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A massive foodborne outbreak of enterohemorrhagic E. coli (EHEC; typically E. coli 0157:H7) has caused16 deaths and sickened over 470 persons in Northern Europe. The source of the outbreak is thought to be fecally-contaminated raw vegetables including cucumbers, tomatoes and leaf lettuce. The source of the outbreak is still uncertain. German public health officials initially pointed to several cucumbers from Spain as the culprits. But, while these products were contaminated with EHEC, it appears that a different EHEC is responsible for the German outbreak.

Most of the sickened individuals are in Northern Germany although public health officials fear that the outbreak may spread. To that end, the outbreak appears to have worsened over the last 24 hours, with nearly 100 more people suffering from severe and potentially fatal symptoms. Typically, there are only 50 to 60 cases of EHEC infections per year in Germany.

Fecal contamination of the raw vegetables is the likely cause of this massive outbreak because E. coli is found in large quantities in the digestive systems of humans, cows and other mammals. Enteropathogenic strains of E. coli have been responsible for a large number of food contamination outbreaks in a wide range of countries. In most cases, the disease caused by these organisms is characterized by severe abdominal pains, diarrhea and generalized malaise. However, EHEC can cause more severe symptoms, ranging from bloody diarrhea to the rare hemolytic uremic syndrome which can lead to kidney failure, seizures, strokes, comas and death. The uremic syndrome is caused by secretion of a potent and sometime lethal enterotoxin manufactured by EHEC.

Unlike Salmonella gastroenteritis, where large number of organisms must be ingested to cause disease, EHEC infections can be caused by far fewer bacteria following ingestion of contaminated foodstuffs. In this regard, infections caused by EHEC are similar to those caused by Shigella spp which can be caused by between 1 to 10 ingested bacteria.

Let’s hope that the source of the outbreak is quickly identified before more people get sick or die.

Until next time...

Good Luck and Wash All Raw Vegetables Before Eating!!!!!!

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The Centers for Disease Control (CDC) in Atlanta, GA estimates that there are about 48 million illnesses caused by food borne bacteria each year. As many of you know, the incidence of outbreaks of Salmonella gastroenteritis is growing steadily and it seems that a week can’t go by without a report of a new outbreak. For those of you who are so inclined, the CDC publishes a weekly report entitled Morbidity and Mortality which tracks and reports the incidence of infectious diseases in the US. 

Interestingly, most food borne disease outbreaks primarily result from improperly handling, storing, transporting or preparing of raw food stuffs and consequently are easily preventable. To that end, the folks at Nursing Schools.net sent me a link to a post on their website that describes ways in which to better manage raw foods that can help to prevent or minimize the incidence of food borne illnesses in the US. An excerpt of the post is shown below.

The 12 Most Common Causes of Food Poisoning

**It is important to point out that the term “food poisoning” is anachronistic because in the past, it was not clear what was responsible for the illnesses caused by tainted food. While not currently used much in food microbiology circles, food poisoning (or intoxication) was historically used to describe ingestion of food that contained bacterial toxins but no living bacteria and caused disease. Staphylococcal “food poisoning” is the most common type of food intoxication that causes disease. In contrast, food borne illness is used to describe disease caused by ingestion of contaminated food containing live bacteria which subsequently colonize the lower gastrointestinal tract, invade the intestinal mucosa and thereby cause disease.**

Raw or undercooked food. Whether you're cooking at home or going out, eating food that hasn't been cooked thoroughly or brought to the appropriate temperature can put you at high risk of developing food poisoning. While you might enjoy rare steak, runny eggs or certain raw veggies, these foods can all carry bacteria when they are not cooked long enough or hot enough to kill off the offending particles. Common bacteria found in undercooked food include Escherichia coli, Salmonella and Campylobacter. Be safe instead of sorry and ask that your food be cooked through or use this chart when at home.

Food that is not stored at the proper temperature. While simple common sense would tell you that leaving foods like meat and dairy products out of refrigeration makes them unfit to eat, temperature regulation can be a bit more complicated. Refrigerators can malfunction, foods can be forgotten on the counter and instructions on labels can be misread. To keep yourself safe, always check the temperature on your fridge and freezer. They should be at 40 degrees F and zero (0) degrees F respectively. Always read the label to see what foods will need be refrigerated immediately and which have to be cooled after opening. If you plan to freeze foods, do it within 2 days of purchase. This can help prevent some very serious bacteria from growing and making you sick.

