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The US Food Safety Modernization Act (FSMA) gives food safety regulators increased authority to require implementation of safety measures to reduce the contamination of produce. To evaluate the future impact of FSMA on food safety, a better understanding is needed regarding outbreaks attributed to the consumption of raw produce. Data reported to the US Centers for Disease Control and Prevention's Foodborne Disease Outbreak Surveillance System during 1998-2013 were analysed. During 1998-2013, there were 972 raw produce outbreaks reported resulting in 34 674 outbreak-associated illnesses, 2315 hospitalisations, and 72 deaths. Overall, the total number of foodborne outbreaks reported decreased by 38% during the study period and the number of raw produce outbreaks decreased 19% during the same period; however, the percentage of outbreaks attributed to raw produce among outbreaks with a food reported increased from 8% during 1998-2001 to 16% during 2010-2013. Raw produce outbreaks were most commonly attributed to vegetable row crops (38% of outbreaks), fruits (35%) and seeded vegetables (11%). The most common aetiologic agents identified were norovirus (54% of outbreaks), Salmonella enterica (21%) and Shiga toxin-producing Escherichia coli (10%). Food-handling errors were reported in 39% of outbreaks. The proportion of all foodborne outbreaks attributable to raw produce has been increasing. Evaluation of safety measures to address the contamination on farms, during processing and food preparation, should take into account the trends occurring before FSMA implementation.

Background: Although the Horn of Africa region has successfully eliminated endemic poliovirus circulation, it remains at risk for reintroduction. International partners assisted Kenya in identifying gaps in the polio surveillance and routine immunization programs, and provided recommendations for improved surveillance and routine immunization during the health system decentralization process., Methods: Structured questionnaires collected information about acute flaccid paralysis (AFP) surveillance resources, training, data monitoring, and supervision at provincial, district, and health facility levels. The routine immunization program information collected included questions about vaccine and resource availability, cold chain, logistics, health-care services and access, outreach coverage data, microplanning, and management and monitoring of AFP surveillance., Results: Although AFP surveillance met national performance standards, widespread deficiencies and limited resources were observed and reported at all levels. Deficiencies were related to provider knowledge, funding, training, and supervision, and were particularly evident at the health facility level., Conclusions: Gap analysis assists in maximizing resources and capacity building in countries where surveillance and routine immunization lag behind other health priorities. Limited resources for surveillance and routine immunization systems in the region indicate a risk for additional outbreaks of wild poliovirus and other vaccine-preventable illnesses. Monitoring and evaluation of program strengthening activities are needed., (Published by Oxford University Press on behalf of the Infectious Diseases Society of America 2014. This work is written by (a) US Government employee(s) and is in the public domain in the US.)

In November 2009, we initiated a multistate investigation of Salmonella Montevideo infections with pulsed-field gel electrophoresis pattern JIXX01.0011. We identified 272 cases in 44 states with illness onset dates ranging from 1 July 2009 to 14 April 2010. To help generate hypotheses, warehouse store membership card information was collected to identify products consumed by cases. These records identified 19 ill persons who purchased company A salami products before onset of illness. A case-control study was conducted. Ready-to-eat salami consumption was significantly associated with illness (matched odds ratio 8·5, 95% confidence interval 2·1-75·9). The outbreak strain was isolated from company A salami products from an environmental sample from one manufacturing plant, and sealed containers of black and red pepper at the facility. This outbreak illustrates the importance of using membership card information to assist in identifying suspect vehicles, the potential for spices to contaminate ready-to-eat products, and preventing raw ingredient contamination of these products.

A multistate outbreak of Escherichia coli O157:H7 infections occurred in the USA in November-December 2006 in patrons of restaurant chain A. We identified 77 cases with chain A exposure in four states - Delaware, New Jersey, New York, and Pennsylvania. Fifty-one (66%) patients were hospitalized, and seven (9%) developed haemolytic uraemic syndrome; none died. In a matched analysis controlling for age in 31 cases and 55 controls, illness was associated with consumption of shredded iceberg lettuce [matched odds ratio (mOR) 8·0, 95% confidence interval (CI) 1·1-348·1] and shredded cheddar cheese (mOR 6·2, CI 1·7-33·7). Lettuce, an uncooked ingredient, was more commonly consumed (97% of patients) than cheddar cheese (84%) and a single source supplied all affected restaurants. A single source of cheese could not explain the regional distribution of outbreak cases. The outbreak highlights challenges in conducting rapid multistate investigations and the importance of incorporating epidemiological study results with other investigative findings.

