H5N1

US: CDC investigation update of E. coli 0157 H7 infections now linked to romaine lettuce

CDC has published CDC Investigation Update of E. coli 0157 H7 Infections Now Linked to Romaine Lettuce. Excerpt:

A CDC investigation notice of a multistate outbreak of E. coli 0157:H7 infections has been posted: https://www.cdc.gov/ecoli/2019/o157h7-11-19/index.html  

What is new: 

• Consumers should not eat and retailers and restaurants should not sell or serve any romaine lettuce harvested from the Salinas, Calif. growing region. 

• This advice includes all types of romaine lettuce harvested from Salinas, such as whole heads of romaine, hearts of romaine, and packages of precut lettuce and salad mixes that contain romaine, including baby romaine, spring mix, Caesar salad, and organic romaine. 

• If you have romaine lettuce at your home or restaurant and the label says “Salinas” (whether alone or with the name of another location). don’t eat it. Throw it away. If you don’t know if the lettuce is romaine or whether a salad mix contains romaine, don’t eat it or serve it. Throw it away. 

• Most romaine lettuce products are labeled with a harvest location showing where they were grown. Do not eat, serve, or sell any lettuce labeled as grown in Salinas, regardless of any other location on the label. 

• Restaurants and retailers should check the label on bags or boxes of romaine lettuce or ask their suppliers about the source of their romaine lettuce. 

Latest outbreak information:  

• A total of 40 people infected with the outbreak strain of coli 0157:H7 have been reported from 16 states. 

• A total of 27 hospitalizations have been reported. Five people have developed hemolytic uremic syndrome, a type of kidney failure. No deaths have been reported. 

• Epidemiologic and laboratory evidence and interviews with ill people indicate that romaine lettuce from the Salinas, Calif., growing region may be contaminated with coli O157:H7 and is making people sick. 

• FDA is tracing the romaine lettuce eaten by ill people in this outbreak. Preliminary information collected indicates that the lettuce eaten by some of the ill people was grown in Salinas, Calif. No common grower, supplier, distributor, or brand of romaine lettuce has been identified. 

• The USDA has recalled several products containing romaine lettuce due to possible coli contamination. 

• Laboratory data confirmed this outbreak is caused by the same strain of coli O157:H7 that caused previous outbreaks linked to leafy greens in 2017 and romaine lettuce in 2018. 

• This investigation is ongoing and CDC will provide updates when more information becomes available. 

About Shiga toxin-producing E. coli:  

• People get sick from Shiga toxin-producing E. coli an average of 3 to 4 days after swallowing the germ. 

• Most people get diarrhea (often bloody), severe stomach cramps, and vomiting. 

• Most people recover within a week, but some illnesses can last longer and be more severe. 

• Antibiotics are not recommended for patients with suspected E. coli infections until diagnostic testing can be performed and E. coli infection is ruled out.

See also this Washington Post report.

Toddler dies from E. coli linked to contact with animals at San Diego County Fair

Via The New York Times: Toddler Dies From E. coli Linked to Contact With Animals at San Diego County Fair. Excerpt:

A 2-year-old boy died from complications of E. coli and three other children were sickened in cases that officials said were linked to contact with animals at the San Diego County Fair in June. 

Four children, ages 2 to 13, visited the fair from June 8 to 15 and exhibited symptoms of Shiga toxin-producing E. coli from June 10 to 16, the County of San Diego Health and Human Services Agency said in a news release on Friday.  

The 2-year-old died on June 24 from complications of the bacteria; the other three children who were sickened were not hospitalized. Their conditions were not immediately available on Sunday. 

The fair features more than 2,900 animals and numerous activities, including pig races and livestock shows with calves, rabbits, pigeons and goats. The fair shut public access to animals on Saturday, and on Sunday it began removing them from the fairgrounds.

Symptoms of E. coli infection include severe abdominal cramps, watery or bloody diarrhea and vomiting, the agency said. Symptoms may occur with or without fever.  

Dr. Robert Glatter, an emergency physician at Lenox Hill Hospital in Manhattan, said the most common form of transmission was the fecal-oral route. In that route, children touch surfaces or animals contaminated with E. coli and then put their hands in their mouths.

“Young children at these zoos come in contact with feces of the animals,” he said on Sunday. “Certainly the animals clean themselves, and obviously contact by virtue of petting is common. We’re looking at calves, cows, goats, sheep as well as deer.” 

Dr. Glatter emphasized the importance of hand washing after coming in contact with animals, calling it “paramount.”

Hong Kong: CHP investigates case of Shiga toxin-producing E. coli infection

Via the Centre for Health Protection: CHP investigates case of Shiga toxin-producing E. coli infection. Excerpt:

The Centre for Health Protection (CHP) of the Department of Health is today (October 31) investigating a case of Shiga toxin-producing Escherichia coli (STEC) infection, and hence reminded the public to maintain good personal, food and environmental hygiene against intestinal infections.      

