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L Hannah Gould,
Rajal K Mody,
Kanyin L Ong,
Paula Clogher,
Alicia B Cronquist,
Katie N Garman,
Sarah Lathrop, Carlota Medus,
Nancy L Spina,
Tameka H Webb,
Patricia L White,
Katie Wymore,
Ruth E Gierke,
Barbara E Mahon,
Patricia M Griffin For The Emerging Infections Program Foodnet Working Group
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ABSTRACT: Abstract Background: Shiga toxin-producing Escherichia coli (STEC) are an important cause of diarrhea and the major cause of postdiarrheal hemolytic uremic syndrome. Non-O157 STEC infections are being recognized with greater frequency because of changing laboratory practices. Methods: Foodborne Diseases Active Surveillance Network (FoodNet) site staff conducted active, population-based surveillance for laboratory-confirmed STEC infections. We assessed frequency and incidence of STEC infections by serogroup and examined and compared demographic factors, clinical characteristics, and frequency of international travel among patients. Results: During 2000-2010, FoodNet sites reported 2006 cases of non-O157 STEC infection and 5688 cases of O157 STEC infections. The number of reported non-O157 STEC infections increased from an incidence of 0.12 per 100,000 population in 2000 to 0.95 per 100,000 in 2010; while the rate of O157 STEC infections decreased from 2.17 to 0.95 per 100,000. Among non-O157 STEC, six serogroups were most commonly reported: O26 (26%), O103 (22%), O111 (19%), O121 (6%), O45 (5%), and O145 (4%). Non-O157 STEC infections were more common among Hispanics, and infections were less severe than those caused by O157 STEC, but this varied by serogroup. Fewer non-O157 STEC infections were associated with outbreaks (7% versus 20% for O157), while more were associated with international travel (14% versus 3% for O157). Conclusions: Improved understanding of the epidemiologic features of non-O157 STEC infections can inform food safety and other prevention efforts. To detect both O157 and non-O157 STEC infections, clinical laboratories should routinely and simultaneously test all stool specimens submitted for diagnosis of acute community-acquired diarrhea for O157 STEC and for Shiga toxin and ensure that isolates are sent to a public health laboratory for serotyping and subtyping.
Foodborne Pathogens and Disease 04/2013; · 2.26 Impact Factor
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ABSTRACT: Abstract Background: Arcobacter species, primarily Arcobacter butzleri, are widely distributed among animals, infrequently isolated from humans, and previously not associated with outbreaks of foodborne illness. We report results of an investigation of a foodborne outbreak that occurred among attendees of a wedding reception in Wisconsin, United States, and was likely caused by A. butzleri. Methods: We conducted a case-control study among reception attendees and a laboratory investigation to determine the extent, source, and cause of the outbreak. A clinical case was defined as diarrhea in an attendee with illness onset ≤7 days following the wedding reception. Results: The case-control study included 47 of 51 case patients and 43 non-ill attendees. Results demonstrated that consuming broasted chicken was the only factor significantly associated with illness (odds ratio 10.51; 95% confidence interval 1.28, 476.4). Five patients provided stool specimens. Comprehensive culture and polymerase chain reaction (PCR) testing did not detect common bacterial or viral pathogens. Subsequent testing with PCRs targeting 16S/23S rDNA of the three most clinically relevant Arcobacter spp. and the rpoB/C gene of A. butzleri provided products confirmed as A. butzleri (four patients) and A. cryaerophilus (one patient) by sequence analysis. Conclusions: The results of this investigation suggest that A. butzleri should be considered an agent that can cause outbreaks of foodborne illness. Rigorous investigation of outbreaks of undetermined etiology is valuable for incrementally increasing our understanding of emerging agents causing foodborne illnesses.
Foodborne Pathogens and Disease 02/2013; · 2.26 Impact Factor
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ABSTRACT: Salmonella enterica causes an estimated 1 million cases of domestically acquired foodborne illness in humans annually in the United States; Enteritidis (SE) is the most common serotype. Public health authorities, regulatory agencies, food producers, and food processors need accurate information about rates and changes in SE infection to implement and evaluate evidence-based control policies and practices.
We analyzed the incidence of human SE infection during 1996-2009 in the Foodborne Diseases Active Surveillance Network (FoodNet), an active, population-based surveillance system for laboratory-confirmed infections. We compared FoodNet incidence with passively collected data from complementary surveillance systems and with rates of SE isolation from processed chickens and egg products; shell eggs are not routinely tested. We also compared molecular subtyping patterns of SE isolated from humans and chickens.
