Outbreaks Of Gastrointestinal Disease Research Articles

The Socioeconomic Factors of Street Food Vending in Developing Countries and Its Implications for Public Health: A Systematic Review.

The sale of ready-to-eat (RTE) street food represents an important source of income in many developing countries. However, these foods are frequently implicated in outbreaks of gastrointestinal diseases. Street food vendors face several constraints that hamper improvement in the microbiological quality of their products. The aim of this review was to update knowledge about the main causes of foodborne illnesses in developing countries, including the growing concern with the microbial transmission of antibiotic resistance. Following PRISMA guidelines, this systematic review was conducted on original articles published from January 2010 to July 2023. The search was carried out using Scopus, PubMed, Web of Science, Food Science and Technology Abstracts (FSTA), the International Information System for Agricultural Sciences and Technology (AGRIS), as well as isolated searches of relevant articles from Google Scholar. The initial search identified 915 articles, 50 of which were included in this systematic review. The results indicate that, in the majority of the 15 countries examined, women constitute the predominant segment of street food vendors, representing more than 55% of the total number of these vendors. In 11 countries, street food vendors under the age of 18 were identified. Most vendors had a low level of education and, consequently, were unaware of good hygiene practices when handling food. The combination of factors such as poor hygiene practices on the part of food handlers and the lack of facilities, namely, the absence of available potable water, were frequently listed as the main causes of food contamination. Enterobacteriaceae such as Escherichia coli (61.9%), Salmonella (30.1%), and Shigella spp. (9.5%), as well as Staphylococcus aureus (30.1%) and Listeria monocytogenes (14.3%), were the most common pathogens found in RTE street foods. In 22 studies from 13 developing countries, 59% (13/22) reported high multidrug resistance in Enterobacteriaceae (40% to 86.4% in E. coli, 16.7 to 70% in Salmonella, and 31 to 76.4% in S. aureus). To address the challenges faced by street vendors and improve their economic activities, it is necessary for government entities, consumers, and vendors to work together collaboratively.

Shiga toxin-producing Escherichia coli (STEC) and atypical enteropathogenic E. coli (aEPEC) in Swedish retail wheat flour.

Wheat flour has been identified as the source of multiple outbreaks of gastrointestinal disease caused by shiga toxin-producing Escherichia coli (STEC). We have investigated the presence and genomic characteristics of STEC and related atypical enteropathogenic E. coli (aEPEC) in 200 bags of Swedish-produced retail wheat flour, representing 87 products and 25 brands. Samples were enriched in modified tryptone soya broth (mTSB) and screened with real-time PCR targeting stx1, stx2 and eae, and the serogroups O157, O121 and O26. Isolation was performed by immunomagnetic separation (IMS) for suspected STEC/aEPEC O157, O121 and O26, and by screening pools of colonies for other STEC. Real-time PCR after enrichment revealed 12 % of samples to be positive for shiga toxin genes (stx1 and/or stx2) and 11 % to be positive for intimin (eae). Organic production, small-scale production or whole grain did not significantly influence shiga toxin gene presence or absence in a generalized linear mixed model analysis. Eight isolates of STEC were recovered, all of which were intimin-negative. Multiple serotype/sequence type/shiga toxin subtype combinations that have also been found in flour samples in other European countries were recovered. Most STEC types recovered were associated with sporadic cases of STEC among humans in Sweden, but no types known to have caused outbreaks or severe cases of disease (i.e. haemolytic uraemic syndrome) were found. The most common finding was O187:H28 ST200 with stx2g, with possible links to cervid hosts. Wildlife associated with crop damage is a plausible explanation for at least some of the surprisingly high frequency of STEC in wheat flour.

Molecular Epidemiology of Bovine Enteroviruses and Genome Characterization of Two Novel Bovine Enterovirus Strains in Guangxi, China.

