December 2007

November 2007

United Kingdom - Norovirus outbreak associated with canteen salad in Suffolk

29 Nov 2007
Eurosurveillance - D Showell
An outbreak of diarrhea and vomiting among employees of an office in Suffolk, in the United Kingdom, was reported to the district council on 11 June 2007. An outbreak investigation was initiated immediately and a case control study was conducted to investigate the possibility of the outbreak being caused by contaminated food.
Methods: Cases were defined as anyone who ate in the office canteen between 6 and 8 June and had at least one of the following symptoms: diarrhoea, vomiting, abdominal pain. Secondary cases were family members of cases with symptoms. In all, 36 cases were identified, including 34 primary and two secondary cases. The average age of cases was 36 years (range 18 to 60 years). Food histories were taken from 31 primary cases (27 females and 4 males) and stool samples were collected from nine cases (eight primary and one secondary case) and all four food handlers working in the canteen. None of the food handlers reported having gastrointestinal symptoms around the time of the outbreak. Food histories were also collected for comparison from 36 persons (26 females and 10 males) who had eaten at the canteen during the same period but who did not report any symptoms. These controls were recruited through an email sent from the affected company to all asymptomatic employees. No food samples from 7 or 8 June were available for testing.
Results: The food histories showed that those who had eaten a mixed salad on either 7 or 8 June were more likely to have become ill, compared with those who had not had a salad. The same salad refrigerated overnight was served on both days. The odds ratio for eating the salad on 7 June and being ill were 74 (CI 95% 8-1685) and for 8 June and being ill were 27 (CI 95% 6-138). The respective attack rates were 21/22 (95%) and 24/28 (86%), and 20 cases had salad on both days. No other food item was revealed as significant in the analytic study. Assuming that the source of the outbreak was the canteen food served at lunchtime on the 7 and 8 June, the incubation period would be in the range of 0-72 hours. This was calculated by taking as the minimum the time between the latest possible exposure and the earliest onset of symptoms, and as the maximum the time between the earliest possible exposure and the latest onset of symptoms. The incubation period of norovirus, 15-40 hours, would fit within this range, if exposure was on either day.
Laboratory results: No significant bacteriological results were found in the stool samples taken from nine cases. However, borderline positive growth of Clostridium perfringens, 105 colony forming units/gram, was found in the stool culture of one of the four tested food handlers. Norovirus was found in samples taken from three cases (two primary and one secondary case) and one food handler. This was the same person who had the borderline positive Clostridium perfringens result. This food handler had prepared the salad eaten on 7 and 8 June. Characterisation of the norovirus strains was undertaken and, of the four samples tested, three contained norovirus genogroup II genotype 4 variant 2 (GII-4 v2), and the fourth was GII-4 v3. The last was found in a secondary case. There was no specimen taken from the implicated primary case.
Conclusion: If the outbreak of norovirus had been caused by an infected food handler, all the subtypes would be expected to be identical [1]. However, if the salad had been faecally contaminated before reaching the canteen, through exposure to sewage, different subtypes would be expected [2,3]. Two different strains of norovirus were detected in this outbreak. Therefore, it is most likely that the food handler was infected by the salad at the same time as the cases, rather than the food handler being the source of the outbreak. The dual infection of Clostridium perfringens and norovirus adds weight to the suspicion that the food handler was infected by the salad and not the other way round. As an added complexity, the food handler in question was taking an anti-obesity drug causing loose stools as a side effect, which made the self-assessment of symptoms more difficult.
We think the genotyping of norovirus samples is useful in the investigation of norovirus outbreaks, especially if food-borne transmission is suspected or suggested through epidemiological analysis. In this case, it helped to rule out the food handler as the source of infection and increased the likelihood of the salad being contaminated before preparation, possibly through exposure to sewage.

