martes, 28 de marzo de 2017

Recent Paper on Whole Genome Sequencing and Salmonella Outbreaks

Recent Paper on Whole Genome Sequencing and Salmonella Outbreaks

Multistate foodborne outbreaks of Salmonella infections associated with chicken can be challenging to investigate due to high consumption rates of chicken and the large number of brands. After a 2014 outbreak of Salmonella Heidelberg, researchers conducted a follow-up analysis by sequencing the genome on some of the outbreak isolates. The findings provided further evidence that chicken from a particular producer was the source of the outbreak. CDC, the U.S. Department of Agriculture’s Food Safety and Inspection Service, and state and local health departments published this research in a new article in the Journal of Food Protection. The article highlights how whole genome sequencing can be used with epidemiologic and traceback evidence to more confidently identify chicken sources of foodborne outbreaks.

 2017 Mar 15:654-660. doi: 10.4315/0362-028X.JFP-16-364. [Epub ahead of print]

Utility of Combining Whole Genome Sequencing with Traditional Investigational Methods To Solve Foodborne Outbreaks of Salmonella Infections Associated with Chicken: A New Tool for Tackling This Challenging Food Vehicle.

Abstract

High consumption rates and a multitude of brands make multistate foodborne outbreaks of Salmonella infections associated with chicken challenging to investigate, but whole genome sequencing is a powerful tool that can be used to assist investigators. Wholegenome sequencing of pathogens isolated from clinical, environmental, and food samples is increasingly being used in multistate foodborne outbreak investigations to determine with unprecedented resolution how closely related these isolates are to one another genetically. In 2014, federal and state health officials investigated an outbreak of 146 Salmonella Heidelberg infections in 24 states. A follow-up analysis was conducted after the conclusion of the investigation in which 27 clinical and 24 food isolates from the outbreak underwent whole genome sequencing. These isolates formed seven clades, the largest of which contained clinical isolates from a subcluster of case patients who attended a catered party. One isolate from a chicken processed by a large producer was closely related genetically (zero to three single-nucleotide polymorphism differences) to the clinical isolates from these subcluster case patients. Chicken from this large producer was also present in the kitchen of the caterer on the day before the event, thus providing additional evidence that the chicken from this producer was the outbreak source. This investigation highlights how whole genomesequencing can be used with epidemiologic and traceback evidence to identify chicken sources of foodborne outbreaks.

KEYWORDS:

ChickenFoodborne outbreak; SalmonellaWhole genome sequencing
PMID:
 
28294686
 
DOI:
 
10.4315/0362-028X.JFP-16-364

Fruit and Vegetable Safety | Features | CDC

Fruit and Vegetable Safety | Features | CDC



 Infographic: Steps to Safe and Health Fruits and Vegetables


Fruit and Vegetable Safety | Features | CDC

Fruit and Vegetable Safety | Features | CDC

Centers for Disease Control and Prevention. CDC twenty four seven. Saving Lives, Protecting People

