The La Crosse County Health Department is conducting a disease investigation on reported cases of E. coli among La Crosse County residents.

Children under age 5 and the elderly are most susceptible to infection. To date, there have been 8 cases of E. coli O157, a particularly nasty form, which produces a toxin that can be harmful to the body organs such as the kidneys. This form of E. coli is also called STEC- Shiga Toxin-Producing Escherichia coli. Of the 8 cases, 6 children have been hospitalized for HUS – Hemolytic Uremic Syndrome.

The Health Department is working with the Wisconsin Division of Health to complete disease investigation to contain the outbreak. At this time, the investigation is ongoing, and a single source of infection or contamination has not be identified.

E. coli is a bacterial infection that is more common during the summer months. Cases can be linked or stand alone. It is transmitted by eating contaminated food or water and by contact with fecal material from infected persons or animals. Person to person spread of bacteria is possible and may occur in family settings, daycare centers and nursing homes.

Signs and symptom of E. coli O157 infection or STEC include severe abdominal cramps and loose and bloody diarrhea. Symptoms occur an average of 3-5 days after swallowing the germ. Some individuals become infected but do not develop symptoms. People do not develop immunity to E. coli.

Parents and caregivers whose children have persistent diarrhea (2-3 days) should consult their child’s doctor, keep the child out of daycare and school and follow extreme hand hygiene to prevent the spread of the bacteria. Testing for E- coli is done by sampling the stool and culturing the bacteria in a laboratory. Testing can take several days for results to be completed.

Precautions for the public at this time consist of:

  • Hand hygiene – hand washing with plenty of soap and water. Special attention should be given to hand washing after using the bathroom, when changing diapers, before preparing food and eating and after coming in from outside activities.
  • Parents need to supervise handwashing for their young children to ensure that hands have been appropriately washed.
  • Parents and caregivers should keep their ill children out of school and daycare until advised to return by their medical provider. The Health Department recommends children stay home until they have been symptom free for 48 hours (2 days).

Persons with E. coli infection usually feel better over a few days without specific treatment. Rest and fluids to prevent and treat dehydration are recommended. For more information on E. coli (O157), STEC or HUS and hand washing techniques, please visit the La Crosse County Health Dept. website at www.lacrossecounty.org/health/

The Times Union reported today that Death Wish Coffee is recalling its Nitro Cold Brew because there is a risk of Clostridium botulinum (C. botulinum) or botulism, a serious toxin that causes weakness of the muscles and difficulty breathing.

The coffee is being pulled from shelves at Price Chopper/Market 32, Healthy Living Market & Café, and independent retailers at the behest of Death Wish Coffee.

Nitrogen-infused coffee is a fairly new process with few federal standards and regulations through the Food and Drug Administration (FDA).

According to the Center for Disease Control, C. botulinum or botulism is a rare but serious illness caused by a toxin that attacks the body’s nerves. Symptoms of botulism usually start with weakness of the muscles that control the eyes, face, mouth, and throat. This weakness may spread to the neck, arms, torso, and legs. Botulism also can weaken the muscles involved in breathing, which can lead to difficulty breathing and even death.

CDC and Texas Health Officials Warn About Illness Linked to Raw Milk from Texas Dairy – Raw milk contained rare but dangerous germ, consumers should get antibiotics

People who consumed raw milk or raw milk products from one Texas dairy should contact their health care provider immediately, warn health investigators from the Centers for Disease Control and Prevention (CDC) and the Texas Department of State Health Services (DSHS). Raw milk from the K-Bar Dairy in Paradise, Texas (northwest of Fort Worth), tested positive for a rare but potentially serious bacteria known as Brucella RB51.

CDC advises that people who consumed raw milk or milk products from the K-Bar Dairy between June 1 and Aug. 7, 2017, should get antibiotic treatment to avoid the risk of lifelong, chronic infections. Initially, people with brucellosis experience fever, sweats, aches and fatigue. If not treated, Brucella RB51 infection can result in long-term complications, like arthritis; heart problems; enlargement of the spleen or liver; and, in rare cases, nervous system problems, like meningitis RB51 can cause severe illness in people with weakened immune systems and miscarriages in pregnant women.

“It’s very important for people who drank raw milk from this dairy to seek treatment to prevent infection with Brucella RB51,” said William Bower, M.D., team lead for the CDC group that investigates brucellosis. “Even if people don’t have any symptoms now, they can develop a chronic infection that can impact their health for years to come.”

