FSnet Oct. 20/05 -- II
A case of
Vibrio cholerae non-O1, non-O139 septicaemia in Slovenia, imported from Tunisia,
July 2005
Outbreak of
norovirus infections associated with consuming food from a catering company,
Austria, September 2005
Experts
refute anti-bacterial soap claims
Groundbreaking
report finds consumer awareness of food safety issues "high!"
New
nationwide food safety campaign aimed at meat outlets – FSAI launches
initiative to encourage vital food safety systems in butcher shops and meat
counters
FSIS to post
information on new technologies on its web site
U.S., Japan
to hold talks next week
Creutzfeldt-Jakob
disease: Australian surveillance update to 31 December 2004
how to subscribe
A
case of Vibrio cholerae non-O1, non-O139 septicaemia in Slovenia, imported from
Tunisia, July 2005
October 20, 2005
Eurosurveillance Volume 10, Issue 10
Iztok _trumbelj1 (iztok.strumbelj@zzv-ms.si), Ivan Prelog2, Tadeja Kotar3, Darja
Dovecar4, Teodora Petra_1, Maja Socan4
1Regional Institute of Public Health Murska Sobota, Murska Sobota, Slovenia
2General Hospital Murska Sobota, Murska Sobota, Slovenia
3Department of Infectious Diseases, University Medical Centre, Ljubljana,
Slovenia
4National Institute of Public Health, Ljubljana, Slovenia
The first case of Vibrio cholerae infection to be reported in Slovenia since
1977 was detected in July 2005. We report an imported case of Vibrio cholerae
non-O1, non-O139 infection from Tunisia to Slovenia.
A 20 year old Slovene man worked in a hotel on Djerba island, Tunisia, from May
to June 2005. He visited the Tunisian mainland, but did not travel out of the
country. In mid-June he presented with vomiting, diarrhoea and fever. The hotel
physician prescribed a 5-day course of trimethoprim-sulfamethoxazole. At first,
his symptoms improved with treatment, but after a couple of days they worsened,
and he was advised to return to Slovenia.
On 1 July he was admitted to a regional hospital in Slovenia with chills, a
fever of 39ºC and mild diarrhoea. Blood and stool cultures were taken and he
was given treatment for suspected septicaemia. Multiple liver and spleen
abscesses were found. Oxidase positive, slightly curved bacilli were isolated in
blood cultures at the regional public health institute. The strain was further
identified as non-O1, non-O139 V. cholerae at both the regional and national
public health institutes in Slovenia. Identification was confirmed at the
Laboratory of Enteric Pathogens, Health Protection Agency Centre for Infections,
England. The strain was susceptible to trimethoprim-sulfamethoxazole, ampicillin,
tetracycline and ciprofloxacin. The stool culture remained negative. The patient
was treated with ampicillin, doxycycline and ciprofloxacin, and since recovery
he has remained in good health.
The patient reported having completed a course of treatment with
trimethoprim-sulfamethoxazole prescribed in Tunisia, and it is not clear why he
did not recover at that time. One hypothesis is that the focus of infection was
in the patient’s liver, biliary tract or spleen, the pathogen was not
completely eliminated, and bacteria multiplied after the end of therapy and
caused his relapse.
Epidemiological investigation revealed no illness with diarrhoea in the
patient’s family or other close contacts. After confirmation of the strain
identification, the national public health institute informed other European
Union member states of the case via the Early Warning and Response System.
This imported case of V. cholerae non-O1, non-O139 infection is unusual. V.
cholerae non-O1, non-O139 serotypes are rare, and do not cause the disease known
as cholera, but infections can be fatal [2]. This case is very similar to a case
imported from Tunisia to Austria in 1997 [3], and is an important reminder to
physicians and microbiologists of the possibility of such events.
Acknowledgements
Tom Cheasty, Laboratory of Enteric Pathogens, Health Protection Agency,
Colindale, London.
