H5N1

DR Congo: 'Konzo' disease rages in Feshi in the Kwango

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Via Digitalcongo.net, an ACP report datelined Kinshasa: "Konzo" disease rages in Feshi in the Kwango. I have just learned from Wikipedia that it's a form of cyanide poisoning caused by inadequately processed kassava. The Google translation:

Konzo, a food-borne illness that paralyzes the legs and back, has been raging in Feshi territory in southwestern DRC's Kwango province for several months, the ACP said here Tuesday. the Director General of the Higher Pedagogical Institute (ISP) of Feshi, Professor Simon Masaki, staying in Kinshasa. 

This disease, he said, particularly affects children and adolescents aged 4 to 18 years. Many children are paralyzed and abandoned to their plight, he lamented. Many families are plunged into distress because of this situation.  

The Feshi Hospital Center, which is not well equipped, is not able to take care of these many cases of Konzo, he said. Professor Masaki makes a strong appeal to the provincial and national authorities and partners of the DRC to come to the rescue of the population of Feshi, a landlocked and very difficult to access. Feshi is located 385 km from Kenge, capital of the Kwango province and more than 700 km from Kinshasa, capital of the DRC. 

Konzo is a disease that attacks the lower limbs and spine, causing a deplorable and often irreversible physical deformity. This disease is caused by the consumption of a very bitter cassava variety that would normally remain soaked in water for at least four days to remove cyanide before being consumed. 

But many people do not respect this deadline. The territory of Kahemba, in the same province of Kwango, was hit in 2018 by the Konzo. 

Dr. Sadiki Ngeleza of the School of Public Health of the University of Kinshasa conducts field studies on Konzo Disease, funded by NIH through the Oregon Health and Science University (OHSU), to determine the biological risk factors associated with Konzo and the role of nutritional factors in susceptibility to konzo. 

Canada: Outbreak of Salmonella infections

Via the Public Health Agency of Canada: Public Health Notice - Outbreak of Salmonella infections. Excerpt:

The Public Health Agency of Canada is collaborating with provincial public health partners, the Canadian Food Inspection Agency and Health Canada to investigate an outbreak of Salmonella infections involving six provinces: British Columbia, Alberta, Saskatchewan, Manitoba, Ontario and Quebec.

The source of the outbreak has not been identified, and the investigation is ongoing. Outbreak investigators are gathering information on possible sources. The outbreak appears to be ongoing, as illnesses continue to be reported. 

The Public Health Agency of Canada is issuing this public health notice to inform Canadians of the investigation findings to date and to share important safe food handling practices to help prevent further Salmonella infections. 

This public health notice will be updated on a regular basis as the investigation evolves. 

Investigation summary 

As of April 5, 2019, there have been 63 laboratory-confirmed cases of Salmonella Enteritidis illness investigated in the following provinces: British Columbia (23), Alberta (10), Saskatchewan (8), Manitoba (10), Ontario (10) and Quebec (2). Individuals became sick between November 2018 and March 2019. Eighteen individuals have been hospitalized. Two deaths have been reported; however, it has not been determined whether Salmonella was a contributing cause in these deaths. Individuals who became ill are between 1 and 87 years of age. The majority of cases (57%) are female. 

It is possible that more recent illnesses may be reported in the outbreak because there is a period of time between when a person becomes ill and when the illness is reported to public health officials. For this outbreak, the illness reporting period is between four and five weeks. 

The Canadian Food Inspection Agency is conducting a food safety investigation. If contaminated food products are identified, they will take the necessary steps to protect the public, including recalling food products as required. Currently there are no Food Recall Warnings associated with this outbreak. 

Who is most at risk 

Anyone can become sick with a Salmonella infection, but infants, children, seniors and those with weakened immune systems are at higher risk of serious illness because their immune systems are fragile.  

Most people who become ill from a Salmonella infection will recover fully after a few days. It is possible for some people to be infected with the bacteria and to not get sick or show any symptoms, but to still be able to spread the infection to others.

Sweden has figured out how to keep food free of salmonella. Why can't Canada?

Via CBC News: Sweden has figured out how to keep food free of salmonella. Why can't Canada? Excerpt:

When it comes to controlling salmonella outbreaks, Canada could learn a lot from Sweden.  