Milk from K-Bar dairy is known to have caused Brucella infection in one Texas resident. One illness in a Texas woman has been linked to the dairy. Purchase records and illness reports indicate additional people in Texas and some as far away as California and North Dakota may need antibiotics to prevent or treat infection. In Texas, raw milk is only allowed to be sold on site at the dairy. According to Texas DHSH, K-Bar dairy has been operating in compliance with state dairy laws and rules and is cooperating fully with the investigation.

CDC and Texas health officials have been trying to reach people in more than 800 households known to have purchased K-Bar raw milk. Texas is following up with 170; CDC tried to contact the remaining 672 households but many did not provide contact information. Of the 485 households with contact information, CDC successfully reached 236 households. Among the 236 households, 83 percent of people were exposed to RB51 by drinking the milk.

Officials Worried People Not Aware of Risk

Due to incomplete contact information, CDC staff have been unable to reach about 200 households in which someone bought K-Bar milk. People who sampled the milk at the dairy or got the milk from friends or family also may not be aware of their risk.

So far, CDC and Texas health officials have received reports about people who drank K-Bar milk or have symptoms consistent with brucellosis caused by RB51 in Alabama, Arkansas, California, Ohio, North Dakota, Tennessee and Texas.

Those Exposed Need Antibiotics

CDC recommends that anyone who drank raw milk or consumed milk products from K-Bar dairy between June 1 and Aug. 7, 2017, see their doctor for antibiotics to prevent infection. Because Brucella can cause complications during pregnancy, including miscarriage, it is especially important for pregnant women who may have been exposed to seek medical care. RB51 is resistant to some antibiotics that would normally be used to prevent or treat brucellosis, so people who drank the milk should tell their doctor that they may have been exposed to RB51 and refer their healthcare provider to the CDC website (link below).

People who have consumed the milk should also check themselves for fever for four weeks after they last drank the milk and watch for other brucellosis symptoms for six months. These symptoms include but are not limited to: muscle pain, lasting fatigue, arthritis, depression, and swelling of the testicles.

Doctors can find more information about testing patients for RB51 and which antibiotics to use to prevent infection on the CDC website at: https://www.cdc.gov/brucellosis/clinicians/rb51-raw-milk.html.

About RB51

RB51 is a weakened strain of Brucella used to vaccinate young female cattle against infection with more serious strains of Brucella. Vaccinating cows with the RB51 vaccine helps prevent abortions in cows and reduces the risk of people coming into contact with cows infected with more severe strains of Brucella. However, in rare cases, vaccinated cows can shed RB51 in their milk.

Testing of milk from the individual cows in the dairy herd revealed two cows that were infected with Brucella RB51, supporting the conclusion that these cows are a source of RB51 contamination of the dairy’s raw milk. Testing is ongoing by Texas officials to assure that the remaining cows in the herd do not pose an ongoing risk of RB51contamination of the dairy’s raw milk. The only way to avoid this potential exposure is to drink milk that has been pasteurized to kill the germs.

Brucella is rare in the United States, largely due to our vaccination practices in cattle to prevent brucellosis. There are about 120 reported cases in people each year. Most cases of brucellosis in the U.S. occur in people who traveled to countries where Brucella is more common and drank contaminated cow, sheep or goat milk or had contact with infected animals. Among cases in the U.S. who acquired brucellosis here, infections occur from contact with feral swine or, more rarely, dogs, or because of accidental exposure in lab settings.

Raw Milk: a Risk for Infections

Raw milk and raw milk products are those that have not undergone a process called pasteurization that kills disease-causing germs. CDC recommends that people only drink milk that has been pasteurized to kill germs. Even healthy animals may carry germs that can contaminate milk. There is no substitute for pasteurization to assure that milk is safe to drink.

The risk of getting sick from drinking raw milk is greater for infants and young children, the elderly, pregnant women, and people with weakened immune systems, such as people with cancer, an organ transplant, or HIV/AIDS. However, healthy people of any age can get very sick if they drink raw milk contaminated with harmful germs.

More info on raw milk: https://www.cdc.gov/foodsafety/rawmilk/raw-milk-index.htmland www.realrawmilkfacts.com

The Ohio Department of Health, several other states, the Centers for Disease Control and Prevention (CDC), and the United States Department of Agriculture Animal and Plant Health Inspection Service (USDA-APHIS) are investigating a multistate outbreak of human Campylobacter infections linked to puppies sold through Petland, a national pet store chain.