Outbreak of Salmonella weltevreden infections in NORWAY, DENMARK and FINLAND associated with alfalfa sprouts, July-October 2007
29 Nov 2007
Eurosurveillance.com
KE Emberland (Knut.Erik.Emberland@fhi.no), S Ethelberg, M Kuusi, L Vold, L Jensvoll, B-A Lindstedt, K Nygård, C Kjelsø
Between 10 and 15 October 2007, the national reference laboratory at the Norwegian Institute of Public Health (FHI) detected Salmonella weltevreden in samples from four gastroenteritis patients. The patients were all living in the south-eastern part of Norway, and had no history of foreign travel during the month prior to onset of illness. S. weltevreden is a common cause of gastroenteritis in south-east Asia, but is a very rare serovar in Norway. Over the past 30 years, fewer than 10 cases were reported annually, only seven of which were domestically acquired. In response to the detected cases, an outbreak investigation was initiated on 19 October in order to identify the source of the outbreak. In response to the enquiry, Denmark reported a cluster of 18 cases of S. weltevreden that was under investigation at the time. The onset of illness of the first cases had been in late July. In three cases, it was thought likely that the infection had been acquired abroad. On 26 October, Finland reported a cluster of seven cases that had occurred between 1 August and 1 October. On 23 October, a Salmonella isolate obtained from a major Danish alfalfa sprout producer was serotyped as weltevreden. The Danish authorities issued an alert through the Rapid Alert System for Food and Feed (RASFF) on the same day.
The seeds for growing the alfalfa sprouts had been imported to Denmark in July and August 2007. The Danish producer had then exported part of the batch of seeds to a Norwegian alfalfa sprout producer on 19 September. The batch of seeds used in Denmark and Norway was traded, according to invoices, via retailers in Germany and the Netherlands to Denmark, and probably originated from Italy (further information is pending). No clear link has been found as yet to the seeds used in Finland, except that they came from the same Dutch supplier. A link may appear when the full traceability accounts from the Netherlands are provided through the RASFF system. The batch of alfalfa seeds had been imported to Finland in June. However, sprouts from this batch were not on the market in Finland before August. The alfalfa sprouts were recalled and withdrawn in Denmark on 18 October, in Norway on 23 October, and in Finland on 28 October.

United Kingdom - Food company 'sold tainted meat to schools'
28 Nov 2007
Telegraph -Gary Cleland and Harry Wallop [edited]
According to this story, a former employee was cited as saying that a company, based in Ashford, Kent, supplied contaminated meat to Government departments, prestigious schools and top hotels. The story says that the company, which has since gone into administration, also supplied hospitals and care homes. A former driver was cited as telling that he frequently had rotten meat in the back of his van and that he was instructed to leave meat on the doorstep of premises if there was no-one there to take it, leaving it open to vermin or contamination. And he claimed if a delivery was not made, meat was routinely left in unrefrigerated vans for up to 24 hours before it was taken back to the customer the following day. He claimed that the vans were not disinfected every day and “some not on a weekly basis”. Other former employees of the food company told how blood would seep through packaging and contaminate other meat before delivery.

United Kingdom - E. coli hits village
22 Nov 2007
Newbury Today - Ben Johnson [edited]
According to this story, a Kingsclere pre-school was forced to close after five cases of the potentially fatal stomach bug, E. coli O157, were discovered in the village. The story says that three toddlers, an older child and an adult were recently diagnosed with the rare infection, although the source of the outbreak is still unclear. All five are recovering. The Health Protection Agency stressed that a number of links between the victims were being investigated to establish the original source, and that attendance at the pre-school may be coincidental. The pre-school voluntarily closed its doors on Monday November 19 and staff launched a deep cleaning operation.

Spain - Outbreak of Norovirus gastroenteritis among staff at a hospital
22 Nov 2007
Eurosurveillance Weekly Release, 22 Nov 2007 [edited]
On 14 Sep 2007, an outbreak of acute gastroenteritis was reported among health care workers (HCW) employed at a hospital in Barcelona, Spain. The Infection Control Team (ICT) at the hospital was informed that several HCW had become suddenly ill, suffering nausea, vomiting and diarrhea (without blood, pus or mucus in the stool) since 10 Sep 2007. The working hypothesis was that meals at the hospital restaurant were related to the cause of the outbreak. We designed an unmatched case-control study, following standard operation procedures for foodborne outbreak investigation. We collected preliminary basic data and inspected the department premises in order to identify the source and the likely pathogen of this outbreak. All HCW reporting vomiting and/or diarrhea who had lunch or dinner at the hospital restaurant between 10 and 14 Sep 2007 were classified as cases. Available cases were interviewed, either personally or by phone, using a structured questionnaire. We collected data on the time and type of food consumed at the hospital restaurant. Frozen samples from all meals offered by the restaurant to HCW staff in this time period were collected from the kitchen. Stool samples were available only from 4 cases, and were collected for microbiological analysis. A total of 38 cases were identified and 31 of them were interviewed. The hypothesis that the outbreak was foodborne was confirmed by the results of the epidemiological analysis and by the identification of norovirus in 2 stool samples taken from cases. Norovirus contamination of rice salad with cocktail sauce was the cause of the outbreak. Noroviruses are considered to be the most frequent etiologic agents of food- and water-borne viral gastroenteritis outbreaks.

United Kingdom - Britain faces CJD epidemic from infected beef
10 Nov 2007
Telegraph - Roger Highfield [edited]
According to this story, the U.K. faces the possibility of a major epidemic of lethal brain disease as a result of the consumption years ago of beef contaminated with mad cow disease, BSE, according to Britain's leading expert on vCJD, or "human BSE".Although the incidence of variant CJD in Britain has been declining, with only four deaths so far this year, this expert believes that only people who are genetically susceptible have succumbed to the devastating illness so far. But in this story, the expert was quoted as saying that many millions of infectious doses of contaminated beef were eaten between 1980 and 1996 and that there is evidence the disease could silently incubate in a person for many decades, without producing symptoms.

