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The recent E. coli 0104:H4 outbreak of gastroenteritis in Europe that sickened thousands and killed over 20 people was one of the largest foodborne disease outbreaks in the world (for the latest updates check out this article). This prompted my colleagues over at Onlinecertificateprograms.org to post an article entitled “10 Worst Food Contamination Outbreaks” that outlines the most serious foodborne illness to afflict the US.

Some of you may remember some of the more highly publicized ones including the “Jack in the Box” and “Sizzler” E. coli outbreaks in 1993 and 2000 respectively. While E. coli is still on everyone’s mind, the other usual suspects including Salmonella, Listeria and botulism are also featured!

 Here is the list! 

1. Washington Packing Corporation, Botulism (1963): After two women died from botulism due to eating a bad can of A&P tuna packed by the Washington Packing Corporation, health authorities began investigating the company's foods, eventually discovering that the bad tuna had been shipped and stocked in major population centers throughout the Midwest. Wary consumers immediately stopped purchasing tuna, causing the then $277 million industry to suffer a 35% decrease in sales. The families of the two women were paid $226,500 by Washington, which was shut down after the incident.
2. Skewer Inn Restaurant, Botulism (1983): Botulism struck again 20 years after Washington, resulting in one death. The oversight occurred at Peoria, Illinois' Skewer Inn, a popular restaurant located in the constantly-busy Northwoods Mall. Each victim ate beef patty-melts containing contaminated onions, later experiencing symptoms such as blurred vision, slurred speech, trouble breathing and paralysis. Overall, 28 people were hospitalized, 12 of whom required ventilatory support for varying periods of time.
3. Jalisco Cheese, Listeria (1985): The deadliest food contamination outbreak in US history was caused by listeria, a bacteria found in sewage, soil, stream water and plants that manifests through fever, aches and diarrhea. Many of the 142 Southern Californians who fell ill from Jalisco's Mexican-style soft cheese suffered dire consequences — 48 died including 19 stillbirths and 10 infants. When an investigation was completed, the bacteria were traced back to poorly pasteurized milk used to make the cheese at an Artesia plant.
4. Hillfarm Dairy, Salmonella (1985): Consumers would've been best-advised to avoid dairy products altogether in 1985. The Hillfarm Dairy debacle wasn't as severe as the Jalisco debacle, but it was far more widespread, as 16,284 cases of food poisoning due to salmonella were confirmed and possibly 200,000 cases altogether existed in the Midwest. Two deaths resulted, and as many as 12 may have occurred due to two batches of tainted milk produced in Melrose Park, Ill.
5. Jack in the Box, E. coli (1993): Highly publicized and nearly catastrophic for Jack in the Box, the 1993 E. coli outbreak in the Pacific Northwest could've been prevented if the fast food chain had selected better meat, or at least cooked the contaminated meat at the right temperature. According to reports at the time, the patties eaten by the victims contained fecal matter and weren't cooked at 155 degrees Fahrenheit as mandated by Washington state law. Four children died and more than 700 others became sick, prompting the USDA to enforce stricter regulations, and Jack in the Box to overhaul its food safety procedures.
6. Sizzler, E. coli (2000): One of the nation's largest steakhouse franchises experienced a crisis in 2000 when an E. coli O157:H7 outbreak in Milwaukee, Wis., originating from two restaurants in the area, sickened 65 people and killed a three-year-old girl. Health officials discovered that raw meat shipped from the Excel meat packing facility in Colorado came into contact with food eaten by the victims. According to Sizzler, it required all of its restaurants to cook beef entrees at the 160-degree temperature recommended by the US Food and Drug Administration.
7. Pilgrim's Pride, Listeria (2002): At the time, it spurred the largest meat recall in US history. The listeria outbreak of fall 2002 ended with 46 illnesses, three miscarriages and the deaths of seven people, causing Pilgrim's Pride, then the second-largest poultry company in the US, to suspend operations at its Franconia, Pa. plant. From there, products were shipped to grocery stores, food service institutions and restaurants around the country, specifically affecting Connecticut, Delaware, Maryland, Michigan, New Jersey, New York, Ohio and Pennsylvania.
8. Chi-Chi's restaurant, Hepatitis A (2003): Typically a problem suffered by residents of developing countries where personal hygiene standards are poor, a hepatitis A outbreak is a problem most Americans don't worry about facing. Thanks to a batch of green onions used in food at Chi-Chi's Mexican restaurant in Beaver, Pa., more than 660 people fell ill and four people died in the nation's worst outbreak of the infectious disease. Almost all of the victims contracted it by eating mild salsa and cheese dip, which contained raw onions that were traced to Mexico.
9. Natural Selection Foods, E. coli (2006): Veggie eaters across America halted their consumption of spinach in late 2006, as reports surfaced that certain helpings were contaminated with E. coli O157:H7. In early fall, 199 people were infected in 26 states — 31 of whom suffered kidney failure — and three people died. At fault was a farm in San Benito County, Calif., where CDC investigators suspected irrigation that was possibly contaminated from cattle feces, originating from nearby Paicines Ranch, came into contact with spinach fields.
10. Peppers and Tomatoes, Salmonellosis (2008): Jalapeno peppers, serrano peppers and tomatoes contributed to the 2008 United States salmonellosis outbreak, which proved difficult for the CDC to trace. Ultimately, investigators discovered the strain in irrigation water and serrano peppers originating from a packing facility in Nuevo Leon, Mexico and grower in Tamaulipas, Mexico. It infected 1,442 people in 42 states, with the most incidences occurring in Texas (384). At least one death was attributed to the outbreak.