The outbreak includes 39 people with laboratory-confirmed Campylobacter infections or symptoms consistent with Campylobacter infection who live in 7 states (Florida, Kansas, Missouri, Ohio, Pennsylvania, Tennessee, and Wisconsin) and were exposed to puppies sold through Petland stores; 12 are Petland employees from four states and 27 either recently purchased a puppy at Petland, visited a Petland, or visited or live in a home with a puppy sold through Petland before illness began.

Epidemiologic and laboratory evidence indicates that puppies sold through Petland stores are a likely source of this outbreak. Petland is cooperating with public health and animal health officials to address this outbreak.

Campylobacter can spread through contact with dog feces. It usually does not spread from one person to another.

Illnesses began on dates ranging from Sept. 15, 2016 through Aug. 12, 2017. The most recent illness was reported on September 1, 2017.

Ill people range in age from <1 year to 64 years, with a median age of 22 years; 28 (72%) are female; and 9 (23%) report being hospitalized. No deaths have been reported.

Epidemiologic and laboratory findings have linked the outbreak to contact with puppies sold through Petland stores. Among the 39 ill people, 12 are Petland employees from 4 states and 27 either recently purchased a puppy at Petland, visited a Petland, or visited or live in a home with a puppy sold through Petland before illness began.

Whole genome sequencing showed samples of Campylobacter isolated from the stool of puppies sold through Petland in Florida were closely related to Campylobacter isolated from the stool of an ill person in Ohio. Additional laboratory results from people and dogs are pending.

Live Science reports that several restaurants in the United States are serving up a raw chicken dish that’s referred to as either chicken sashimi or chicken tartare, according to Food & Wine Magazine. Though the “specialty” hasn’t caught on much in the U.S., it’s more widely available in Japan. Eating chicken sashimi puts a person at a “pretty high risk” of getting an infection caused by Campylobacter or Salmonella, two types of bacteria that cause food poisoning, said Ben Chapman, a food safety specialist and an associate professor at North Carolina State University.

Campylobacter infections are one of the most common causes of diarrheal infections in the U.S., according to the Centers for Disease Control and Prevention (CDC). The bacteria cause gastrointestinal symptoms including diarrhea, cramping and abdominal pain, and in some cases can also cause nausea and vomiting, the CDC says. There are an estimated 1.3 million cases in the U.S. each year and fewer than 100 deaths, on average, each year from the infection.

Salmonella infections also cause symptoms such as diarrhea, fever and abdominal cramps, according to the CDC. About 1.2 million people contract Salmonella each year, and about 450 people die from the infection, the CDC says.

Chapman noted that eating raw chicken is different from eating raw fish, which can be found in sushi dishes. With raw fish, the germs that are most likely to make a person sick are parasites, and these parasites can be killed by freezing the fish, he said. Salmonella, on the other hand, “isn’t going to be affected by freezing.”

In Japan, where the dish is more popular, the Ministry of Health, Labour and Welfare advised restaurants in June 2016 to “re-evaluate raw and half-raw chicken menus,” according to The Asahi Shimbun, a Japanese newspaper. The ministry urged restaurants to cook chicken to an internal temperature of 75 degrees Celsius (167 degrees Fahrenheit). The recommendation from the ministry came after more than 800 people said they were sickened several months earlier after eating chicken sashimi and chicken “sushi” rolls, The Asahi Shimbun reported.

The Los Angeles County Department of Public Health (Public Health) warns consumers of possible hepatitis A exposure associated with produce that was possibly contaminated by a worker at a street-side fruit vendor who was infected with Hepatitis A. The fruit vendor was located on the corner of W Ave L and 20th Street West, in Lancaster, CA. Anyone who bought fruit from the vendor’s fruit cart (at this location) during the period of August 15 through August 22 may be at risk for hepatitis A.

The LA County Health Officer recommends that individuals who ate products from a fruit vendor at this location should receive an immune globulin (IG) shot or hepatitis A vaccination within the next week to prevent or reduce illness. Public Health will offer free vaccinations at the Antelope Valley Public Health Center from 8:00 a.m. – 4:30 p.m. beginning, Tuesday, September 5, for anyone who may have been exposed.