Bovine enterovirus (BEV) is a highly infectious pathogen that may cause respiratory and gastrointestinal disease outbreaks in cattle. This study aimed to investigate the prevalence and genetic characteristics of BEVs in Guangxi Province, China. A total of 1,168 fecal samples from 97 different bovine farms were collected between October 2021 and July 2022 in Guangxi Province, China. BEV was confirmed using a reverse transcription-PCR (RT-PCR) method targeting the 5' untranslated region (UTR), and isolates were genotyped by sequencing their genomes. The nearly complete genome sequences of eight BEV strains showing cytopathic effects in MDBK cells were determined and analyzed. In total, 125 (10.7%) of 1,168 fecal samples were positive for BEV. BEV infection was significantly associated with farming patterns and clinical symptoms (P < 0.05; odds ratio [OR] > 1). Molecular characterization indicated that five BEV strains from this study belonged to EV-E2 and one strain to EV-E4. Two BEV strains (GXNN2204 and GXGL2215) could not be assigned to a known type. Strain GXGL2215 showed the closest genetic relationship with GX1901 (GenBank accession number MN607030; China) in its VP1 (67.5%) and P1 (74.7%) and with NGR2017 (MH719217; Nigeria) in its polyprotein (72.0%). It was also close to the EV-E4 strain GXYL2213 from this study when the complete genome (81.7%) was compared. Strain GXNN2204 showed the closest genetic relationship with Ho12 (LC150008; Japan) in the VP1 (66.5%), P1 (71.6%), and polyprotein (73.2%). Genome sequence analysis suggested that strains GXNN2204 and GXGL2215 originated from the genomic recombination of EV-E4 and EV-F3 and EV-E2 and EV-E4, respectively. This study reports the cocirculation of multiple BEV types and the identification of two novel BEV strains in Guangxi, China, and it will provide further insights into the epidemiology and evolution of BEV in China. IMPORTANCE Bovine enterovirus (BEV) is a pathogen that causes intestinal, respiratory, and reproductive disease infections in cattle. This study reports on the widespread prevalence and biological characteristics of the different BEV types which currently exist in Guangxi Province, China. It also provides a reference for the study of the prevalence of BEV in China.

Comparative Genomics of Shiga Toxin-Producing Escherichia coli Strains Isolated from Pediatric Patients with and without Hemolytic Uremic Syndrome from 2000 to 2016 in Finland.

ABSTRACTShiga toxin-producing Escherichia coli (STEC) infection can cause mild to severe illness, such as nonbloody or bloody diarrhea, and the fatal hemolytic uremic syndrome (HUS). The molecular mechanism underlying the variable pathogenicity of STEC infection is not fully defined so far. Here, we performed a comparative genomics study on a large collection of clinical STEC strains collected from STEC-infected pediatric patients with and without HUS in Finland over a 16-year period, aiming to identify the bacterial genetic factors that can predict the risk to cause HUS and poor renal outcome. Of 240 STEC strains included in this study, 52 (21.7%) were from pediatric patients with HUS. Serotype O157:H7 was the main cause of HUS, and Shiga toxin gene subtype stx2a was significantly associated with HUS. Comparative genomics and pangenome-wide association studies identified a number of virulence and accessory genes overrepresented in HUS-associated STEC compared to non-HUS STEC strains, including genes encoding cytolethal distending toxins, type III secretion system effectors, adherence factors, etc. No virulence or accessory gene was significantly associated with risk factors for poor renal outcome among HUS patients assessed in this study, including need for and duration of dialysis, presence and duration of anuria, and leukocyte counts. Whole-genome phylogeny and multiple-correspondence analysis of pangenomes could not separate HUS STEC from non-HUS STEC strains, suggesting that STEC strains with diverse genetic backgrounds may independently acquire genetic elements that determine their varied pathogenicity. Our findings indicate that nonbacterial factors, i.e., characteristics of the host immunity, might affect STEC virulence and clinical outcomes.IMPORTANCE Shiga toxin-producing Escherichia coli (STEC) is a serious public health burden worldwide which causes outbreaks of gastrointestinal diseases and the fatal hemolytic uremic syndrome (HUS) characterized by the triad of mechanical hemolytic anemia, thrombocytopenia, and acute renal failure. Understanding the mechanism underlying the disease severity and patient outcome is of high importance. Using comparative genomics on a large collection of clinical STEC strains from STEC-infected patients with and without HUS, our study provides a reference of STEC genetic factors/variants that can be used as predictors of the development of HUS, which will aid risk assessment at the early stage of STEC infection. Additionally, our findings suggest that nonbacterial factors may play a primary role in the renal outcome in STEC-infected patients with HUS; further studies are needed to validate this.

