07/02,2012
ISSUE:502

                                 

Comprehensive News List
General Food Safety News/ Outbreak News/ Recall News/ New Methods News/
USDA/FDA News
/ On-Line Slides/ Job Information/Internet Journal of Food Safety


New Salmonella Outbreak Linked to Chicks and Ducklings From Estes Hatchery
Source : http://foodpoisoningbulletin.com/2012/new-salmonella-outbreak-linked-to-chicks-and-ducklings-from-estes-hatchery/
By Linda Larsen (June 26, 2012)
The CDC has announced a new outbreak of Salmonella linked to baby chicks and ducklings. This outbreak strain, Salmonella Montevideo, is different from the outbreak caused by the three strains we reported on earlier this month. Sixty-six people in 20 states are sick with the outbreak strain of Salmonella; 16 have been hospitalized; and one death has been reported, but the Salmonella infection wasn’t a contributing factor in that person’s death.

The case count is distributed among the following states:
¡áAlaska (1)
¡áCalifornia (2)
¡áColorado (1)
¡áGeorgia (1)
¡áIllinois (1)
¡áIndiana (8)
¡áIowa (2)
¡áKansas (10)
¡áKentucky (1)
¡áMassachusetts (1)
¡áMissouri (22)
¡áNebraska (5)
¡áNevada (1)
¡áNew York (1)
¡áNorth Carolina (1)
¡áOhio (1)
¡áOklahoma (4)
¡áSouth Dakota (1)
¡áVermont (1)
¡áWyoming (1)
Lab and epidemiological findings have linked this outbreak to baby poultry from the Estes Hatchery in Springfield, Missouri. Mail-order hatcheries that sell chicks and other baby birds should always provide health information to anyone who purchases them, including the risks of acquiring infections and illnesses from live poultry.
Thirty-five percent of the patients are 10 years old or younger. Patients range in age from less than 1 year to 83 years old. Forty-six percent of the ill are female. The illnesses began between February 28, 2012 and June 6, 2012. There may be more people who are sickened in this outbreak; if someone became ill after June 21, 2012, their illness may not be reported.


Of the 46 patients interviewed, 39, or 85%, had contact with live poultry before becoming ill. Of those, 38, or 97%, had contact with chicks or ducklings or both.
State health departments have tested chicken samples. Four samples from homes in California, Kentucky, Missouri, and Vermont had the outbreak strain of Salmonella Montevideo.

Washington State Warns of Increased Bacteria in Raw Oysters
Source : http://foodpoisoningbulletin.com/2012/washington-state-warns-of-increased-bacteria-in-raw-oysters/
By Linda Larsen (Jul 01,2012)
Right on the heels of a Vibrio outbreak in Missouri, the Washington state Department of Health is warning consumers to cook oysters before eating them. Traditionally, raw oysters are avoided in the summer months (months without an “R” in the name) because Vibrio parahaemolyticus grows more readily in brackish water during the warm summer months.
Jerrod Davis, director of the Department of Health’s Office of Shellfish and Water Protection, said in a statement, “Vibriosis is completely preventable. We want people to enjoy our state’s wonderful shellfish, and following some simple safety tips can help keep people healthy this summer.”
Most people cook shellfish, such as oysters, mussels, and clams, until the shells open. But that’s not enough to kill any bacteria that may be present. Shellfish should be cooked to a minimum internal temperature of 145 degrees F for at least 15 seconds to be safe.
If you boil shellfish, cook for 3 to 5 minutes after the shells open, then check the internal temperature with a food thermometer. If you choose to steam shellfish, cook for 4 to 9 minutes after the shells open. Check with that thermometer again.
Unfortunately, shellfish can be the source of other illnesses, according to the Department. The Office of Shellfish and Water Protection also monitors shellfish for biotoxins, such as paralytic shellfish poisoning (PSP), amnesic shellfish poisoning (ASP), and diarrhetic shellfish poisoning (DSP) that exist in the waters off the coast.
Those toxins are not destroyed by cooking; anyone who eats shellfish, cooked or raw, contaminated with those toxins can die. You can’t tell by looking at, smelling, or tasting shellfish if it contains those toxins; only lab tests can detect them.
There were 825 cases reported to the Centers for Disease Control and Prevention in 2009, the latest year for which statistics are available.
So before you harvest shellfish, stay safe by following these tips:
¡áCall the Biotoxin hotline at 1-800-562-5632 to see if the state has closed beaches for vibrio, biotoxins, or pollution.
¡áHarvest shellfish right after the tide recedes.
¡áDon’t harvest shellfish that have been sitting in the sun for more than two hours.
¡áChill shellfish on ice right after harvest
¡áCook shellfish to an internal temperature of 145 degrees F for 15 seconds.

149 Sick - 6th Salmonella Outbreak Linked to Turtles
Source :http://www.foodpoisonjournal.com/foodborne-illness-outbreaks/149-sick---6th-salmonella-outbreak-linked-to-turtles/?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+FoodPoisonBlog+%28Food+Poison+Blog%29
By Bill Marler (June 30,2012)
The CDC reports that a total of 149 persons infected with outbreak strains of Salmonella Sandiego, Salmonella Pomona, and Salmonella Poona have been reported from 28 states.
The number of ill persons identified in each state is as follows: Alabama (2), Alaska (2), Arizona (5), California (26), Colorado (5), Delaware (3), Georgia (3), Illinois (1), Indiana (1), Kentucky (1), Massachusetts (3), Maryland (6), Michigan (2), Minnesota (1), New Jersey (7), New Mexico (4), New York (25), Nevada (6), North Carolina (1), Ohio (2), Oregon (1), Pennsylvania (14), South Carolina (4), Tennessee (2), Texas (17), Vermont (1), Virginia (3), and West Virginia (1).
28 ill persons have been hospitalized, and no deaths have been reported.
64% of ill persons are children 10 years of age or younger, and 28% of ill persons are children 1 year of age or younger.
One new multistate outbreak linked to small turtles has been identified since the prior update on May 10, 2012. Overall, 6 multistate outbreaks of human Salmonella infection are linked with exposure to small turtles.

