Food Outbreak Scan for Jan 15, 2016

News brief

Salmonella outbreak tied to nut butter is over after 13 cases in 10 states

A multistate Salmonella outbreak linked to nut butter produced by an Oregon company has reached 13 cases but now appears to be over, the Centers for Disease Control and Prevention (CDC) said today.

The number of cases is 2 more than reported Dec 3 in the initial outbreak announcement. The number of affected states rose from 9 to 10 as Maine was added to the list. Oregon has the most cases, with 4, and it reported the other new case. All other states have 1 case each.

No patients have been hospitalized with the outbreak strain of Salmonella Paratyphi B variant L(+) tartrate(+), the CDC said, and no one died from their illness.

All 10 ill people interviewed reported exposure to a nut butter or nut butter spread in the week before they became ill, and 8 of them specifically reported exposure to JEM Raw brand sprouted nut butter spread. On December 2, 2015, JEM Raw Chocolate, LLC, of Bend, Ore., voluntarily recalled its entire line of sprouted nut butter spreads because of potential contamination with Salmonella.
Jan 15 CDC update
Dec 3, 2015, CIDRAP News story on initial announcement

CDC study shows cruise ship norovirus outbreaks uncommon

Despite common perceptions, outbreaks of norovirus disease on cruise ships are relatively uncommon, and the rate of diarrheal disease has decreased 24% since 1990, according the CDC today in Morbidity and Mortality Weekly Report (MMWR).

The agency reported that, among 73,599,005 passengers on cruise ships from 2008 through 2014, a total of 129,678 cases (0.18%) of acute gastroenteritis, or diarrheal disease, were reported. And among 28,281,361 crew members, 43,132 cases (0.15%) were reported. That amounts to about 2 passengers or crew getting sick among every 1,000. And only a small proportion of those cases were caused by norovirus, even though the pathogen is the leading cause of outbreaks on cruise ships, the CDC said.

The rate of acute gastroenteritis on cruise ships fell from 29.2 cases per 100,000 travel days in 1990 to 28.5 in 2004, a 2.4% drop. It further fell from 27.2 cases per 100,000 travel days in 2008 to 22.3 in 2014, for an overall drop of 23.6%.

The authors noted, "Norovirus, the most common causative agent of outbreaks, accounted for 14,911 cases among passengers and crew members during 2008-2014, 0.01% of the estimated number of norovirus cases in the United States during the study period."
Jan 15 MMWR report

News Scan for Jan 15, 2016

News brief

Vietnam reports new H5N6 avian flu outbreak; Taiwan details H5N2 events

Vietnam has reported a new H5N6 avian flu outbreak, and Taiwan officials have confirmed seven separate H5N2 events, according to reports posted today by the World Organization for Animal Health (OIE).

The Vietnamese outbreak involves a flock of 220 backyard poultry in Lang Son province in the far north. The H5N6 virus killed 155 of the birds, and the remaining 65 were culled to prevent disease spread. The event began on Jan 2.

Vietnam has battled a slew of H5N6 poultry outbreaks beginning last summer, the most recent two being confirmed just yesterday and involving more than 4,500 birds total. China, Laos, and Hong Kong are the only other countries to report the virus in birds.

In Taiwan, H5N2 avian flu struck six flocks in four counties on the western side of the island as well as a thrush in Taipei city, according to a separate OIE report.

Two of the outbreaks began in late December, and the other four began the first week of this month. Affected counties are Yunlin and Chiayi, each with two outbreaks, and Kaohsiung and Changhua, each with one outbreak. The outbreak in Kaohsiung involved a chicken abattoir, while the other five involved farm birds.

Flocks ranged in size from 1,000 to 18,000 chickens, turkeys, ducks, and geese. All told 11,122 of 32,310 poultry died from their infections, while the surviving birds were euthanized to contain the outbreaks.

The H5N2 finding in Taipei city involved a dead pale thrush that was discovered on Dec 15.
Jan 15 OIE report on Vietnam
Jan 15 OIE report on Taiwan

Duodenoscope outbreaks exacerbated by lack of response, report says

Drug-resistant infections linked to inadequately cleaned duodenoscopes sickened at least 250 patients in 25 outbreaks from 2013 to 2015 because of repeated failures by manufacturers, hospitals, and the Food and Drug Administration (FDA) to adequately report and respond to the problem, according to a US Senate report released this week.

The 301-page report, initiated by Sen Patty Murray (D-Wash.), the Ranking Member of the Senate Health, Education, Labor, and Pensions Committee, found that, by early 2013, Olympus, the Japanese manufacturer of 85% of the nation's duodenoscopes, knew of lab confirmation that its closed-channel model could harbor bacteria even after cleaning according to manufacturer's instructions. Yet it did not inform the FDA of this finding and only relayed the information to hospitals and physicians in February 2015.

The probe also found that Olympus, Pentax, and Fujifilm, which also produce duodenoscopes used in the United States, as well as Custom Ultrasonics, which makes the cleaning machine for the scopes, failed to meet regulatory obligations. As well, 16 US hospitals traced antibiotic-resistant infections to the scopes but failed to send the required adverse event forms to the device manufacturers.

The report also said, "While FDA started investigating how closed-channel duodenoscopes cleaned according to manufacturers' instructions spread infection in September of 2013, the agency took no action to alert hospitals, doctors and the public to the risk posed by closed-channel duodenoscopes for 17 months. At least 68 patients in seven different hospitals in the United States were infected with antibiotic-resistant bacteria linked to duodenoscopes during this period."

Recommendations listed in the report focus on Senate regulatory action and changes necessary at the FDA.

Reuters reported today that the FDA cleared Olympus's duodenoscope with changes to the device's design and labeling that are designed to reduce the risk of bacterial infections. Olympus, the world's leading maker of duodenoscopes, will voluntarily recall its original model, the story said.
Jan 13 US Senate report
Jan 15 Reuters story