The case involves a 1-year-old girl, with good past health, who has developed diarrhoea since October 26 and was admitted to a private hospital for management on October 27. She was discharged on October 28 in stable condition.      

Her stool specimen grew STEC upon laboratory testing.      

Initial enquiries of the CHP revealed that the patient had travelled to Bali, Indonesia, from October 22 to 25 and consumed fresh orange juice. She did not consume unpasteurised milk or raw food, or have contact with animals or visit farms. Her home contacts had diarrhoea during the trip and all recovered after seeking medical advice locally. Investigations are ongoing.      

"Escherichia coli (E. coli) is a bacterium that is commonly found in the gut of humans and warm-blooded animals. Most strains of E. coli are harmless. Some strains, however, such as STEC, can produce powerful toxins and cause severe food-borne disease. The most recognised serogroup of STEC is E. coli O157:H7," a spokesman for the CHP explained.

WHO: Enterohemorrhagic Escherischia coli – United Kingdom

WHO has published Enterohaemorrhagic Escherischia coli – United Kingdom. Excerpt:

On 1 July 2016, the National IHR Focal Point for the United Kingdom notified WHO of an outbreak of Enterohaemorrhagic Shiga toxin-producing Escherischia coli (STEC) O157 PT34 in England and Wales. 

 The increase in the notifications of E. coli O157 cases was first observed by the South West Public Health England (PHE) Centre on 21 June. An outbreak control team was convened on 22 June to investigate this increase and, on 24 June, the first samples associated with this increase were confirmed as STEC serogroup O157 phage type 34, positive for the eae (intimin) and verocytotoxin 2 genes but negative for the verocytotoxin 1 gene (hereafter referred to as 'the outbreak strain').  

On 27 June, a significant increase in the number of cases with the outbreak strain was observed nationally, and the incident was declared and managed as a national outbreak. Analysis of whole genome sequencing data confirmed that the isolates fall within the same cluster. The outbreak strain is not related to strains currently circulating amongst the UK bovine reservoir but rather closely related to sequences identified in people reporting recent travel to the Mediterranean region. This suggests that the outbreak strain is likely to be imported. 

As of 14 July, 158 cases had been identified, of which 105 had been classified as confirmed cases and 53 as probable. Four of these patients remain in hospital. Features of haemolytic uraemic syndrome (HUS) have been reported in seven cases. Two cases have died, both of whom have E. coli infection listed as a causative factor. 

Cases are distributed throughout the UK, with the majority (91%) residing in England. The outbreak is characterised by multiple small clusters linked to catering and residential care premises. The proportion of hospitalised cases is high (40%). Cases are predominantly female (75%) and over the age of 18 (91%) – the age range is between 1 and 98 years. Onset dates for cases range from 31 May 2016 to 5 July 2016.  

Multiple analytical studies have provided evidence that consumption of mixed salad leaves, particularly from catering establishments such as cafes and restaurants, is associated with the infection. Sampling and microbiological examination of salad products is continuing although all results to date have been negative for STEC O157.

ECDC: CDTR, week 14

ECDC has published Summary of public health threats, CDTR week 14/2016. Click or tap through to download the full CDTR and to use other links. 

The ECDC Communicable Disease Threats Report (CDTR) is a weekly bulletin for epidemiologists and health professionals about active public health threats. This issue covers the period of 3 to 9 April 2016 and includes updates on seasonal influenza in Europe, haemolytic uraemic syndrome (HUS) cases in Romania and Italy, outbreak of yellow fever in Angola and other threats.  

Seasonal influenza in Europe 

Despite decreasing trends being reported by 27 countries influenza was reported as widespread, largely in the south-western part of the Region. The number of cases of severe disease was lower than in previous weeks but varied between countries. Most severe cases were associated with A(H1N1)pdm09 infection and were in people aged 15–64 years.   

ECDC publishes joint weekly updates on seasonal influenza on Flu News Europe.   

Haemolytic uraemic syndrome (HUS) cases in Romania and Italy 

Twenty five cases have been identified as associated with an outbreak of Shiga toxin-producing Escherichia coli (STEC) O26 in Romania (24) and in Italy (1). Of these 25 cases, 19 were hospitalised for haemolytic uraemic syndrome (HUS), and three of the cases died.   

A joint rapid outbreak assessment with the European Food Safety Authority (EFSA) has been published.    

Outbreak of yellow fever in Angola 

Since the initial cases were detected in Luanda province, there has been a rapid increase in the number of suspected cases recorded since mid-January 2016. Local transmission is no longer restricted to Luanda. As of 30 March, 16 of 18 provinces across the country have reported suspected cases. A mass vaccination campaign has been ongoing since February aiming to immunise 6.7 million people in Luanda province.   