References:
1. Draga_ AZ, Kariolic R, Zajc-Sattler J, Muic V. Identifikacija Vibrio cholerae
biotipa eltor pri treh tujih dr_avljanih. [Identification of Vibrio cholerae
byotype eltor, isolated from three foreign citizens] [in Slovene] Zdrav Vestn
1977; 46: 637-40.
2. Safrin S, Morris JG Jr, Adams M, Pons V, Jacobs R, Conte JE Jr. Non-O:1
Vibrio cholerae bacteremia: case report and review. Rev Infect Dis 1988; 10:
1012-1017.
3. Halabi M, Haditsch M, Renner F, Brinninger G, Mittermayer H. Vibrio cholerae
non-O1 septicaemia in a patient with liver cirrhosis and Billroth-II-gastrectomy.
J Infect. 1997; 34: 83-84.
Outbreak
of norovirus infections associated with consuming food from a catering company,
Austria, September 2005
October 20, 2005
Eurosurveillance Volume 10, Issue 10
Ingeborg Lederer, Daniela Schmid, Anna-Margaretha Pichler, Regine Dapra, Peter
Kraler, Andreas Blassnig, Anita Luckner-Hornische
Centre for Infectious Disease Epidemiology, Österreichische Agentur für
Gesundheit und Ernährungssicherheit, Vienna, Austria
On 7 September 2005 a cluster of acute gastroenteritis cases was reported to a
public health department in southern Austria. All cases were in staff at a
factory manufacturing electrical appliances and had symptom onset on 6
September. About 120 of 1357 employees had vomiting and/or diarrhoea (attack
rate 8.8%). The large number of cases with symptom onset on the same day
indicated a point-source outbreak. The factory provides food items from a local
caterer for its staff, including snacks (with sandwiches, for breakfast and
afternoon breaks), lunch, and dinner for workers on the second shift.
Initial investigations, including interviews of the catering company’s staff,
revealed that a female catering company staff member reported having been ill
from 4-5 September. She had worked on these days, and prepared sandwiches
without wearing gloves. Further interviews revealed that one of the cooks at the
catering company had become ill on 1 September, and further employees had become
ill on 4 September (1 employee), 6 September (2 employees), 7 September (1
employee), and 8 September (2 employees).
A cohort study of the staff of the appliance factory is underway to identify the
cause of the outbreak and to assess how this outbreak is related to the cluster
of cases among the staff of the catering company. The regional food inspection
agency closed the catering company late on 7 September and provided
recommendations for disinfection. The company stayed closed for one week until
hygiene measures were completed (excluding ill employees from work, cleaning and
disinfection of all areas, and discarding all foodstuffs prepared by the
catering company). Sick employees from both companies were requested not to
return to work until they had had no nausea, diarrhoea or vomiting for at least
48 hours.
Stool specimens from cases were tested for bacterial pathogens; all samples were
negative. On September 12, RT-PCR testing of the samples revealed that norovirus
was the causative agent for the outbreak: all 19 stool samples tested gave
positive results (11 employees from the catering company and 8 from the
factory). The isolates from the catering staff were indistinguishable those from
the factory workers.
The source of the outbreak in the electrical appliance factory has not yet been
determined but it is likely that the kitchen staff at the catering company
played contaminated a foodstuff with the virus. This outbreak underlines
existing guidelines for food business managers: anyone suffering from diarrhoea
and/or vomiting should report this to the manager and leave food handling areas
immediately. If there is only one episode of diarrhoea and/or vomiting in a 24
hour period and no fever, then the person can return to work. If symptoms
persist, then he or she should return to work only when vomiting has ceased for
48 hours and/or there have been no loose stools for 48 hours.
Experts
refute anti-bacterial soap claims
October 20, 2005
Associated Press/Reuters
SILVER SPRING, Md.— Experts were cited as telling an independent U.S. panel,
the Nonprescription Drugs Advisory Committee, which advises the Food and Drug
Administration, Thursday, that antibacterial soaps and body washes in the
household aren't any more effective in reducing illness than regular soap, and
could potentially contribute to bacterial resistance to antibiotics.
The stories explain that the FDA is not bound by their decisions but often
follows their advice. The agency has the authority to add warning labels to or
restrict the availability of such soaps and related items, but it has given no
indication any such ruling is imminent.