Outbreak of STEC O157:H7 linked to a milk pasteurisation failure at a dairy farm in England, 2019.

In November 2019, an outbreak of Shiga toxin-producing Escherichia coli O157:H7 was detected in South Yorkshire, England. Initial investigations established consumption of milk from a local dairy as a common exposure. A sample of pasteurised milk tested the next day failed the phosphatase test, indicating contamination of the pasteurised milk by unpasteurised (raw) milk. The dairy owner agreed to immediately cease production and initiate a recall. Inspection of the pasteuriser revealed a damaged seal on the flow divert valve. Ultimately, there were 21 confirmed cases linked to the outbreak, of which 11 (52%) were female, and 12/21 (57%) were either <15 or >65 years of age. Twelve (57%) patients were treated in hospital, and three cases developed haemolytic uraemic syndrome. Although the outbreak strain was not detected in the milk samples, it was detected in faecal samples from the cattle on the farm. Outbreaks of gastrointestinal disease caused by milk pasteurisation failures are rare in the UK. However, such outbreaks are a major public health concern as, unlike unpasteurised milk, pasteurised milk is marketed as 'safe to drink' and sold to a larger, and more dispersed, population. The rapid, co-ordinated multi-agency investigation initiated in response to this outbreak undoubtedly prevented further cases.

Plesiomonas: A Review on Food Safety, Fish-Borne Diseases, and Tilapia.

Fish and fish products are considered a fundamental part of the human diet due to their high nutritional value. Food-borne diseases are considered a major public health challenge worldwide due to their incidence, associated mortality, and negative economic repercussions. Food safety is the guarantee that foods will not cause harm to the health of those who consume them, and it is a fundamental property of food quality. Food safety can be at risk of being lost at any stage of the food chain if the food is contaminated by pathogenic microorganisms. Many diverse bacteria are present in the environment and as part of the microbiota of food that can be transmitted to humans during the handling and consumption of food. Plesiomonas shigelloides has been mainly associated with outbreaks of gastrointestinal diseases due to the consumption of fish. This bacterium inhabits the environment and aquatic animals and is associated with the microbiota of fish such as tilapia, a fish of importance in fishing, aquaculture, commercialization, and consumption worldwide. The purpose of this document is to provide, through a bibliographic review of databases (Scopus, Web of Science, and Google Scholar, among others), a general informative perspective on food-borne diseases and, in particular, the consumption of fish and tilapia. Diseases derived from contamination by Plesiomonas shigelloides are included, and control and prevention actions and sanitary regulations for fishery products established in several countries around the world are discussed to promote the safety of foods of aquatic origin intended for human consumption and to protect public health.

Molecular Monitoring of Enteropathogens in Sewage During NATO Exercise Trident Juncture 2018: Potential Tool in Early Outbreak Warning?