United Kingdom - Stomach bug toll in Ilkley is now 46
09 Nov 2007
Ilkley Gazette-Paul Langan [edited]
The number of people in Ilkley suffering from a gastro-intestinal illness caused by the Giardia lamblia parasite has now, according to this story, risen to 46.The Health Protection Agency and Bradford Council's environmental health department are continuing to investigate the cause and source of the outbreak. A restaurant in Station Plaza Ilkley, is the current focus for these investigations.
Related source :
10 Nov 2007 - Telegraph & Argus

Spain – Tularemia
8 Nov 2007
Eurosurveillance [edited]
In late June 2007, the Epidemiological Surveillance Network in Castilla y Leon, northern Spain, reported a series of cases in a rural area in the province of Palencia and in the provincial capital city of Leon, labelled as "fever of unknown origin." Subsequent epidemiological investigation confirmed an outbreak of tularemia. On 22 Oct 2007, the Epidemiological Surveillance Network in Castilla y Leon confirmed 362 cases of tularemia. The onset of symptoms in half of the cases occurred between epidemiological weeks 28 (ending 14 Jul 2007) and 31 (ending 4 Aug 2007); 81.4 percent of reported cases were males and 18.6 percent females. Some 62.5 percent of cases were concentrated in the 45 to 64 year old age group, although all ages were affected (6 to 88 years old). Patient recovery in all cases was favorable, with a good response to the prescribed treatment and few complications. The most frequently used antimicrobials in this outbreak have been ciprofloxacin and doxycycline, but other fluroquinolones and tetracyclines were also used. The epidemiological surveillance showed that 33.7 percent of cases were farm workers or people whose jobs involve contact with the environment (for example, gardeners and lake and reservoir maintenance staff). A significant number of cases report having been in contact with rodents (23.5 percent), recent arthropod bites (16.6 percent) or animals such as dogs or cats (17.4 percent), or having handled crayfish (17.1 percent), taken frequent walks in the country (10.5 percent), having contact with livestock (9.7 percent), straw, manure or alfalfa hay (5.8 percent) or having handled and/or skinned hares (4.4 percent). The most frequent clinical presentation of the disease and background risk factors reported suggest 2 different means of transmission responsible for the outbreak; firstly and principally by inhaling the bacteria, a pattern seen in just over half the cases (pneumonic and probably many of the typhoid forms); and secondly, through direct inoculation with local manifestations of the disease.
Further cases are actively being sought. The general public and, in particular, workers with high risk of exposure have been informed of the disease and of preventive measures that should be taken. These were:
- avoid contact with dead, sick or unusually behaving animals;
- avoid the consumption of unsanitary water that has not had adequate sanitary control;
- use protective clothing and repellent products to avoid bites from insects and ticks,
- use gloves and masks when handling animals;
- do not allow children to touch dead animals;
- ensure that the meat of wild animals is cooked through before you eat it, as freezing does not inactivate the agent responsible for tularemia,
- communicate to hunting and/or animal health authorities the presence of dead, sick or unusually behaving animals; and - in case of the appearance of symptoms compatible with this disease, contact your doctor immediately.

Serbia - Serb officials want hands washed before dinner
08 Nov 2007
Reuters [edited]
In this story, Serbian health officials were cited as appealing to the public to wash their hands and step up personal hygiene to stop jaundice spreading in the impoverished south of the country. Some 400 people are infected so far by this form of Hepatitis A -- commonly known as "the poor people's disease" -- mostly in or around south Serbia's biggest city of Nis.

United Kingdom - National CJD Surveillance Unit - Monthly statistics
5 Nov 2007
UK National CJD Surveillance Unit, Monthly Statistics, 2007 [edited]
Monthly Creutzfeldt-Jakob disease statistics - as of 2 Nov 2007 These following figures show the number of suspect cases of CJD referred to the CJD surveillance unit in Edinburgh and the number of deaths of definite and probable variant Creutzfeldt-Jakob disease
Summary of vCJD cases – deaths Deaths from definite vCJD (confirmed): 114
Deaths from probable vCJD (without neuropathological confirmation): 47
Deaths from probable vCJD (neuropathological confirmation pending): 1
Number of deaths from definite or probable vCJD (as above): 162
Summary of vCJD cases – alive
Number of probable vCJD cases still alive: 4
Total Number of definite or probable vCJD (dead and alive): 166 T
hese data indicate that there have been no new cases diagnosed during the past month, but one patient has died, raising the vCJD death toll to 162. These data are still consistent with the view that the vCJD outbreak in the UK is in decline. The peak number of deaths was 28 in the year 2000, followed by 20 in 2001, 17 in 2002, 18 in 2003, 9 in 2004, 5 in 2005, 5 in 2006, and so far 4 in 2007. As of 2 Nov 2007 in the UK in the year 2007, so far there have been 93 referrals, 38 deaths from sporadic CJD, 2 deaths from iatrogenic CJD, 2 deaths from familial CJD, one from GSS, and 4 deaths from vCJD.