Where:

Antelope Valley Public Health Center
335-B East Avenue K6
Lancaster, CA 93535
(661) 471-4860

“We are actively investigating this situation. It is important that anyone who may have bought or consumed fruit from this vendor during the period of August 15 through August 22 should contact their doctor to discuss possible hepatitis A prevention and treatment options,” said Jeffrey Gunzenhauser, MD, MPH, Interim Health Officer, Los Angeles County. “Those who purchased this product should discard any remaining fruit if still found in their home.”

This new case may be linked to the outbreaks of hepatitis A infections occurring in San Diego and Santa Cruz counties. The large majority of those cases have occurred in persons who are homeless and/or use illicit drugs (injection and non-injection), with several cases also occurring among people who provide services to the homeless. The worker with hepatitis A who worked at the fruit stand had previously spent time in San Diego, has received care, and is no longer infectious.

Public Health has confirmed 3 cases of hepatitis A among high-risk individuals who lived in San Diego during their exposure period as well as 3 secondary cases that have occurred in a health facility in Los Angeles County. Public Health has not identified any new cases associated with the fruit cart.

HAV causes acute liver disease, which may be severe. It is transmitted by contact with the feces of a person who is infected – often through contact with food or water or during sex or other close contact. Signs and symptoms of acute HAV include fever, malaise, dark urine, lack of appetite, nausea, and stomach pain, followed by jaundice. Symptoms generally last for less than 2 months although some persons may have prolonged or more severe illness. Infection can be prevented in close contacts of patients by vaccination within 2-weeks of exposure or administration of immune globulin. If you experience these symptoms, contact your physician.

Persons who have been vaccinated against hepatitis A or have received IG within the last three months or have ever had laboratory confirmed infection with the hepatitis A virus also do not need an injection of IG.

For more information on Public Health clinics, visit http://publichealth.lacounty.gov/chs/phcenters.htm , or call the LA County Information line at 2-1-1 from any landline or cell phone within the county.

The Chicago Department of Public Health (CDPH) has identified an outbreak of Salmonella, impacting at least 14 individuals. As part of the CDPH investigation, Best BBQ at 1648 W. 115th Street has been linked to the outbreak. Following a request from CDPH, Best BBQ closed voluntarily and is fully cooperating with the investigation. At least six individuals have been hospitalized related to the outbreak.
 
CDPH recommends anyone who recently ate at the restaurant in question and is suffering symptoms to see a medical provider and inform them of the possibility of Salmonella.

“This is a serious condition that is treatable,” said CDPH Commissioner Julie Morita, M.D. “Anyone who believes they may be symptomatic and ate at this restaurant should see their medical provider immediately. CDPH is taking every precaution as part of our robust response in order to limit the impact of this outbreak.”
 
Salmonella is a bacteria that can be treated with antibiotics. Most people infected develop diarrhea, fever and abdominal cramps between 12 and 72 hours after infection.

Salmonella symptoms usually last four to seven days, and most individuals recover without any treatment. In some cases, diarrhea may be so severe that the patient needs to be hospitalized. In these patients, the Salmonella infection may spread from the intestines to the blood stream, and then to other body sites. In these cases, Salmonella can cause death unless the person is treated promptly with antibiotics. The elderly, infants, and those with impaired immune systems are more likely to have a severe illness. The Centers for Disease Control and Prevention estimates that Salmonella causes approximately one million illnesses and 450 deaths in the United States each year.

The outbreak was detected by CDPH officials’ ongoing surveillance, reviewing laboratory reports of patients diagnosed with specific diseases. Investigators recognized an uptick in a particular laboratory serotype of Salmonella cases and then contacted patients to determine if there were any commonalities between the various cases. This led to the determination that a number of individuals with a single Salmonella serotype recently ate at the restaurant in question. Working with CDPH food protection inspectors, the restaurant is addressing any possible contamination issues, to ensure sanitary and health conditions are in place. They are also providing a list of suppliers to investigate possible concerns with food sources. CDPH has also issued an alert to area physicians of the outbreak, providing medical guidance.

The CDC, public health and regulatory officials in several states, and the U.S. Food and Drug Administration are investigating a multistate outbreak of Salmonella infections.

This outbreak includes four different types of Salmonella: Thompson, Kiambu, Agona, and Gaminara. The same strain of these types of Salmonella were found in samples collected from papayas and from ill people.

