I just received the Final Summary Report on the 2014 Royal Hawaiian Norovirus Outbreak from the State of Hawaii Department of Health (HDOH).  It was well done and to the point.

On May 17, 2014, management at the Royal Hawaiian Hotel (RHH) reported illnesses linked to a wedding reception at the Azure Restaurant held on May 15th.  Illnesses were reported on May 16th.

The investigation found that 114 individuals reported illnesses compatible with a confirmed (stool culture positive for Norovirus) or probable case.  Illness onset ranged from May 14th to May 26th.

Ill persons identified a wide variety of food consumed at various venues.  The common denominator was that the food was prepared in the kitchen at the RHH.

17 RHH employees reported illness during the outbreak period.  On employee reported and episode of diarrhea on May 14th just prior to serving dinner.  On May 15th another employee reported vomiting into a kitchen area trashcan.

On May 19th HDOH inspected the RHH kitchen and observed violation of sanitizing procedure and cold holding temperatures.

The HDOH conclusion was “[t]his was a confirmed outbreak of Norovirus GL3B associated with consumption of a meal prepared by the [RHH]….  Of the 114 primary ill persons identified, 17 were employees of the [RHH]….  Illness among food handling personnel and coincident environmental contamination were likely contributing factors which served to propagate the infection among hotel guests and employees.”

NBC News asks the right question:

If a restaurant in your neighborhood were temporarily closed because it made people sick, wouldn’t you want to know?

The Orange Health Department told the NBC Connecticut Troubleshooters they have no right to that information.

Thankfully, one of the victims, Kamran Niazi, came forward recalling the effects of three slices of chicken pizza from Oregano Joe’s on Boston Post Road in Orange.

“I had 104-degree fever, diarrhea – extreme diarrhea – extreme vomiting. Niazi said an ambulance took him to Yale-New Haven Hospital, where he spent almost a week in the Intensive Care Unit.

But when he was released from the hospital, Niazi couldn’t get any information on his case from the Orange Health Department, even though inspectors had called him with questions while he was hospitalized.

The Orange Health Department and the state DPH cite several statutes that they said forbid them from speaking with the Troubleshooters about any information in a food-borne illness case.

The Orange Health Department told the Troubleshooters it has ordered Oregano Joe’s to close down twice, once for a day on May 30 and then again on June 20 for a span of five weeks. But the department won’t say why.

“The public health department is supposed to help us. I think it’s a disaster,” said John Tomas, a law professor at Quinnipiac University.  Thomas said what the Orange Health Department is doing isn’t serving anybody.

“I think it’s absolutely, completely wrong. The government statute does mandate privacy and confidentiality for records, but only records that the health department obtains in a study designed to reduce mortality and morbidity, that is death and illness in a particular setting, and this is not that kind of study,” he said.

The NBC Connecticut Troubleshooters have filed a complaint with the Freedom of Information Commission against the Orange Health Department for failing to disclose basic information on the nature of the Oregano Joe’s closings and the number of people who may have become ill like Niazi.

I received this email from the mother of some great kids I represented in an E. coli Outbreak over eight years ago.

Dear Bill Marler and firm:

We have been blessed to interact with your firm first hand. While the majority of those interactions were several years ago I wanted to write and say how much I admire each of you for what you have accomplished and the work you have done! It’s not just the financial success I would like to acknowledge but your ability to focus on what truly matters at the heart of it, people. The fact that I have seen only a portion of your success as well as what you give back to society! Thank you for allowing me to experience this from you! Truly successful people are successful because of what they give not what they take. It’s an honor to be associated with a group of truly successful people such as the one you have created!

Its good to be reminded what an honor my job really is.

“No illnesses have been reported to date.” How many times have we read a food recall notice posted on either the FDA or FSIS websites by the companies recalling the product with that self-serving statement? I would say most of the time.

In the past few months the CDC has reported three outbreaks – one Salmonella outbreak and two Listeria outbreaks that have used Whole Genome Sequencing to connect ill people to tainted product. Perhaps “No illnesses have been reported to date” is a statement of the past trumped by science.

So, what is the science?

State and CDC Public health investigators have used the PulseNet system to identify cases of illness that were part of and outbreak for nearly two decades. PulseNet, the national subtyping network of public health and food regulatory agency laboratories coordinated by CDC, receives from state laboratories DNA “fingerprints” of bacteria obtained through diagnostic testing using Pulsed-field Gel Electrophoresis (PFGE).

Multiple Locus Variable-number Tandem Repeat Analysis (MLVA) is another technique used by scientists to generate a DNA fingerprint for a bacterial isolate. Scientists usually perform MLVA after PFGA to find out more specific details about the type of bacteria that may be causing an outbreak.

Whole Genome Sequencing, is a newer, more highly discriminatory subtyping method, that has been used to define the following outbreaks:

  • Oasis Brands Inc., Cheese Recalls and Investigation of Human Listeriosis Cases – One person became ill in September 2013 and two persons who became ill in June and August 2014. These three ill persons were reported from three states: New York (1), Tennessee (1), and Texas (1). All ill persons were hospitalized. One death was reported in Tennessee. One illness was related to a pregnancy and was diagnosed in a newborn.