What is California link to Canadian E. coli cases linked to Romaine Lettuce?
Source :http://www.marlerblog.com/case-news/what-is-california-link-to-canadian-e-coli-cases-linked-to-romaine-lettuce/?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+MarlerBlog+%28Marler+Blog%29
By Bill Marler (June 30,2012)
The CBC reported yesterday that romaine lettuce is the likely source of an E. coli O157:H7 outbreak in Miramichi in April that sickened 18 at a Jungle Jim’s Restaurant. Dr. Eilish Cleary, the chief medical officer of health, said all of those in the study who were sick with E. coli O157:H7 appear to have consumed romaine lettuce.
"The lettuce was used in salads, as an ingredient in wraps and hamburgers and as a garnish. These results indicate a strong likelihood that contaminated lettuce was served at the restaurant,” Cleary said in a statement.
According to the CBC, the federal agency became aware that cases matching the E. coli O157:H7 strain involved in the Miramichi outbreak had also been identified in Quebec AND CALIFORNIA.
So, is the California case an ill person who ate lettuce in Canada and came to California, or ate lettuce in California - and where did the lettuce come from - California?  Canada?  Some where else?
Well, according to the CBC:
The lettuce is no longer in the marketplace and the investigation has been closed, the department said.
Boy, don't you feel better now?

Norovirus cause of sickness at Notre Dame
Source :http://www.southbendtribune.com/news/sbt-norovirus-cause-of-sickness-at-notre-dame-20120629,0,6226797.story?track=rss&utm_medium=twitter&utm_source=twitterfeedBy South Bend Tribune (June 29,2012)
Laboratory tests have confirmed norovirus as the cause of a gastrointestinal outbreak that affected 106 students attending sport camps earlier this week at the University of Notre Dame, St. Joseph County Health Officer Dr. Thomas A. Felger said Friday.
A total of 29 students were treated and released from local emergency departments for the intestinal illness.
Norovirus is a contagious virus, and is the most common “stomach bug” in the United States, Felger said.
Norovirus can be spread by an infected person, contaminated food or water, or by touching contaminated surfaces. Symptoms usually occur 12 to 48 hours after exposure, and include diarrhea, stomach pain, nausea and vomiting. Most people recover in 1 to 3 days, but remain contagious for up to two weeks after recovery.
Hand washing is the most effective way to prevent the spread of norovirus, according to the county health department.

Food flops: Avoid holiday disasters with some basic safety precautions in handling those goodies
Source :http://www.courier-journal.com/article/20120628/PRIME04/306280040/food-safety-fourth-of-july-picnics-fireworks-fun?odyssey=tab%7Ctopnews%7Ctext%7CFeatures
By Darla Carter (June 29,2012)
Even the most well-meaning cooks and grill masters can turn the family barbecue or picnic into a food-safety disaster.
“Many people will tell me they had the stomach flu and, in fact, probably it was something that they ate,” said Cynthia Chandler, a culinary nutritionist at Sullivan University in Louisville. “But the symptoms are rather vague in that your stomach hurts. You have diarrhea. Sometimes you’re throwing up, and you never often pinpoint the food.”
With Fourth of July fast approaching, Chandler recommends taking basic safety precautions to protect relatives and guests, especially older people and others who are vulnerable to food poisoning or food-borne illnesses, such as E. coli, salmonella and listeria infections.
Along with the elderly, “preschoolers are particularly susceptible to food poisoning,” Chandler said. “Also, anybody on chemotherapy is at very high risk” as are people with weakened immune systems.
Dr. Michael Newkirk, a Louisville physician who used to practice emergency medicine in Western Kentucky, agreed that food-borne illness is a concern during this time of year.
While practicing in Madisonville, Ky., “we absolutely saw this every summer, without fail, that you’d get folks with both fireworks and food-related injury and illness,” said Newkirk, who’s now the medical director of Baptist Community Health Services.
Risks range from undercooked hamburger to “watermelon that’s cut at home, transported in the car and served without refrigeration,” Chandler said.
Chandler recommends rinsing melons at home and cutting them at the picnic location. If you choose to slice the fruit ahead of time, keep it chilled on ice during transport.
Also, it’s good to invest in an inexpensive food thermometer — purchased at a grocery story or other retailer — to make sure that meat has reached the right temperature on the grill.
Simply eyeballing the meat will not tell you whether it’s reached a safe internal temperature, Chandler said. The U.S. Department of Agriculture recommends that all raw ground beef, pork, lamb and veal be cooked to an internal temperature of 160 degrees and that poultry be cooked to an internal temperature of 165 degrees.
“People will think that hamburger is done because it looks charred on the outside,” Chandler said. “They put it (the burger) on your plate. You bite into it, and all of a sudden, you see a lot of the red still there.”
On the way to the barbecue site, such as a park, Chandler recommends that raw meat be kept in a separate cooler from other products. That will help keep meat juices from dripping on other things.
Also, coolers that contain drinks get “opened and closed so much that the temperature variation can affect foods in there, so just have a separate cooler for your drinks,” Chandler said.
It’s also important not to leave foods that can spoil out too long because they will become a breeding ground for bacteria. Such foods can be left out for two hours when the weather is relatively mild (less than 90 degrees), but when it’s hotter, perishable food can only be left out for an hour safely.
It’s also important to maintain foods at proper temperatures. “The rule of thumb is if you keep the hot things hot and the cold things cold, you’ll be better off,” Newkirk said.
Keeping your hands clean also is important, especially if you’re the cook.
“Washing your hands is an exceptionally important thing, especially when you’re dealing with raw meats,” Newkirk said. “Raw meat really carries a lot of bacteria, and if you don’t wash your hands you’re going to cross-contaminate into your things that are not high bacteria-laden things.”
Sometimes, grill masters “touch the hamburger raw and then they’ll touch it when it’s cooked,” Chandler said.
But, of course, dirty hands can be a problem for anyone at the picnic. If there’s no water available, have a backup.
“Take hand sanitizer with you,” Chandler said. “It does not do the exact job that 20 seconds of scrubbing and washing your hands does, but it does a darn good job.”
Watch out for dirty plates as well. “They’ll use the plate that they’ve brought the raw meat out on to throw the buns on and then put the meat on it ...” Newkirk said. “You really need to wash those plates right away and then you can reuse them after washing.”