Outbreaks of gastrointestinal disease among military service personnel can have severe impact on operational effectivity and force readiness. Thus, early outbreak detection is critical to minimize spread. This pilot study aimed to explore field-based molecular screening of sewage as a supplemental tool in early outbreak warning before disease is diagnosed in personnel seeking medical care. Sewage from permanent (n = 3) and temporary (n = 3) military camps, hosting national and international military personnel, were sampled during the NATO Exercise TRJE18 taking place in southern Norway during fall 2018. Samples were screened for 22 gastrointestinal pathogens using multiplex PCR. Markers of multiple enteropathogens were detected in samples from all locations with some variations in diversity. Yersinia enterocolitica, pathogenic Escherichia coli, adenovirus, and Giardia were detected in sewage from all six camps during the exercise. Agent diversity seemed to increase with population size, regardless of nationality. Only a minor outbreak (n = 6) of norovirus was reported in one of the permanent camps. From the same camp, genetic markers of norovirus were detected in sewage 2 days before outbreak notification. No other outbreaks of gastrointestinal disease were reported during the exercise, indicating that markers of several enteropathogens can be normally found in sewage from healthy soldier populations. Thus, discriminating between true outbreaks and nonrelevant "background levels" would be of critical importance for correct decision-making in operational contexts. Molecular screening of sewage allows rapid detection of multiple gastrointestinal pathogens in biological waste from military camps. However, background levels of pathogens challenges interpretation of qualitative analyses in outbreak situations. As such, quantitative measures, as well as high-resolution sequence-based methods, which allows strain identification and broader target spectrum, should be further explored in future studies.

Accounting for Unexpected Risk Events in Drinking Water Systems

Unexpected risk events in drinking water systems, such as heavy rain or manure spill accidents, can cause waterborne outbreaks of gastrointestinal disease. Using a scenario-based approach, these unexpected risk events were included in a risk-based decision model aimed at evaluating risk reduction alternatives. The decision model combined quantitative microbial risk assessment and cost–benefit analysis and investigated four risk reduction alternatives. Two drinking water systems were compared using the same set of risk reduction alternatives to illustrate the effect of unexpected risk events. The first drinking water system had a high pathogen base load and a high pathogen log10 reduction in the treatment plant, whereas the second drinking water system had a low pathogen base load and a low pathogen Log10 reduction in the treatment plant. Four risk reduction alternatives were evaluated on their social profitability: (A1) installation of pumps and back-up power supply, to remove combined sewer overflows; (A2) installation of UV treatment in the drinking water treatment plant; (A3) connection of 25% of the OWTSs in the catchment area to the WWTP; and (A4) a combination of A1–A3. Including the unexpected risk events changed the probability of a positive net present value for the analysed alternatives in the decision model and the alternative that is likely to have the highest net present value. The magnitude of the effect of unexpected risk events is dependent on the local preconditions in the drinking water system. For the first drinking water system, the unexpected risk events increase risk to a lesser extent compared to the second drinking water system. The main conclusion was that it is important to include unexpected risk events in decision models for evaluating microbial risk reduction, especially in a drinking water system with a low base load and a low pathogen log10 reduction in the drinking water treatment plant.

Retrospective assessment of rapid outbreak investigation for gastrointestinal diseases using only cases and background exposure data.

For outbreaks of gastrointestinal disease, rapid identification of the source is crucial to enable public health intervention and prevent further cases. Outbreak investigation comprises analyses of exposure information from cases and, if required, undertaking analytical epidemiological studies. Hypothesis generation has been reliant on empirical knowledge of exposures historically associated with a given pathogen. Epidemiology studies are resource-intensive and prone to bias, one of the reasons being the difficulties in recruiting appropriate controls. For this paper, the information from cases was compared against pre-defined background exposure information. As exemplars, three past outbreaks were used, one of common and two of rare exposures. Information from historical case trawling questionnaires was used to define background exposure having removed any exposures implicated with the outbreak. The case-background approach showed good sensitivity and specificity, identifying correctly all outbreak-related exposures. One additional exposure related to a retailer was identified and four food items where all cases had been exposed. In conclusion, the case-background method, a development of the case-case design, can be used to assist with hypothesis generation or when a case-control study may not be possible to carry out.

