Food Outbreak Scan for Nov 13, 2015

News brief

Two-state Chipotle E coli outbreak total rises to 49

Seven more illnesses have been reported in an Escherichia coli O26 outbreak in Washington and Oregon linked to eating at Chipotle restaurants, boosting the overall total to 49, the two states reported yesterday. The Washington State Department of Health (WSDH) said it has confirmed 31 cases, while the Oregon Health Authority (OHA) put its total at 18.

Federal health officials are assisting with the outbreak. The US Centers for Disease Control and Prevention (CDC) said in an update yesterday that 14 people have been hospitalized, but so far no patients have developed hemolytic uremic syndrome, a potentially fatal kidney complication.

An investigation is still under way to determine if the sick people had a common meal item or ingredient, according to the CDC. It noted that 33 isolates from patients have been uploaded to PulseNet, the national subtyping network, adding that all have the same DNA fingerprints.

Chipotle has reopened most of its restaurants in Washington and Oregon that had been temporarily closed in the wake of the investigation.
Nov 12 WSDH update
Nov 12 OHA update
Nov 12 CDC outbreak update

FDA finalizes rules on produce safety, food auditors, foreign suppliers

The US Food and Drug Administration (FDA) today finalized rules on produce safety, third-party accreditation, and Foreign Supplier Verification Programs (FSVPs), leaving only two of seven major rules left to be finalized in 2015, as required by the 2011 Food Safety Modernization Act (FSMA).

In September the FDA finalized rules covering prevention steps for both human and animal food. Today's finalized reports were due Oct 31.

The produce safety rule establishes science-based minimum standards for growing, harvesting, packing, and holding fresh produce, the agency said. It was first proposed in January 2013. The FDA today also published an environmental impact for the produce safety rule.

The third-party certification rule establishes a voluntary accreditation program for auditors to conduct food safety audits of and issue certifications to foreign facilities and the human and animal food they produce. "These requirements will help ensure the competence and independence of the accreditation bodies and third-party certification bodies participating in the program," the FDA said.

The finalized FSVP rule requires that importers perform specified risk-based activities to verify that food imported into the country meets US safety standards. Compliance requirements begin in 18 months.

The two rules due to be finalized by Dec 31 cover registration of food facilities and auditor user-fee programs.
FSMA update page, with links to final rules
Sep 10 CIDRAP News scan "FDA finalizes FSMA rules on human, animal food safety steps"

News Scan for Nov 13, 2015

News brief

Measles vaccine has saved 17.1 million lives since 2000, CDC says

Global measles deaths have dropped 79% in the past 15 years, and the measles vaccine saved an estimated 17.1 million people in that span, but vaccine uptake has stagnated in recent years, the US Centers for Disease Control and Prevention (CDC) reported today in Morbidity and Mortality Weekly Report (MMWR).

About 114,900 people worldwide died of measles in 2014, down dramatically from 546,800 in 2000, the CDC said. Measles cases decreased 69%, from 853,479 to 267,482, and incidence of the disease declined 73%, from 146 to 40 cases per million population. Declines in 2014 would have been even more dramatic if not for large outbreaks in China (52,628 cases), the Philippines (58,848), and Vietnam (15,033).

After rising from 72% to 85% from 2000 to 2010, coverage of the first dose of the measles vaccine has remained unchanged for 4 years, the report notes.

The authors conclude, "Measles can serve as an indicator of the strength and reach of the health system, as measles outbreaks reveal populations poorly served by health services."

In a World Health Organization (WHO) news release on the report, Jean-Marie Okwo-Bele, MD, MPH, director of the WHO's Department of Immunization, Vaccines and Biologicals, said, "We cannot afford to drop our guard. If children miss routine vaccination and are not reached by national immunization campaigns, we will not close the immunization gap."
Nov 13 MMWR report
Nov 12 WHO news release

US flu markers still at low levels

US flu indicators changed very little last week, remaining at low levels, the US Centers for Disease Control and Prevention (CDC) said today.

The percentage of outpatient visits for flulike illness remained the same as the previous week at 1.4, well below the national baseline. The percentage of respiratory specimens testing positive for flu dropped slightly, to 1.2%. Nearly 59% of positive specimens reported to the CDC by clinical labs were influenza A. Of the influenza A viruses subtyped by public health labs, H3N2 predominated.

No pediatric flu deaths were reported to the CDC, and the overall deaths from pneumonia and flu remained below the seasonal baseline.

Puerto Rico was the only area that reported moderate flulike illness activity, another marker based on clinic visits. Widespread geographic circulation was reported by only one area, Guam, with Puerto Rico reporting regional activity. Four states—Hawaii, Iowa, Massachusetts, and Oregon—reported local activity, up from two the previous week.
Nov 13 CDC weekly flu update

Study: Flu more severe than other respiratory illnesses

Lab-confirmed influenza illness was more severe and resulted in more missed work than other acute respiratory illnesses, and flu vaccination may modestly reduce severity, US researchers reported yesterday in Clinical Infectious Diseases.

The researchers analyzed data on acute, medically attended respiratory cases from the US Influenza Vaccine Effectiveness Network for the 2012-13 flu season. Cases were subjectively assessed for severity based on multiple factors such as health status, activity level, and sleep quality.

Flu cases were deemed significantly more severe than non-flu cases. Also, flu patients reported missing 20.5 hours of work for their illness, compared with 15.0 for non-flu patients. Finally, flu patients who had received a flu vaccine had modest but statistically significant better health status and activity level than non-vaccine flu patients, but there was no difference in terms of sleep quality, missed work hours, or lost work productivity.

The authors conclude, "These findings highlight the burden of influenza illnesses and illustrate the importance of laboratory-confirmation of influenza outcomes in evaluations of vaccine effectiveness."
Nov 12 Clin Infect Dis abstract

Fecal transplant drug shows early promise against C difficile

An experimental fecal microbiota transplantation drug cured almost 90% of Clostridium difficile patients, according to a small study yesterday in Clinical Infectious Diseases.

The commercially prepared drug, called RBX2660, is administered via an enema. Of 31 patients who received treatment at 1 of 11 US centers in late 2013 for recurrent or severe C difficile and completed 6-month follow-up, 16 patients were cleared of the bacterium with one dose and 11 with two doses, for an overall efficacy of 87.1%.

Common side effects included diarrhea, flatulence, abdominal pain or cramping, and constipation, but their frequency and severity decreased over time. Twenty serious adverse events were reported in 7 patients, but none were related to RBX2660 use.
Nov 12 Clin Infect Dis abstract