CDPH Warns Not to Eat Certain Banner Mountain Organic Sprouts
Source : http://www.cdph.ca.gov/Pages/PH12-028.aspx
By CDPH (June 27,2012)
California Department of Public Health (CDPH) Director Dr. Ron Chapman today warned people not to eat Banner Mountain Organic Alfalfa Sprouts, Organic Clover Sprouts, and Organic Sprout Blends containing alfalfa or clover sprouts, because these products may be contaminated with Salmonella. To date, no illnesses have been reported.
Banner Mountain Sprouts, Inc. of Sacramento initiated a voluntary recall after learning that a routine surveillance sample of its sprouts tested positive for Salmonella. The recalled sprouts have “sell by” dates between June 17, 2012 and July 6, 2012 and were distributed to retail and wholesale locations throughout California.
The recalled sprouts were packaged in clear four- and five-ounce plastic “clamshell-type” containers, and one- and two-pound plastic bags with labels applied to each. The following product labels are currently being recalled by Banner Mountain Sprouts:
• Alfalfa Sprouts – 1 and 2 pound plastic bags / 4 ounce plastic container
• Clover Sprouts – 1 pound plastic bag / 4 ounce plastic container
• Zesty Greens – 4 ounce plastic container
• Sprout Salad – 5 ounce plastic  container
•Alfalfa-Broccoli Sprouts – 4 ounce plastic container
Consumers in possession of these recalled sprout products should discard or return to the store of purchase for refund. Symptoms of Salmonella infection include fever, abdominal cramps, and diarrhea which may be bloody. Most infected people recover within a week. Some may develop complications that require hospitalization. Infants, the elderly, and people with weakened immune systems are at highest risk for more severe illness.

USDA offers food safety tips in advance of hurricane season
Source : http://www.thepostsearchlight.com/2012/06/26/usda-offers-food-safety-tips-in-advance-of-hurricane-season/
By Sarah Okeson (June 26,2012)
The U.S. Department of Agriculture’s Food Safety and Inspection Service (FSIS) is urging residents of coastal states to plan ahead this hurricane season and minimize the potential for foodborne illness in the event of power outages, flooding, and other problems that could be associated with weather emergencies.
“As you prepare your home for hurricane season, remember to protect food from being exposed to contaminated water or unsafe storage temperatures in a power outage,” USDA Under Secretary for Food Safety Dr. Elisabeth Hagen said. “When it comes to emergencies of any kind, planning ahead is always the best strategy to help reduce the risk of foodborne illness.”
FSIS encourages those living in coastal areas to be prepared, particularly when it comes to ensuring access to safe food and water after weather emergencies. Families should have an emergency plan in place that includes food and water safety precautions.
Steps to follow to prepare for a possible weather emergency:
• Keep an appliance thermometer in the refrigerator and freezer to help determine if food is safe during power outages. The refrigerator temperature should be 40 degrees Fahrenheit or lower and the freezer should be 0 degrees F or lower.
• Store food on shelves that will be safely out of the way of contaminated water in case of flooding.
• Group food together in the freezer — this helps the food stay cold longer.
• Freeze refrigerated items such as leftovers, milk and fresh meat and poultry that you may not need immediately — this helps keep them at a safe temperature longer.
• Have coolers on hand to keep refrigerator food cold if the power will be out for more than four hours.
• Purchase or make ice and store in the freezer for use in the refrigerator or in a cooler. Freeze gel packs ahead of time for use in coolers.
• Plan ahead and know where dry ice and block ice can be purchased.
Steps to follow if the power goes out:
• Keep refrigerator and freezer doors closed as much as possible.
• A refrigerator will keep food cold for about 4 hours if you keep the door closed.
• A full freezer will keep its temperature for about 48 hours (24 hours if half-full).
• If the power is out for an extended period of time, buy dry or block ice to keep the refrigerator as cold as possible. Fifty pounds of dry ice should keep a fully-stocked 18-cubic-feet freezer cold for two days.