Iceland - STEC O157 outbreak, September-October 2007
01 Nov 07
Eurosurveillance
G Sigmundsdottir, A Atladottir, H Hardardottir, E Gudmundsdottir, M Geirsdottir, H Briem
From 28 September to 22 October, nine domestically acquired cases of Shiga toxin (Stx)-producing Escherichia coli (STEC) O157 were diagnosed in Iceland, one of which is probably a secondary case. The cases were between two and 61 years of age, five males and four females. All except two were hospitalised, one with elevated creatinine levels. No cases developed haemolytic uraemic syndrome (HUS). The onset of symptoms was between 23 September and 18 October. The cases reside in different parts of the country: four in the area of Reykjavik, two in the north of Iceland, one in the east of Iceland, and two in the Westman Islands (Figure).
Eight of the nine patients (presumed secondary case was excluded) answered a trawling questionnaire on food consumption, travel and mass gathering; supermarket purchase records were collected from three cases. The results from the questionnaires showed that seven had eaten fish or ham, and six had eaten lettuce. The source of infection is unknown at this point. Five cases had consumed lettuce packaged and imported from the Netherlands, as verified either by questionnaire (three cases) or by supermarket purchase records (two cases). Intensified surveillance in lettuce with increased sampling began in mid-October and is ongoing. Culture results have so far been negative. The strain that caused the outbreak in Iceland was identified by the Laboratory of Enteric Pathogens at the Health Protection Agency in the United Kingdom as STEC O157, phagetype 8, carrying the stx1 and stx2 shiga toxin genes. The PFGE pattern of all nine Icelandic isolates was identical to the strain that caused the current STEC O157 outbreak in the Netherlands. That outbreak is described in an accompanying article in this issue.

Netherlands - STEC O157 outbreak, September-October 2007
01 Nov 2007
Eurosurveillance
I Friesema, B Schimmer, O Stenvers, A Heuvelink, E de Boer, K van der Zwaluw, C de Jager, D Notermans, I van Ouwerkerk, R de Jon
Early in October 2007, an increase in notifications of human cases infected with Shiga toxin (Stx)-producing Escherichia coli (STEC) O157 was seen in the Netherlands. All cases reported diarrhoea, and most also had bloody diarrhea. No cases developed haemolytic uraemic syndrome (HUS). The onset of illness for the first cases was in mid-September. STEC O157 strains that contained both stx1 and stx2 genes were isolated from 36 patients. The PFGE pattern was compared to the pattern found in Iceland, which appeared to be identical. The age and sex distribution of the cases is shown in Figure 2. Most cases (67%) were between 10 and 50 years of age. More females than males were affected in these age groups. The cases were distributed across the whole country, with a concentration of the cases in the western part. A case to case comparison revealed raw vegetables as the possible source of the outbreak. Municipal health services undertook further trawling interviews with the current outbreak cases, which pointed towards pre-packaged shredded iceberg lettuce purchased at several supermarket chains as the possible source. The environmental investigation is ongoing. The Dutch Food and Safety Authority (FSA) is investigating the distribution channels of packed fresh vegetables and the individual ingredients. An alert was sent by the Dutch FSA to the Rapid Alert System for Food and Feed on 26 October.

October 2007

United Kingdom - 17 struck down with Salmonella after meal
31 Oct 07
Macclesfield Express - Laura Thistlethwaite [edited]
A Poynton restaurant which was forced to close after 17 diners contracted Salmonella has, according to this story, re-opened after being given the all-clear by environmental health.An Environmental Health Officer was quoted as saying that they had received on October 10 a complaint that a party of 15 had eaten at the restaurant and six of them suffered from vomiting and diarrhoea. The officer added that the majority had eaten the tiramisu made with raw egg and that there were 17 confirmed cases of Salmonella. A wiping cloth used at the premises was found to contain the Salmonella bacteria. According to the officer, the illness suffered by the customers had been “severe” and one woman was ill for around 21 days with vomiting and diarrhoea.

Russia - Hepatitis A outbreak in Nizhny Novgrod
28 Oct 2007
Russian News Room [edited]
The Hepatitis A outbreak in Nizhny Novgrod is, according to this story, claiming new victims, as another 23 people have been hospitalized since Thursday, raising the number of the afflicted to 2,500. An official at the Rospotrebnadzor Federal Service of the Protection of Consumer Rights and Human Welfare was quoted as telling Itar-Tass that epidemiologists believe that the outbreak has stabilized. Meanwhile, city authorities keep maintaining a ban on street trade in places lacking water supply and on hand-made vegetable dishes, and the sanitary condition of the local markets is regularly checked.

