly Cheese Steaks, UPC code 0 41322 35618 5, case code 1 00 41322 35618 2 Foodservice products– 25-lb. cases containing 2.5-lb. foodservice paks of BBQ Chicken Sandwich Melt, UPC code 00041322653024, Product code 65302 25-lb. cases containing 2.5-lb. foodservice paks of Meatball Marinara Sandwich Melt, UPC code 00041322653031, Product 65303 25-lb. cases containing 2.5-lb. foodservice paks of Farm Rich Whole Grain Rich Pepperoni Pizzata, UPC code 10041322652321, Product code 65232 27-lb. cases containing 3-lb. foodservice paks of Farm Rich Turkey Pizzata, UPC code 00041322652348, Product code 65234 24.75-lb. foodservice paks of Pepperoni Pizzata, UPC code 00041322652829 , Product code 65282 25.7-lb. cases of 2.57-lb. foodservice paks of Farm Rich Handheld Stuffed Pepperoni Pleezer, UPC code 10041322652925, Product code 65292 Each product package above contains the establishment number “EST. 27232″ or “P-27233″ inside the USDA mark of inspection. The following FDA-regulated products are subject to the expanded recall. FSIS is issuing this news release to make the public aware that these products are also considered potentially adulterated and should be properly discarded or destroyed. Retail products– 44-oz. cartons of Farm Rich in a pizzeria style crust, UPC code 0 41322 32521 1 22-oz. bags of Farm Rich mozzarella bites in a pizzeria style crust, UPC code 0 4132237813 2 22-oz. bags of Farm Rich mozzarella bites in a pizzeria style crust, UPC code 0 72180610008 9 22-oz. bags of Farm Rich mozzarella bites in a pizzeria style crust, UPC code 0 4132237443 1 22-oz. cartons of Farm Rich mozzarella bites in a pizzeria style crust, UPC code 0 4132280435 5 7-oz. cartons of Farm Rich mozzarella bites in a pizzeria style crust, UPC code 0 4132237691 3 2-lb. cartoons of Farm Rich mozzarella bites in a pizzeria style crust, UPC code 04132237455 4 Foodservice products– 5-lb. foodservice paks of Farm Rich Better For You Pizza Dipper, UPC code 10041322652338 25-lb. foodservice paks of Farm Rich Stuffed Crust Pizza Dippers, UPC code 10041322652680 2.7-lb. foodservice paks of Farm Rich Stuffed Crust Pizza Dippers, UPC code 10041322652659 2.7-lb. foodservice paks of Farm Rich Better For You Pizza Dipper, UPC code 00041322652782 The following products are subject to the FSIS recall issued March 28: 7.2-oz. cartons of Farm Rich mini pizza slices with cheese pepperoni and sauce in pizza dough, UPC code 041322376909 22-oz. cartons of Farm Rich mini pizza slices with cheese pepperoni and sauce in pizza dough, UPC code 041322356437 18-oz. bags of Farm Rich mini quesadillas with cheese, grilled white meat chicken in a crispy crust, UPC code 041322356352 21-oz. bags of Farm Rich philly cheese steaks with cheese, beef & onions in a crispy crust, UPC code 041322356345 Each product package above contains the establishment number “EST. 27232″ or “P-27233″ inside the USDA mark of inspection. In addition, the following products, which fall under FDA jurisdiction, were also recalled March 28. FSIS is issuing this news release to make the public aware that these products are also considered potentially adulterated and should be properly discarded or destroyed. 22-oz. cartons of Farm Rich mozzarella bites in a pizzeria style crust, UPC code 041322374431 7-oz. cartons of Farm Rich mozzarella bites in a pizzeria style crust, UPC code 041322376916 22-oz. bags of Market Day Mozzarella Bites, UPC code 041322804358 The products subject to recall were produced between July 1, 2011 and March 29, 2013 then distributed for retail or restaurant sale nationwide. FSIS and the establishment are concerned that some product may be present in household freezers. FSIS was notified of a multistate investigation of E. coli O121 illnesses on March 19, 2013. Food samples were collected from an ill individual in New York as part of this investigation, and tested by the New York State Department of Health Wadsworth Laboratory. At present, the outbreak includes 24 cases in 15 states that led to seven hospitalizations and one case of Hemolytic Uremic Syndrome (HUS), a type of kidney failure. A sample of a Farm Rich frozen chicken mini quesadilla product from a New York case tested positive for the outbreak strain of E. coli O121. Additionally, a sample of leftover Farm Rich mini pepperoni pizza slices product from a Texas case tested positive for the same strain, confirmed by FSIS lab technicians. Ten cases in Michigan, Mississippi, New York, Ohio, Pennsylvania, Texas, and Virginia report consuming Farm Rich products. FSIS is continuing to work with federal and state public health partners on this investigation, including the New York State Department of Health, New York State Department of Agriculture & Markets, Food and Drug Administration, and Centers for Disease Control and Prevention. FSIS routinely conducts recall effectiveness checks to ensure that steps are taken to make certain that the product is no longer available to consumers. When available, the retail distribution list(s) will be posted on the FSIS website at: www.fsis.usda.gov/FSIS_Recalls/ Open_Federal_Cases/index.asp. Infection with E. coli O121 can result in dehydration, bloody diarrhea and abdominal cramps 2-8 days (3-4 days, on average) after exposure to the organism. While most people recover within a week, some develop HUS. This condition can occur among persons of any age but is most common in children under 5-years old and older adults. Symptoms of HUS may include fever, abdominal pain, pale skin tone, fatigue, small, unexplained bruises or bleeding from the nose and mouth and decreased urination. Persons who experience these symptoms should seek emergency medical care immediately. Consumers with questions regarding the recall should contact the company’s consumer line at (888) 220-5955 from 8 a.m. to 8 p.m. EST Monday through Friday or visit the company website at www.farmrich.com. Media with questions regarding the recall should contact the company’s vice president of communications, Dwight Gram, at (716) 878-8749. Consumers with food safety questions can “Ask Karen,” the FSIS virtual representative available 24 hours a day at AskKaren.gov or via smartphone at m.askkaren.gov. “Ask Karen” live chat services are available Monday through Friday from 10 a.m. to 4 p.m. ET. The toll-free USDA Meat and Poultry Hotline 1-888-MPHotline (1-888-674-6854) is available in English and Spanish and can be reached from l0 a.m. to 4 p.m. (Eastern Time) Monday through Friday. Recorded food safety messages are available 24 hours a day. The online Electronic Consumer Complaint Monitoring System can be accessed 24 hours a day at: www.fsis.usda.gov/FSIS_Recalls/ Problems_With_Food_Products/index.asp #

