H5N1

Planning for the next food-safety crisis

Via Bionity.com: EHEC and other crises know no boundaries. Excerpt:

The EHEC outbreak 2011 resulted in over 50 deaths and was one of the most severe food-borne crises in Europe for a long time. Incidents like these can reoccur at any time. 

How can crises be overcome? What can be done to prevent them? What lessons are learned by government and society from crises in the past, and what form and shape should cooperation at the various government and supranational levels take? 

These questions are discussed by representatives from the worlds of politics, economy, science, public institutions as well as other stakeholders at the Federal Institute for Risk Assessment (BfR) in Berlin-Marienfelde on 13 and 14 September 2012. 

“The EHEC outbreak clearly showed that crises do not stop at borders”, says Professor Dr. Dr. Andreas Hensel, President o f the BfR. “All those involved must effectively cooperate at the international level and they must be willing to constantly learn from the crisis.” 

The BfR is organising the symposium “Handling and Prevention of Crises” together with the French Agency for Food, Environmental and Occupational Health and Safety (ANSES) and the National Food Institute of the Danish Technical University. 

Despite the fact that food safety standards are very high in Europe, those responsible must always be prepared for possible incidents. There is a wide variety of different triggers for crises. Only through the coordinated efforts of all involved parties is it possible to avoid crises and / or to ensure their adequate and quick management. 

A number of stakeholders are involved in this internationally oriented event which the BfR is organising with its French counterpart ANSES and the National Food Institute of the Danish Technical University. 

On the two event days, experts from Germany, other European countries, the European Union and the World Health Organisation WHO will grapple with the following questions: responsibilities in times of national and international food crises; the role of governments and other institutions; institutional and scientific cooperation in times of crisis; and instruments of crisis management and crisis prevention in the food industry. 

Thus the different perspectives from politics, business, public institutions and science in the event of a crisis are all represented and discussed. On the second day, representatives of the civil society and other stakeholders will discuss the possibilities of crisis prevention and institutional cooperation. 

As part of these discussions, they will exchange ideas on what courses of action are most effective and what preventative measures are acceptable to ensure food safety.

CIDRAP: News scan for July 16

Via CIDRAP: NEWS SCAN: Cholera in Cuba, Ohio E coli outbreak, H1N1 traits, malaria in Myanmar, polio efforts in Pakistan. Excerpt:

County health officials in Dayton, Ohio, are investigating an Escherichia coli O157:H7 outbreak linked to a Jul 3 lawn care company employee picnic that has so far sickened at least 62 people. 

Public Health–Dayton and Montgomery County (PHDMC) said in a Jun 13 statement that 13 patients have been hospitalized, including a 4-year-old girl who is in critical condition with hemolytic uremic syndrome (HUS), a potentially fatal kidney complication. 

As many as 300 people may have attended the company's annual picnic, PHDMC said, urging people who got sick after attending the event to come forward. So far E coli O157:H7 infections have been confirmed in 11 of the patients, but investigation hasn't revealed what food was contaminated. 

Health department spokesman Bill Wharton said several people who attended the picnic brought food to share, and the company supplied some of the food at the event, which is making it difficult to pinpoint the source, according to a Jul 13 Dayton Daily News story. 

PHDMC said in its statement that authorities are exploring food sources, handling practices, temperature controls, and the possibility of cross-contamination.

After last year's E. coli outbreak: The impact on children

Thanks to Michael Walsh for tweeting the link to this report in Clinical Infectious Diseases: An Outbreak of Shiga-Toxin Producing E. coli O104:H4 Hemolytic Uremic Syndrome (STEC-HUS) in Germany: Presentation and Short-term Outcome in Children. The abstract: 

Background. In May and June 2011 the largest known HUS-outbreak occurred in northern Germany. Since, quite unusually, a large number of adults was affected and the causative E. coli strain, serotype O104:H4, showed an atypical virulence factor pattern, it was speculated that this outbreak was associated with an aggressive course and an unfavorable prognosis also in children. 

Methods. Retrospective analysis of medical records of 90 children and comparison to previous outbreak and sporadic case series. 

Results. Median age in was unusually high compared to historical series (11.5 years). Only one patient (1.1%) died in the acute phase. Most patients (67/90, 74%) received supportive care only. Renal replacement therapy was required in 64/90 (71%) of the children. Neurological complications, mainly seizures and altered mental stage, were present in 23/90 (26%) patients. Ten patients received plasmapheresis, six eculizumab, and seven a combination of both. 