Russia - Salmonella infects 42 children in Russian kindergarten
24 Oct 2007
RIA Novosti [edited]
A total of 42 children and three staff have, according to this story, been infected with Salmonella since Monday at a kindergarten in the Amur Region in Russia's Far East. Preliminary reports said the outbreak was caused by inappropriate cooking methods in the kindergarten canteen.

Norway - Listeriosis: (Oslo)
19 Oct 2007
Aftenposten [edited]
Officials at Norway's National Hospital in Oslo are battling an outbreak of infection linked to the Listeria bacteria; 2 patients are already dead. Personnel at both Rikshositalet and Radiumhospitalet, which have merged, were scrambling to pinpoint the source of Listeria infections but suspect it stemmed from contaminated cold food. According to the story, cheese had emerged as the main suspect. Hospital officials have discarded all supplies of refrigerated food from the kitchen that serves both Radium Hospital and Rikshospital. Intense testing was being carried out and officials said they couldn't rule out the possibility of new cases, since the bacterias' incubation period can extend up to a month.
Related stories
19 Oct 2007 - Hospital infection by Listeria kills two
United Press International [edited]
Two patients died at the National Hospital in Oslo, Norway, as a result of an infection linked to Listeria bacteria. According to this story, the hospital has identified 12 Listeria infections since Oct. 1, including the fatalities that hospital officials said were likely facilitated by the patients' weakened immune systems from previously contracted illnesses.

Sweden - Outbreak of Salmonella stanley associated with alfalfa sprouts, July-August 2007
18 Oct 2007
Eurosurveillance Weekly
S Werner (simon.werner@skane.se)1,2, K Boman1, I Einemo3, M Erntell4, R Helisola5, B de Jong6, A Lindqvist7, M Löfdahl1, S Löfda
The Swedish Institute for Infectious Disease Control (SMI) and the Swedish Regional Centres for Communicable Disease Control recently completed the investigation of a nationwide outbreak with 51 cases of Salmonella Stanley infection. A matched case-control study (using telephone interviews) was performed that strongly indicated an association between consumption of alfalfa sprouts produced in Sweden and S. Stanley infection (OR 28.6, 95% CI 3.8-216.4).

Spain - International outbreak of salmonellosis in a hotel in Lloret de Mar -August 2007
18 Oct 2007
Eurosurveillance Weekly
N El Omeiri, L Puell-Gomez, N Camps, N Follia, F Simón-Soria, P Soler-Crespo, A Martin-Granado, A Echeita-Sarrionandia, D Herrera-Guibert
On 21 August 2007, a hospital in Barcelona, Spain, informed local health authorities of the occurrence of an outbreak of gastrointestinal illness among three families who had eaten lunch at a hotel in Lloret de Mar on 14 August 2007. Samples for stool culture were collected from six of the affected individuals in this outbreak and all tested positive for Salmonella spp. Although results of the investigation were not conclusive regarding the source of contamination, they strongly suggest that a spaghetti dish was the contamination vehicle.

Ireland - One household in five supplied with drinking water from polluted source
12 Oct 2007
Independent Online [edited]
According to an Environmental Protection Agency report, almost a third of rivers supplying drinking water to hundreds of thousands of families nationwide are polluted. It is reported that the crisis is worsening with an alarming 60pc of groundwater supplies sampled during the year-long investigation polluted by E. coli from human and animal waste. Almost one-in-five householders get their tap water from groundwater supplies which are increasingly contaminated, according to the report. Bacteria such as E. coli and cryptosporidium is increasing in our groundwater, the nationwide-probe concludes. Local authorities' sewage discharges and slurry and fertiliser run-off from farms are branded the main culprits for the pollution.

Moldova - Dysentery
12 Oct 2007
Moldova Azi [in Moldovan (Romanian), edited]
According to this story, the epidemiological situation in the village of Tomai, Ceadir-Lunga district is now stabilized after the dysentery outbreak. Fewer cases have been registered within the last few days. So far, 27 of the hospitalized patients have had the dysentery diagnosis confirmed. The Head of the Centre of Epidemiology for Particularly Dangerous Diseases and Bioterrorism announced that all patients with gastrointestinal problems are held under medical observation, even when the dysentery diagnosis was not confirmed in their case, since there is a danger of the epidemic reemerging among those who had contact with dysentery patients. The precise origin of the outbreak is being sought by the investigation that has been started. Epidemiologists suppose the patients were infected through drinking water contamination with sewage. Water sources in the village have been decontaminated and checked for leaks. Another dysentery outbreak was reported at the Cahul boarding school, where 33 patients contacted a mild form of the disease. Physicians warned the inhabitants of the area about respecting basic food safety norms, washing fruits and vegetables and drinking boiled water only. Health officers are investigating the source of the outbreak and whether there is a link between the cases. The school is co-operating with the council and tests to determine the strain and cause may take up to a week. and infection was confirmed Friday morning [19 Oct 2007] at the National Hospital (Rikshospitalet og Radiumhospitalet), which is the country's foremost cancer hospital and takes in patients from all over the country. Friday's case bring[s] to 12 the number of infections identified since 1 Oct 2007. Of the infected patients, 2 have since died, probably because their immune systems were already weak because of their illnesses. Hospital officials still haven't confirmed the source of the outbreak