Thermal Inactivation Kinetics of Tulane Virus in Cell-Culture Medium and Spinach.

Human noroviruses (HNoVs) cause significant gastrointestinal disease outbreaks worldwide. Tulane virus (TV) is a cultivable HNoV surrogate widely used to determine control measures against HNoVs. The objective of this study was to determine the heat inactivation kinetics (D- and z-values) of TV in cell-culture media and on spiked homogenized spinach using the first-order and Weibull models. TV in cell-culture media at approximately 7 log PFU/mL (PFU-plaque forming unit) in 2-mL glass vials was heated at 52, 54, and56°C for up to 10 min in a circulating water bath. Survivors were enumerated using confluent host LLC-MK2 cells in six-well plates by plaque assay. Data from three replicate treatments assayed in duplicatewere analyzed statistically. D-values by the first-order model for TV in cell-culture media at 52, 54,and 56°C were 4.59±0.05, 2.91±0.05, and 1.74±0.07 min, respectively, with a z-value of 9.09±0.01°C (R2 =0.997). The Weibull model showed td =1 values of 2.53±0.08, 1.99±0.10, and 0.57±0.64 min, respectively, at the same temperatures. The D-values for TV in spinach were 7.94±0.21, 4.09±0.04, and 1.43±0.02 min and the z-value was 10.74±0.01°C (R2 =0.98) by the first-order model and 4.89±0.02, 3.21±0.45, and 0.25±0.38 min for the Weibull model at 50, 54, and 58°C, respectively. In comparison to previously reported results for the cultivable HNoV surrogate, murine norovirus -1, TV in cell-culture media and spiked on spinach homogenates showed lower D- and z-values. TV may not be an ideal HNoV surrogate for heat inactivation studies in cell-culture media or homogenized spinach in vacuum bags.

Use of whole-genome sequencing for public health intervention: outbreak investigation of a cluster of cases of salmonella foodborne illness in England, 2016

BackgroundPreventing foodborne outbreaks of gastrointestinal disease is a public health priority; however, outbreak investigations into non-typhoidal Salmonella enterica infections are challenging. Only cases with confirmed microbiological diagnoses are investigated, and links are hard to identify. Microbiological tests that offer greater discrimination between isolates are thus, in theory, attractive public health tools to identify, and interrupt, transmission. Whole-genome sequencing (WGS) was introduced in England in 2016 as part of routine surveillance. Here we describe its usefulness to support public health action. MethodsWe were alerted to a cluster of isolates of Salmonella enterica subsp enterica serovar Enteritidis (S Enteritidis) that were linked by single nucleotide polymorphism (SNP) comparison to a reference genome to determine genetic relatedness of bacterial isolates after whole-genome sequencing. The isolates (from stool samples) were from 18 individuals living in London in 2016 with gastrointestinal disease. We contacted all cases and undertook a standard questionnaire, and then focused questioning on, and food sampling at, the suspected infectious source, to direct public health intervention, in collaboration with environmental health officers. FindingsAll 18 cases were adults (age 21–70 years), five of whom were admitted to hospital. From whole-genome sequencing data, nine of the 18 isolates had no SNP differences, and nine had fewer than five SNP differences from these, of which six were identical. We identified an epidemiological link, in all cases, to a food establishment in London. S Enteritidis was subsequently isolated from food samples from this establishment and linked to isolates from the cases through whole-genome sequencing. An enforcement action and notice was served by environmental health officers to the establishment because of breaches in food hygiene, and we notified the Food Standards Agency, the Department for Environment, Food and Rural Affairs, and the Animal and Plant Health Agency. The contaminated food source was successfully removed to prevent further linked cases. InterpretationThe introduction of whole-genome sequencing to public health surveillance, despite demanding resources, refines the microbiological data provided to public health practitioners, allowing focused epidemiological investigation on likely linked cases. As illustrated here, this can allow identification of an ongoing source, and action to prevent further transmission. FundingNone.