Representatives of the soap industry argue antibacterials are safe and more
effective than regular soap.
Elizabeth Anderson, associate general counsel for the Cosmetic, Toiletry and
Fragrance Association, was quoted as saying, "The importance of controlling
bacteria in the home is no different than the professional setting. We feel
strongly that consumers must continue to have the choice to use these
products."
In documents, FDA officials have raised concerns about whether the
antibacterials contribute to the growth of drug-resistant bacteria, and said the
agency has not found any medical studies that definitively linked specific
anti-bacterial products to reduced infection rates.
Allison E. Aiello, an assistant professor at the Department of Epidemiology at
the University of Michigan, was quoted as telling the panel, "there's a
lack of evidence that antiseptic soaps provide a benefit beyond plain
soap," citing a series of studies in the United States and Pakistan.
Both kinds of soaps reduced infections in households, but neither one worked
better than the other, she said.
The stories note that the popularity of antibacterials has skyrocketed in the
last decade as consumers decided killing bacteria in the home was better than
just washing them off.
Dr. Stuart B. Levy, president of the Alliance for Prudent Use of Antibiotics,
was cited as saying that laboratory studies have suggested the soaps sometimes
leave behind bacteria that have a better ability to flush threatening
substances—from anti-bacterial soap chemicals to antibiotics—from their
system, adding, "What we're seeing is evolution in action."
He advocates restricting anti-bacterial products from consumer use, leaving them
for hospitals and homes with very sick people, where he says they are needed
most.
Groundbreaking
report finds consumer awareness of food safety issues "high!"
October 20, 2005
PRNewswire
New York - "Safety" is one of the most basic factors driving consumer
food purchasing behaviors, and consumer awareness of food safety issues is high,
according to Understanding Consumer Attitudes About Food Safety: How Food
Manufacturers, Retailers and the Food Service Industry Can Build Consumer Trust
In this groundbreaking report, Packaged Facts reveals that a full 25% of the
general population can be classified as "highly aware", concerned, and
actively avoiding foods and food sources they believe to be unsafe. Yet safety
rarely gets the focus it deserves from manufacturers, retailers, and food
service providers-until there's a problem.
"Paramount for the food industry is understanding that safety has grown
from the sporadic scares about Salmonella and E.coli contamination into a huge
area of consumer concern," said Don Montuori, the publisher of Packaged
Facts. "Consumers are educating themselves about major food issues, such as
allergens, contamination and spoilage, growing and processing practices, and
ingredient content such as GMOs. This awareness is growing swiftly in every
demographic in society and is affecting how and where consumers are spending
their food dollars."
Drawing on more than six months of primary, proprietary research that involved
more than 400 U.S. consumers, Understanding Consumer Attitudes About Food Safety
demonstrates consumers' sense of perceived safeness for both foods and food
sources, as well as the steps they take to avoid foods and establishments which
they consider unsafe. Additionally, consumers responded to a battery of over 140
statements, enabling the compilation of the first-ever Attitudinal Segmentation
of Food Safety Perceptions and psychographic profiles.
Understanding Consumer Attitudes About Food Safety offers the food industry
first-hand insight into the consumer psyche surrounding safety, and offers a
unique roadmap to responding to, and benefiting from, these insights. Priced at
$6000, this report can be purchased directly from Packaged Facts by clicking:
http://www.packagedfacts.com/pub/1034737.html
New
nationwide food safety campaign aimed at meat outlets – FSAI launches
initiative to encourage vital food safety systems in butcher shops and meat
counters
October 19, 2005
Food Safety Authority of Ireland
http://www.fsai.ie/news/press/pr_05/pr20050919.asp
The Food Safety Authority of Ireland (FSAI) today announced details of a new
national information campaign focused on food safety practices in butcher shops
and meat counters. Environmental health officers (EHOs) across the country have
been working closely with food businesses in this particular sector of the food
industry to encourage an increase in the adoption of food safety management
systems based on the principles of HACCP (Hazard Analysis and Critical Control
Point). The FSAI have devised an information campaign to support this work,
specifically aimed at butcher shops and meat counters which includes a suite of
literature to assist food businesses in this sector to implement a HACCP
programme.