Salmonella Escapes for Clark College Lab
Source : http://www.marlerblog.com/
By Sarah Okeson (June 26,2012)
KOIN TV Sally Showman reported on a very interesting way of contracting Salmonella.
A teenager was sickened by a strain of Salmonella that originated inside a Clark College microbiology lab earlier this month.
"We believe the child could have been infected one of two ways," Catherine Kroll, an epidemiologist with the Clark County Public Health Department (CCPH) said. "The first could be that the person working in the lab became ill and brought that home... Or that person brought home items that were used in the lab, such as pens and pencils and those were then used by the child."
Clark College spokeswoman Barbara Kerr released a written statement last Friday morning:
"This type of incident has never happened before in our nearly 79-year history, but one time is one too many. We appreciate the opportunity to work closely with Clark County Public Health to ensure that we are implementing best practices in our classrooms.  The safety of our students always comes first."
CCPH did a review of Clark College lab procedures after the case of salmonella was reported.
"One of the big recommendations we made involved taking personal items in and out of the lab," Kroll said.  "Often, students will bring pens and pencils from home and use them in the laboratory, and what we've recommended, is that Clark College actually purchase pens and pencils and keep them in the lab and not have students take them back and forth."
You have to wonder how often this really does happen?  Earlier this year the CDC reported that it had collaborated with public health officials in several states to investigate a multistate cluster of Salmonella Typhimurium infections associated with exposure to clinical and teaching microbiology laboratories.  Apparently, between August 20, 2010 and June 29, 2011, a total of 109 individuals infected with strain X of Salmonella Typhimurium were reported from 38 states: AK (2), AL (4), AZ (4), CA (3), CO (1), FL (1), GA (6), IA (1), ID (2), IL (4), IN (2), KS (4), KY (4), MA (4), MD (3), MI (3), MN (9), MO (2), NC (1), ND (1), NE (2), NH (1), NJ (3), NM (3), NV (1), NY (4), OH (3), OK (1), OR (1), PA (9), SC (2), SD (1), TN (2), TX (1), UT (4), WA (5), WI (4), and WY (1). Among persons with available information, illness onset dates range from August 20, 2010 to June 14, 2011, 2011. Infected individuals ranged in age from less than 1 year to 91 years old, and the median age was 21 years. Sixty-one percent of patients were female. Twelve percent of patients were hospitalized. One death was reported.

Area health departments put swimming holes to the test
Source : http://www.kplctv.com/story/18874426/recent-ecoli-outbreak-calls-attention-to-food-safety-rules
By Sarah Okeson (June 26,2012)
Gwyn Rippy, now 28, has memories of Pecker’s Beach on the James River from about the time she could walk.
On the Fourth, people used to set off fireworks. There were rocks to explore up the river. She and her friends played on a rope swing.
“We come down here quite often,” said Rippy, who brought her two children Monday to the beach near Farm Road 164. “It’s the cleanest and closest place.”
Area health departments test popular swimming holes during the summer to monitor levels of E. coli bacteria tied to the presence of fecal matter. The results in Greene County are posted on the website of the Springfield-Greene County Health Department.
“We only test the public swimming holes that people have access to,” said Karen McKinnis, a community and environmental health planner.
In Greene County, that includes the James River, Galloway Creek, Lake Springfield, Little Sac River and Wilson’s Creek. The most recent results, posted after tests Tuesday, found acceptable levels of E. Coli at all the Greene County sites except on Galloway Creek near U.S. 65 and U.S. 60.
McKinnis said the health department doesn’t tell people not to go in rivers with high levels of E. coli.
“It could be — and probably is — quite different than it was then,” McKinnis said. “We just say use good hygiene when you’re in a natural body of water. Don’t drink or ingest the water. Don’t go in if you have a cut or a sore. Wash your hands before having a picnic.”
Greene County officials said they use the standard set by the U.S. Environmental Protection Agency of less than 235 colony forming units of E. coli in 100 millileters of water.
Nicole Boucher, a volunteer with the Watershed Committee of the Ozarks, collects samples on Tuesdays.
“We try to look for places where the water is flowing really quickly,” she said.
The health departments in Christian and Stone counties also test water from area swimming holes.
Cindy Bilyeu, the administrator for the Christian County Health Department, said the department will put up a notice on a public board near the swimming hole if there are problems with the water.
In Taney County, the health department doesn’t test area streams but relies on the Missouri Department of Natural Resources.
“We currently do not test natural recreational waters,” said Jean Mueller, a spokeswoman for the Taney County Health Department.
Angel Woods of Springfield brought her 8-year-old son, Brayden, to the James River on Monday.
“There are a lot of areas that are shallow enough for little kids,” Woods said. “It’s nice to be with nature instead of smelling like chemicals. I’d rather be out here than in chlorine.”

Norovirus Infection Rates Correlate with Google Search Trends for Symptoms
Source : http://www.kplctv.com/story/18874426/recent-ecoli-outbreak-calls-attention-to-food-safety-rules
By James Andrews (June 25,2012)
Trends in Google internet searches for norovirus symptoms strongly correlate with rates of norovirus infection, suggesting internet searches could serve as reliable surveillance tools for diseases prone to seasonal variations, according to a study conducted by researchers at the U.S. Centers for Disease Control and Prevention and Google Labs in Tel-Aviv, Israel.
The study, published in the July 2012 edition of Clinical Infectious Diseases, tracked rises and falls in Google internet searches for certain keywords and phrases related to gastroenteritis, such as "diarrhea," "vomiting," and "stomach virus," that could indicate a norovirus infection. Norovirus is the most common cause of gastroenteritis in the U.S., responsible for an estimated 21 million illnesses a year.
The researchers then compared the Google data to trends in lab-confirmed norovirus infections around the nation. If the searches matched up with the rates of confirmed cases, the researchers would uncover a new method of tracking the activity of norovirus, a pathogen with very scarce amounts of surveillance up until now.
The result? The searches and the known cases matched up almost perfectly.
"I think we were surprised at just how strong the correlation was," said Benjamin Lopman, epidemiologist at the Division of Viral Diseases at the CDC and one of the study's co-authors. "Even having to rely on general search terms, they still match up very well with the actual outcome."
Each year, norovirus infections see a rise in October, November and December before peaking in January or February. Looking at national search data for four years from 2007 to 2010, the researchers found that searches and infections peaked in the same month twice and followed very similar patterns from year to year.
They also tested their theory at a smaller scale, analyzing gastroenteritis searches and norovirus illnesses in Boston, Massachusetts from 2006 to 2011. Again, the data showed significant correlation.
"We have, potentially, a timely surveillance tool that can be used on various levels of public health surveillance," Lopman told Food Safety News. "Not only can we look at activity on a national level, we can also look at it on a local level in a way we couldn't with lab data."
Because the timing and magnitude of norovirus infections varies from year to year, public health officials have few methods at their disposal to monitor norovirus activity fast enough to react. Knowing that internet searches could provide insight into the pathogen's infection rates means clinics and health officials can react accordingly. Similar techniques have already been put to use when looking at influenza infection rates.
But the method isn't perfect. As Lopman pointed out, media coverage of major illness events -- such as the case of H1N1 a few years ago -- can disrupt the technique's reliability, as a far larger number of people begin searching about the event than just those actually affected by it.
Lopman added that health professionals could likely use the internet search technique for most pathogens prone to seasonal variation, such as many of the most notorious foodborne illness-related pathogens such as E. coli and Salmonella, which typically see increased infection rates in the summer.
Considering an estimated 90 percent of those who suffer from a norovirus infection never seek medical attention, Lopman said he hopes that in coming years the method might provide public health with an economical, instantaneous approximation of infection rates among any given location when more traditional methods are not a possibility.