Since the period 1996-1999, the incidence of human SE infection in FoodNet has increased by 44%. This change is mirrored in passive national surveillance data. The greatest relative increases were in young children, older adults, and FoodNet sites in the southern United States. The proportion of patients with SE infection who reported recent international travel has decreased in recent years, whereas the proportion of chickens from which SE was isolated has increased. Similar molecular subtypes of SE are commonly isolated from humans and chickens.
Most SE infections in the United States are acquired from domestic sources, and the problem is growing. Chicken and eggs are likely major sources of SE. Continued close attention to surveillance data is needed to monitor the impact of recent regulatory control measures.
Clinical Infectious Diseases 06/2012; 54 Suppl 5:S488-97. · 9.15 Impact Factor
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Benjamin J Silk,
Kashmira A Date,
Kelly A Jackson,
Régis Pouillot,
Kristin G Holt,
Lewis M Graves,
Kanyin L Ong,
Sharon Hurd,
Rebecca Meyer,
Ruthanne Marcus,
Beletshachew Shiferaw,
Dawn M Norton, Carlota Medus,
Shelley M Zansky,
Alicia B Cronquist,
Olga L Henao,
Timothy F Jones,
Duc J Vugia,
Monica M Farley,
Barbara E Mahon
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ABSTRACT: Listeriosis can cause severe disease, especially in fetuses, neonates, older adults, and persons with certain immunocompromising and chronic conditions. We summarize US population-based surveillance data for invasive listeriosis from 2004 through 2009.
We analyzed Foodborne Diseases Active Surveillance Network (FoodNet) data for patients with Listeria monocytogenes isolated from normally sterile sites. We describe the epidemiology of listeriosis, estimate overall and specific incidence rates, and compare pregnancy-associated and nonpregnancy-associated listeriosis by age and ethnicity.
A total of 762 listeriosis cases were identified during the 6-year reporting period, including 126 pregnancy-associated cases (17%), 234 nonpregnancy-associated cases(31%) in patients aged <65 years, and 400 nonpregnancy-associated cases (53%) in patients aged ≥ 65 years. Eighteen percent of all cases were fatal. Meningitis was diagnosed in 44% of neonates. For 2004-2009, the overall annual incidence of listeriosis varied from 0.25 to 0.32 cases per 100,000 population. Among Hispanic women, the crude incidence of pregnancy-associated listeriosis increased from 5.09 to 12.37 cases per 100,000 for the periods of 2004-2006 and 2007-2009, respectively; among non-Hispanic women, pregnancy-associated listeriosis increased from 1.74 to 2.80 cases per 100,000 for the same periods. Incidence rates of nonpregnancy-associated listeriosis in patients aged ≥ 65 years were 4-5 times greater than overall rates annually.
Overall listeriosis incidence did not change significantly from 2004 through 2009. Further targeted prevention is needed, including food safety education and messaging (eg, avoiding Mexican-style cheese during pregnancy). Effective prevention among pregnant women, especially Hispanics, and older adults would substantially affect overall rates.
Clinical Infectious Diseases 06/2012; 54 Suppl 5:S396-404. · 9.15 Impact Factor
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ABSTRACT: Escherichia coli O157:H7 is a Shiga toxin-producing E. coli (STEC) associated with numerous foodborne outbreaks in the United States and is an important cause of bacterial gastrointestinal illness. In May 2009, we investigated a multistate outbreak of E. coli O157:H7 infections.
Outbreak-associated cases were identified using serotyping and molecular subtyping procedures. Traceback investigation and product testing were performed. A matched case-control study was conducted to identify exposures associated with illness using age-, sex-, and state-matched controls.
Seventy-seven patients with illnesses during the period 16 March-8 July 2009 were identified from 30 states; 35 were hospitalized, 10 developed hemolytic-uremic syndrome, and none died. Sixty-six percent of patients were <19 years; 71% were female. In the case-control study, 33 of 35 case patients (94%) consumed ready-to-bake commercial prepackaged cookie dough, compared with 4 of 36 controls (11%) (matched odds ratio = 41.3; P < .001); no other reported exposures were significantly associated with illness. Among case patients consuming cookie dough, 94% reported brand A. Three nonoutbreak STEC strains were isolated from brand A cookie dough. The investigation led to a recall of 3.6 million packages of brand A cookie dough and a product reformulation.