The Nordic country is on a passionate mission to eliminate the harmful bacteria from its food. Thanks to strict regulations that apply to chickens and other animals, few Swedes get sick from salmonella. 

Meanwhile, outbreaks caused by contaminated food, especially chicken, are frequent occurrences in Canada.  

Every year, there are an estimated 87,500 cases of salmonella infection across Canada, according to the federal government's yearly foodborne illness estimates. While it's not clear how many of them were caused by contaminated chicken, as of last week, 566 Canadians had been diagnosed since May 2017 with salmonella infections linked specifically to frozen breaded chicken products, and 95 of them were so sick with fever and diarrhea, they had to be hospitalized.  

As a consequence, there have been 13 recalls of raw breaded chicken products in Canada since July 2017.  

What is salmonella? 

Salmonella is normally found in the intestines of animals, including birds, but the bacteria can be harmful when humans ingest it. 

Diarrhea, nausea, vomiting, fever and chills are all symptoms of salmonella infection, also known as salmonellosis.  

The bacteria can be spread between animals and people, through water, and can even survive on the surface of some objects.

Sweden's anti-salmonella stance 

While Canadians continue getting sick, Sweden is leading the fight against foodborne illness. Along with strict biosecurity rules, it's normal procedure in the country to heat chicken feed to kill bacteria and to regularly inspect for salmonella contamination 

"The number of cases among humans that are affected in Sweden is very low," said Lena Hult, the contagious disease co-ordinator with the Swedish Board of Agriculture's animal welfare department.    

Only about 3,000 people a year get sick from salmonella, and between 70 and 80 per cent are infected while travelling outside the country, according to Sweden-based research.

ECDC rapid outbreak assessment: Multi-country outbreak of Salmonella Poona infections linked to consumption of infant formula

ECDC has published Rapid outbreak assessment: Multi-country outbreak of Salmonella Poona infections linked to consumption of infant formula. The executive summary:

An outbreak of Salmonella Poona cases affecting France (30 cases), Belgium (1) and Luxembourg (1) has been linked to infant formula products based on rice proteins. All 32 patients were infants and young children infected with the same bacterial strain with onset of symptoms between August 2018 and February 2019. 

The suspected infant formula products based on rice proteins were made by a factory in Spain between August and October 2018 and marketed by a French company. The products were distributed to EU/EFTA and four non-European countries through wholesalers, online shops or e-commerce. 

So far all tests performed at the Spanish factory and on samples of the implicated batches have been negative for Salmonella Poona. This may be due to the fact that Salmonella is typically difficult to detect in dried products and requires sampling and testing methods with a high degree of sensitivity.  

A recall and a withdrawal of infant formula products and baby food of the same brand were initiated on 24 January 2019 by the French company in France, followed by a recall in Luxembourg. Public warnings released in France, Belgium and Spain should decrease the risk of new infections. However, additional outbreak cases may be reported, among those who bought and consumed the products before the recall. 

In order to prevent infections when using infant formula, Member States should consider providing advice to the public on basic hygiene rules for the preparation of food for infants, including information on the safe preparation, handling and storage of powdered infant formula products. Caregivers of children who have consumed infant formula and develop diarrhoea should be advised to contact their healthcare provider. 

Cases of salmonellosis in infants should be notified to the national health authorities for serotyping. S. Poona isolates should be sequenced to identify whether they are associated with this outbreak. 

ECDC is funding whole genome sequencing (WGS) analysis of human S. Poona isolates from cases possibly related to this outbreak and reported in countries that do not routinely perform WGS.

US: FDA 2018 lapse in funding information

Via the US Food & Drug Administration: FDA 2018 Lapse in Funding Information.

In the absence of either an FY 2019 appropriation or a Continuing Resolution for FDA, beginning on December 22, 2018 and continuing until the date of enactment of an FY 2019 appropriation or Continuing Resolution ("lapse period"), agency operations continue to the extent permitted by law, such as activities necessary to address imminent threats to the safety of human life and activities funded by carryover user fee funds.  

The FDA plays a critical public health role. Our work protects the food that families feed their children and pets and ensures the effectiveness of the medicine they need, all of which contribute to improving the health and welfare of Americans. All our work is important, but only some of our work is permitted to continue during a lapse in funding. 