Fruit and Vegetable Safety

Vegetables and fruits

Eating a diet with plenty of fruits and vegetables provides important health benefits when you select and prepare them safely.
Fruits and veggies add nutrients to your diet that help protect you from heart disease, stroke, and some cancers. And choosing produce including vegetables, fruits, and nuts—instead of high-calorie foods also helps you manage your weight.
But sometimes raw fruits and vegetables may contain harmful germs, such as SalmonellaE. coli, and Listeria, which can make you and your family sick with food poisoning. In the United States, nearly half of foodborne illnesses are caused by germs on contaminated fresh produce.
Safer choices for fresh produce are washed fresh vegetables, including salads, and cooked vegetables. Unwashed fresh vegetables, including lettuce and salads, are more likely to make people sick with a foodborne illness.
 Bean sprouts
Cook sprouts thoroughly to reduce the risk of illness.
Sprouts are a particular concern because the warm, humid conditions needed to grow sprouts also are ideal for germs to multiply. Therefore, eating raw or lightly cooked sprouts may lead to food poisoning. It's especially important to avoid raw sprouts if you are in a group more likely to get a foodborne illness: pregnant women, young children, older adults, and people with weakened immune systems.
Learn about Salmonella and E. coli outbreaks linked to sprouts in 2016.
Enjoy uncooked fruits and vegetables while taking steps to avoid food poisoning.
  • Check fruits and vegetables for bruising and damage .
  • Throw away fruits and vegetables that are spoiled or have been recalled.
  • Wash your hands, kitchen utensils, and food preparation surfaces, including chopping boards and countertops, before and after preparing fruits and vegetables.
  • Clean fruits and vegetables before eating, cutting, or cooking, unless the package says that the contents have been pre-washed.
    • Wash or scrub all fruits and vegetables under running water—even if you do not plan to eat the peel—so dirt and germs are not transferred from the surface to the inside when you cut the produce.
    • Dry fruit or vegetables with a clean paper towel.
  • Keep fruits and vegetables separate from other foods that could contaminate them, such as raw meat and seafood.
  • Refrigerate fruits and vegetables that you have cut up, peeled, or cooked as soon as possible, or within 2 hours. Refrigerate within 1 hour if the temperature outside is above 90°F. Chill them at 40°F or below in a clean container.
Anyone can get a foodborne illness, but people in certain groups are more likely to get sick and to have a more serious illness. These groups of people are:
  • Young children
  • Pregnant women
  • Adults aged 65 and older
  • People with weakened immune systems
If you or someone you care for has a greater chance of food poisoning, it's especially important to take steps to prevent food poisoning when preparing and eating fresh fruits and vegetables.

Multistate Outbreak of Listeriosis Linked to Soft Raw Milk Cheese Made by Vulto Creamery | Listeria | CDC

Multistate Outbreak of Listeriosis Linked to Soft Raw Milk Cheese Made by Vulto Creamery | Listeria | CDC

Centers for Disease Control and Prevention. CDC twenty four seven. Saving Lives, Protecting People



Multistate Outbreak of Listeriosis Linked to Soft Raw Milk Cheese Made by Vulto Creamery

At a Glance:

  • Case Count: 6
  • States: 4
  • Deaths: 2
  • Hospitalizations: 6
  • Recall: Yes
 Ouleout Cheese








Posted March 13, 2017 2:30 PM ET

What's New?

  • On March 10, 2017, Vulto Creamery expanded its recall to include four additional cheeses. Vulto Creamery has now recalled all lots of the following cheeses: Heinennellie, Miranda, Willowemoc, Ouleout, Andes, Blue Blais, Hamden, and Walton Umber.

Highlights

  • Read the Recall & Advice to Consumers and Retailers>>
  • CDC, public health and regulatory officials in several states, and the U.S. Food and Drug Administration (FDA) are investigating a multistate outbreak of Listeriamonocytogenes infections (listeriosis).
    • Listeria can cause a serious, life-threatening illness.
  • Six people infected with the outbreak strain of Listeria have been reported from four states since September 1, 2016.
    • All six people were hospitalized, and two people from Connecticut and Vermont died. One illness was reported in a newborn.
  • Epidemiologic and laboratory evidence indicate that soft raw milk cheese made by Vulto Creamery of Walton, New York, is the likely source of this outbreak.
    • Six of six people interviewed reported eating various types of soft cheeses in the month before their illness started.
    • The outbreak strain of Listeria was identified in samples taken from three intact wheels of Ouleout cheese collected from Vulto Creamery.
  • On March 7, 2017, Vulto Creamery recalled all lots of Ouleout, Miranda, Heinennellie, and Willowemoc soft wash-rind raw milk cheeses. On March 10, 2017, Vulto Creamery expanded its recall to include four additional cheeses.
    • All lots of the following cheeses have been recalled: Heinennellie, Miranda, Willowemoc, Ouleout, Andes, Blue Blais, Hamden, and Walton Umber.
    • The raw milk cheeses were distributed nationwide, with most being sold at retail locations in the northeastern and Mid-Atlantic states, California, Chicago, Portland, Oregon, and Washington, D.C.
  • CDC recommends that consumers do not eat, restaurants do not serve, and retailers do not sell recalled raw milk cheeses made by Vulto Creamery.
  • This investigation is ongoing. Updates will be provided when more information is available.