From the paper: (Panel A) Norovirus Google search data (blue) for the entire US population were compared with estimated norovirus?associated hospital discharges (red) from January 1, 2004 through June 30, 2007. (Panel B) Norovirus Google search data (blue) for 30 US states were compared with norovirus outbreak surveillance data (red) from January 1, 2007 through April 30, 2010.

From the paper: Norovirus Google search data (blue) for Boston compared with the proportion of llnesses in the Boston Public Health Commission syndromic surveillance system for gastrointestinal illness (red) from January 1, 2006 through July 2, 2011.

Recent E.coli outbreak calls attention to food safety rules
Source : http://www.kplctv.com/story/18874426/recent-ecoli-outbreak-calls-attention-to-food-safety-rules
By E'Lyn Taylor (June 26,2012)
The following is a Press Release from the LSU AgCenter:
The recent outbreak of foodborne illness in several southern states, including the death of a young girl in New Orleans, calls attention to the need for individuals to follow food safety practices, says LSU AgCenter nutritionist Beth Reames.
The outbreak and death have been linked to E. coli 0145, a strain of bacteria that produces a deadly toxin that can cause severe kidney damage and death, Reames said.
Most strains of E. coli are harmless and live in the intestines of animals, including humans. But several of them can cause mild to serious disease. Symptoms of E. coli infection include a mild fever, severe abdominal and stomach cramps, diarrhea – which is often bloody – and vomiting.
Some people, especially young children and the elderly, can develop Hemolytic Uremic Syndrome (HUS), a condition that can lead to serious kidney damage and even death, as a result of exposure to the Shiga-toxin produced by some strains of E. coli. 
Several outbreaks of the E. coli 0157:H7 strain infection have occurred in recent years. These outbreaks were associated with undercooked or raw hamburger, alfalfa sprouts, contaminated lettuce and other leafy greens, unpasteurized fruit juices, game meat, dry-cured salami, cheese curds and raw milk, Reames said.
"We're finding more strains of E. coli bacteria besides the 0157 strain," said Marlene Janes, LSU AgCenter food scientist.
Because of this, the U.S. Department of Agriculture Food Safety Inspection services have begun testing ground beef for additional strains of E. coli, Janes said.
"Food can become unsafe to eat at any step in the flow of food – where it is grown, during packaging and shipping, or when it is prepared for eating," Reames said. "Although the American food supply is generally safe and wholesome, disease-causing microorganisms can be anywhere, and research to prevent foodborne illness is ongoing."
Petting zoos are another way for children to come in contact with E. coli bacteria, Janes said.
"I don't recommend taking children to petting zoos," Janes said. "But if you do, make certain the children thoroughly wash their hands. If they get fecal matter on their clothes, make sure the clothes are washed, too."
Most foodborne illness can be prevented by following basic food safety rules:
– At the grocery, choose frozen and refrigerated items last so they remain cold until you get home.
– Refrigerate or freeze perishable foods as soon as you get home.
– Wash hands, utensils and work surfaces often, both before and after preparing foods.
– Don't allow raw meats, poultry or seafood (or their juices) to contact and contaminate other foods. Keep raw food separate from ready-to-eat or already cooked foods.
– Use one cutting board for fresh produce and a separate one for raw meat, poultry and seafood.
– Cook meats to recommended temperatures using a food thermometer.
– Cook all raw ground beef, pork, lamb and veal to an internal temperature of 160 degrees as measured with a food thermometer.
– Cook all poultry to an internal temperature of 165 degrees as measured with a food thermometer.
– Marinate food in the refrigerator, not at room temperature on the counter.
– Thaw food in the refrigerator, under cold tap water or in the microwave, not on the counter.
– When preparing fruits and vegetables, cut away any damaged or bruised areas because bacteria that cause illness can thrive in those places. Remove and discard outer leaves.
– Wash fresh fruits and vegetables thoroughly in clean, running water. Immediately refrigerate any fresh-cut items such as salad or fruit for best quality and food safety.
– Refrigerate leftovers promptly and reheat leftovers to 165 degrees before eating.
– Don't leave cooked food out at room temperature for more than two hours, one hour when the temperature is above 90 degrees.
– Use leftovers within a few days of preparation.
"I always add, When in doubt, throw it out!" Reames said.