This is the first reported STEC outbreak associated with consuming ready-to-bake commercial prepackaged cookie dough. Despite instructions to bake brand A cookie dough before eating, case patients consumed the product uncooked. Manufacturers should consider formulating ready-to-bake commercial prepackaged cookie dough to be as safe as a ready-to-eat product. More effective consumer education about the risks of eating unbaked cookie dough is needed.
Clinical Infectious Diseases 12/2011; 54(4):511-8. · 9.15 Impact Factor
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Elizabeth Cavallaro,
Kashmira Date, Carlota Medus,
Stephanie Meyer,
Benjamin Miller,
Clara Kim,
Scott Nowicki,
Shaun Cosgrove,
David Sweat,
Quyen Phan, [......],
Peter Gerner-Smidt,
Robert M Hoekstra,
Colin Schwensohn,
Adam Langer,
Samir V Sodha,
Michael C Rogers,
Frederick J Angulo,
Robert V Tauxe,
Ian T Williams,
Casey Barton Behravesh
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ABSTRACT: Contaminated food ingredients can affect multiple products, each distributed through various channels and consumed in multiple settings. Beginning in November 2008, we investigated a nationwide outbreak of salmonella infections.
A case was defined as laboratory-confirmed infection with the outbreak strain of Salmonella Typhimurium occurring between September 1, 2008, and April 20, 2009. We conducted two case-control studies, product "trace-back," and environmental investigations.
Among 714 case patients identified in 46 states, 166 (23%) were hospitalized and 9 (1%) died. In study 1, illness was associated with eating any peanut butter (matched odds ratio, 2.5; 95% confidence interval [CI], 1.3 to 5.3), peanut butter-containing products (matched odds ratio, 2.2; 95% CI, 1.1 to 4.7), and frozen chicken products (matched odds ratio, 4.6; 95% CI, 1.7 to 14.7). Investigations of focal clusters and single cases associated with nine institutions identified a single institutional brand of peanut butter (here called brand X) distributed to all facilities. In study 2, illness was associated with eating peanut butter outside the home (matched odds ratio, 3.9; 95% CI, 1.6 to 10.0) and two brands of peanut butter crackers (brand A: matched odds ratio, 17.2; 95% CI, 6.9 to 51.5; brand B: matched odds ratio, 3.6; 95% CI, 1.3 to 9.8). Both cracker brands were made from brand X peanut paste. The outbreak strain was isolated from brand X peanut butter, brand A crackers, and 15 other products. A total of 3918 peanut butter-containing products were recalled between January 10 and April 29, 2009.
Contaminated peanut butter and peanut products caused a nationwide salmonellosis outbreak. Ingredient-driven outbreaks are challenging to detect and may lead to widespread contamination of numerous food products.
New England Journal of Medicine 08/2011; 365(7):601-10. · 53.30 Impact Factor
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Dina Hoefer,
Sharon Hurd, Carlota Medus,
Alicia Cronquist,
Samir Hanna,
Julie Hatch,
Tameka Hayes,
Kirsten Larson,
Cyndy Nicholson,
Katie Wymore,
Melissa Tobin-D'Angelo,
Nancy Strockbine,
Paula Snippes,
Robyn Atkinson,
Patricia M Griffin,
L Hannah Gould
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ABSTRACT: Clinical laboratory practices affect patient care and disease surveillance. It is recommended that laboratories routinely use both culture for Escherichia coli O157 and a method that detects Shiga toxins (Stx) to identify all Stx-producing E. coli (STEC) and that labs send broths or isolates to a public health laboratory. In 2007, we surveyed laboratories serving Foodborne Diseases Active Surveillance Network sites that performed on-site enteric disease diagnostic testing to determine their culture and nonculture-based testing practices for STEC identification. Our goals were to measure changes over time in laboratory practices and to compare reported practices with published recommendations. Overall, 89% of laboratories used only culture-based methods, 7% used only Stx enzyme immunoassay (EIA), and 4% used both Stx EIA and culture-based methods. Only 2% of laboratories reported simultaneous culture for O157 STEC and use of Stx EIA. The proportion that ever used Stx EIA increased from 6% in 2003 to 11% in 2007. The proportion that routinely tested all specimens with at least one method was 66% in 2003 versus 71% in 2007. Reference laboratories were less likely than others to test all specimens routinely by one or more of these methods (48% vs. 73%, p=0.03). As of 2007, most laboratories complied with recommendations for O157 STEC testing by culture but not with recommendations for detection of non-O157 STEC. The proportion of laboratories that culture stools for O157 STEC has changed little since 2003, whereas testing for Stx has increased.