After a median follow-up of four months, renal function normalized in 85/90 (94%) patients, while three patients still had CKD stage III or IV, and one patient (1.1%) still requires dialysis. Complete neurological recovery occurred in 18/23 patients. Mild to moderate and major residual neurological changes were present in three and one patient, respectively, although all patients were still improving. 

Conclusions. E. coli O104:H4 caused the largest HUS-outbreak in children reported in detail to date and most patients received supportive treatment only. Initial morbidity as well as short-term outcome due to this pathogen is comparable to previous pediatric series of STEC-HUS.

Reform falters after Europe’s E. coli scare

Via Nature News & Comment: Reform falters after Europe’s E. coli scare. Excerpt:

One year on from Europe’s worst recorded outbreak of Escherichia coli infection, governments have made little progress towards improving the monitoring and reporting systems that allowed the crisis to drag on for weeks. 

The disease, which was spread by contaminated fenugreek sprouts, swept across northern Germany in May and June 2011, infecting thousands and killing 53 people (see Nature 474, 137; 2011). Yet although the panic has sparked some proposed policy changes, these have become mired in political debate at both German and European levels. 

Under Germany’s current system, it can take up to 18 days for local and state health departments to relay case reports to the Berlin-based Robert Koch Institute (RKI), the German federal agency for disease surveillance. Legislators have proposed a law to bring the country’s disease-reporting schedule into line with the World Health Organization’s International Health Regulations. The law would require local health authorities to report cases of notifiable diseases to state authorities on the next working day; the states would then have another day to relay the information to the RKI. 

“We’ve been waiting almost a decade for this,” says Alexander Kekulé, a microbiologist at the Martin Luther University of Halle-Wittenberg in Halle, Germany. 

The draft law has been passed by Germany’s federal parliament but is stuck in negotiations at the legislative council that represents Germany’s 16 states. For scientists, though, this change would still not be enough. 

“What really delayed the detection of this outbreak was the irregularity with which patients were referred for microbiological follow-up,” says Gérard Krause, an epidemiologist at the RKI. Like many European countries, Germany does not require that a patient with bloody diarrhoea or haemolytic uraemic syndrome (a life-threatening complication of some E. coli infections) be tested for the causative bacterial strain. The same is true of the United States. 

After the outbreak, German diagnostic laboratories were provided with kits to test samples for genes belonging to certain pathogenic strains of bacteria, such as those expressing particular toxins, or proteins involved in adhesion or invasion. But physicians are responsible for requesting the tests, and the cost is not covered by German health-insurance companies. 

“The problem is mostly getting the money to use these kits,” says Angelika Fruth, a microbiologist at the RKI, “and that situation is just the same as before the outbreak.”

CIDRAP: News scan for January 27

Via CIDRAP: NEWS SCAN: H5N1 invasion of CNS, low-path H5 in Australia, viral co-evolution, E coli O104 in Turkey. Excerpt:

A French woman who returned home from a tour of Turkey last September with hemolytic uremic syndrome (HUS) was infected with a strain of Shiga toxin–producing Escherichia coli (STEC) O104:H4 similar to the one that caused a widespread outbreak in France and Germany earlier in 2011, according to a report in Eurosurveillance. 

The earlier outbreak was attributed to contaminated fenugreek sprouts. The French traveling group comprised 22 people; eight experienced diarrhea, including two hospitalized with HUS on their return. No common food source could be traced, but no one in the group reported eating sprouts before or during the trip. The timing of the cases suggested the illnesses were acquired in Turkey. 

Both HUS cases showed positive serology for STEC O104:H4. One, which showed the same resistance profile as the strain in the European outbreak, was compared by pulsed-field gel electrophoresis with cases from the earlier outbreak. It was similar but not identical, showing differences in two bands for the gene Xbal and in three bands for Notl. 

The authors conclude from these and several cases that occurred from 2004 through 2009 that STEC O104 circulates in Turkey and certain other countries, such as Egypt and Tunisia, and that the strain should be considered in travelers who return from these areas with HUS.

E. coli: Spanish firm sues Hamburg over false cucumber warning

Via TerraNet, an AFP report: Spanish firm sues Hamburg over false cucumber warning. Excerpt:

A Spanish company is suing the German city of Hamburg for more than two million euros after its cucumbers were wrongly blamed for a deadly E.coli outbreak, officials said Thursday. 

Frunet, a Spanish organic fruit and vegetable company, has lodged a 2.3-million-euro ($3.0 million) claim against the northern port city's health and consumer protection authority. 