Another Salmonella outbreak linked to mail-order chicks, ducklings
Source : http://www.cidrap.umn.edu/cidrap/content/fs/food-disease/news/jun2512chicks.html
By Lisa Schnirring  Staff Writer (June 25,2012)
The US Centers for Disease Control and Prevention (CDC), along with public health and agriculture officials in several states, is investigating a Salmonella Montevideo outbreak linked to chicks and ducklings from a Missouri company's mail-order hatchery.
The outbreak is the fourth Salmonella outbreak linked to mail-order chicks and ducklings to surface since 2011.
In a statement today the CDC said it has received reports of 66 illnesses in 20 states, about half of the cases in Kansas and Missouri. Sixteen of the patients were hospitalized.
One death was reported, but the Salmonella infection wasn't considered a contributing factor. The CDC said about 35% of the sick people are children age 10 or younger.
For cases reported so far, illness onsets began between Feb 28 and Jun 6.
Trace-back, epidemiologic, and lab investigations have linked illnesses to chicks and ducklings from Estes Hatchery in Springfield, Mo. Thirty of 36 sick patients with purchase information had reported buying live baby poultry from various locations of 13 different agricultural feed store companies in multiple states. Five more purchased baby poultry directly from mail-order hatcheries.
Sick patients reported buying the poultry for backyard flocks to produce for eggs or meat or to keep as pets. State health department testing of chick samples from sick patients' homes in California, Kentucky, Missouri, and Vermont yielded the outbreak strain.
Health officials are using PulseNet, the CDC's national subtyping network, to identify more cases that may be part of the outbreak. The CDC said the hatchery owners are cooperating with the investigation.
Another Salmonella outbreak involving chicks and ducklings from a different mail-order hatchery in Ohio has so far sickened 123 people from 25 states, according to a Jun 7 CDC update. That outbreak involved three different Salmonella strains: Infantis, Newport, and Lille.
Last year, the CDC and its partners linked two Salmonella outbreaks to chicks and ducklings to the same mail-order hatchery in Ohio. The outbreaks involved two different outbreaks strains. The Salmonella Altona outbreak sickened 68 patients in 20 states, and the Salmonella Johannesburg outbreak sickened 28 patients in 15 states.
The CDC has said that contact with live poultry poses a risk of Salmonella infections. It has urged mail-order hatcheries, agricultural feed stores, and others who sell or display chicks or ducklings to provide health information for owners and at the point of purchase for potential buyers.

Can Animals Make Us Sick? Yes.
Source : http://foodpoisoningbulletin.com/2012/can-animals-make-us-sick-yes/
By Carla Gillespie (June 25,2012)
Animal Health was the topic of a June 22 event on Capitol Hill called “From Fido to Food Safety: Roles, Responsibilities and Realities Veterinarians Face in Protecting Public Health,” that was hosted by the American Veterinary Medical Association and the Animal Health Institute.
During his keynote address, USDA Chief Veterinary Officer John Clifford, stated that zoonotic diseases, which are diseases that are transmitted from animals to humans, have accounted for 75 percent of emerging infectious diseases among humans over the last three decades.
Zoonotic diseases include diseases that can be contracted from contact with live animals such as rabies or Lyme’s disease and from animals used as a food sources such as Salmonella and E.coli.
So far this year there has been: one Salmonella Sandiego outbreak linked to pet turtles that sickened 124 in 27 states;  two Salmonella outbreaks associated with contact from live chicks and ducks: a Salmonella Montevideo outbreak that has sickened 66 people in 20 states and a Salmonella Infantis outbreak that has sickened 123 in 25 states, and one Salmonella Infantis outbreak associated with tainted pet food. And every year, hundreds of thousands of Americans contract food poisoning from meat or poultry tainted with Salmonella or E.coli.
To improve the health and well being of animals and humans, the USDA has created a program called One Health which operates on the premise healthy livestock and pets lead to healthy people and sound environments.
“Veterinarians are the critical link to ensuring a safe food supply and effectively dealing with zoonotic diseases – diseases that can be transmitted from animals to humans,” Alex Mathews, president and CEO of the Animal Health Institute, said in a statement.  “It is this vital link and the important role they play in maintaining animal health to protect human health that was the basis for Wednesday’s important discussion.”
To take a quiz about zoonotic diseases, visit the healthanimals.org website

Job openings
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06/28. Food Safety Senior Manager – Elkhart Lake, WI
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Outbreak of Vibrio in Missouri
Source : http://foodpoisoningbulletin.com/2012/outbreak-of-vibrio-in-missouri/
By Carla Gillespie (Jul 01, 2012)
The Missouri Department of Health and Senior Services (DHSS) has announced there is an outbreak of Vibriosis in eastern Missouri. The illnesses are caused by Vibrio parahaemolyticus, which is usually associated with eating raw or undercooked shellfish, particularly oysters.
Three cases of the illnesses have been identified June 27 and 28, 2012. Risk factors for acquiring this disease include eating raw or undercooked oysters, clams, mussels, or crabs; or cross-contamination of other foods or surfaces with raw seafood. The bacteria lives in brackish water and grows easily in warm water during the summer months.
Symptoms of the illness include nausea, vomiting, watery diarrhea, and abdominal cramps. Some people become very ill, with fever and low blood pressure; those with weakened immune systems are most at risk for complications. The symptoms usually start 4 to 96 hours (3 days) after eating contaminated food.
When Vibirosis is diagnosed, the disease must be reported to public health authorities within three days. Health workers should call DHSS at 800-392-0272 to report any new cases; that line is open 24/7.