Foodborne Pathogens and Disease 12/2010; 8(4):555-60. · 2.26 Impact Factor
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ABSTRACT: The frequency of Salmonella-infected food workers identified through routine surveillance from 1997 to 2004 in Minnesota was determined in order to evaluate the impact of surveillance on the detection of outbreaks in restaurants and to quantify the duration of Salmonella shedding in stool. Of 4,976 culture-confirmed Salmonella cases reported to the Minnesota Department of Health, 110 (2.2%) were identified as food workers; this was less than one-half the number expected based on the incidence of Salmonella in the general population. Twenty food workers (18%) were associated with outbreaks. Twelve were involved in nine independent outbreaks at the restaurants where they worked. The identification of the index food worker in six of these outbreaks was critical to the initiation of outbreak investigations that revealed much larger problems. Among food workers who submitted specimens until at least one negative result was obtained (n = 69), the median duration of shedding was 22 days (range, 1 to 359 days). Among the four most common serotypes (Enteritidis, Typhimurium, Heidelberg, and Newport) the median duration of shedding was significantly longer for Salmonella Newport (80 days; P = 0.02) and for Salmonella Enteritidis (32 days; P = 0.04) than for Salmonella Heidelberg (8 days). Food workers should be considered an important source of Salmonella transmission, and those identified through surveillance should raise a high index of suspicion of a possible outbreak at their place of work. Food service managers need to be alert to Salmonella-like illnesses among food workers to facilitate prevention and control efforts, including exclusion of infected food workers or restriction of their duties.
Journal of food protection 11/2010; 73(11):2053-8. · 1.94 Impact Factor
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Stacy M Holzbauer,
Aaron S DeVries,
James J Sejvar,
Christine H Lees,
Jennifer Adjemian,
Jennifer H McQuiston, Carlota Medus,
Catherine A Lexau,
Julie R Harris,
Sergio E Recuenco, [......],
Bryan F Buss,
Mady Hornig,
John D Gibbins,
Scott E Brueck,
Kirk E Smith,
Richard N Danila,
W Ian Lipkin,
Daniel H Lachance,
P James B Dyck,
Ruth Lynfield
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ABSTRACT: In October 2007, a cluster of patients experiencing a novel polyradiculoneuropathy was identified at a pork abattoir (Plant A). Patients worked in the primary carcass processing area (warm room); the majority processed severed heads (head-table). An investigation was initiated to determine risk factors for illness.
Symptoms of the reported patients were unlike previously described occupational associated illnesses. A case-control study was conducted at Plant A. A case was defined as evidence of symptoms of peripheral neuropathy and compatible electrodiagnostic testing in a pork abattoir worker. Two control groups were used - randomly selected non-ill warm-room workers (n = 49), and all non-ill head-table workers (n = 56). Consenting cases and controls were interviewed and blood and throat swabs were collected. The 26 largest U.S. pork abattoirs were surveyed to identify additional cases. Fifteen cases were identified at Plant A; illness onsets occurred during May 2004-November 2007. Median age was 32 years (range, 21-55 years). Cases were more likely than warm-room controls to have ever worked at the head-table (adjusted odds ratio [AOR], 6.6; 95% confidence interval [CI], 1.6-26.7), removed brains or removed muscle from the backs of heads (AOR, 10.3; 95% CI, 1.5-68.5), and worked within 0-10 feet of the brain removal operation (AOR, 9.9; 95% CI, 1.2-80.0). Associations remained when comparing head-table cases and head-table controls. Workers removed brains by using compressed air that liquefied brain and generated aerosolized droplets, exposing themselves and nearby workers. Eight additional cases were identified in the only two other abattoirs using this technique. The three abattoirs that used this technique have stopped brain removal, and no new cases have been reported after 24 months of follow up. Cases compared to controls had higher median interferon-gamma (IFNgamma) levels (21.7 pg/ml; vs 14.8 pg/ml, P<0.001).