“No illnesses have been reported to date,” may well be a statement of the past.

Aaron Kinney reports that the San Mateo County health officials announced Friday that norovirus was behind an outbreak of acute gastrointestinal illness at the upscale Hotel Sofitel in Redwood Shores.

Lab analysis of samples taken from some of the people who were sickened confirmed the highly contagious virus was to blame. At least 60 hotel guests and employees reported falling ill with symptoms including vomiting and diarrhea beginning Oct. 26, county health spokeswoman Robyn Thaw said.

Thaw said the hotel told county health investigators that guests at three separate special events became sick.

The outbreak began at the conclusion of the NAACP’s annual state convention. Attendees said several dozen people became sick on the morning of Oct. 26, a little more than 12 hours after a banquet dinner where roughly 300 people dined on salmon and salad. Twelve people were taken by ambulance to hospitals.

Norovirus is spread through contact with the vomit or feces of an infected person. Food service workers can spread the virus by not properly washing their hands before touching food.

People typically come down with norovirus symptoms between 12 and 48 hours after exposure, according to the CDC.  It causes 19-21 million illnesses per year in the United States, according to the CDC.  Norovirus is often linked to restaurant food.

The Centers for Disease Control and Prevention (CDC) reported tonight than the U.S. Food and Drug Administration (FDA) isolated Listeria monocytogenes from mung bean sprouts and sprout irrigation water samples obtained during a routine assignment on August 13, 2014, at Wholesome Soy Products, Inc. Based on this finding, FDA conducted an inspection of the facility from August 12, 2014, through September 3, 2014, and isolated Listeria monocytogenes from 25 environmental swabs obtained during the inspection. FDA also issued a report with 12 inspectional observations, citing the firm for numerous unsanitary conditions and poor equipment maintenance.

On August 28, 2014, Wholesome Soy Products, Inc. agreed to conduct a voluntary recall of mung bean sprouts and notified customers by telephone. Wholesome Soy Products, Inc. ceased production of sprouts on August 28, 2014, and resumed production on September 15, 2014 after Listeria monocytogenes was not identified in finished product. From October 7, 2014, to October 31, 2014, FDA re-inspected the facility and identified Listeria monocytogenes in nine environmental swabs. FDA investigators issued another report to the firm, noting 12 inspectional observations involving unsanitary conditions and poor equipment maintenance. Nine of these observations had persisted from the previous inspection.

On October 14, 2014, Wholesome Soy Products, Inc. ceased production of all products except mung bean and soy bean sprouts. FDA is working with the company to ensure that they do not produce sprouts until FDA has adequate assurances that this persistent and dangerous strain of Listeria monocytogenes is sufficiently controlled. Illinois Department of Public Health (IDPH) is working to embargo all product at Wholesome Soy Products, Inc. and the other wholesalers that presently have product. In addition, IDPH has asked local health departments to contact facilities in their jurisdictions that have received the product to have the facilities either hold the product or destroy per the CDC recommendations.

FDA performed pulsed-field gel electrophoresis (PFGE) and whole genome sequencing (WGS) on the isolates from mung bean sprouts and environmental samples from Wholesome Soy Products, Inc. to further characterize the Listeria isolates. Compared with PFGE, WGS provides a clearer distinction of genetic differences among Listeria isolates (strains that are highly related by WGS are more likely to have a common source).

Public health investigators used PFGE and WGS to identify cases of illness that were caused by highly related strains and therefore possibly related to products made at Wholesome Soy Products, Inc. This included data from PulseNet, the national subtyping network of state and local public health laboratories, CDC, and federal food regulatory laboratories that perform molecular surveillance of foodborne infections.

Whole-genome sequences of Listeria strains isolated from five ill people were found to be highly related to sequences of the Listeria strain isolated from mung bean sprouts produced by Wholesome Soy Products, Inc. These ill people have been reported from two states: Illinois (4) and Michigan (1).  They became ill from June through August 2014. All five people were hospitalized, and two deaths were reported. Two of the five people were interviewed, and both reported consuming bean sprouts in the month before becoming ill.

The high degree of genetic similarity between isolates from ill people and from mung bean sprouts and environmental samples collected at Wholesome Soy Products, Inc. shows that the food was contaminated with a strain of Listeria monocytogenes that can cause serious illness. Although limited information is available about the specific sprout products that the ill people consumed, the whole genome sequencing findings, together with the sprout consumption history of two patients and inspection findings at the firm, suggest that these illnesses could be related to products from Wholesome Soy Products, Inc.

CDC, the states involved, and FDA continue to work closely on this ongoing investigation, and new information will be provided when available.