During the lapse period, the agency will be continuing vital activities, to the extent permitted by the law, that are critical to ensuring public health and safety in the United States. The mission critical, public health activities that will continue include, among other things: maintaining core functions to handle and respond to emergencies – such as monitoring for and quickly responding to outbreaks related to foodborne illness and the flu, supporting high-risk food and medical product recalls when products endanger consumers and patients, pursuing civil investigations when we believe public health is imminently at risk and pursuing criminal investigations, screening the food and medical products that are imported to the U.S. to protect consumers and patients from harmful products, and addressing other critical public health issues that involve imminent threats to the safety of human life. Mission critical surveillance for significant safety concerns with medical devices and other medical products will also continue. 

In addition, the FDA will continue to support activities funded by carryover user fee balances, which allows us to continue to bring new therapeutic options to the patients that need them. However, during the lapse period, the FDA will not have legal authority to accept user fees assessed for FY 2019 until an FY 2019 appropriation or Continuing Resolution for the FDA is enacted. This will mean that the FDA will not be able to accept any regulatory submissions for FY 2019 that require a fee payment and that are submitted during the lapse period.

Only romaine lettuce from central and northern California is unsafe, FDA says

Via The New York Times: Only Romaine Lettuce From Central and Northern California Is Unsafe, F.D.A. Says. Excerpt:

It’s O.K. to eat romaine lettuce again, federal health officials said on Monday — as long as you’re sure it wasn’t grown on California’s north and central coast. 

The Food and Drug Administration and the Centers for Disease Control and Prevention said investigators had traced the romaine lettuce associated with an outbreak of E. coli that has sickened 65 people in 12 states and Canada to “end of summer” romaine lettuce harvested from that region.  

With the growing and harvesting season over there, according to the F.D.A., people may eat romaine lettuce that has been hydroponically or greenhouse grown, or has been harvested from the winter growing desert regions of the United States, and is labeled such.

“If it does not have this information,” the agency said in a statement posted on its website, “you should not eat or use it.” 

 Dr. Scott Gottlieb, the F.D.A. commissioner, said that, to protect consumers, the industry had agreed to label romaine lettuce with the harvest date and region.  

“The F.D.A. also has commitments from the romaine lettuce industry that such labeling will continue into the future and become standard for their products,” Dr. Gottlieb said. The labels may be extended to other leafy greens, he said.

Romaine and Ebola

Via the website of CBC Radio's excellent current-affairs program: The Current for November 22, 2018. Click or tap through to hear the items:

• After a warning that romaine lettuce could be contaminated with E. coli, we weigh the pros and cons of leafy greens, and ask: is it time to give up on salad?

• Efforts to contain an Ebola outbreak in the Democratic Republic of Congo are being complicated by an armed conflict in the area. We hear from aid workers about the challenges of fighting a deadly disease, in deadly circumstances.

Public Health Notice - Outbreak of E. coli infections linked to romaine lettuce

Via the Public Health Agency of Canada: Public Health Notice - Outbreak of E. coli infections linked to romaine lettuce. Excerpt and then a comment:

The Public Health Agency of Canada is collaborating with provincial public health partners, the Canadian Food Inspection Agency, Health Canada, as well as the United States Centers for Disease Control and Prevention (U.S. CDC) and the United States Food and Drug Administration (U.S. FDA), to investigate an outbreak of E. coli infections in Ontario and Quebec, and several U.S. states. 

In Canada, based on the investigation findings to date, exposure to romaine lettuce has been identified as a source of the outbreak, but the cause of contamination has not been identified. Laboratory analysis indicates that the illnesses reported in this outbreak are genetically related to illnesses reported in a previous E. coli outbreak from December 2017 that affected consumers in both Canada and the U.S. 

This tells us that the same strain of E. coli is causing illness in Canada and the US as was seen in 2017 and it suggests there may be a reoccurring source of contamination. Investigators are using evidence collected in both outbreaks to help identify the possible cause of the contamination in these events.  

The current outbreak appears to be ongoing as illnesses linked to romaine lettuce continue to be reported. These recent illnesses indicate that contaminated romaine lettuce may still be on the market, including in restaurants, grocery stores and any establishments that serve food. At this time, the investigation evidence in Ontario and Quebec suggests that there is a risk of E. coli infections associated with eating romaine lettuce. 