"The Office for Health and Consumer Protection rejects these claims since the warning about the company's cucumbers was necessary and right," the health office said in a written statement. 

Insisting it believed it had taken the right course of action in issuing a warning with the information it had at the time, it said: "Protecting health comes before economic interests of companies."

UK: Unpublicised E coli outbreak leaves 250 ill and one dead

Thanks to a tweet from Maryn McKenna with a link to this Guardian report: Unpublicised E coli outbreak leaves 250 ill and one dead. Excerpt:

An eight-month E coli outbreak across the UK left 250 people ill and one dead but was not publicised at the time because its origins were unknown, health officials say. 

After six months of investigations the infection was ultimately linked to people handling loose raw leeks and potatoes in their homes, said the Health Protection Agency (HPA), which has only now acknowledged the outbreak. 

The cases began last December and continued until July. In total 250 victims – 100 of them under 16 – were left sick with vomiting and diarrhoea. Of those, 74 needed hospital treatment, including four who developed a rare digestive disorder which can lead to kidney failure in children. One unnamed patient, who the HPA said had underlying health problems, died. 

The four were treated for haemolytic uraemic syndrome, a serious but rare complication of E coli infection, although most people recover from it. 

The outbreak involved a rare strain of E coli 0157 called Phage Type 8 (PT8). 

It affected 193 people in England, 44 in Scotland and 14 in Wales. While 40% of the 250 were under-16s, 69% were female. 

In each of the past three years an average of 81 people across the UK have been infected with E coli 0157 PT8. 

The HPA said it, Health Protection Scotland and Public Health Wales began becoming aware of increased numbers of E coli cases from December onwards. 

An initial inquiry, which asked all those affected about their food intake and places they had visited, proved inconclusive. Unlike other E coli outbreaks it was not possible to identify one source for the outbreak, such as a commercial or children's farm, or food producer. 

It was only after a second round of in-depth interviews with 30 sufferers that investigators realised that victims were 40 times more likely to have been in a home where people handled leeks sold loose and 12 times more likely to have been in a household where potatoes bought in or sold from sacks had been handled, compared with a control group of 62 unaffected people.

And not a single Spanish cucumber in sight.

CIDRAP: News scan for September 29

Via CIDRAP: NEWS SCAN: Benefit of H1N1 vaccine, flu deaths in Asia, E coli treatment lessons, local dengue in Miami, HEV68 respiratory illness. Excerpt:

German clinicians who treated patients with hemolytic uremic syndrome (HUS) during Europe's sprout-related Escherichia coli O104:H4 outbreak recently shared several lessons they learned, according to an overview of a Sep 9 event in Berlin that appears in Eurosurveillance today. 

In one unusual finding, 14 HUS patients treated at Hamburg-Expender University who were assessed as having severe kidney damage based on histopathological images recovered better than expected, and none will need regular dialysis. The researcher, Dr Udo Helmchen, said initial histopathological ratings may have been misleading. 

The presentations did not help resolve unanswered questions about monoclonal antibody (Eculizumab) treatment for patients not responding to other treatments such as plasma exchange therapy or the use of antibiotics for enterohemorrhagic E coli (EHEC) infections, according to the report. 

However, other clinicians reiterated the benefits they found for the use of immunoabsorption for patients who went on to experience neurologic symptoms about 5 to 12 days after the onset of gastrointestinal symptoms.  

So far the E coli O104:H4 strain doesn't appear to have become established as an endemic strain in Germany. A German EHEC-HUS registry has data from 589 patients; the overall mortality rate was 4.4%.

Australia: SA illnesses prompt animal contact warning

Via The Sydney Morning Herald: SA illnesses prompt animal contact warning. Excerpt:

South Australian health authorities have issued a warning over contact with animals after three children who visited the Royal Adelaide Show contracted bacterial infections. 

Two cases of the Shiga-E.coli (STEC) infection and one case of Haemolytic Uraemic Syndrome (HUS) have been reported in children who attended the recent Royal Adelaide Show. 

Two of the three children - all aged between 4 and 12 years - had been in contact with farm animals at the show's animal nursery. 

STEC, which can cause diarrhoea and abdominal cramping, can develop into HUS, which in turn can lead to neurological damage and kidney disease. 

SA Health's Paddy Phillips said one of the children infected is in hospital with HUS and is in a serious but stable condition. 

Symptoms of STEC infection include simple or bloody diarrhoea, abdominal cramps but little or no fever or vomiting. 

The STEC bacteria is commonly found in animal faeces.