A recent survey undertaken by EHOs throughout the country has identified
approximately 1,100 butcher shops and 500 meat counters within supermarkets
across Ireland. Through this campaign the FSAI will target high-risk butchers
which have been identified as those selling ready-to-eat meat products in
addition to raw meat products. Survey results show that from the 961 high-risk
butchers examined, approximately 27% are compliant and an additional 60% have
started the process, with 13% who have yet to show any compliance with HACCP
requirements. A core focus of the FSAI campaign is to significantly increase
this level to achieve 100% compliance in the interest of protecting consumer
health.
According to Dr. Wayne Anderson, Chief Specialist Food Science, FSAI, good
hygiene practice and HACCP are crucial for safe food management.
“Implementing a food safety management system is crucial in today’s
environment of increasing customer demands. By not complying with the principles
of best food safety practice, food businesses not only place the viability of
their business in question by flouting the law, they also place the health of
their customers at risk. If a system of checks and balances, such as those
offered by a tailored HACCP system, are not in place, a food business is at
greater risk of a food safety problem.”
The FSAI has previously implemented similar campaigns focused on other sectors
of the food industry including hotels with function catering, hospitals and
nursing homes which resulted in a significant increase in the level of
compliance with HACCP. In addition to the current campaign targeting butcher
shops and meat counters, the FSAI will be focusing on other categories of the
food industry in the near future to ensure compliance with HACCP is achieved
throughout the entire spectrum of the Irish food industry.
“Some businesses perceive the development of a food safety management system
as a complicated procedure involving a lot of paperwork. While it may be seen as
an onerous task, HACCP can be implemented with minimum difficulty as
demonstrated by the majority of compliant food businesses. At this point there
is no excuse for non-compliance and every food business must know the steps in
their business that are critical to food safety and take responsibility for
controlling them. Besides obvious food safety benefits, HACCP offers other
advantages to the everyday operation of a business such as reducing product
losses and helping to keep staff aware of food safety issues,” concludes Dr
Anderson.
Since 1998 all Irish food businesses are required by law to have a food safety
management system based on the principles of HACCP. It is a systematic approach
to identifying and controlling hazards that could pose a danger in the
preparation of safe food. HACCP helps food managers identify what could go wrong
in their food business and assists them put plans and systems in place to
prevent negative occurrences. The principles of HACCP incorporate: identifying
hazards; determining the critical control points (CCPs); establishing critical
limits; establishing a system to monitor control of the CCP; establishing the
corrective action when monitoring indicates a CCP is not under control;
establishing procedures for verification to confirm the HACCP system is working
effectively and establishing documentation concerning all procedures and records
appropriate to these principles and their applications.
FSIS
to post information on new technologies on its web site
October 20, 2005
FSIS News Release
http://www.fsis.usda.gov/News_&_Events/NR_101905_01/index.asp
WASHINGTON - The USDA's Food Safety and Inspection Service (FSIS) today
announced that summary information on new technologies approved for use in the
production of meat, poultry and egg products will be available on its Web site.
Posting the brief descriptions of new technologies will encourage public and
industry awareness by small and very small plants, thus helping to improve
public health protection.
FSIS established the New Technology Staff (NTS) in 2003, to review new
technologies that companies intend to use in the slaughter of livestock and
poultry and in the processing of meat, poultry, and egg products. Review by NTS
ensures that the use of new technologies will not adversely affect product
safety, inspection procedures or the safety of FSIS inspectors.
FSIS defines the term "new technology" as new, or new applications of,
equipment, substances, methods, processes or procedures affecting the slaughter
of livestock and poultry or processing of meat, poultry, or egg products. The
new technologies have contributed to the reduction of threats posed by
pathogenic microorganisms in the recent years. For further details on the new
technologies, visit www.fsis.usda.gov.
This notice will become effective on November 18, 2005.