This novel polyradiculoneuropathy was associated with removing porcine brains with compressed air. An autoimmune mechanism is supported by higher levels of IFNgamma in cases than in controls consistent with other immune mediated illnesses occurring in association with neural tissue exposure. Abattoirs should not use compressed air to remove brains and should avoid procedures that aerosolize CNS tissue. This outbreak highlights the potential for respiratory or mucosal exposure to cause an immune-mediated illness in an occupational setting.
PLoS ONE 01/2010; 5(3):e9782. · 4.09 Impact Factor
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ABSTRACT: Salmonella is the most common bacterial cause of foodborne outbreaks in the United States; approximately half of Salmonella outbreaks occur in restaurant settings. In February 2008, investigation of a cluster of Salmonella Enteritidis cases with indistinguishable pulsed-field gel electrophoresis (PFGE) patterns revealed that five cases had eaten at the same restaurant. Cases were identified through routine surveillance activities and by contacting meal companions of culture-confirmed cases. Well meal companions and well patrons contacted via check stubs served as controls. Illness histories and stool samples were collected from all restaurant employees. Sandwiches were the only menu item or ingredient significantly associated with illness (15 of 15 cases versus 17 of 37 controls; odds ratio, undefined; P < 0.001). None of the six restaurant employees reported experiencing recent gastrointestinal symptoms. The outbreak PFGE subtype of Salmonella Enteritidis was identified in two food workers. One of the positive employees began working at the restaurant shortly before the first exposure date reported by a case, and assisted in the preparation of sandwiches and other foods consumed by cases. The other positive employee rarely, if ever, handled food. The restaurant did not have a glove use policy. There was no evidence of ongoing transmission after exclusion of the positive food workers. This was a restaurant Salmonella Enteritidis outbreak associated with an asymptomatic infected food worker. Routine PFGE subtyping of Salmonella Enteritidis isolates, routine interviewing of cases, and an iterative approach to cluster investigations allowed for timely identification of the source of an outbreak of Salmonella Enteritidis infections.
Journal of food protection 11/2009; 72(11):2332-6. · 1.94 Impact Factor
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ABSTRACT: Escherichia coli O157:H7 (O157) is the Shiga toxin-producing E. coli (STEC) serotype most frequently isolated and most often associated with hemolytic uremic syndrome (HUS) in the United States. Non-O157 STEC serotypes can also cause serious illness, but their impact as pathogens remains undefined. We compared characteristics of non-O157 and O157 STEC infections identified through sentinel surveillance.
Sentinel sites included a metropolitan health maintenance organization laboratory and a hospital laboratory serving a small city and rural area. We received sorbitol-MacConkey agar plates from every stool culture performed at both sites during 2000-2006. Colony sweeps were screened for stx1 and stx2 by polymerase chain reaction. E. coli identity, serotype, and presence of stx1 and/or stx2 were confirmed on individual isolates.
Two hundred six STEC isolates were identified: 108 (52%) were non-O157 serotypes, and 98 (48%) were O157. Of non-O157 cases, 54% involved bloody diarrhea, and 8% involved hospitalization. Non-O157 isolates with at least stx2 were not more likely to cause severe illness (bloody diarrhea, hospitalization, or HUS) than were non-O157 isolates with only stx1. O157 cases were more likely than non-O157 cases to involve bloody diarrhea (78% vs 54%; P < .001), hospitalization (34% vs 8%; P < .001 and HUS (7% vs 0%; P = .005). When including only isolates with at least stx2, O157 cases were still more likely to involve bloody diarrhea (78% vs 56%; P = .02) and hospitalization (33% vs 12%; P = .01) than non-O157 cases.
Differences in severity among STEC infections could not be explained by stx2, suggesting that additional factors are important in STEC virulence.