Update on Multistate Outbreak of Salmonella Linked to Small Turtles
Source : http://foodpoisoningbulletin.com/2012/update-on-multistate-outbreak-of-salmonella-linked-to-small-turtles/
By Linda Larsen (Jul 01, 2012)
The CDC has released updated information about multistate outbreaks of Salmonella linked to small turtles. So far, 149 people in 28 states are infected with outbreak strains of four types of bacteria: Salmonella Sandiego, Salmonella Pomona, Salmonella Newport, and Salmonella Poona. We’ve told you about this outbreak in March 2012 and again in May 2012. In the last update, there were five outbreaks; now there are six.
The case count is as follows:
¡áAlabama (2)
¡áAlaska (2)
¡áArizona (5)
¡áCalifornia (26)
¡áColorado (5)
¡áDelaware (3)
¡áGeorgia (3)
¡áIllinois (1)
¡áIndiana (1)
¡áKentucky (1)
¡áMassachusetts (3)
¡áMaryland (6)
¡áMichigan (2)
¡áMinnesota (1)
¡áNew Jersey (7)
¡áNew Mexico (4)
¡áNew York (25)
¡áNevada (6)
¡áNorth Carolina (1)
¡áOhio (2)
¡áOregon (1)
¡áPennsylvania (14)
¡áSouth Carolina (4)
¡áTennessee (2)
¡áTexas (17)
¡áVermont (1)
¡áVirginia (3)
¡áWest Virginia (1)
These are the outbreaks the CDC is following:
Outbreak 1: Salmonella Sandiego, Strain A, and Salmonella Newport, Strain A
A total of 62 people are infected with these bacterial strains. Seven new cases are reported in this outbreak, from California (3), New Mexico (1), Nevada (1) and Texas (2). Illness onset dates range from August 3, 2011 to May 24, 2012. Age range is 1 to 86 years; median age is 8 years. Ten people have been hospitalized.
Outbreak 2: Salmonella Pomona, Strain A
A total of 11 people in 8 states are infected with this bacteria. There are two new cases, from New York and Pennsylvania. Illness onset dates range from December 9, 2011 to May 29, 2012. Age range is less than 1 year to 90 years; median age is 16 years. Three people have been hospitalized.
Outbreak 3: Salmonella Poona, Strain A
A total of 17 people have been reported from 9 states in this outbreak. Two new cases are from Tennessee and Texas. Illness onset dates range from October 20, 2011 to April 6, 2012. Age range is less than 1 year to 70 years; the median age is 3 years. Sixty-nine percent of patients are female. Four are hospitalized.
Outbreak 4: Salmonella Sandiego, Strain B
No new cases are reported since the update on May 10, 2012.  At that time, six people were ill with this outbreak strain in 3 states. Age range is less than 1 year to 65 years old; the median age is 17 years. One person was hospitalized.
Outbreak 5: A total of 47 people have been reported from 18 states. the 8 new cases are from Alabama (1), Arizona (1), California (2), Nevada (1), South Carolina (1), Tennessee (1), and Texas (1). Illness onset dates range from June 21, 2011 to June 16, 2012. The patient age range is from less than 1 year to 86 years; median age is 2. Forty-nine percent of the patients are female. Nine people have been hospitalized.
Outbreak 6: Salmonella Poona, Strain B
A total of six people infected with this outbreak strain have been reported from 3 states: Arizona (1), Pennsylvania (4), and Texas (1). Illness onset dates are from April 1, 2012 to May 26, 2012. The patient age range is from less than 1 year to 74 years; median age is 8 years. One person has been hospitalized.
According to the CDC, 64% of the patients are 10 years of age or younger, and 28% are 1 year of age or younger. Exposure to small turtles or their environments, such as water from a turtle habitat, is the cause of these outbreaks.
Ninety-four percent of ill persons with turtle exposure specifically reported exposure to small turtles less than 4 inches in length. Thirty-three percent of the patients purchased turtles from street vendors, which makes it very difficult to determine the source of the turtles. Small turtles are a well-known source of human Salmonella infections, especially among young children. The FDA has banned the sale and distribution of these animals as pets since 1975.
Amphibians and reptiles can carry Salmonella and still appear healthy. The bacteria are shed in the animal’s droppings and contaminate their bodies and everything in their habitats.