For further information pertaining to the new technologies, contact Shauket H.
Syed, D.V.M., New Technology Staff, Office of Policy, Program, and Employee
Development, FSIS, U.S Department of Agriculture, at (202) 205-0675 or by fax at
(202) 205-0080.
U.S.,
Japan to hold talks next week
October 20, 2005
Meatingplace.com
Pete Hisey
Undersecretary of State for political affairs Nicholas Burns will visit Tokyo on
Sunday and Monday in advance of the planned visit by President Bush on November
15 and 16. The ban on U.S. beef will be on the agenda, as the Food Safety
Commission prepares to release its decision on reopening the Japanese market to
American beef products. Many Japanese observers expect the formal announcement
to be made while Bush is in Tokyo, assuming the decision is positive.
Creutzfeldt-Jakob
disease: Australian surveillance update to 31 December 2004
September, 2005
Communicable Diseases Intelligence Vol 29 No 3
Genevieve M Klug, Alison Boyd, Victoria Lewis, Madga Kvasnicka, James S Lee,
Colin L Masters, Steven J Collins
Abstract
The Australian National Creutzfeldt-Jakob Disease Registry (ANCJDR) was
established in October 1993 after the identification of probable iatrogenic CJD
in recipients of human pituitary hormones. Since this time and with the
recommendations of the Allars inquiry into CJD in Australia,1 the registry has
performed surveillance of CJD in Australia with retrospective ascertainment to
1970 and ongoing prospective ascertainment of all human prion diseases or
transmissible spongiform encephalopathies (TSEs). Prion diseases include CJD,
Gerstmann-Straussler-Scheinker syndrome, fatal familial insomnia and Kuru. This
brief summary presents the epidemiological findings of the ANCJDR based on data
from 1970 to 31 December, 2004. Commun Dis Intell 2005;29:269–271.
From 1 October 1993 to 31 December 2004, 1,004 suspected transmissible
spongiform encephalopathy (TSE) cases acquired between 1970 and 2004, have been
notified to the Australian National Creutzfeldt-Jakob Disease Registry (ANCJDR)
for investigation. Of these, 293 definite cases and 186 probable cases have been
classified (Table 1) and comprise of 434 sporadic (91.0%), 36 familial (7.3%)
and 9 iatrogenic cases (1.7%). Seven cases of possible CJD have been identified
of which six were sporadic and one iatrogenic and a total of 86 cases were still
under investigation with 47 of these cases still alive. After detailed follow-up
and investigation, 432 suspect cases (43%) were excluded from the registry as
non-TSE cases. As of December 2004, no further cases of iatrogenic CJD have been
detected since the last identified case in 2000. Australia remains free of
variant CJD (vCJD).
Between 1970 and 2000, a steady increase in the annual incidence of spongiform
encephalopathies can be observed (Figure 1). This is consistent with, and
analogous to, the experience of other CJD surveillance programs, with the
increase probably reflecting case ascertainment bias stemming from improved
recognition, reporting, investigation and case confirmation.2 Since 2000, a
decline in numbers, in particular probable cases, has been apparent. This may
relate to a number of issues, including broadened surveillance responsibilities
and difficulties encountered following changes to privacy legislation. T he
average annual age-adjusted mortality rate during the period from 1970 to 2004
is 0.84 deaths per million per year. During the prospective period of ANCJDR
surveillance from 1993 to 2004, the average annual rate of mortality was 1.19
deaths per million persons. The rate for this prospective ascertainment epoch is
considered to be a more robust representation of Australian CJD incidence as
during this period standardised approaches to case classification and
ascertainment were implemented nationally.3
Mortality rates were calculated using the Australian Bureau of Statistics 2000
resident population estimates for Australia
The duration of illness for CJD cases varies depending on aetiology and other
determinants. The median length of illness duration for all CJD cases was four
months. For sporadic cases, the median duration was found to be four months
(range, 0.9-60 months), for iatrogenic cases 6.25 months (range, 2-25 months)
and for familial cases eight months (range, 1.5-192 months). Familial CJD was
found to be associated with a significantly greater survival time in comparison
to sporadic CJD (p<0.0001 by Log Rank Test).