Clinical Infectious Diseases 07/2009; 49(3):358-64. · 9.15 Impact Factor
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ABSTRACT: From 1998 through 2006, four outbreaks of salmonellosis associated with raw, frozen, microwaveable, breaded, prebrowned, stuffed chicken products were identified in Minnesota. In 1998, 33 Salmonella Typhimurium cases were associated with a single brand of Chicken Kiev. In 2005, four Salmonella Heidelberg cases were associated with a different brand and variety (Chicken Broccoli and Cheese). From 2005 to 2006, 27 Salmonella Enteritidis cases were associated with multiple varieties of product, predominately of the same brand involved in the 1998 outbreak. In 2006, three Salmonella Typhimurium cases were associated with the same brand of product involved in the 2005 Salmonella Heidelberg outbreak. The outbreak serotype and pulsed-field gel electrophoresis subtype of Salmonella were isolated from product in each outbreak. In these outbreaks, most individuals affected thought that the product was precooked due to its breaded and prebrowned nature, most used a microwave oven, most did not follow package cooking instructions, and none took the internal temperature of the cooked product. Similar to previous salmonellosis outbreaks associated with raw, breaded chicken nuggets or strips in Canada and Australia, inadequate labeling, consumer responses to labeling, and microwave cooking were the key factors in the occurrence of these outbreaks. Modification of labels, verification of cooking instructions by the manufacturer, and notifications to alert the public that these products contain raw poultry, implemented because of the first two outbreaks, did not prevent the other outbreaks. Microwave cooking is not recommended as a preparation method for these types of products, unless they are precooked or irradiated prior to sale.
Journal of food protection 11/2008; 71(10):2153-60. · 1.94 Impact Factor
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ABSTRACT: Most human infections are caused by closely related serotypes within 1 species of Salmonella. Few data are available on differences in severity of disease among common serotypes.
We examined data from all cases of Salmonella infection in FoodNet states during 1996-2006. Data included serotype, specimen source, hospitalization, and outcome.
Among 46,639 cases, 687 serotypes were identified. Overall, 41,624 isolates (89%) were from stool specimens, 2524 (5%) were from blood, and 1669 (4%) were from urine; 10,393 (22%) cases required hospitalization, and death occurred in 219 (0.5%). The case fatality rate for S. Newport (0.3%) was significantly lower than for Typhimurium (0.6%); Dublin (3.0%) was higher. With respect to invasive disease, 13 serotypes had a significantly higher proportion than Typhimurium (6%), including Enteritidis (7%), Heidelberg (13%), Choleraesuis (57%), and Dublin (64%); 13 serotypes were significantly less likely to be invasive. Twelve serotypes, including Enteritidis (21%) and Javiana (21%), were less likely to cause hospitalization than Typhimurium (24%); Choleraesuis (60%) was significantly more so.
Salmonella serotypes are closely related genetically yet differ significantly in their pathogenic potentials. Understanding the mechanisms responsible for this may be key to a more general understanding of the invasiveness of intestinal bacterial infections.
The Journal of Infectious Diseases 08/2008; 198(1):109-14. · 6.41 Impact Factor
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Andrew C Voetsch,
Frederick J Angulo,
Timothy F Jones,
Matthew R Moore,
Celine Nadon,
Patrick McCarthy,
Beletshachew Shiferaw,
Melanie B Megginson,
Sharon Hurd,
Bridget J Anderson,
Alicia Cronquist,
Duc J Vugia, Carlota Medus,
Suzanne Segler,
Lewis M Graves,
Robert M Hoekstra,
Patricia M Griffin
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ABSTRACT: Listeriosis is a leading cause of death among patients with foodborne diseases in the United States. Monitoring disease incidence is an important element of listeriosis surveillance and control.
We conducted population-based surveillance for Listeria monocytogenes isolates obtained from normally sterile sites at all clinical diagnostic laboratories in the Foodborne Diseases Active Surveillance Network from 1996 through 2003.
The incidence of laboratory-confirmed invasive listeriosis decreased by 24% from 1996 through 2003; pregnancy-associated disease decreased by 37%, compared with a decrease of 23% for patients > or =50 years old. The highest incidence was reported among Hispanic persons from 1997 through 2001. Differences in incidence by age group and ethnicity may be explained by dietary preferences.
The marked decrease in the incidence of listeriosis may be related to the decrease in the prevalence of L. monocytogenes contamination of ready-to-eat foods since 1996. The crude incidence in 2003 of 3.1 cases per 1 million population approaches the government's Healthy People objective of 2.5 cases per 1 million population by 2005. Further decreases in listeriosis incidence will require continued efforts of industry and government to reduce contamination of food and continued efforts to educate consumers and clinicians.