United Kingdom – Scotland - Major bid to reduce risk of E. coli O157 in rural communities
11 Oct 2007
University of Aderdeen
Aberdeen researchers today (Thursday, October 11) launch a unique collaboration which aims to reduce the risk of a potentially deadly bug which is particularly prevalent in North East Scotland. Grampian has one of the world's highest rates of E. coli O157. Last year (2006) 53 people were struck with the bug which is around 10 in every 100,000 local people.
Now the area's problem will be scrutinised by leading scientists who will spend the next three years fact finding and developing guidance for UK authorities on how to beat the bug. Today the University of Aberdeen officially launches a new partnership which for the first time pulls together social scientists, microbiologists, economists, food scientists, ecologists and medical and geography experts to examine the problem in rural areas.
The collaboration brings together the University of Aberdeen; the London School of Hygiene and Tropical Medicine; the University of Manchester; the University of Bangor; the Institute of Grassland and Environmental Research, the Veterinary Laboratories Agency and RIVM National Institute for Public Health and the Environment, Bilthoven, The Netherlands. Thanks to a £1.3M grant from Rural Economy and Land Use the scientists will compare Grampian's situation with a similar rural stretch of North Wales which has a relatively low incidence of E. coli O157 cases. Researchers will try to find answers to a wide range of unknowns such as why agricultural workers appear to be less susceptible to infection than urban populations. They will also speak to key stakeholders such as farmers, rural workers, residents, food processors and tourists to establish how risk of this kind of infection is perceived, communicated and managed. The cost to the UK economy of E. coli O157 will also be examined.

Russia - Shigellosis - (Stavropol)
8 Oct 2007
Nezavisimaya gazeta [in Russian, trans. Mod.NR] [edited]
According to this story, the producers of dairy products appear to be responsible for a large-scale outbreak of dysentery in Stavropol. During the last several days, the number of cases has doubled and reached almost 600. The cases began in Lermontov on 3 Oct 2007, when children from 3 kindergartens started to come to a number of hospitals. Later, a new locus of infection emerged in Kislovodsk. According to the information from the Deputy of Regional Office of Rospotrebnadzor [Territorial Directorate of the Federal Services for Consumer Protection and Human Welfare], 6 townships had been affected by 6 Oct 2007: Lermontov, Kislovodsk, Pyatigorsk, Essentuki, Jeleznovodsk, and Vinsadi. The cumulative number of cases is 595, among which 551 are children; 374 cases have been hospitalized. Tests confirm the outbreak as dysentery. It appears that all the affected people had consumed products of a dairy company. According to the deputy, this link has been established in 454 cases. The management of the dairy company said that they have stopped the production and tests are being carried out from product samples and on specimens from personnel.
Related Source: Itar-Tass News Agency

United Kingdom - Norwalk: Isle re-opens after bug all-clear
05 Oct 2007
BBC News [edited]
According to this story, the first visitors to Lundy in nearly two weeks have spent the night on the north Devon Island.
It has been closed since an outbreak of Norwalk virus caused vomiting and diarrhea in about 50 people. The island's only pub, shop, and even the supply ship the MS Oldenburg have been deep-cleaned in an attempt to stamp out the problem.