Letting food sit out. Most of us are smart enough to not let refrigerated foods sit out, but sometimes we can forget to put away the leftovers or want it on hand at a party. In order to keep these foods safe to eat and avoid some common bacteria taking hold, you should always put leftovers away as soon as you can. If you're serving food at a party, keep hot food at 140 degrees F or warmer, cold foods at 40 degrees F. Never leave perishable food out for more than two hours, especially if the weather is warm. This will help ensure that neither you nor your guests end up sick.

Not washing hands before eating or preparing food. Contamination of foods from dirty hands is a big cause of many cases of food poisoning. Always wash your hands thoroughly before and after handling foods at home (for at least 20 seconds) and only eat at restaurants with strong showings in health department assessments. Additionally, always make sure your hands are clean before eating food as well, especially if you will be touching them. Without these precautions, you could put yourself at risk of coming in contact with bacteria like staphylococcus-aureus and Clostridium perfringens.

Contamination of other foods by raw meat. Cross-contamination of foods is a major health issue and one that many out there should be highly conscious of avoiding at home. When juices from contaminated meat get onto cutting boards, hands and into the refrigerator, contamination can spread to other foods, some of which you might not plan to cook at all. It is essential to keep raw meat, poultry and fish separate from other foods. Always wash any utensils, countertops and cutting boards that have come in contact with them immediately, sanitizing them with bleach and water, or even having separate tools for handling meat can be a big help.

Eating raw shellfish. Raw oysters may be a delicacy, but ingesting them doesn't come without some serious risks. Oysters from the Gulf of Mexico are commonly contaminated with Vibrio vulnificus bacteria which can cause mild to serious food poisoning. Additionally, even oysters that do not come from this region are often left un-refrigerated for several hours while being brought to shore. While you may be fine after eating raw oysters, be aware that ingestion of these shellfish uncooked is a big risk and could lead to serious health issues.

Improper canning. Canning foods at home has been a common practice for several decades, but it's one that needs to be carefully monitored in order to ensure that the food being preserved won't carry contaminates along with it. Botulism is perhaps the most common bacteria contaminant in improperly canned food, and is one of the most serious and potentially deadly forms of food poisoning out there. Always boil jars and lids to be used in canning to kill off any lingering bacteria and make sure that all cans are properly sealed. Improper canning can also happen with foods you get off grocery store shelves so look out for bulges, discolored food, or seepage.

Ingesting expired food. We've all done it at one point or another, but eating expired food comes with a big risk for food poisoning attached. Always check expiration dates before ingesting any food in your home or purchased at the store. If there is no date on the package, no packaging or only a sell by date, use the government guidelines for cold storage to help you determine if a food is safe to eat or not.

Not heating or reheating thoroughly. You might think that you only have to worry about food poisoning in foods that haven't already been cooked, but that's not entirely the case. You should also be careful with foods that you're reheating, especially if they've been hanging out in your fridge for more than a couple of days. When reheating foods, make sure that meats reach a temp of at least 160-170 degrees F and that other foods come to around 165 degrees F. This will ensure that any bacteria that might have made its way into the food will be killed off and that you'll be able to avoid a common cause of food poisoning.

Not washing produce thoroughly before preparation. Even those seemingly innocuous veggies can be the source of food poisoning if not washed and prepared properly. Prior to reaching your table, there's no telling how many things they may have come in contact with, so always clean any fruit or vegetables with a soft kitchen brush and water (or a pre-prepared veggie wash) to ensure that any bacteria it contains will be largely washed away. This is especially important with foods that you do not plan to cook. While foodborne illness is more commonly caused by meats, recent outbreaks of Salmonella and E. coli have originated in spinach and tomatoes.

Unclean cooking utensils and surfaces. When it comes to food safety, cleanliness matters. Dirty kitchens attract mice and rats that can spread disease and also create ideal places for bacteria to grow and thrive and access your food. It's essential to keep any space you plan to cook in and any tools you plan to use highly sanitized. The USDA advises putting a tablespoon of bleach into one gallon of water to create a sanitizing liquid. This can help prevent any bacteria hanging out in your kitchen from getting on food and will ensure that none are able to cross contaminate one another.