Clinical Infectious Diseases 03/2007; 44(4):513-20. · 9.15 Impact Factor
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Jay K Varma,
Michael C Samuel,
Ruthanne Marcus,
Robert M Hoekstra, Carlota Medus,
Suzanne Segler,
Bridget J Anderson,
Timothy F Jones,
Beletshachew Shiferaw,
Nicole Haubert,
Melanie Megginson,
Patrick V McCarthy,
Lewis Graves,
Thomas Van Gilder,
Frederick J Angulo
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ABSTRACT: Listeria monocytogenes has been estimated to cause >2500 illnesses and 500 deaths annually in the United States. Efforts to reduce foodborne listeriosis have focused on foods frequently implicated in outbreaks. Potential sources for L. monocytogenes infection not associated with outbreaks remain poorly understood.
The Foodborne Diseases Active Surveillance Network conducts surveillance for culture-confirmed listeriosis at clinical laboratories in 9 states. After excluding outbreak-associated cases, we attempted to enroll eligible case patients with L. monocytogenes infection in a case-control study from 2000 through 2003. Control subjects were recruited through health care providers and were matched to case patients by state, age, and immunosuppression status. Data were collected about exposures occurring in the 4 weeks before specimen collection from the case patients.
Of the 249 case patients with L. monocytogenes infection, only 12 (5%) had cases that were associated with outbreaks; 6 other patients were ineligible for other reasons. Of 231 eligible case patients, 169 (73%) were enrolled in the study. We classified 28 case patients as having pregnancy-associated cases. We enrolled 376 control subjects. In multivariable analysis, L. monocytogenes infection was associated with eating melons at a commercial establishment (odds ratio, 2.6; 95% confidence interval, 1.4-5.0) and eating hummus prepared in a commercial establishment (odds ratio, 5.7; 95% confidence interval, 1.7-19.1).
Most cases of L. monocytogenes infection were not associated with outbreaks. Reducing the burden of foodborne listeriosis may require interventions directed at retail environments and at foods, such as melons and hummus, that are not commonly recognized as high risk. Because of the severity of listeriosis, pregnant women and other persons at risk may wish to avoid eating these newly implicated foods.
Clinical Infectious Diseases 03/2007; 44(4):521-8. · 9.15 Impact Factor
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ABSTRACT: The 23 restaurant-associated salmonellosis outbreaks that occurred in Minnesota from 1995 through 2003 were reviewed to characterize the role of infected foodworkers. The median duration of the outbreaks was 21 days (range, 1 to 517 days). The median number of culture-confirmed patron cases per outbreak was seven (range, 1 to 36 cases). The median incubation for patron cases ranged from 9 h to 5.9 days. A specific food vehicle was implicated in four outbreaks and suspected in five. Salmonella of the same serotype and pulsed-field gel electrophoresis subtype as that found in patrons was recovered from foodworkers in 19 outbreaks. Overall, 12% (129 of 1,033) of foodworkers tested positive for Salmonella. Sixty-four (53%) of 121 Salmonella-positive foodworkers reported not having had a recent gastrointestinal illness. Overall, the median duration of Salmonella shedding was 16 days. Among foodworkers who reported gastrointestinal illness, the median shedding duration was 30 days as compared with 3 days for asymptomatic foodworkers. Positive environmental samples were recovered in 4 (33%) of 12 outbreaks. No specific food vehicle was identified in any outbreaks associated with Salmonella-positive environmental samples. The median duration of outbreaks with positive environmental samples (187 days) was significantly longer than the median duration of outbreaks with negative environmental results (26 days, P = 0.03). A higher proportion of Salmonella-positive foodworkers (22 versus 8%) was identified in outbreaks with positive environmental samples. Salmonella outbreaks in restaurants are frequently prolonged yet produce a small number of confirmed patron cases. Prolonged outbreak durations suggest a persistent reservoir of contamination. Infected foodworkers likely serve as an important source for Salmonella transmission. Therefore, assessment of foodworker infection is essential for controlling restaurant outbreaks.
Journal of food protection 09/2006; 69(8):1870-8. · 1.94 Impact Factor
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ABSTRACT: Laboratory-based surveillance is a foundation for public health and is essential for determining the incidence of most foodborne diseases caused by bacterial pathogens; however, reported cases represent a subset of infections in the community. To identify the factors associated with seeking medical care and submitting a stool specimen among persons with acute diarrheal illness, we used multivariate logistic regression to analyze data from two 12- month population-based telephone surveys conducted in the Foodborne Diseases Active Surveillance Network (FoodNet) from 2000 to 2003. Of 31,082 persons interviewed, 5% reported an acute diarrheal illness in the four weeks prior to the interview; of these, 20% sought medical care. On multivariate analysis, among persons with an acute diarrheal illness, factors associated with seeking medical care included: male sex; age <5 or >or=65 years; household income <25,000 dollars; having health insurance; diarrhea duration >or=3 days; having bloody diarrhea, fever, vomiting, sore throat, or cough. Of those seeking medical care, 19% provided a stool sample. Bloody diarrhea (odds ratio [OR] 3.35; 95% confidence interval [CI] 1.18-9.51) and diarrhea duration >or=3 days (OR 3.81; 95% CI: 1.50-9.69) were the most important factors associated with submission of a stool specimen. Cases of acute diarrheal illness ascertained through laboratory-based public health surveillance are likely to differ systematically from unreported cases and likely over-represent those with bloody diarrhea and longer diarrhea duration.