ECDC published a rapid risk assessment on 25 March and an epidemiological update on 1 April.

ECDC on STEC, HUS outbreaks in Romania and Italy

ECDC has published Joint ECDC/EFSA rapid outbreak assessment: multi-country outbreak of Shiga toxin-producing Escherichia coli infection associated with haemolytic uraemic syndrome in Romand and Italy. Click or tap through to download the RRA. The summary:

​An outbreak of Shiga toxin-producing Escherichia coli (STEC) infection associated with haemolytic uraemic syndrome (HUS) and affecting mostly young children has been reported in February and March in Romania. Italy reported one HUS case with an epidemiological link to Romania on 21 March 2016. Overall, 25 cases have been identified as associated with this multi-country outbreak, of which 19 developed HUS and three of these died. 

Information collected from patients points towards a milk processing establishment in Romania as a possible source of infection. Several strains of STEC have been identified so far, and it is possible that multiple sources of contamination have contributed to this outbreak. 

The recall of suspected food products has been undertaken by food safety authorities in Romania, Italy and other countries who have imported the suspected food items. However, potentially contaminated items could still be present in households. Since the precise source of contamination has not yet been identified, cases possibly linked to the this outbreak may occur in Romania and in those EU countries to which the implicated food products have been distributed.   

To minimise the further spread of the infection and investigate possible new cases promptly, ECDC and EFSA recommend EU Member States to consider enhancing monitoring for HUS and STEC cases. In addition, if new cases possibly linked to the outbreak are identified, these should be reported to the Epidemic Intelligence Information System for food- and waterborne diseases (EPIS-FWD). 

The investigation of the European dimension of this multi-country foodborne outbreak has demonstrated the added value of collaboration between Romanian and Italian public health and food authorities as well as ECDC and EFSA in enabling appropriate risk assessment and response.

Eurosurveillance: Early findings in outbreak of haemolytic uraemic syndrome among young children caused by Shiga toxin-producing Escherichia coli, Romania, January to February 2016

Via Eurosurveillance: Measles outbreak in a refugee settlement in Calais, France: January to February 2016. The abstract:

As at 29 February 2016, 15 cases of haemolytic uraemic syndrome with onset between 25 January and 22 February were reported among children between five and 38 months in Romania, and three of them died. Cases were mostly from southern Romania. Six cases tested positive for Escherichia coli O26 by serology. Fruits, vegetables, meat and dairy products were among the possible common food exposures. Investigations are ongoing in Romania to control the outbreak.

Australia: Measles, norovirus, E. coli in Queensland

Via The Australian: Fifth measles case confirmed in Qld.

A fifth case of measles in Queensland has sparked a major health alert after the infected person visited a public hospital and travelled on a train. 

The latest case is not related to previously confirmed cases, heightening concern among health authorities. 

They have issued a measles alert for the city of Ipswich, west of Brisbane, where the infected resident visited a hospital on August 26, August 30 and on September 1. 

The person also travelled on a train from Dinmore to Ipswich on August 30, unaware they had the highly infectious disease. 

Public health physician Dr Heidi Carroll says measles is a serious viral infection that causes fever, a cough and a runny nose followed by a red spotty rash and sore eyes. 

"Symptoms usually start around 10 days after infection but sometimes longer so anyone who develops measles-like symptoms within the next week or two should contact their GP for advice," she said in a statement. 

The four cases of measles previously confirmed had been spread by passengers travelling between Queensland, NSW and Victoria. 

Meanwhile, Queensland health authorities are also battling serious outbreaks of E coli and norovirus. 

There are 132 confirmed cases of norovirus in the southeast, after two more people were found to have the form of viral gastroenteritis on Thursday. 

The norovirus outbreak has mostly hit the elderly, with 69 of those affected living at an Ipswich nursing home. 

Patients and staff at Ipswich Hospital, Boonah Health Service, Caloundra Hospital and Nambour Hospital have also been hit by the disease. 

The E coli outbreak originated from animals at Brisbane's Ekka Show and has so far infected 44 people after another four cases were confirmed on Friday morning. 

A Queensland Health spokesman said the number of cases was likely to increase as authorities waited for more samples to be tested.

Hong Kong: Woman treated for Shiga toxin

Via the Hong Kong government website: Woman treated for Shiga toxin. Excerpt:

The Centre for Health Protection is investigating a confirmed case of Shiga toxin-producing E.coli infection involving a 75-year-old woman.   

She fell ill on June 2 and was admitted to Queen Elizabeth Hospital on June 7, and discharged on June 11.   

She tested positive for Shiga toxin-producing E.coli.   She has no recent travel history and her home contacts are asymptomatic.   

Most strains of E.coli are harmless but Shiga toxin-producing E.coli can produce powerful toxins and cause severe food-borne disease.

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.