Denmark and Australia - Outbreaks of shigellosis associated with imported baby corn, August 2007 – final summary
04 Oct 2007
Eurosurveillance: HC Lewis (haw@ssi.dk), M Kirk, S Ethelberg, R Stafford, KEP Olsen, EM Nielsen, M Lisby, SB Madsen and K Mølbak
The recently reported concurrent outbreaks of Shigella sonnei infections in Denmark [1] and Australia [2] have been found to be linked to a common baby corn packing house in Thailand via trace-back of the distribution chain. Distribution records indicated that three additional countries received affected product from the implicated Thai packing house during the period of potential contamination. These countries were notified through the World Health Organization’s International Food Safety Authorities Network (INFOSAN). Associated cases of S. sonnei have not been reported in these three countries.
Denmark: In Denmark, 218 cases of laboratory-confirmed S. sonnei infection were reported to the Statens Serum Institut, Copenhagen between 1 August and 30 September 2007. During investigations, 12 cases reported recent foreign travel, two had an alternative exposure and three were deemed to be secondary cases and were therefore excluded, leaving 201 primary domestic cases. Of the 201 primary cases, the median age was 38 years old (range 2-92 years) and 150 cases (75 %) were female. Symptom onset dates, which ranged from 6 August until 20 August, were available for 94 cases (Figure 1). The last recorded onset date (20 August) in Denmark was no more than three days after the recall of the implicated product on 17 August 2007.
Australia: In Australia, a total of 12 laboratory-confirmed cases were reported, all of whom acquired their infection in the state of Queensland. This included two residents of the state of Victoria and one from New Zealand. The onset of illness among all cases was between 9 and 27 August 2007.
Food analysis: Microbiological examination of the suspected batches of imported baby corn in Denmark detected various serotypes of Salmonella enterica and high levels of Escherichia coli, indicating fecal contamination. Shigella spp. were not detected, suggesting that contamination levels were low. Australia was unable to test the implicated batch of corn, but did detect >100 colony forming units of E. coli per gram in 25 gram samples from other batches from the same importer.
Conclusion: Baby corn was implicated in the Danish outbreak following case reports of baby corn consumption and baby corn being found to be significantly associated with illness in a cohort study [1]. The possibility that the outbreaks might be linked was raised by the Australian public health authorities following the publication of the Danish outbreak strain’s antibiotic resistance pattern [1]. This was further reinforced when isolates from Denmark and Australia were found to display indistinguishable PFGE patterns. As well as the report in Eurosurveillance, international awareness of the outbreak and the outbreak strain was raised via numerous international networks, such as the Early Warning Response System (EWRS) and Rapid Alert System for Food and Feed (RASSF) of the European Union, Enternet, Pulsenet Europe, Pulsenet US, Pulsenet Asia, and INFOSAN. This outbreak highlights the importance of timely international communications in helping to identify when a contaminated food enters international trade and results in human illness.

United Kingdom - Super spicy Thai chili sauce sparks road closures, evacuations in central London
03 Oct 07
Associated Press -Raphael G. Satter [edited]
Police were cited as saying Wednesday that super spicy chili sauce sparked road closures and evacuations in central London after passers-by complained that a chemical emanating from a Thai restaurant was burning their throats. In this story, the restaurant owner was cited as saying that they were being prepared for a batch of ``nam prik pao,'' a spicy Thai sauce. The police spokesman was further cited as saying that no one was arrested.

United Kingdom - E. coli closes city nursery
03 Oct 2007
Evening Leader [edited]
Children and staff from a Chester nursery are, according to this story, being told to stay at home today after four cases of E. coli were confirmed. The story notes that two adults and two children aged two-and-a-half have been infected with E. coli O157. Those affected are an adult and child from one family and an adult and child from another family. All 120 children and staff will be tested and must give two clear samples before being given the all-clear. If all children test negative, the nursery will reopen tomorrow.
Related stories
04 Oct 2007 - United Kingdom - Six diagnosed in E. coli outbreak
BBC News [edited]
According to this story, three toddlers and three others have been diagnosed with E. coli in an outbreak in Chester.
The Health Protection Agency are now screening over 120 children and 28 staff at the nursery two of the children attended in the city. Four cases were initially found when two children and two of their parents were discovered to have the disease. A third toddler and the 12-year-old sibling of another of the sick children have now also been diagnosed. The Health Protection Agency said there is no evidence at this stage the nursery is the source of infection.
05 Oct 2007 -Two more E. coli cases after outbreak in nursery pupils
Liverpool Daily Post - Eryl Crump [edited]
Two more cases of E. coli O157 have been identified in an outbreak which hit children at a Chester nursery school. It brings the total number of laboratory confirmed cases to six among pupils.

United Kingdom - Prion Disease Update 2007
03 Oct 2007
ProMed Mail Post
The definitions of the designations deaths, definite cases, probable vCJD cases, can be found by accessing the UK Department of Health website ( ) in the vCJD thread. Data on vCJD cases from any part of the world are now included in these updates where appropriate, and other forms of CJD (sporadic, iatrogenic, familial, and GSS -- Gerstmann-Straussler-Scheinker disease) are included also when they have some relevance to the incidence and etiology of vCJD. In addition, prion-related diseases of domesticated and free-living animals may also be included if relevant.

United Kingdom - Department of Health monthly CJD statistics
2 Oct 2007
UK Department of Health, Monthly Creutzfeldt-Jakob disease (CJD) Statistics [edited]
Monthly Creutzfeldt-Jakob disease statistics - 2 Oct 2007
The Department of Health is today [Mon 2 Oct 2007] issuing the latest information about the numbers of known cases of Creutzfeldt-Jakob disease (CJD). This includes cases of variant Creutzfeldt-Jakob disease, the form of the disease thought to be linked to BSE (bovine spongiform encephalopathy).
Definite and probable CJD cases in the UK as of 28 Sep 2007 Summary of vCJD cases – deaths Deaths from definite vCJD (confirmed): 114
Deaths from probable vCJD (without neuropathological confirmation): 47
Deaths from probable vCJD (neuropathological confirmation pending): 0
Number of deaths from definite or probable vCJD (as above): 161
Summary of vCJD cases – alive Number of probable vCJD cases still alive: 5
Total Number of definite or probable vCJD (dead and alive): 166
These data are still consistent with the view that the vCJD outbreak in the UK is in decline. The peak number of deaths was 28 in the year 2000, followed by 20 in 2001, 17 in 2002, 18 in 2003, 9 in 2004, 5 in 2005, 5 in 2006, and so far 3 in 2007. Totals for all types of CJD cases in the UK since 1995 As of 28 Sep 2007, in the UK in the year 2007, so far there have been 82 referrals, 30 deaths from sporadic CJD, 2 deaths from iatrogenic CJD, 2 deaths from familial CJD, one from GSS, and 3 deaths from vCJD.