Foodborne Pathogens and Disease 02/2006; 3(4):432-8. · 2.26 Impact Factor
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ABSTRACT: Salmonella enterica serotype Typhimurium outbreaks occurred at two elementary schools after science club students dissected owl pellets. Forty primary cases were identified (26 culture-confirmed). At the first school, pellets were dissected on a cafeteria table, concurrent with after-school child care in the cafeteria. Subsequently, the table was not sanitized before use by after-school care students for snack, or before the next school lunch. At the second school, pellets were dissected in a dedicated science room, and fewer cases occurred. Pellets in both outbreaks originated from a single captive barred owl. The outbreak pulsed-field gel electrophoresis subtype of S. Typhimurium was isolated from the owl's pellets and feces, and from four frozen chicks from a batch used to feed the owl.
Vector Borne and Zoonotic Diseases 02/2005; 5(2):133-6. · 2.44 Impact Factor
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ABSTRACT: This study was conducted by the Environmental Health Specialists Network (EHS-Net), a network of environmental health specialists and epidemiologists at federal and state health agencies, whose mission is to improve environmental health practice. One of EHS-Net's primary goals is to improve the understanding of the underlying causes of foodborne illness using a system-based approach. As part of this ongoing effort, EHS-Net analyzed data from a telephone survey of food service workers designed to increase our understanding of food preparation practices (a cause of foodborne illness) in restaurants. Results indicated that risky food preparation practices were commonly reported. Respondents said that at work they did not always wear gloves while touching ready-to-eat (RTE) food (60%), did not always wash their hands or change their gloves between handling raw meat and RTE food (23% and 33%), did not use a thermometer to check food temperatures (53%), and had worked while sick with vomiting or diarrhea (5%). Several factors were associated with safer food preparation practices. Workers responsible for food preparation reported washing their hands and wearing gloves when handling RTE food more often than workers not responsible for food preparation. Workers who cooked reported changing their gloves more often than workers who did not cook. Older workers and managers reported washing their hands more often than younger workers and non-managers. Workers in chain restaurants more frequently reported using thermometers than workers in independently owned restaurants. This study provides valuable information concerning the prevalence of food preparation practices and factors that may impact those practices. Additional research is needed to better understand those factors.
International Journal of Hygiene and Environmental Health 02/2005; 208(1-2):27-35. · 3.81 Impact Factor
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Ruthanne Marcus,
Terry Rabatsky-Ehr,
Janet C Mohle-Boetani,
Monica Farley, Carlota Medus,
Beletshachew Shiferaw,
Michael Carter,
Shelley Zansky,
Malinda Kennedy,
Thomas Van Gilder,
James L Hadler
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ABSTRACT: Salmonella serotype Enteritidis (SE) emerged as the most common Salmonella serotype among infected persons in the United States during the 1980s and 1990s, with infections reaching a peak in 1995. During the past decade, farm-to-table control measures have been instituted in the United States, particularly in regions with the highest incidence of SE infection. We report trends in the incidence of SE in the 5 original surveillance areas of the Foodborne Diseases Active Surveillance Network during 1996-1999: Minnesota, Oregon, and selected counties in California, Connecticut, and Georgia. Overall, the incidence of SE decreased 46% from 1996 to 1999. The greatest decrease was in Connecticut (71%), followed by northern California (50%), Minnesota (46%), and Oregon (13%). Although SE infection remains an important public health concern, there has been a remarkable decrease in its incidence. This decrease may be a result of targeted interventions, including on-farm control measures, refrigeration, and education efforts.
Clinical Infectious Diseases 05/2004; 38 Suppl 3:S135-41. · 9.15 Impact Factor