Until next time...

 Good Luck and Good Eating!!!!!!!!

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There was an extremely troubling article in today’s New Jersey Trenton Times that indicated that a New Jersey’s childhood vaccination rates ranked 42nd in 2009—45^th in 2008—in the nation. The ranking were based on annual vaccination statistic compiled by the Centers for Disease Control in Atlanta, GA.

The lead-in paragraph to the article elegantly captured the irony of the dubious statistic:

“One of the most affluent (and most populous states) states in the country, home to more than a few giants in the pharmaceutical industry also has one of the lowest rates of immunizing babies and toddlers in the nation.”

New Jersey’s vaccination rates among infants and toddlers for childhood diseases— mumps, measles, diphtheria, Pertussis (whooping cough), hepatitis B and rubella—was roughly 64 percent in 2009. This was significantly lower than the national average of 71 percent and the lowest in the Northeast. For example, in Pennsylvania and New York, two of the states bordering New Jersey, the vaccination rates in 2009 were 72 and 71 present respectively.

The reasons given for the low rate are plausible but, in most cases, incomprehensible from an infectious diseases and public health perspectives. It has been postulated that low-income and immigrant communities lack health insurance and access to medical information about mandatory childhood vaccination regimens. While it is facile to blame low income and immigrant populations for New Jersey's  egregiously low vaccination rate, the problem may actually lie with more affluent and educated NJ citizens who have medical insurance (help to pay the salaries of medical billing workers) and understand the public health implications of mandatory childhood immunizations. 

According to the article, parents and even some health care professionals are backing away from mandatory vaccination because they “don’t like seeing kids cry” after sometimes receiving up to four vaccinations during a single office visit! Say what????? I accompanied my three children for most of their childhood immunizations, and while some tears may have been shed, they recovered quickly and are now protected against a variety of potentially life-threatening diseases.  Apparently, some parents and health care professionals are willing to jeopardize the public health of a nation because the “shots hurt.” To that I say; get over it—like it or not, life can be painful and no matter how hard you may try you cannot shield your kids from it!

The fallacious and recently publicly discredited link between childhood vaccination and autism, coupled with the growing public distrust of the pharmaceutical companies that manufacture the vaccines may be more plausible explanations for New Jersey’s declining immunization rates in NJ. This suggests that vaccine manufacturers and public health officials ought to work closely together to be educate the American public about the benefits and potential risks associated with childhood vaccination.

Finally, as some of you may know, many states like New Jersey have religious exemptions that allow children to skip mandatory childhood immunizations. Interestingly and troublingly these children are allowed to attend public schools despite the fact that they haven’t been vaccinated. Again, I say what??? Increasingly, these unvaccinated students have been implicated as the reservoirs for the pertussis outbreaks that are currently ravaging school aged children and older adults throughout the US. It is my belief that children who fail to receive the appropriate immunizations because of religious reason should not be allowed to attend public school. This is because, unlike many of the low income and immigrant families who may be unaware or cannot afford to immunize their children because they lack health insurance, many of the folks claiming religious exemptions have health insurance and are living above the poverty level. Consequently, if these parents choose to not immunize their children (and fail to meet mandated public health requirements for entry into public schools), then they ought to be financially responsible for their child’s education.