http://www.fsis.usda.gov/News_&_Events/Recall_025_2013_Release/index.asp

http://www.hpa.org.uk/webw/HPAweb&HPAwebStandard/HPAweb_C/1317138367615?p=1317137526707

HPA study shows poor hygiene practices at mobile vendors

13 March 2013

Research from the Health Protection Agency (HPA) has revealed that food, water, chopping boards, cleaning cloths and security wristbands sampled from mobile and outdoor food vendors were contaminated with a range of bacteria including E.coli. This bacteria, which originates from human or animal faeces indicates either poor hygiene, undercooking or cross-contamination in the kitchen.

The report ‘A follow-up study of hygiene practices in catering premises at large scale events in the United Kingdom’ is now published on the HPA website.

Over a seven month period in 2010, 1,662 samples were collected from 153 events by Local Authority sampling officers and tested by the HPA for a range of bacteria including Enterobacteriacae, E.coli and Staphylococcus aureus.

The events where samples were taken included 50 concerts or music festivals, 20 sports events, 39 carnivals, fetes and fairs and 44 ‘other’ events of a type not stated.

Eight per cent of food samples (53/659) were noted as being of an unsatisfactory quality with a further one per cent (seven samples) containing potentially hazardous levels of bacteria including, among others, the presence of Salmonella and Clostridium perfringens. Food poisoning caused by this bacteria most often occurs when food, usually meat, is cooked and then kept warm for several hours before serving.

