H5N1

US: Tainted pork, ill consumers and an investigation thwarted

Via The New York Times: Tainted Pork, Ill Consumers and an Investigation Thwarted. Excerpt:

It was 7 a.m. on Independence Day when a doctor told Rose and Roger Porter Jr. that their daughter could die within hours. For nearly a week, Mikayla, 10, had suffered intensifying bouts of fever, diarrhea and stabbing stomach pains. 

That morning, the Porters rushed her to a clinic where a doctor called for a helicopter to airlift her to a major medical center.  

The gravity of the girl’s illness was remarkable given its commonplace source. She had gotten food poisoning at a pig roast from meat her parents had bought at a local butcher in McKenna, Wash., and spit-roasted, as recommended, for 13 hours. 

Mikayla was one of nearly 200 people reported ill in the summer of 2015 in Washington State from tainted pork — victims of the fastest-growing salmonella variant in the United States, a strain that is particularly dangerous because it is resistant to antibiotics.

 What followed was an exhaustive detective hunt by public health authorities that was crippled by weak, loophole-ridden laws and regulations — and ultimately blocked by farm owners who would not let investigators onto their property and by their politically powerful allies in the pork industry. 

The surge in drug-resistant infections is one of the word’s most ominous health threats, and public health authorities say one of the biggest causes is farmers who dose millions of pigs, cows and chickens with antibiotics to keep them healthy — sometimes in crowded conditions before slaughter.

Overuse of the drugs has allowed germs to develop defenses to survive. Drug-resistant infections in animals are spreading to people, jeopardizing the effectiveness of drugs that have provided quick cures for a vast range of ailments and helped lengthen human lives over much of the past century.

But public health investigators at times have been unable to obtain even the most basic information about practices on farms. Livestock industry executives sit on federal Agriculture Department advisory committees, pour money into political campaigns and have had a seat at the table in drafting regulations for the industry, helping to ensure that access to farms is generally at the owners’ discretion. 

Dr. Parthapratim Basu, a former chief veterinarian of the Agriculture Department’s Food Safety and Inspection Service, said the pork industry regularly thwarted access to information on antibiotic use. 

“When it comes to power, no one dares to stand up to the pork industry,” he said, “not even the U.S. government.”

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.

ECDC CDTR, week 8

ECDC has published Communicable disease threats report, 17-23 February 2019, week 8.

The ECDC Communicable Disease Threats Report (CDTR) is a weekly bulletin for epidemiologists and health professionals on active public health threats. This issue covers the period from 17-23 February 2019 and includes updates on Middle East respiratory syndrome coronavirus (MERS-CoV), chikungunya virus disease and dengue, Ebola virus disease, influenza, Neisseria gonorrhoeae, Salmonella Poona and influenza A(H9N2).

WHO: Typhoid fever – Islamic Republic of Pakistan

WHO has published Typhoid fever – Islamic Republic of Pakistan. Excerpt:

Pakistan Health Authorities have reported an ongoing outbreak of extensively drug resistant (XDR) typhoid fever that began in the Hyderabad district of Sindh province in November 2016. An increasing trend of typhoid fever cases caused by antimicrobial resistant (AMR) strains of Salmonella enterica serovar Typhi (or S. Typhi) poses a notable public health concern. 

In May 2018, the case definitions for non-resistant, multi-drug resistant (MDR) and XDR typhoid fever were formally agreed by the Regional Disease Surveillance and Response Unit (RDSRU) in Karachi, following a review by an expert group of epidemiologists, clinicians and microbiologists from Pakistan. All typhoid fever cases reported from 2016 to 2018 were reviewed and classified according to these case definitions (see Table 1).    

From 1 November 2016 through 9 December 2018, 5 274 cases of XDR typhoid out of 8 188 typhoid fever cases were reported by the Provincial Disease Surveillance and Response Unit (PDSRU) in Sindh province, Pakistan. Sixty-nine percent of cases were reported in Karachi (the capital city), 27% in Hyderabad district, and 4% in other districts in the province (Table 2). The circulating XDR strain of S. Typhi haplotype 58 was resistant to first and second-line antibiotics as well as third generation cephalosporins. Informal reports of XDR typhoid cases occurring in other parts of Pakistan were made and required further verification.  