Unpasteurized foods. For the most part, people are fine after eating foods that are unpasteurized, provided they have been stored and served in a safe manner. Yet for those with compromised immune systems, who are pregnant and the very young and very old could be at risk for food poisoning from these. Commonly pasteurized foods include milk, cheeses, yogurt, ice cream, ciders and juices. Unpasteurized versions of these foods can carry Salmonella, E coli, and Listeria monocytogenes, which can make individuals very sick

While these precautionary and preventative tactics will help to reduce food borne illnesses, it will not eliminate them completely. But, it is a good place to start to improve food safety and public health!

Until next time...

Good Luck and Good Job Hunting!!!!!!

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On episode #4 of the podcast This Week in Microbiology, Vincent, Cliff, Margaret, and Michael review foodborne bacterial illness in the context of outbreaks associated with cantaloupes and Lebanon bologna.

Right click to download TWiM #4 (51 MB .mp3, 75 minutes).

Links for this episode:

• CDC statement on Salmonella outbreak
• CDC statement on E. coli outbreak
• CIDRAP summaries of cantaloupe and bologna associated outbreaks
• ProMedMail summary of Salmonella outbreak
• Summary of food related illness in US (pdf)
• Food safety and irradiation (CDC)
• Geosmin (thanks, Atila!)
• Letters read on TWiM #4

Subscribe to TWiM (free) on iTunes,  Zune Marketplace, via RSS feed, by email or listen on your mobile device with the Microbeworld app.

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Last week, I took a group of Seattle researchers to task about issuing a press release about isolating methicillin resistant Staphylococcus aureus (MRSA) from sand samples taken from public beaches in Washington State. Their findings were neither remarkable nor news worthy and likely did more harm than good. Sadly, another article about MRSA—designed to alarm rather than inform and educate the American public—appeared in today’s Science section of the NY Times.

The article, “Ties to Pets Has Germ Jumping To and Fro” in which the word “germ” appeared several times, reports on the possible transmission of MRSA between humans and their pets, most notably dogs and cats. Much of the article focuses on the “strong link between animal to human transmission,” offers several frightening examples of serious zoonotic cases that have been recently reported and suggests that cats are eight times more likely than other pets to transmit MRSA to their owners. After reading the first part of the article, readers would rightfully believe that we are in the midst of a massive zoonotic MRSA epidemic with family pets at its epicenter.  However, on the second page of the article the author mentions an epidemiological survey study conducted by Dr. J. Scott Weese, a veterinarian from the University of Guelph in Ontario Canada which showed  that only “two to three percent of pets carry MRSA on their fur or skin or in their saliva.” Further, the study suggests that healthy animals that are transiently colonized by MRSA eliminate them “in a manner of weeks.” Compare the 2 to 3 per cent carrier rate in pets with an almost 70% human carriage rate of MRSA. While I am a PhD-trained infectious disease microbiologist, I don’t think it requires a PhD to quickly realize that pets really aren’t a major source or cause of MRSA infections for humans. That said, raising awareness among veterinarians about MRSA might aid in the development of appropriate disease surveillance, diagnostic testing, andinfection control to lessen the impact of MRSA on smallanimals.

I have no doubt that many people will look at and possibly treat their pets differently after reading the Times article. Further, many will unnecessarily spend money to have their pets tested for the presence or absence of MRSA. While informing the American public that pets (like humans) might unknowingly transmit MRSA is a good thing, turning the rare transmission of MRSA from animals to humans into a major epidemiological brou-ha-ha is misleading, scientifically disingenuous and reckless. Good journalism should inform and educate, not alarm and frighten people by presenting misleading and wrong-headed information. 

Until next time....

Good Luck and Good petting your pets (it will do more good than harm)

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As an iPhone user, I am constantly amazed at the applications that are developed for it. I recently downloaded a flashlight app that converts my iPhone into a flash light in case of a power outage or finding myself in the dark like I did two summers ago at Moosehead Lake in Maine. Just when I thought iphone apps couldn’t get cooler, I learned about a new app called “Outbreaks By Me.” It was developed by researchers at Children's Hospital Boston in collaboration with the MIT Media Lab, enables users to track and report outbreaks of infectious diseases, such as H1N1 (swine flu), on the ground in real time. The application can be downloaded from iTunes.