Of the water samples tested, results revealed that 27 per cent (56/209) contained unacceptable levels of coliform bacteria which can be found in the environment in soil, water and on plants and may also be a sign of faecal contamination. E.coli and/or enterococci bacteria (of faecal origin) were found in 16 samples (eight per cent).

Environmental swabs were taken from chopping boards, food containers, serving counters, utensils, work surfaces and other areas. The study shows that chopping boards had the most unsatisfactory levels of contamination with 60 per cent (84/141) not meeting the required standard. Overall, of 585 swabs from environmental testing 188 (32 per cent) were not of the required standard.

Bacterial levels twenty times what is considered acceptable were found on 56 per cent (97/156) of the cleaning cloths tested. Bacterial contamination is measured in colony forming units with 97 cloths showing the presence of 10,000 colony forming units (cfu) of Enterobacteriacae where the acceptable level is 500 or less. Some cloths also tested positive for E.coli and species of Listeria.

Some events now require vendors to wear a security wristband for the duration of the event as proof of their authorisation to trade. As these are worn permanently it was considered that there may be some risk of cross contamination. Of those tested one fifth (6/33) of wristbands worn by catering staff were contaminated with Enterobacteriacae, E.coli which are all common bacteria found in the human gut and/or Staphylococcus which lives on the skin.

Dr Caroline Willis, a specialist microbiologist at the HPA’s Food, Water and Environment laboratory in Porton Down and one of the authors of the report, said: “Gastrointestinal illnesses are some of the most common problems encountered by people attending festivals and large-scale outdoor events. Various studies have looked at the microbiological standards of food and environments in such locations and although this study showed some improvement in standards of cleanliness there is clearly a lot of room for improvement.

“There are various reasons why hygiene is lower at such events including the volume of customers, use of temporary staff, working in cramped conditions, lack of storage space and difficulties with on-site cleaning. These all combine to lead to greater cross contamination risks which can be increased if levels of personal hygiene are not good.

“Local Environmental Health Departments have done much to improve standards at mobile and outdoor catering premises over recent years but staff need to ensure that both cooking standards and thorough hygiene are rigorously maintained to avoid the risk of people becoming unwell.”

Ends

Notes to editors

1. The report can be found from the HPA website’s LG Regulation Reports page.
2. E.coli bacteria are only found in the human or animal gut. Contamination with E.coli could have occurred by caterers not washing their hands after using the toilet or by cross-contamination from raw meat that becomes contaminated with faecal material in the abattoir.
3. Species of Enterobacter can be found in the environment and are also part of the normal flora in the human intestines. The presence of Enterobacteriaceae are indicators of poor hygiene but not necessarily of faecal contamination. They may indicate cross-contamination from raw salad ingredients.
4. Staphylococci are a group of bacteria which are often found on the skin or inside the nose. They can cause disease if the bacteria enters the body via cuts or medical procedures.
5. The Environmental Health officers were asked to collect samples as follows: ready-to-eat foods; a cleaning cloth that had been used in areas where ready-to-eat foods were prepared; and swabs from food contact surfaces including empty, clean food containers used for ready-to-eat food; utensils, chopping boards used for ready-to-eat foods and work surfaces or serving counters. There was also an option to collect a water sample as the customer would receive it or as the caterer would use it from the vendor’s main supply of water; and to take a swab of the outer surface of a food handler’s security wrist band.
6. Of the one per cent of food samples that we considered to be potentially injurious to health four had elevated levels of Bacillus species; one had Clostridium perfringens; one tested positive for coagulase-positive staphylococci and the last one tested positive for Salmonella.
7. The Health Protection Agency is an independent UK organisation that was set up by the government in 2003 to protect the public from threats to their health from infectious diseases and environmental hazards. On 1 April 2013 the Health Protection Agency will become part of a new organisation called Public Health England, an executive agency of the Department of Health. To find out more, visit our website: http://www.hpa.org.uk or follow us on Twitter @HPAuk or ‘Like’ us on Facebook at www.facebook.com/HealthProtectionAgency [external link].
8. For more information please contact the national HPA press office at Colindale on 0208 327 7901 or email colindale-pressoffice@hpa.org.uk. Out of hours the duty press officer can be contacted on 0208 200 4400.

Last reviewed: 13 March 2013