March 9, 2017

Initial Announcement
CDC is collaborating with public health and regulatory officials in several states, and the U.S. Food and Drug Administration (FDA) to investigate a multistate outbreak of Listeriamonocytogenes infections (listeriosis). Listeria can cause a serious, life-threatening illness.
Public health investigators are using the PulseNet system to identify illnesses that may be part of this outbreak. PulseNet is the national subtyping network of public health and food regulatory agency laboratories coordinated by CDC. DNA "fingerprinting" is performed on Listeria bacteria isolated from ill people by using techniques called pulsed-field gel electrophoresis (PFGE) and whole genome sequencing (WGS). CDC PulseNet manages a national database of these DNA fingerprints to identify possible outbreaks. WGS gives a more detailed DNA fingerprint than PFGE.
Six people infected with the outbreak strain of Listeria have been reported from four states since September 1, 2016. A list of states and the number of cases in each can be found on the Case Count Map page. WGS performed on clinical isolates from all six ill people shows that the isolates are closely related genetically. This close genetic relationship provides additional evidence that people in this outbreak became ill from a common source.
Listeria specimens from ill people were collected from September 1, 2016 to January 22, 2017. Ill people range in age from less than one year to 89 years, with a median age of 55. Five of six ill people are female. All six (100%) ill people reported being hospitalized, and two people from Connecticut and Vermont died. One of the illnesses was reported in a newborn.
The outbreak can be illustrated with a chart showing the number of people who were diagnosed each week. This chart is called an epidemic curve or epi curve.

Investigation of the Outbreak

Epidemiologic and laboratory evidence indicates that soft raw milk cheese made by Vulto Creamery of Walton, New York, is the likely source of this outbreak.
State and local health departments interviewed ill people or their family members about the foods they may have eaten or other exposures in the month before their illness started. Six (100%) of six people reported eating a soft cheese. The ill resident of Florida reported traveling to New York State and eating soft cheese there before becoming ill. Available information indicates that cheese made by Vulto Creamery was for sale at stores where at least five of the ill people purchased cheese before becoming ill.
The Connecticut Department of Public Health collected leftover cheeses from the deceased person's home in Connecticut. The outbreak strain of Listeria was identified in a leftover cheese that the family identified as Ouleout cheese from Vulto Creamery.
The New York Division of Milk Control and Dairy Services collected three intact wheels of Ouleout cheese from Vulto Creamery during a joint inspection with FDA. The outbreak strain of Listeria was identified in samples taken from the three wheels of cheese. On March 7, 2017, Vulto Creamery recalled all lots of Ouleout, Miranda, Heinennellie, and Willowemoc soft wash-rind raw milk cheeses. The soft raw milk cheeses were distributed nationwide, with most being sold at retail locations in the northeastern and Mid-Atlantic States, California, Chicago, Portland, Oregon, and Washington, D.C.
CDC and state and local public health partners are continuing laboratory surveillance through PulseNet to identify additional ill people and to interview them. This investigation is ongoing, and updates will be provided when more information is available.

Multistate Outbreak of Shiga toxin-producing Escherichia coli O157:H7 Infections Linked to I.M. Healthy Brand SoyNut Butter

Multistate Outbreak of Shiga toxin-producing <em>Escherichia coli</em> O157:H7 Infections Linked to I.M. Healthy Brand SoyNut Butter

Centers for Disease Control and Prevention. CDC twenty four seven. Saving Lives, Protecting People



Multistate Outbreak of Shiga toxin-producing Escherichia coli O157:H7 Infections Linked to I.M. Healthy Brand SoyNut Butter




Posted March 21, 2017 12:00 PM EST

What's New?

  • Read the Recall and Advice to Consumers and Institutions >>
  • Laboratory testing found the outbreak strains of STEC O157:H7 in I.M. Healthy brand SoyNut Butter collected from the homes of ill people and from retail locations.
  • Seven more ill people have been reported since the last update on March 13, 2017. The most recent illness started on March 5, 2017.
  • Two more hospitalizations and two more ill people with hemolytic uremic syndrome, a type of kidney failure, have been reported.