In sporadic CJD, no significant sex differences have been observed. Overall,
47.2 per cent of cases were male and 52.8 per cent were female. The average age
of death in sporadic cases by sex was 65 years (range, 25-89) for males and 66
years (range, 33-89) for females. Over the period of 1970 to 2004, there was no
difference between the average age-specific mortality rates of males (0.62
deaths/million/year) and females (0.68 deaths/million/year). In males, the peak
mortality rate occurred between 70-74 years (4.0 deaths/million/year) and in
females between 65-69 years (4.6 deaths/million/year).
In comparison to sporadic cases, the average death age of familial cases was 51
years (range, 20-82 years) in males and 62.5 years (range, 42-82 years) in
females. Peak mortality rates occurred in the 65-69 year age group in both males
(0.26 deaths/million/year) and females (0.41 deaths/million/year) and in
iatrogenic cases, the average death age was 45 years (range, 27-62 years) for
males and 39 (range, 26-50 years) for females.
Analysis of the geographical distribution of sporadic CJD cases showed no
significantly increased risk for any individual Australian state or territory.
The number of total TSE deaths by state or territory between 1993 to 2004 is
shown in Table 2 and reflects geographical population distributions. Crude
incidence rates show little variability in the larger regions of Australia and
are similar to international rates where similar surveillance mechanisms are in
place. The lowest rates were observed in Tasmania and the Northern Territory and
may suggest lower ascertainment. No geographical birth region of sporadic CJD
cases demonstrated a significantly increased or decreased rate of sporadic CJD
incidence.
The notification of suspect cases to the ANCJDR initially peaked (132 cases)
during the first year of the registry's surveillance. This was the result of the
investigation of the Australian Institute Health and Welfare (AIHW) death
certificate searches, which ascertained cases retrospectively to 1988. Further
peaks of referrals were observed in 1995-1996 (129 and 125 cases respectively)
and again in 1999 (103 cases). The 1995-1996 consecutive peaks were a direct
result of AIHW death certificate and hospital and State Morbidity data searches
while the 1999 peak was representative of an increased level of acceptance and
utilisation of the 14-3-3 cerebrospinal fluid (CSF) diagnostic test by
clinicians. More recently, referrals have plateaued with around 60–70 cases
referred to the registry each year for evaluation. Overall, the large majority
of notifications of suspect cases have been obtained by personal communication
from clinicians (34.5%), CSF 14–3–3 protein test request (34.1%), death
certificates (13.3%) and hospital and health department searches (12.2%). Since
1998, the diagnostic CSF test has been the most dominant initial notification
source of definite and probable cases (45–86%) of CJD cases. Compulsory
notification of suspect CJD cases has been implemented in four Australian states
and territories since 2003–2004. The effect of scheduling CJD as a notifiable
disease will be closely monitored by the ANCJDR. At present, there has been no
demonstrable change to the number of referrals.
Acknowledgements
The Australian National Creutzfeldt-Jakob Disease Registry wishes to thank
families, medical practitioners and associated staff for their generous support
of Australian CJD surveillance. The Australian National Creutzfeldt-Jakob
Disease Registry also thanks Dr Handan Wand, Dr Matthew Law and Professor John
Kaldor (National Centre in HIV Epidemiology and Clinical Research at the
University of New South Wales) for their expert epidemiological and statistical
support.
References
1. Allars M. Inquiry into the use of pituitary derived hormones in Australia and
Creutzfeldt-Jakob disease. Report – June 1994. Australian Government
Publishing Service, 1994.
2. Ladogana A, Puopolo M, Croes EA, Budka H, Jarius C, Collins S, et al.
Mortality from Creutzfeldt-Jakob disease and related disorders in Europe,
Australia, and Canada. Neurology 2005;64:1586–1591.
3. Collins S, Boyd A, Lee JS, Lewis V, Fletcher A, McLean CA, et al.
Creutzfeldt-Jakob disease in Australia 1970–1999 Neurology
2002;59:1365–1371.
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