Background: In February 2002, clinicians at the Dartmouth College Health Service recognized an outbreak of conjunctivitis; cultures of conjunctival swabs implicated Streptococcus pneumoniae. An investigation was begun to determine the extent of the outbreak, confirm the cause, identify modes of transmission, and implement control measures., Methods: Investigators reviewed the health service's data base for diagnoses of conjunctivitis. Viral and bacterial cultures were obtained from ill students. Bile-soluble isolates that were susceptible to ethylhydrocupreine (optochin) and therefore were presumed to be pneumococci underwent serotyping, capsular staining, pulsed-field gel electrophoresis, a DNA probe, and multilocus sequence typing. A cohort study of risk factors was conducted with the use of the Internet. Control measures included distribution of alcohol-based hand gel and messages about prevention., Results: Among 5060 students, 698 (13.8 percent) received a diagnosis of conjunctivitis from January 1, 2002, through April 12, 2002, including 22 percent of first-year students. Presumed pneumococci were isolated from 43.3 percent of conjunctival swabs (110 of 254); viral cultures performed on 85 specimens were negative. DNA probes and multilocus sequence typing confirmed that the organisms were pneumococci, although the bacteria did not have the characteristic capsule. On pulsed-field gel electrophoresis, strains were found to be identical to pneumococci that caused outbreaks of conjunctivitis in other parts of the country in 1980. Analysis of survey data from 1832 students indicated that close contact with a student with conjunctivitis, wearing contact lenses, membership on a sports team, and attending parties at or living in a fraternity or sorority house were associated with conjunctivitis. The rate of diagnosis of conjunctivitis declined after the implementation of control measures and after spring break., Conclusions: This large outbreak of conjunctivitis on a college campus was caused by an atypical, unencapsulated strain of S. pneumoniae that was identical to strains that had caused outbreaks two decades earlier., (Copyright 2003 Massachusetts Medical Society)

The article summarizes the results of an investigation concerning the multistate outbreak of human Salmonella Typhimurium infections connected with aquatic frogs during 2009 in the U.S. The cases identified by the Utah Department of Health all had isolates indistinguishable by pulsed field gas electrophoresis. The investigation commenced with interviews of salmonellosis patients about exposures in the week prior to illness onset. The likely source of transmission in the outbreak was contact with water from the aquariums of the frogs.

Background: Among 21.5 million children globally who did not receive a single dose of measles vaccine in 2013, 6.4 million (30%) were in India, resulting in a large susceptible population at risk for propagating measles outbreaks. On March 20, 2015, a single health facility in Goalpara District in Assam reported 73 children < 18 years with fever and rash. We investigated the suspected measles outbreak to confirm and describe the outbreak, estimate vaccine effectiveness, and propose recommendations for prevention and control measures. Methods & Materials: We defined a case of measles as fever and maculo-papular non-vesicular rash with cough, coryza, or conjunctivitis in three villages (Bhelterghat, Ghanapara and Pekbeki) from 31 January 2015 to 12 April 2015. We conducted a retrospective cohort study of children 6 months to 18 years in the three villages. We interviewed mothers of children and reviewed vaccination cards and immunization registers at health care facilities to assess vaccination coverage and vaccine effectiveness. We tested five serum samples for IgM antibodies for measles towards the end of the outbreak. Results:Weidentified 103 cases with an attack rate of 8%. There were no hospitalizations and no deaths. Attack rate was highest in children aged between 6-9 months (92%) followed by 10-24 months (19%). Among 103 cases, 53% were female. Most cases (65%) lived in Bhelterghat (10% attack rate) followed by 21% in Ghanapara (3% attack rate) and 14% in Pekbeki (2% attack rate). All cases were treated with vitamin A supplementation during the outbreak. Amongthe cases, 20 (19%) were vaccinated against measles. Among children 6 months to 18 years, vaccination coverage for first dose measles-containing vaccine was 37% (500/1359) and Vaccine effectiveness of measles-containing vaccine was 60% (95% CI= 33.4 - 74.3). All five serum samples were positive for IgM antibodies for measles. Conclusion: This measles outbreak was caused by low vaccination coverage in the area and subpar vaccine effectiveness. We recommended annual trainings every year for all staff involved in vaccine service delivery and vaccine management. We also recommend strengthening routine immunization in the area by increasing community awareness about vaccines and by increasing outreach vaccination services. [ABSTRACT FROM AUTHOR]

Background: Kyasanur Forest disease (KFD), a tick-borne viral hemorrhagic fever has a case fatality rate as high as 10%. KFD is endemic to Karnataka but is spreading. Infected ticks transmit infection to monkeys, the amplifying host. Vaccination of high risk populations is the primary control strategy. On February 6, 2015, an outbreak of KFD was reported in Wayanad district, Kerala near Chikenji forest. We investigated to describe the outbreak and identify risk factors. Methods & Materials: We defined cases as residents of Sulthan Bathery taluk who during 25 December 2014 - 13 March 2015 presented with fever, headache, and myalgia. House to house survey and health facility-based surveillance was established for case finding. For each caseweselected two healthy controls matched for age, sex and place of residence and interviewed regarding exposures. We conducted entomological and monkey death investigations to better understand transmission. Results: Among 113 cases, including 6 deaths, 62% were females; median age was 40 (3-70). None had received vaccination. Of 81 cases tested by reverse transcription polymerase chain reaction, 43 (53%) were confirmed for KFD virus. Among 59 cases and 118 controls, a recent visit to forest (aOR=4.8, 95%CI=2.1-10.6), grazing animals in forest (aOR=3.1, 95%CI=2.2-6.9), exposure to monkey death (aOR=4.1, 95%CI=2.2-7.2) and collecting heaps of leaves around house (aOR=1.9, 95%CI=1.09-2.8) were significantly associated with illness. The tick vector (Hemophysalis spinigera) for KFD was abundantly found and 18 monkey deaths (5 tested positive for KFD) were reported from affected area. Conclusion: This was the first reported outbreak of KFD in Kerala with virus, and vector also found in the area. We recommended vector control, use of personal protective measures and vaccination policy for prevention of KFD outbreaks in future. [ABSTRACT FROM AUTHOR]