Online market research panel members as controls in case-control studies to investigate gastrointestinal disease outbreaks: early experiences and lessons learnt from the UK - ERRATUM.

Online market research panel members as controls in case-control studies to investigate gastrointestinal disease outbreaks: early experiences and lessons learnt from the UK - ERRATUM.

Online market research panel members as controls in case-control studies to investigate gastrointestinal disease outbreaks: early experiences and lessons learnt from the UK.

Established methods of recruiting population controls for case-control studies to investigate gastrointestinal disease outbreaks can be time consuming, resulting in delays in identifying the source or vehicle of infection. After an initial evaluation of using online market research panel members as controls in a case-control study to investigate a Salmonella outbreak in 2013, this method was applied in four further studies in the UK between 2014 and 2016. We used data from all five studies and interviews with members of each outbreak control team and market research panel provider to review operational issues, evaluate risk of bias in this approach and consider methods to reduce confounding and bias. The investigators of each outbreak reported likely time and cost savings from using market research controls. There were systematic differences between case and control groups in some studies but no evidence that conclusions on the likely source or vehicle of infection were incorrect. Potential selection biases introduced by using this sampling frame and the low response rate are unclear. Methods that might reduce confounding and some bias should be balanced with concerns for overmatching. Further evaluation of this approach using comparisons with traditional methods and population-based exposure survey data is recommended.

Series of Norovirus Outbreaks Caused by Consumption of Green Coral Lettuce, Denmark, April 2016.

Introduction: In early April 2016, an unusual high number of point-source outbreaks of gastrointestinal disease were reported to occur in Denmark.Methods: Outbreaks were individually investigated. Two analytical studies were performed. Patient stool samples collected and analysed; positive stool samples were sequenced over the polymerase and/or capsid gene areas. Implicated lettuce heads were collected and analysed for the presence of norovirus. Foods were traced-back and traced-forward and international alert systems applied.Results: A total of 23 linked point-source outbreaks occurred over the course of one week. Fresh green coral lettuce (Lollo Bionda lettuce) had been consumed in all settings. In a cohort study including 234 participants a dish containing green lettuce was associated with illness. Norovirus of Genogroup I (GI) was detected in samples from 28 patients comprising eight of the outbreaks. Sequencing showed GI.P2-GI.2. GI norovirus was detected in one of 20 examined lettuce heads. All lettuce consumed was supplied by the same packer who in turn had bought the lettuce from a wholesaler in France. The two lots of lettuce came from two different growers in different parts of France.Discussion: Green coral lettuce produced in France was found to have caused a large series of linked norovirus outbreaks in Denmark as established by a number of lines of evidence. A similar incidence occurred in 2010. Fresh lettuce increasingly appear to be a risk food for norovirus infections.

Risk-based cost-benefit analysis for evaluating microbial risk mitigation in a drinking water system.

Waterborne outbreaks of gastrointestinal diseases can cause large costs to society. Risk management needs to be holistic and transparent in order to reduce these risks in an effective manner. Microbial risk mitigation measures in a drinking water system were investigated using a novel approach combining probabilistic risk assessment and cost-benefit analysis. Lake Vomb in Sweden was used to exemplify and illustrate the risk-based decision model. Four mitigation alternatives were compared, where the first three alternatives, A1-A3, represented connecting 25, 50 and 75%, respectively, of on-site wastewater treatment systems in the catchment to the municipal wastewater treatment plant. The fourth alternative, A4, represented installing a UV-disinfection unit in the drinking water treatment plant. Quantitative microbial risk assessment was used to estimate the positive health effects in terms of quality adjusted life years (QALYs), resulting from the four mitigation alternatives. The health benefits were monetised using a unit cost per QALY. For each mitigation alternative, the net present value of health and environmental benefits and investment, maintenance and running costs was calculated. The results showed that only A4 can reduce the risk (probability of infection) below the World Health Organization guidelines of 10-4 infections per person per year (looking at the 95th percentile). Furthermore, all alternatives resulted in a negative net present value. However, the net present value would be positive (looking at the 50th percentile using a 1% discount rate) if non-monetised benefits (e.g. increased property value divided evenly over the studied time horizon and reduced microbial risks posed to animals), estimated at 800-1200 SEK (€100-150) per connected on-site wastewater treatment system per year, were included. This risk-based decision model creates a robust and transparent decision support tool. It is flexible enough to be tailored and applied to local settings of drinking water systems. The model provides a clear and holistic structure for decisions related to microbial risk mitigation. To improve the decision model, we suggest to further develop the valuation and monetisation of health effects and to refine the propagation of uncertainties and variabilities between the included methods.