As the risk is ongoing, the Public Health Agency of Canada is advising individuals in Ontario and Quebec to avoid eating romaine lettuce and salad mixes containing romaine lettuce until more is known about the outbreak and the cause of contamination. Currently, there is no evidence to suggest that residents in other parts of Canada are affected by this outbreak. 

The U.S. CDC has also issued communications with similar advice for U.S individuals in affected states. The outbreak investigation is ongoing, and this public health notice will be updated as the Canadian investigation evolves.

We eat a lot of romaine, but a quick check in the fridge confirms that ours in grown in Canada. So we'll continue until PHAC advises British Columbians to ditch it also.

'Brussels a European hub for bush meat'

Thanks to Pierre Don for alerting me to this story. Via VRT News: "Brussels a European hub for bush meat".

Research undertaken by VRT's flagship current affairs programme Pano has revealed that dozens of tons of bush meat, meat originating from wild animals, chiefly from the region of the African rain forests, are being imported into Belgium. 

 As a result more and more species of animal are becoming endangered. Public health is also under threat because this meat threatens to bring nasty viruses including Ebola into the country. 

Our reporter Stijn Vercruysse showed how easy it was to buy bush meat in Brussels. With the assistance of African Belgians VRT managed to buy two pieces of monkey meat and some antelope in shops in the Matonge area of Brussels. The Royal Belgian Institute for Natural Sciences in Brussels analysed the meat and confirmed its provenance. All three pieces of meat came from endangered species. The institute too appreciates how easy it is to purchase such meat after it got Congolese interns to purchase 12 pieces, including meat from protected species. 

The World Wildlife Fund says that Brussels is a hub for the trade in bush meat originating from Africa and headed for the rest of Europe.  Research undertaken by the Swiss shows that half the meat impounded at Swiss airports arrived on flights from Brussels and transit passengers. Two weeks ago 6 kilos of crocodile meat were seized in Zurich in the luggage of a Cameroonian travelling via Brussels.  Crocodiles are an endangered species. 

The WWF believes up to 150 tons of bush meat is imported via Zaventem. It presses for greater checks at the airport. At present only one large scale check is staged every month. Last year customs found 2,000 kilos of meat including bush meat.  

People carrying bush meat in their luggage often in picnic coolers risk little chance of being caught. Nobody has been prosecuted or sentenced for importing bush meat in four years now.  Significant sentences are on the statutes.  Meat found is seized and destroyed. 

Bush meat could be a conduit to bring tropical diseases including Ebola into the country.  Prof Herwig Leirs of Antwerp University: "There's a small chance but the consequences would be enormous.  The problem is that tropical diseases are often found too late.  By then the virus has spread among the population." 

Bush meat is usually smoked in Congolese villages because there is little refrigeration. If it's insufficiently smoked and badly prepared when eaten, viruses could spread.

ECDC: Outbreak of Salmonella agona reported in five EU countries

ECDC has published Outbreak of Salmonella agona reported in five EU countries. Excerpt:

A multi-country outbreak of Salmonella enterica subspecies enterica serovar Agona (S. Agona) is under investigation in the European Union (EU), with cases retrospectively identified back to 2014. 

Overall, 147 outbreak cases have been reported by five EU countries: 122 cases since 1 January 2017, and 25 historical cases between 2014 and 2016. The United Kingdom is reporting most outbreak cases (129), with Finland (15), Denmark, Germany and Ireland (one case each) reporting the other cases. 

Most persons infected with Salmonella develop diarrhoea, fever, and abdominal cramps in 12–36 hours after infection. The illness usually lasts 4 to 7 days. Although most people recover without treatment, severe infections may occur. Infants, elderly persons, immune-compromised persons are more likely than others to develop severe illness. 

Based on the information available, the microbiological evidence suggests ready-to-eat products containing cucumbers as a possible vehicle of infection but so far it has not been possible to identify the specific point in the production chain where the contamination occurred. Further investigations along the food chain are therefore needed to identify the source of contamination. 

Until the source of infection and the specific point of contamination along the food production chain have been identified and controlled, new outbreak cases may occur, with a high likelihood that the outbreak strains will re-emerge in early 2019, as observed in the seasonal occurrence of cases in previous years. 

A joint rapid outbreak assessment produced by European Centre for Disease Control (ECDC) and European Food Safety Authority (EFSA), published on 26 July 2018, provides further information about the outbreak, including options for response for national health authorities.