According to a press release “the application builds upon the mission and proven capability of HealthMap, an online resource that collects, filters, maps and disseminates information about emerging infectious diseases, and provides a new, contextualized view of a user's specific location – pinpointing outbreaks that have been reported in the vicinity of the user and offering the opportunity to search for additional outbreak information by location or disease.” An additional feature of Outbreaks Near Me is the ability to set alerts that will notify users via text or by e-mail when new outbreaks are reported in their proximity, or if users enter a new area of activity. It also offers an option for users to submit an outbreak report which will allow people in cities and countries around the world to interact with the HealthMap team and participate in the public health surveillance process.

What will iPhone app developers think of next— an app for swine flu vaccination?   Now that would be way cool!

Until next time....

Good Luck and Good Swine Flu Hunting!!!!!!!

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As we all know, the H1NI pandemic has been raging on for close too 10 ten days now. Curiously, “Fear & The Flu: The New Age of Pandemics” is the title this week’s cover story in Newsweek magazine. From an informational standpoint point, “this may be too little, too late”—as the old saying goes. While the Internet has been around for over twenty years now, government agencies, most notably the US Food and Drug Administration (FDA) and the Centers for Disease Control (CDC) continue to rely almost exclusively on old media to communicate with the American public during infectious disease outbreaks. Apparently, the administrators who run these government agencies haven’t been listening closely enough to President Obama’s assertion that “we live in the digital age.”

Communications between the public and government health officials is vital when trying to manage and control infectious disease outbreaks. “Every single government agency as well as companies and non-profits need to be digitally literate and competent in a time of pandemic” asserts Eye on FDA blogger Mark Senak. For their performances in recent infectious disease outbreaks, Mark gives CDC an “A” for effort—although there is substantial room for improvement. FDA on the other hand didn’t fair as well. “The FDA is not nearly as sophisticated in terms of digital. Their only Twitter account is for food recalls.  And their YouTube channels are all confusing and unorganized. They have a long way to go.”

The Internet was originally designed as a digital tool to transmit and move large amounts of information from one place to another. That said, it is also a powerful communication vehicle that can be used to broadcast valuable, scientifically-accurate information during infectious disease outbreaks by leveraging social media tools like Twitter, Facebook and instant messaging. To that end, it’s time for public health agencies to recognize the power of digital media and craft communication plans that can be implemented in the next infectious disease outbreak.

Until next time...

Good Luck and Good Job Hunting!!!!!!

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A quick perusal of the media coverage of the swine flu outbreak of 2009 would lead many to conclude that this outbreak has the potential to rival or surpass the 1918 flu pandemic—widely regarded as the worst influenza outbreak in history. While the emergence of a new H1N1 swine flu variant is significant note worthy— and has possible public health implications— the unrelenting, often scientifically-inaccurate media coverage did little to quell the fear and anxiety of many Americans.  Once again, the media—rather than physicians, public health officials and influenza experts—“got out in front of the story” and managed to create enough panic, fear and anxiety, the likes of which haven't been seen since the 2003 SARS pandemic. It wasn't until last Friday, when the Wall Street Journal published an interview with Dr. Peter Palese—a leading scientific expert on influenza A infections— did a clearer picture emerge about the severity and public health implications of the current swine flu pandemic.

According to Dr. Palese, there are several reasons why people and public health officials ought to be optimistic about the current pandemic:

• In 1976 there was a an outbreak of an H1N1 swine virus in Fort Dix, New Jersey, which showed human to human transmission but did not go on to become a highly virulent pandemic strain
• The presently circulating swine virus is most likely not more virulent than the other seasonal strains we have experienced over the last several years
• The current swine virus lacks an important molecular signature (the protein PB1-F2) which was present in the 1918 virus and in the highly lethal H5N1 chicken viruses.  If this virulence marker is necessary for an influenza virus to become highly pathogenic in humans or in chickens, then the current swine virus doesn’t have what it takes to become a major killer
• Since people have been exposed to H1N1 viruses over many decades, we likely have some cross-reactive immunity against the swine H1N1 virus. While it may not be sufficient to prevent becoming ill, it may very well dampen the impact of the virus on mortality.  I would postulate that by virtue of this “herd immunity” even a 1918-like H1N1 virus could never have the horrific effect it had in the past.  The most likely outcome is that the current swine virus will become another (fourth) strain of regular seasonal influenza