Paradoxically, the plummeting vaccination rates in New Jersey and elsewhere are being driven by a small but extremely vocal segment of the American public. Unfortunately, this anti-vaccine sentiment in America is unlikely to abate until an increasing number of children begin to die from easily preventable childhood diseases. As far as I am concerned, the benefits of childhood vaccines far outweigh their risks and help to maintain the public health of all Americans.

Until next time...

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

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On several occasions while driving in upstate New York, I noticed an exit sign on the NY State Thruway for Coxsackie, NY. And, not surprisingly, I began to wonder whether or not the Coxsackie virus was named after this obscure upstate NY town.

I first learned about coxsackie viruses as a graduate student while taking a medical virology course at the University of Wisconsin taught by the late noble laureate Howard Temin. However, despite a thirty year friendship with Vincent Racaniello, a BioCrowd co-founder and virologist extraordinaire, I never asked him about the origin of the coxsackie virus name. Much to my surprise, he had recently taken a trip to upstate NY and noticed the Coxsackie NY exit sign while driving on the thruway. This prompted him to blog about the coxsackie virus isolation, its pathogenic properties and of course, the origin of its name!

Coxsackie NY and the virus named after it 

by Vincent Racaniello,PhD

Recently while driving north on the New York State Thruway I passed the exit for the town of Coxsackie, NY (population 8,884). I grabbed my camera and photographed the exit sign, and reminded myself to write about the virus named after this small town.

In the summer of 1947 there were several small outbreaks of poliomyelitis in upstate New York. Gilbert Dalldorf, the director of the Wadsworth Laboratory in Albany, NY, and his associate Grace M. Sickles investigated this outbreak. In particular they sought polioviruses that could replicate in mice. This search was motivated by the fact that research on poliovirus required the use of monkeys which were extremely expensive. Dalldorf had attended the Fourth International Congress for Microbiology in 1947 where he heard that very young mice – suckling mice – could readily be infected with Theiler’s virus.

Dalldorf and Sickles made fecal suspensions from two children suspected of having poliomyelitis, and inoculated these into adult and suckling mice. Only the suckling mice (1 – 7 days old) developed paralysis; animals more than one week old were resistant to infection. The damage responsible for limb paralysis was widespread lesions in skeletal muscles, not in the central nervous system as occurs with poliovirus. Further study revealed that the viruses could be distinguished serologically from poliovirus.

Not only had Dalldorf and Sickles identified the first members of a very large group of human viruses, but they also introduced and popularized a new and inexpensive animal into the virology laboratory – the suckling mouse. In 1949 Dalldorf suggested that the new viruses be called Coxsackie viruses, because the first recognized human cases were residents of that New York village. This unique name is of native North American origin.

Over ten years later the importance of this work was recognized by Dr. Max Finland of Boston City Hospital:

The isolation by Dalldorf and Sickles of viruses which produced paralysis with destructive lesions of muscle in sucking mice and hamsters, from the stools of two children with signs of paralytic poliomyelitis was an achievement that may rank in importance with Landsteiner and Popper’s production of human poliomyelitis in monkeys.

In subsequent years many different Coxsackie viruses were isolated that cause a variety of clinical syndromes. Today at least 30 serotypes of Coxsackie viruses are classified in the enterovirus genus of the Picornaviridae. The viruses are classified into groups A or B depending upon the pathological effect in suckling mice.

Not every locale is pleased to have a virus named after it. In May 1993, an outbreak of an unexplained pulmonary illness occurred in the southwestern United States, in an area shared by Arizona, New Mexico, Colorado and Utah called “The Four Corners.” Muerto Canyon was proposed as the name for the etiologic agent of the disease, because the virus was first isolated from a rodent near the canyon. However after residents objected, the name Sin nombre virus was given to the agent of hantavirus pulmonary syndrome.

Dalldorf G, & Sickles GM (1948). An Unidentified, Filtrable Agent Isolated From the Feces of Children With Paralysis. Science (New York, N.Y.), 108 (2794), 61-62 PMID: 17777513

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The sequence of all known rhinovirus genomes reported in Science last week is an important advance for the field. Analyses of the sequences have revealed new relationships among the viruses, evidence for recombination, a new viral species, and conserved regions of the genome. These findings will be extremely valuable for those studying the biology, pathogenesis, and epidemiology of the common cold. But the press has over reacted to this work -  it was reported on the front page of the New York Times with the headline “Cure for the Common Cold? Not Yet, but Possible“.  Does the work deserve such fanfare?