My friends at Barf Blog document at least 55 sprout-associated outbreaks occurring worldwide affecting a total of 15,233 people since 1988. A comprehensive table of sprout-related outbreaks can be found at http://barfblog.com/wp-content/uploads/2014/08/Sprout-associated-outbreaks-8-1-14.xlsx.

According to the CDC, most norovirus outbreaks from contaminated food occur in food service settings, according to a report by the Centers for Disease Control and Prevention. Infected food workers are frequently the source of these outbreaks, often by touching ready-to-eat foods served in restaurants with their bare hands. The food service industry can help prevent norovirus outbreaks by enforcing food safety practices, such as making sure workers always practice good hand hygiene on the job and stay home when they are sick.

Norovirus often gets a lot of attention for outbreaks on cruise ships, but those account for only about 1 percent of all reported norovirus outbreaks. Norovirus is highly contagious and can spread anywhere people gather or food is served, making people sick with vomiting and diarrhea. About 20 million people get sick from norovirus each year; most get infected by having close contact with other infected people or by eating contaminated food.

The Vital Signs report provides key recommendations to help the food service industry prevent norovirus outbreaks from contaminated food. The recommendations, which underscore provisions in the Food and Drug Administration model Food Code (http://www.fda.gov/Food/GuidanceRegulation/RetailFoodProtection/FoodCode/default.htm) and CDC guidelines (http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6003a1.htm), include:

  • Making sure food service workers practice proper hand washing and use utensils and single-use disposable gloves to avoid touching ready-to-eat foods with bare hands,
  • Certifying kitchen managers and training food service workers in food safety practices, and
  • Establishing policies that require food service workers to stay home when sick with vomiting and diarrhea and for at least 48 hours after symptoms stop.

CDC analyzed norovirus outbreak data reported by state, local, and territorial health departments from 2009 to 2012 through CDC’s National Outbreak Reporting System (NORS). Over the four years, health departments reported 1,008 norovirus outbreaks from contaminated food, most of which occurred in food service settings such as restaurants and catering or banquet facilities.

Factors contributing to food contamination were reported in 520 of the outbreaks, with an infected food worker implicated in 364 (70 percent) of them. Of these outbreaks, 196 (54 percent) involved food workers touching ready-to-eat foods with their bare hands. Ready-to-eat foods are foods that are ready to be served without additional preparation, such as washed raw fruits and vegetables for salads or sandwiches, baked goods, or items that have already been cooked.

Our hearts are heavy as we say a final farewell to the dear co-founder and former CEO and chair of the College Success Foundation (CSF) – Robert “Bob” E. Craves. The visionary leader passed away on November 5, 2014, following a brief struggle with cancer. He died peacefully, surrounded by his family.

Bob was the leader of the foundation for 13 years since he co-founded it in 2000. He was always a passionate advocate for equal access to higher education for all. As a champion for underserved students, he raised $600 million to further educational opportunities for our most vulnerable youth – including those who were the first in their families to pursue college, low-income youth, students of color and foster youth. After his retirement in 2013, he continued as a board member and an enthusiastic supporter in both Washington state and in Washington, D.C.

Bob was a leader and a giant, and will be remembered by the thousands of young people whose life trajectories he influenced with the gift of education. By the end of 2013, more than 12,000 scholarships were disbursed and nearly 4,000 CSF Scholars had earned bachelor’s degrees, with thousands more still attending college.

Bob was my hero and my friend.

Reason to vaccinate employees – especially, those that work with a vulnerable population.

Surry County North Carolina health officials are warning of a possible Hepatitis A exposure at a Mount Airy assisted living facility.

The potential exposure affects anyone who ate at the Golden Living Center on Allred Mill Road on Oct. 22. An employee was recently diagnosed with Hepatitis A and may have been infectious while making food, health officials said.

Anyone who may have been exposed to the virus could feel symptoms as early as Thursday and as late as Dec. 11.

Hepatitis A is a liver disease with symptoms including fever, loss of appetite, diarrhea, abdominal discomfort, darker urine and jaundice. Most people recover after several weeks.

San Francisco area news reports that Hotel Sofitel in Redwood City closed its kitchen and dining facilities last week after dozens of guests and a few employees reported becoming ill at the annual NAACP State Convention, including former Oakland Mayor Elihu Harris.

San Mateo County public health officials, with help from the California Department of Public Health, are investigating what could be an outbreak of foodborne illness during the Oct. 23 to Oct. 26 event. The cause of the sicknesses has not been confirmed, but officials hope lab tests this week will provide clarity.

A hotel spokeswoman said food and beverage service was suspended “out of an abundance of caution we responded as if either cause was possible — foodborne illness or community acquired virus such as norovirus.”

On the morning of Oct. 26, 12 convention attendees were taken by ambulance to a local hospital — and several others drove themselves — after complaining of gastrointestinal symptoms including nausea, vomiting and diarrhea, officials said. More people who were at the event have since reported problems.

“One hundred-plus of my members have either been in the hospital or ill because of food poisoning,” said Alice Huffman, president of the California NAACP. “ I’ve never seen anything like this at a hotel.”