United Kingdom - A community outbreak of Campylobacter jejuni infection from a chlorinated public water supply
01 Oct 2007
Journal of Epidemiology and Infection Vol 135 G. Richardsona1, D. Rh. Thomasa1, R.M.M. Smitha1, L. Nehaula2, C.D. Ribeiroa3, A.G. Browna4 and R. L. Salmona1 c1
An outbreak of Campylobacter jejuni infection occurred in a South Wales Valleys housing estate. Illness in estate residents was associated with tap water consumption [population attributable risk (PAR) 50%, relative risk (RR) 2·53, 95% confidence interval (CI) 1·9–3·37] and residence in the upper estate (PAR 49%, RR 2·44, 95% CI 1·83–3·24). Amongst upper estate residents, rates of diarrheal illness increased with rates of water consumption (OR 18, 95% CI 3·5–92·4 for heaviest consumers, χ2 trend P <0·0001). The upper estate received mains water via a covered holding reservoir. A crack in the wall of the holding reservoir was identified. Contamination with surface water from nearby pasture land was the likely cause of this outbreak. Service reservoirs are common in rural communities and need regular maintenance and inspection. The role of water in sporadic cases of campylobacter enteritis may be underestimated.

September 2007

United Kingdom -Outbreak of Escherichia coli O157 in Aberdeen, Scotland
27 Sept 2007
Eurosurveillance - D Webster, J Cowden, M Locking
Scotland has higher rates of Escherichia coli O157 infection than other countries in the United Kingdom (UK) and Europe. In recent years, between 200 and 250 cases of E. coli O157 infection have been reported annually; 85% of all cases are indigenous i.e. infections acquired in Scotland (or occasionally, in other UK countries); the remainder are imported infections, acquired abroad. National Health Service’s (NHS) Grampian Public Health Protection Unit is currently working with Health Protection Scotland to investigate an outbreak of E. coli O157 infection in Aberdeen. Between 13 and 19 September 2007, nine confirmed cases of E. coli O157 infection have been identified.

United Kingdom - Threat from ‘new E. coli’
23 Sept 2007
The Times - Sarah-Kate Templeton [edited]
A new superbug that scientists believe is brought into Britain through the food chain is, according to this story, infecting about 30,000 people a year, according to government experts. Research has found that between 10% and 14% of those who are infected with the drug-resistant form of E. coli die within 30 days of catching the bug, which would suggest 3,000-4,200 deaths. It is reported that unlike traditional forms of E. coli, the drug-resistant strain Extended-Spectrum Beta-Lacta-mase (ESBL) affects healthy young adults as well as the elderly.

United Kingdom - Viral sickness shuts Lundi island
23 Sept 2007
The Telegraph -Richard Gray [edited]
Staff on the three-and-a-half mile long granite outcrop are, according to this story, being forced to stay there after an outbreak of a crippling stomach virus.The story explains that Lundy has been closed to the public for 12 days and the staff have been effectively quarantined as the authorities try to tackle the illness, which causes vomiting, diarrhoea and fatigue. About 26 holidaymakers have been allowed to leave, but the 26 members of residential staff have been confined to the island.

United Kingdom - Sickness bug hits Butlins
21 Sept 2007
Chichester Observer [edited]
Dozens of holiday makers have fallen ill after a violent stomach bug hit Butlins in Bognor Regis. The story says that up to 80 people are believed to have caught the diarrhoea and vomiting bug norovirus during their stay at the popular family resort. Some of the people infected were forced to abandon their holidays while others are too ill to leave. They have been confined to their rooms and advised and keep away from public areas to avoid spreading the virus. Staff have stepped up cleaning procedures and will inform all new arrivals about the outbreak as they turn up to check in.

Armenia – Paratyphoid Fever
17 Sept 2007
CDC of Republic of Armenia, 14 Sept 2007 [trans.AS; edited]
5 samples have been tested positive forSalmonella [enterica serovar] paratyphi B during the scheduled examination among the workers of the confectionary factory. All of them have been referred to the infectious diseases hospital for further follow up. After the detailed clinical and laboratory examination, paratyphoid B has been confirmed in 2 cases and carriage in 3 cases.

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