Highlights

  • CDC, multiple states, and the U.S. Food and Drug Administration (FDA) are investigating a multistate outbreak of Shiga toxin-producing Escherichia coliO157:H7 (STEC O157:H7) infections.
    • Twenty-three people infected with the outbreak strains of STEC O157:H7 have been reported from nine states.
    • Ten ill people have been hospitalized. Seven people developed hemolytic uremic syndrome, a type of kidney failure, and no deaths have been reported.
    • Twenty (87%) of the 23  ill people in this outbreak are younger than 18 years.
  • Epidemiologic and laboratory evidence indicates that I.M. Healthy brand SoyNut Butter is the likely source of this outbreak. I.M. Healthy brand SoyNut Butter may be contaminated with E. coli O157:H7 and could make people sick.
    • Laboratory testing found the outbreak strains of STEC O157:H7 in I.M. Healthy brand SoyNut Butter collected from the homes of ill people and from retail locations.
  • On March 7, 2017, The SoyNut Butter Company recalled all varieties of I.M. Healthy SoyNut Butters and all varieties of I.M. Healthy Granola products. On March 10, 2017, The SoyNut Butter Company expanded its recall of SoyNut Butter products to include Dixie Diner's Club brand Carb Not Beanit Butter.
  • CDC recommends that consumers do not eat, and childcare centers, schools, and other institutions do not serve, any variety or size of I.M. Healthy brand SoyNut Butter, I.M. Healthy brand granola, or Dixie Diner's Club brand Carb Not Beanit Butter, regardless of the date of purchase or the date listed on the container.
    • Even if some of the product was eaten or served and no one got sick, throw the rest of it away. Put it in a sealed bag in the trash so that children, pets, or other animals can't eat it.
  • This investigation is ongoing. CDC will provide updates as more information becomes available.

March 21, 2017

Case Count Update

Since the last update on March 13, 2017, seven more ill people have been reported from four states.
Twenty-three people infected with the outbreak strains of STEC O157:H7 have been reported from nine states. A list of the states and the number of cases in each can be found on the Case Count Map page.
Illnesses started on dates ranging from January 4, 2017, to March 5, 2017. Ill people range in age from 1 to 48 years, with a median age of 8. Twenty (87%) of the 23 ill people are younger than 18 years. Among ill people, 61% are male. Ten ill people have been hospitalized and seven people developed hemolytic uremic syndrome (HUS), a type of kidney failure. No deaths have been reported.
Illnesses that occurred after February 24, 2017, might not yet be reported due to the time it takes between when a person becomes ill and when the illness is reported. This takes an average of 2 to 3 weeks. Please see the Timeline for Reporting Cases of E. coli O157:H7 Infection for more details.

Investigation Update

In interviews, ill people or their family members answered questions about the foods they ate and other exposures in the week before they became ill. Twenty (87%) of the 23 people reached for interview reported either eating I.M. Healthy brand SoyNut Butter at home (14 people) in the week before they became ill, attending a facility that served I.M. Healthy brand SoyNut Butter (2 people), or attending childcare centers that served I.M. Healthy brand SoyNut Butter and I.M. Healthy brand granola coated with SoyNut Butter (4 people). SoyNut Butter is a nut-free substitute for peanut butter.
Investigators have reported to CDC two more ill people who either developed HUS or had a diagnostic test showing they were infected with STEC bacteria. In interviews, both of these ill people reported eating I.M. Healthy brand SoyNut Butter in the week before becoming ill. However, CDC is not including these people in the outbreak case count because no bacterial isolates, or samples, were available for DNA fingerprinting. Public health investigators use DNA fingerprinting to identify illnesses that are part of outbreaks.
Laboratory testing identified STEC O157:H7 in opened containers of I.M. Healthy brand SoyNut Butter collected from the homes of ill people in California, Oregon, and Washington. Officials in California also isolated STEC O157:H7 in unopened containers of I.M. Healthy brand SoyNut Butter collected from retail locations. Further testing using pulsed-field gel electrophoresis (PFGE) showed that the STEC O157:H7 in all of these containers of SoyNut Butter had the same DNA fingerprints as the STEC O157:H7 isolates from ill people.
The investigation is ongoing. CDC will update the public when more information becomes available.