The landscape of vaccines and anti-influenza drugs has dramatically improved over what it was just a few years ago. Based on what we know of the structure and sequence of the swine virus, these FDA-approved drugs and FDA-licensed vaccines (modified to include the swine strain) would be highly effective against this new virus.  Also, present technologies as well as manufacturing capacities will allow us to make sufficient quantities of a swine virus vaccine for the winter 2009-10 influenza season in the US.

In other words, there is reason for concern but no need to panic beyond typical public health precautions that are taken during “normal” influenza outbreaks.

Dr. Vincent Racaniello, a viral disease expert who writes the Virology Blog, reported that as of Monday there have been laboratory confirmed cases of H1N1 infections in 30 US states with a total of 226 cases and one death in Texas. Globally, 20 countries had reported 985 cases of infection. The highest numbers are in Mexico, with 590 cases and 25 deaths. While there have been 26 deaths to date, the severity of the infection appears to be waning and person-to-person transmission appears to be low.

Unfortunately, there has been some fallout from the news media’s oft times “over the top” coverage of the pandemic. Many US hospital emergency rooms (most notably in Texas and California) have been overwhelmed and overburdened by visits from people who think they may have swine flu. Also, while some schools and daycare center closures were warranted, others may not have been. Finally, and perhaps most important, it is becoming increasingly apparent that the lay public's understanding of infectious agents and the outbreaks that they cause is grossly deficient and must be improved. 

We live in a world where viral pandemics, food poisoning outbreaks and infections caused by multiple-antibiotic resistant bacteria are becoming commonplace. While vaccines, antivirals and antibiotics can afford some protection against many viral and bacterial disease, the best way to fight infectious diseases is to understand what causes them, how they are spread and what public health measures can be implemented to prevent or control their transmission. Until the world becomes better educated about infectious diseases, we will continue to be overly-dependent on the news media during future outbreaks and epidemics.

Until next time....

Good Luck and Good Job Hunting!!!!!!!!!

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I just returned from a weekend of teaching regulatory affairs to biotechnology students at Georgetown University where I tried to convince them that the US Food and Drug Administration (FDA) is fundamentally sound despite its near demise during the Bush administration. Even before the Bush-induced wreckage, the agency was chronically understaffed, under funded and had serious leadership and morale problems. This, coupled with two nationwide Salmonella outbreaks in the past year, several highly publicized drug recalls, and steadily declining drug approval rates has prompted its critics to propose that FDA be split into two separate agencies—one that oversees the drug industry and another that would have responsibility for cosmetic and food safety. For those of you who may not know, FDA became responsible for oversight and regulation of the food and drug industries, in addition to the drugs, after passage of the Food, Drug and Cosmetic Act in 1938.

Drug industry advocates and longtime FDA critics contend that the agency as it exists today can no longer effectively oversee and insure the safety of American food and drug supplies. Critics argue that the history of FDA suggests that the agency focuses on medical products and only focuses on food safety when a crisis comes up. And when they occur, FDA is so distracted that it interferes with the drug review/approval process. While this is what FDA critics want you to believe, it is simply not the case. Despite its recent problems, the FDA has historically done an outstanding job when it comes to drug and food safety—when it is funded and staffed to appropriate levels.

Unbeknownst to the American public, food borne illnesses are very common and Americans are only alerted when the outbreaks reach a certain size. While the recent Salmonella outbreaks were larger in scope and breadth than past outbreaks, they were not extraordinary. However, they were extremely media worthy at the time that they were reported on. You may recall that at the time of the outbreaks, the American economy was beginning to fail and there was an inordinate amount of China, Mexico and free trade bashing going on in the US. Unfortunately, the news media decided to exploit the outbreaks to make a case that Americans ought to reduce their reliance on imported foods—a practice that was beginning to cut into the revenues of the US agriculture and food industries. Ironically, the Salmonella outbreaks might have been prevented if the production facilities (owned by American companies) were compliant with FDA mandated quality control and assurance regulations which were designed to insure food safety.