Shiga Toxin Therapeutics: Beyond Neutralization.

Ribotoxic Shiga toxins are the primary cause of hemolytic uremic syndrome (HUS) in patients infected with Shiga toxin-producing enterohemorrhagic Escherichia coli (STEC), a pathogen class responsible for epidemic outbreaks of gastrointestinal disease around the globe. HUS is a leading cause of pediatric renal failure in otherwise healthy children, resulting in a mortality rate of 10% and a chronic morbidity rate near 25%. There are currently no available therapeutics to prevent or treat HUS in STEC patients despite decades of work elucidating the mechanisms of Shiga toxicity in sensitive cells. The preclinical development of toxin-targeted HUS therapies has been hindered by the sporadic, geographically dispersed nature of STEC outbreaks with HUS cases and the limited financial incentive for the commercial development of therapies for an acute disease with an inconsistent patient population. The following review considers potential therapeutic targeting of the downstream cellular impacts of Shiga toxicity, which include the unfolded protein response (UPR) and the ribotoxic stress response (RSR). Outcomes of the UPR and RSR are relevant to other diseases with large global incidence and prevalence rates, thus reducing barriers to the development of commercial drugs that could improve STEC and HUS patient outcomes.

Association of Paid Sick Leave Laws With Foodborne Illness Rates

Previous studies suggest an association between paid sick leave (PSL) and better population health, including fewer infectious and nosocomial gastrointestinal disease outbreaks. Yet few studies examine whether laws requiring employers to offer PSL demonstrate a similar association. This mixed-methods study examined whether laws requiring employers to provide PSL are associated with decreased foodborne illness rates, particularly laws that are more supportive of employees taking leave. The four earliest PSL laws were classified by whether they were more or less supportive of employees taking leave. Jurisdictions with PSL were matched to comparison jurisdictions by population size and density. Using difference-in-differences, monthly foodborne illness rates (2000-2014) in implementation and comparison jurisdictions before and after the laws were effective were compared, stratifying by how supportive the laws were of employees taking leave, and then by disease. The empirical analysis was conducted from 2015-2017. Foodborne illness rates declined after implementation of the PSL law in jurisdictions with laws more supportive of employees taking leave, but increased in jurisdictions with laws that are less supportive. In adjusted analyses, PSL laws that were more supportive of employees taking sick leave were associated with an adjusted 22% decrease in foodborne illness rates (p=0.005). These results are driven by campylobacteriosis. Although the results suggest an association between more supportive PSL laws and decreased foodborne illness rates, they should be interpreted cautiously because the trend is driven by campylobacteriosis, which has low person-to-person transmission.

Microbiological quality of ice and ice machines used in food establishments.