Strategic Plan | Overview | Interagency Food Safety Analytics Collaboration | Food Safety | CDC

Strategic Plan | Overview | Interagency Food Safety Analytics Collaboration | Food Safety | CDC

Food Safety Masthead



CDC and Federal Partners Issue New Food Safety Analytics Strategic Plan

The Centers for Disease Control and Prevention (CDC), U.S. Food and Drug Administration (FDA), and the U.S. Department of Agriculture’s (USDA) Food Safety and Inspection Service (FSIS) have issued a new Strategic Plan for 2017-2021 as part of the Interagency Food Safety Analytics Collaboration (IFSAC).
IFSAC was created in 2011 to improve coordination of federal food safety analytic efforts and address cross-cutting priorities for food safety data collection, analysis, and use. Its projects and studies aim to identify foods that are important sources of human illness. IFSAC focuses analytic efforts on four priority pathogens:  Salmonella, Escherichia coli (E. coli) O157:H7, Listeria monocytogenes (Lm), and Campylobacter. CDC estimates that together, these four pathogens cause 1.9 million cases of foodborne illness in the United States each year.
Under the new strategic plan, IFSAC will focus on continuing to improve estimates of the sources of foodborne illnesses and developing methods to estimate how these sources change over time. The three goals of the new strategic plan are to improve the use and quality of new and existing data sources; improve analytic methods and models; and enhance communication about IFSAC progress.
The strategic plan outlines key objectives to achieve those goals, including:
  • Enhance the collection and quality of relevant source data;
  • Enhance the use of existing regulatory and foodborne illness surveillance data;
  • Incorporate genomic data and other novel data sources;
  • Explore ways to address key gaps in data quality, methods and models;
  • Develop new analytic approaches and models to maximize use of  existing data;
  • Expand the availability of technical and scientific expertise through collaboration with internal and external partners;
  • Enhance relationships and engagement with internal and external groups; and
  • Improve the synthesis, interpretation and dissemination of analytical findings for multiple audiences.
The plan also highlights accomplishments from IFSAC’s first five years, and the group’s intent to continue engaging with stakeholders on future work.
For more information on IFSAC, please visit the collaboration’s website.


The IFSAC Strategic Plan[PDF - 12 pages] outlines goals and objectives for the five-year time period from 2017 through 2021.

Objectives

  1. Enhance the collection and quality of relevant source data
  2. Enhance the use of existing regulatory and foodborne illness surveillance data sources
  3. Incorporate genomic data and other novel data sources
  4. Explore ways to address key gaps in data quality, methods and models
  5. Develop new analytic approaches and models to maximize use of already available data
  6. Expand the availability of technical and scientific expertise through collaboration with internal and external partners
  7. Enhance relationships and engagement with both internal and external groups
  8. Improve the synthesis, interpretation and dissemination of analytical findings for multiple audiences 

Priority Pathogens

IFSAC identified four priority pathogens as the initial focus of projects:
  1. Salmonella
  2. E. coli O157:H7
  3. Listeria monocytogenes (Lm)
  4. Campylobacter

Previous IFSAC Strategic Plans

The above strategic plan represents an update to IFSAC’s 2012-2016 Strategic Plan[PDF - 16 pages].
Strategic Plan | Overview | Interagency Food Safety Analytics Collaboration | Food Safety | CDC

Seasonal Allergies and Complementary Health Approaches | NCCIH

Seasonal Allergies and Complementary Health Approaches | NCCIH

National Center for Complementary and Integrative Health (NCCIH)



A woman outside prepares to sneeze.



There is reasonably good evidence that nasal irrigation with saline can be useful for relief of seasonal allergy symptoms. Other complementary practices frequently used for symptom relief, such as acupuncture, probiotics, or the herb butterbur might be helpful. However, the scientific evidence on these practices is limited, conflicting, or demonstrates safety concerns of the therapies. More studies are needed before researchers can say whether these approaches are effective and safe for treating seasonal allergy symptoms.
This issue of the Digest provides information on what the science says about several complementary health approaches for seasonal allergies, such as saline nasal irrigation, butterbur, honey, probiotics, and acupuncture.


What the Science Says:
Seasonal Allergies and Complementary Health Approaches

Learn what current research has to say about:

Additional Resources