Drug industry advocates who argue that FDA ought to be split into two separate agencies have financial interests rather than safety concerns in mind.  As an investment banker or VC will tell you, slow, new drug approval rates can have serious financial consequences for the companies that are developing them—it can literally cost a company millions of dollars a day for every day the drug is kept off the market.  Interestingly, when FDA increased its drug approval rates in the late 1990s and early 2000s, there weren’t many industry insiders advocating a break up of the agency. Only recently, as FDA has become more risk adverse which in turn, has caused the new drug approval rates to slow again have critics begun to call for massive organizational changes at FDA.

Like I told my biotech students over the weekend, the only mechanism by which FDA can insure food and drug safety is by conducting regular inspections of drug and food manufacturing facilities. Unfortunately, FDA hasn’t been able to keep up with its mandatory inspections schedule because the agency has been under funded and poorly staffed for over a decade. Several FDA inspectors, who I talked with suggested that routine inspections of manufacturing facilities takes place every three to five years rather than every two years as required by FDA regulations. While in theory this shouldn’t affect a company’s ability to remain compliant with FDA regulations, in reality it does. Put simply, pharmaceutical and food companies, like most other for profit industries are incapable of policing themselves in the absence of regulatory oversight.

I ‘m not certain that the agency needs to be split into two separate agencies to continue to insure the safety of the American drug and food supplies. What I know is the agency needs more funding and much larger numbers of trained inspectors to be successful. In my opinion, the safety of the American food and drug supplies can only be guaranteed if the companies regulated by FDA make a commitment to quality manufacturing and play by the rules.

Until next time...

Good Luck and Good Job Hunting!!!!!!!!!

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Salmonella enteriditis, an organism dear to my heart (luckily not my posterior small intestine) is a common cause of food poisoning. As some of you may know, I did my PhD thesis work on Salmonella gastroenteritis (aka food poisoning) and I like to think that I am something of an expert on the topic. 

Typically, Salmonella food poisoning outbreaks are localized and rarely reach epidemic proportions. However, there have recently been two major nationwide Salmonella outbreaks in the US —one in 2007 and now in early 2009.

The current outbreak has afflicted 388 people in 42 states and may be caused by the same strain (Saint Paul) that was responsible for the 2007 outbreak. Ultimately, the 2007 outbreak was linked to contaminated tomatoes. The jury is still out on the cause of the most recent outbreak. Needless to say, CDC scientists are scurrying to quickly identify the source of the current outbreak because it took the agency over 5 months to conclusively identify the culprit in the 2007 epidemic. Not surprisingly, many grocery stores and restaurants suffered financially because of the outbreak.

Many of you may be wondering why Salmonella food poisoning is becoming such a problem in the US. I don’t believe that the strains responsible for the most recent outbreaks are more virulent than the ones that have traditionally caused more localized outbreaks. Instead, the reliance of food manufacturers and grocery store chains on one or two major food distributors (rather than multiple suppliers) is likely responsible for the severity and breadth of these nationwide outbreaks. This suggests that regulatory agencies ought to more closely scrutinize the microbiological quality of the operations of the major distributors. I believe that those efforts would greatly reduce the likelihood of future major outbreaks of food poisoning.

Until next time.

Good Luck and Good Job Hunting (avoid raw vegetables, undercooked poultry and raw eggs)
 

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Vincent Racaniello, my partner at BioCrowd, and I were chatting the other day about how cool it would be to develop a web-based map that was able to track infectious diseases outbreaks in real time. After a spirited chat, we both thought that we were on to something REALLY big. And, as is frequently the case, somebody else also had the very same idea.

For those infectious disease aficionados out there, you must check out the Health Map: A Global Disease Alert Map. The map was developed by Clark Freifeld and John Brownstein and is based on an algorithm that is beyond my comprehension. It is not as robust as the map that Vincent and I envisioned, but it is pretty cool and it works very nicely.

Until next time…

Good Luck and Good Disease Hunting!!!!!!!

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