A total of 201 people infected with the outbreak strains of Salmonella Thompson (131), Salmonella Kiambu (57), Salmonella Agona (8), or Salmonella Gaminara (5) have been reported from 23 states.

Sixty-five ill people have been hospitalized. One death was reported from New York City.

Epidemiologic and laboratory evidence indicates that Maradol papayas from the Carica de Campeche farm in Mexico are the likely source of this multistate outbreak.

Two additional outbreaks of Salmonella infections linked to imported papayas from two other farms in Mexico, Caraveo Produce and El Zapotanito, have been identified. Available information indicates that illnesses in these two outbreaks are not linked to papayas from the Carica de Campeche farm and are being investigated separately.

CDC recommends that consumers not eat, restaurants not serve, and retailers not sell Maradol papayas from the Carica de Campeche, Caraveo Produce, or El Zapotanito farms in Mexico.

Because three separate outbreaks linked to papayas from different farms have been identified, CDC is concerned that papayas from several other farms in Mexico might be contaminated with Salmonella and have made people sick.

Thanks to HepMag.com for a great summary of ongoing hepatitis A outbreaks going on in the US.

California

Public health officials first detected the hepatitis A outbreak in November 2016 and as of July 21, 2017, 251 cases and 5 deaths have been reported in San Diego. Those affected have largely been homeless individuals, which has made public health efforts more challenging to implement, particularly in reaching individuals with vaccinations and improving hygiene practices. Local officials and community organizations have been working to raise awareness of hepatitis A vaccination, distribute “Hepatitis A Prevention Kits” (containing sanitary supplies), and plans are underway to install hand-washing stations in areas frequented by homeless persons to help stop the spread. Since the outbreak began, the county has administered over 4,000 hepatitis A vaccinations, and more work is planned to expand those efforts. With this combined approach, San Diego is hoping to end the outbreak, the largest in California in nearly 20 years.

Colorado

Between January and early July 2017, 43 cases of hepatitis A were reported in Colorado, a significant increase from 2016 where 23 cases were reported for the full year. Half of these cases resulted in hospitalization and one person has died. Unlike many hepatitis A outbreaks, there is no apparent common link to a restaurant or food item. 74% of hepatitis A cases are men and at least half are men who have sex with men (MSM). Local public health agencies are working to battle the epidemic by targeting MSM with outreach and offering vaccination at a variety of sites.

Michigan

Between August 2016 and June 2017 in southeast Michigan, almost 200 people have been diagnosed with hepatitis A infection, 90% of those infected have required hospitalization, and 10 people have died. Public health officials believe the outbreak to be unrelated to water or food contamination, but rather person-to-person spread through use of illicit drugs, sexual contact, and close proximity. Nearly 50% of those infected report a history of substance use disorders and 20% are also infected with hepatitis C.

Thanks to Blythe Bernhard and the St. Louis Post-Dispatch for recalling all the risk of past floods that will certainly be at play during and after Harvey

  • After the cleanup, wash hands with soap and warm water that has been previously boiled. Clothes should be washed in hot water and detergent, separately from clothes that aren’t contaminated. Use a laundromat if the wastewater system in the area has been compromised.
  • Open wounds and rashes can be any entry point for infection if exposed to floodwater. Use waterproof bandages and thoroughly wash any areas exposed to floodwater. Health officials recommend updated vaccinations for tetanus and diphtheria for anyone exposed to raw sewage.
  • Raw sewage in floodwater can carry bacteria, viruses and parasites. Those that can cause intestinal illness or gastroenteritis include strains of E. coli, salmonella, shigella and enterovirus. The main symptom of these illnesses is diarrhea, and those at higher risk of developing severe disease are the youngest and oldest in the community and people with compromised immune systems.
  • After the water recedes, mold can become another health concern. Remove and throw away any drywall or insulation that has been touched by floodwater or sewage. Mattresses, carpets, carpet pads, upholstered furniture, stuffed animals, pillows, books, paper products and anything else that can’t be washed and disinfected should be tossed out if they get wet.
  • Hard surfaces including flooring and countertops should be thoroughly cleaned with hot water and detergent. Any food that came in contact with floodwater must be discarded, even canned goods. All toys should be disinfected with a bleach solution.
  • People affected by flooding are also at risk of experiencing fear, anxiety and sadness. The American Psychiatric Association said anyone struggling with the emotions should seek professional help.