In addition, from January to October 2018, there were reports indicating international transmission of the XDR typhoid strain through persons who had travelled to Pakistan. Six travel-associated cases of XDR typhoid were reported; one in the United Kingdom of Great Britain and Northern Ireland, and five in the United States of America. Four of the travel-associated cases had visited or resided in Karachi (Sindh province), Lahore (Punjab province) and/or Islamabad in Pakistan. Details regarding these four cases are as follows:  

• Two of the cases travelled to Karachi, Lahore, and Islamabad. 

• One case travelled only to Karachi. 

• One case pending confirmation, is a resident from Lahore with travel history to the US where he/she was diagnosed and treated. The case has since returned to Pakistan. 

Limited information is available about their mechanism of exposure or the exact date of onset of illness for these cases but, there are evidence that all the travel-associated cases were successfully treated.

Pakistan: Outbreak of drug-resistant typhoid triggers level two alert

Via The News International: Outbreak of drug-resistant typhoid triggers level two alert. Excerpt:

Islamabad: An on-going outbreak of extensively drug-resistant (XDR) typhoid fever in Pakistan that has triggered the level two alert can be controlled by sensitizing public and health professionals on following preventive measures religiously and offering vaccination particularly to the population at risk. 

The US Centres for Disease Control and Prevention has already issued a travel alert saying anyone heading to Pakistan should take extra care of food and water and get vaccination against typhoid. The CDC said the XDR typhoid strain in Pakistan does not respond to many antibiotics. 

Typhoid or Enteric fever is a bacterial infection caused by Salmonella typhi. The faecal oral transmission is the commonest route infecting the healthy ones. Contaminated water and food are the main sources for the spread of the infection.  

Associate Professor of Pathology and Consultant Microbiologist at Al-Nafees Medical College Islamabad Dr Humaira Zafar expressed this while talking to The News on Sunday. 

She said the intestines are primary site of infection. The most common symptoms include continuous high grade fever, generalized weakness, blood stream infection and constipation or diarrhoea. If the infection prolongs either due to partial treatment, drug resistance or any other cause, a patient can land up to chronic phase along with the emergence of complications. The highlighted complications can be enlargement of the spleen, intestinal haemorrhage, perforation of the bowel and meningitis (inflammation of outer layers of brain), she explained.  

She added the mortality rate in untreated or drug resistant cases ranges from 12-30 per cent. “Despite the availability of effective antibiotics, about 200,000 people die annually while in successfully treated cases, the survival rate is 99%.” 

Typhoid fever is a treatable and curable infection provided accurately treated for proper duration after confirmed diagnosis by culture and sensitivity (blood, stool and bone marrow), she said.  

She said currently the biggest challenge is the emergence of drug resistant strain of Salmonella typhi bacteria. The antibiotics from penicillin, quinolones and cephalosporin groups are usually considered amongst the good treatment options but the challenge faced for public health concern was the emergence of resistant pattern to first line treatment (ampicillin, chloramphenicol, and trimethoprim-sulfamethoxazole) and the second-line option as well (fluoroquinolones). 

Due to this situation, ceftriaxone (third generation cephalosporin) is considered as the empirical treatment of choice for typhoid fever patients. However, now there is emergence of a strain that is also resistant to ceftriaxone. Thus giving this bug a label of extensively drug-resistant (XDR) typhoid, said Professor Humaira. 

She added the condition severely limits treatment options. The six months statistical data of National Institute of Health in Islamabad confirmed about 2000 cases of (XDR) Salmonella typhi in Pakistan. Emergence of such cases in Pakistan is becoming a global voice and has brought Pakistan in a lime light. The travellers and tourists visiting Pakistan are advised to take additional precautionary measures in order to not acquire infection, she said. 

The crisis in Pakistan represents the first known outbreak of an XDR strain and this state of affairs if not controlled may lead some researchers to warn that it could turn the clock 70 years back when surviving the disease was more a matter of luck than treatment, said Dr. Humaira.

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.

‘Frightening’ drug-resistant strain of typhoid spreads in Pakistan

Via Science: ‘Frightening’ drug-resistant strain of typhoid spreads in Pakistan. Excerpt:

An antibiotic-defying strain of the bacterium that causes typhoid fever is gaining a foothold in Pakistan, leading some researchers to warn that it could turn the clock back 70 years, when surviving the disease was more a matter of luck than treatment. 