The ice used in the food industry has to be safe and the water used in ice production should have the quality of drinking water. The consumption of contaminated ice directly or indirectly may be a vehicle for transmission of pathogenic bacteria to humans producing outbreaks of gastrointestinal diseases. The objective of this study was to monitor the microbiological quality of ice, the water used in producing ice and the hygienic conditions of ice making machines in various food enterprises. Escherichia coli was detected in seven (6.7%) ice and 23 (21.9%) ice chest samples whereas E. coli was negative in all examined water samples. Psychrophilic bacteria were detected in 83 (79.0%) of 105 ice chest and in 68 (64.7%) of 105 ice samples, whereas Enterococci were detected only in 13 (12.4%) ice samples. Coliforms were detected in 13 (12.4%) water, 71 (67.6%) ice chest and 54 (51.4%) ice samples. In order to improve the microbiological quality of ice, the maintenance, cleaning and disinfecting of ice machines should be carried out effectively and periodically. Also, high quality water should be used for ice production.

Hydrological modelling in a drinking water catchment area as a means of evaluating pathogen risk reduction

Waterborne outbreaks of gastrointestinal diseases are of great concern to drinking water producers and can give rise to substantial costs to the society. The World Health Organisation promotes an approach where the emphasis is on mitigating risks close to the contamination source. In order to handle microbial risks efficiently, there is a need for systematic risk management. In this paper we present a framework for microbial risk management of drinking water systems. The framework incorporates cost-benefit analysis as a decision support method. The hydrological Soil and Water Assessment Tool (SWAT) model, which was set up for the Stäket catchment area in Sweden, was used to simulate the effects of four different mitigation measures on microbial concentrations. The modelling results showed that the two mitigation measures that resulted in a significant (p<0.05) reduction of Cryptosporidium spp. and Escherichia coli concentrations were a vegetative filter strip linked to cropland and improved treatment (by one Log10 unit) at the wastewater treatment plants. The mitigation measure with a vegetative filter strip linked to grazing areas resulted in a significant reduction of Cryptosporidium spp., but not of E. coli concentrations. The mitigation measure with enhancing the removal efficiency of all on-site wastewater treatment systems (total removal of 2 Log10 units) did not achieve any significant reduction of E. coli or Cryptosporidium spp. concentrations. The SWAT model was useful when characterising the effect of different mitigation measures on microbial concentrations. Hydrological modelling implemented within an appropriate risk management framework is a key decision support element as it identifies the most efficient alternative for microbial risk reduction.

Norovirus genotype distribution in outbreaks of acute gastroenteritis among children and older people: an 8-year study.

BackgroundNoroviruses (NoVs) are the most frequent cause of acute gastroenteritis worldwide among people of all ages and the leading cause of gastrointestinal disease outbreaks in various settings. To clarify the differences in epidemic situations among different settings, we investigated epidemiological trends and the distribution of NoV genotypes in Yokohama, Japan.MethodsBetween September 2007 and August 2015, 746 outbreaks of NoV gastroenteritis were reported in kindergarten/nursery schools (K/Ns), primary schools (PSs), and nursing homes for the aged (NHs). Stool samples were collected for NoV testing, and the NoV gene was amplified and sequenced to determine the genotype.ResultsDuring the eight seasons, 248 NoV outbreaks occurred in K/Ns, 274 outbreaks in PSs, and 224 outbreaks in NHs. These outbreaks occurred throughout the year, except in August, and the number increased in November and peaked in December. The number of outbreaks that occurred from November to February comprised 76.8 % of all outbreaks. The outbreaks originated in K/Ns or PSs in every season, except for one season. Five genogroup (G)I and nine GII genotypes in K/Ns, six GI and 10 GII genotypes in PSs, and three GI and six GII genotypes in NHs were detected during the eight seasons. GII.4 was the most prevalent genotype in K/Ns and NHs. However, GII.6 was the most prevalent genotype in PSs. The epidemic genotypes in K/Ns and PSs changed by NoV season, although GII.4 was always predominant in NHs. Moreover, the distribution of genotypes was significantly different between epidemic and non-epidemic periods in each facility (p < 0.01 for all).ConclusionsThe epidemic situation of NoV outbreaks differs by facility, NoV season, and month. The genotype distribution is likely dependent on the facility and is significantly different between epidemic and non-epidemic periods.