The Times quoted Stephen Liggett, an asthma expert, as saying “We are now quite certain that we see the Achilles’ heel, and that a very effective treatment for the common cold is at hand.” He was apparently referring to the observation that a sequence within the 5′-noncoding region of the viral genome is highly conserved among the 99 rhinovirus sequences, in comparison with other regions of the viral RNA. He suggested that all 99 rhinovirus serotypes would therefore be susceptible to the same drug. But what kind of drug, and what function would it inhibit? The very 5′-end of the genome of enteroviruses and rhinoviruses binds viral and cellular proteins, and these interactions are essential for viral replication. So it might be possible to identify small molecules that block these protein-RNA interactions. But such drugs are very difficult to identify. Furthermore, if such a drug were identified, its efficacy would have to be tested against all rhinovirus serotypes. Therefore it is not clear that knowing that this sequence of the genome is conserved helps to identify drug targets and more readily than did the observations made years ago about the importance of RNA-protein interactions in this region. Clearly, many years of research are needed before such drugs are developed - not consistent with Dr. Liggett’s a treatment is ‘at hand’.

An even more crucial aspect of the problem was omitted from the Times article. Even if an antiviral drug could be identified that blocks essential RNA-protein interactions, it probably would not be useful in treating the common cold. As we discussed last week, rhinoviruses cause acute infections - characterized by rapid onset of disease, a relatively brief period of symptoms, and resolution within days. Most are complete by the time the patient feels ill, and the virus has already spread to another host. Antiviral therapy  must be given early in infection to be effective. There is little hope of treating most acute viral infections with antiviral drugs until rapid diagnostic tests are become available.

To be fair, some of the scientists quoted in the Times article were more realistic about the possibilities for rhinovirus treatments. One antiviral drug expert noted that it costs about $700 million to bring a drug to market. Because most rhinovirus infections are benign, who would pay for such an expensive drug, and would the Food and Drug Administration ever approve it? Ann Palmenberg, the lead author on the study, was even more realistic, admitting that a rhinovirus vaccine would not likely be made.

I cannot see how this new study identified a new or better target for therapeutic intervention. So why get the public excited by running a front page headline in the New York Times? It’s great to keep the public informed about scientific progress - but the press should not cry wolf. If this advance does not soon lead to a treatment for the common cold, the public will shake their heads and lose a bit more trust in science.

I’m not blaming the scientists for this over reaction to their study. I am sure that the journal Science engaged in strong pre-publication promotion: more publicity is better for their advertising revenues. And the newspapers are equally at fault: they should speak to a broader range of scientists to obtain a more balanced view. I particularly blame the author of the Times article, Nicholas Wade, for not sufficiently researching his article.

Perhaps Dr. Liggett and his colleagues would benefit from the lessons of history - specifically, the history of poliomyelitis and its conquest. On March 9, 1911, three years after the isolation of poliovirus, The Rockefeller Institute issued a press release, saying that it believed “that its search for a cure for infantile paralysis is about to be rewarded. Within six months, according to Dr. Simon Flexner, definite announcement of a specific remedy may be expected.” They quoted Dr. Flexner:  “We have already discovered how to prevent the disease, and the achievement of a cure, I may conservatively say, is not now far distant.” Dr. Flexner’s imminent ‘cure’ was a failure, and a successful poliovirus vaccine required another 44 years of research. Last week’s Times article seemed to have a similar overdose of hubris.

A. C. Palmenberg, D. Spiro, R. Kuzmickas, S. Wang, A. Djikeng, J. A. Rathe, C. M. Fraser-Liggett, S. B. Liggett (2009). Sequencing and Analyses of All Known Human Rhinovirus Genomes Reveals Structure and Evolution Science DOI: 10.1126/science.1165557

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Vincent Racaniello, Professor of Microbiology at the College of Physicians and Surgeons at Columbia University and co-founder of BioCrowd ,has created a weekly series called This Week In Virology (TWiV). Each week Professors  Racaniello and Dickson Despommier (another Columbia virologist) discuss the latest developments and public health concerns for a variety of viral diseases.

The weekly discussions are packaged as podcasts, posted on TWiV and Science Podcasters.org and can be downloaded from iTunes. Dr. Racaniello eventually wants to offer TWiV in a vcast format and use it to inform the public and teach students about viral diseases.

So far, Vincent and Dick have created nine TWIV podcasts. Some of viruses that they have discussed include: HIV, Polio, Lassa fever, Rabies, West Nile Virus and even video game viruses. The podcasts are interesting, informative and a good way to learn something about virology—something that may liven up your daily commute!

Until next time,

Good Luck and Good Job Hunting

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