In the past 6 months, more than 2000 people in Pakistan have been infected with extensively drug-resistant (XDR) Salmonella typhi, according to the National Institute of Health in Islamabad. Only one oral antibiotic, azithromycin, works against the XDR strain, and the other options—expensive intravenous (IV) drugs—are impractical for widespread use in Pakistan and other low-income nations. S. typhi experts worry that the outbreak could soon spill into other countries. 

“This is indeed a really alarming situation,” says pediatrician Zulfiqar Bhutta of The Aga Khan University in Karachi, Pakistan. “I’m not sure what can be done, as the horse has bolted. This will jump boundaries before long.”  

Spread through contaminated water and food, S. typhi causes up to 22 million cases of typhoid fever a year. Early symptoms include high fever, headaches, and stomach pain. Left untreated, typhoid fever can lead to intestinal hemorrhage and perforation of the bowel, and kill up to 15% of infected people. Despite the availability of effective antibiotics, about 200,000 people die annually. 

Early this year, researchers warned that Pakistan was experiencing the world’s first outbreak of  XDR S. typhi strain, reporting 339 cases that were mainly in Hyderabad, east of Karachi. The strain can’t be stopped by the three antibiotics most commonly used to treat typhoid fever, or two additional classes of drugs used to treat strains resistant to those antibiotics, they reported on 20 February in mBio. The XDR strain, which has now made significant headway in Karachi and other locales, is “really quite frightening,” says Myron Levine, an S. typhi vaccine developer at the University of Maryland School of Medicine in Baltimore who was not involved in the mBio study. 

It is only a matter of time, he notes, before S. typhi develops resistance to azithromycin, too. If that happens, the remaining effective drugs, carbapenems, require hospitalization and an IV drip; treatment can cost thousands of dollars per patient. 

Pakistan began a vaccination campaign in February using a recently approved formulation that, for the first time, works in young children and triggers longer-lasting immunity than older versions. The Bill & Melinda Gates Foundation in Seattle, Washington, is funding the campaign, which aims to administer 200,000 doses of the new vaccine. And earlier this month, Gavi, the Vaccine Alliance, a nonprofit based in Geneva, Switzerland, agreed to purchase 10 million additional doses for Pakistan.

Growing ’superbug’ threat in Finnish broiler meat – but still safest in EU

Via Yle Uutiset: Growing ’superbug’ threat in Finnish broiler meat – but still safest in EU. Excerpt:

A fresh report from the European Food Safety Agency (EFSA) indicates that there are ever-higher levels of aggressive, antibiotic-resistant bacteria in broiler meat sold in the EU. This first pan-European study is based on samples from 2016.  

For instance coli bacteria, which are usually harmless or even beneficial when found in humans’ or animals’ intestines, can cause infections when they appear elsewhere. These can usually be cleared up with antibiotics – but some bacteria can also defend themselves by breaking down antibiotics into a harmless form, using ESBL enzymes.

“E. coli bacteria are normal microbes in our digestive system, but in certain conditions they can also cause serious infections. And when they have the ESBL ability, then drugs are not effective,” says Dr Annamari Heikinheimo, a researcher and lecturer in food hygiene at the University of Helsinki.  

More than half of EU broiler affected 

The incidence of coli bacteria that can produce ESBL or the similar AmpC enzymes in broiler meat varies greatly within the EU. According to the new EFSA study, Finland had the lowest incidence of these bacteria in chicken, found in 22 percent of samples. In Belgium, they were found in virtually all broiler meat. The EU average is 57 percent.  

“When you look more closely at the range of bacterial enzymes, it is often much broader in southern and central Europe than in Finland,” says Heikinheimo. “In our broiler bacteria, you primarily find a type of enzyme that to my knowledge is rare in human ESBL infections in Finland.” 

According to Heikinheimo, the data reflects Finland’s extremely high level of food hygiene, which is the result of long-term cooperation, she says.  

“In Finland, officials, researchers and companies interact closely. Since we’re a small country, I would hope that this cooperation continues. I’ve monitored many other countries where the situation is not like this,” she tells Yle.  

Heikinheimo takes salmonella as an example. When Finland joined the EU in 1995, it was granted a special exemption for its own anti-salmonella legislation.  

“The incidence of salmonella on Finnish farms is less than one percent,” the researcher says. “When you don’t have salmonella, you also don’t have the problem of resistant salmonella. The EFSA report notes that people elsewhere in Europe have very difficult salmonella-related infections that generally can no longer be treated effectively with antibiotics.”