Sodium Azide Poisoning at a Restaurant
Source : http://drjudystone.visibli.com/share/HsWN2V
By Kathy Will (June 26, 2012)
In April 2010, Dallas County Health and Human Services (DCHHS) staff members investigated reports of acute-onset dizziness among patrons in a local restaurant. Symptoms, which included fainting resulting from low blood pressure, occurred within minutes of consuming food from the restaurant and were consistent with chemical poisoning. Toxicologic and epidemiologic investigations were begun to determine the cause of the poisonings and identify potentially exposed persons. This report summarizes the results of those investigations, including a case-control study that identified iced tea as the likely contaminated food or drink (odds ratio [OR] = 65; 95% confidence interval [CI] = 2.4–3,292). Approximately 5 months after the incident, extensive laboratory testing identified sodium azide (NaN3) and hydrazoic acid (formed when sodium azide contacts water) as the toxic agents in the iced tea. All five ill restaurant patrons recovered from their symptoms. For rapid-onset foodborne illnesses, chemical poisons should be considered as a potential cause, regardless of negative initial toxicologic screening tests. Although unusual chemicals can be challenging to detect, a multidisciplinary approach involving public health officials and forensic and medical toxicologists can lead to appropriate testing. In the absence of an identified agent, epidemiologic tools are valuable for active case-finding and confirming suspected contaminated food vehicles.
Multi-Agency Investigation
In April 2010, city fire and police departments notified a city health department in Texas of four persons transported from a restaurant to an emergency department (ED) over a period of 4 hours, after developing similar symptoms minutes after consuming iced tea from paper cups filled from a self-serve urn. Symptoms included lightheadedness, nausea, and diaphoresis (Table). The city fire department, responding to emergency medical services calls, contacted the police and the city environmental health departments after a third call came from the same restaurant. These agencies conducted a site visit that evening and temporarily suspended further sale of the iced tea. Samples of the iced tea were collected by authorities from restaurant tea urns and from two patients who brought their paper cups of iced tea to the ED.
Laboratory and radiographic diagnostic tests performed in the ED did not reveal a cause for the illness; none of the four patients were acidotic. Toxicologic evaluation in the ED, consisting of serum ethanol concentrations and urine drug screens, was nondiagnostic. All four patients received supportive treatment and were discharged either that night or after an overnight hospitalization. Upon learning of the cases, DCHHS epidemiology and environmental health staff members obtained and reviewed medical records, interviewed the patients and restaurant staff members, and conducted a site visit. Because of a high suspicion for chemical etiology, DCHHS staff members consulted with multiple agencies, including the Dallas County Southwestern Institute of Forensic Sciences (SWIFS), Food and Drug Administration, Texas Department of State Health Services, and medical toxicologists at the University of Texas Southwestern School of Medicine (UTSW) and the North Texas Poison Center, regarding testing for possible etiologic agents. A comprehensive list of potential agents was developed by medical toxicologists; the list included metabolic inhibitors (e.g., cyanide and sodium azide), heavy metals (e.g., arsenic), antihypertensives, organophosphates, and sedatives. Toxicologists at SWIFS and UTSW assisted in identification of laboratories capable of conducting appropriate testing.
To determine whether other cases existed, the Electronic Surveillance System for the Early Notification of Community-based Epidemics (ESSENCE) database was searched for patients with similar symptoms visiting any of 18 area EDs on the same day and during the same timeframe as the four patients. Of 1,827 ED visits recorded in ESSENCE that day, 81 patients reported symptoms of altered mental status, dizziness, fainting, tingling, or hypotension. Records of these cases were reviewed by DCHHS staff members and excluded if alternate diagnoses were well documented. Of 29 cases selected for further review, one additional case belonging to the restaurant cluster was identified. The patient (Table, patient 3) initially was taken by relatives to the same hospital as the other four patients and registered a chief symptom of "tingling" at triage, but left the ED before evaluation by a physician. The patient was then examined at an outpatient clinic and referred to a different ED because of hypotension and arrhythmia.
The five patients visited the restaurant separately, over a 4.5-hour period, beginning in the afternoon. All five patients reported that iced tea was the only beverage they consumed at the restaurant; the amount of consumption ranged from two sips to 8 ounces (Table). All of the tea came from a single self-serve urn that was in service during the period the five visited the restaurant. Regarding the food items in common, two reported eating a cookie and three reported eating bites of a sandwich. The five patients ranged in age from 32 to 52 years; three were women. Among the five, comorbidities included hypertension, anemia, hypothyroidism, hyperlipidemia, and a bicuspid aortic valve condition. Their initial heart rates at examination ranged from 62 bpm to 127 bpm; blood pressures ranged from 84/42 mmHg to 110/68 mmHg. Three of the five were discharged from the ED, and two were hospitalized (Table).
Case-Control Study
Because no contaminated vehicle was confirmed immediately, a case-control study was conducted to assess the association of the illnesses with specific food and drink. Potential controls were identified among the restaurant patrons and contacted by using records of credit card transactions. A case-patient was defined as a restaurant patron reporting dizziness or fainting within a 6-hour period that encompassed the time of symptom onset for the five known patients. Controls were patrons who purchased food or drink at the restaurant during the same timeframe and did not report dizziness or fainting after their meal. Thirteen of the 14 controls said they did not consume iced tea. The fourteenth control recalled drinking iced tea but having no symptoms; however, further investigation revealed that this person drank iced tea from a different self-serve urn, before the urn used by the five case-patients was placed in service. The case-control study found that consuming iced tea was 65 times more likely among the case-patients than the controls (OR = 65.0; CI = 2.4–3,292).
Testing of iced tea samples by SWIFS was negative for approximately 100 different chemicals and drugs, except for caffeine. The following analyses were performed: gas chromatography/mass spectrometry to screen for drugs (including gamma-hydroxybutyric acid, diltiazem, labetalol, metoprolol, propranolol, and verapamil), atomic absorption spectrometry with hydride generation for arsenic analysis, chemical tests for cyanide, a Geiger counter scan for radioactivity, and gas chromatography to identify alcohols and other volatiles. Samples also were sent to a private toxicology laboratory to test for nitrites and nitrates; all of those samples were positive because nitrites and nitrates were components of the leaves used to brew the tea. SWIFS then referred tea samples to the Federal Bureau of Investigation (FBI).
Detection of Sodium Azide
Nearly 5 months after the restaurant incident, headspace gas chromatography/mass spectrometry analysis by the FBI laboratory detected hydrazoic acid, which is formed when sodium azide contacts water. The presence of hydrazoic acid led to the use of infrared spectroscopy to detect sodium azide. Both chemicals were found in three samples: two from patients' paper cups and one from the tea urn in use at the time of the incident. No sodium azide or hydrazoic acid was found in a control sample from a second tea urn used earlier that day. Neither chemical compound was used in the FBI laboratory or at the restaurant.
The mechanism by which the tea became contaminated with sodium azide remains unknown. Investigators learned that water for the tea and soda served in the restaurant came from a common line. The self-serve iced tea urns were kept in an open location in the restaurant, accessible by customers, and out of the direct line-of-sight of employees.
After receiving notification of sodium azide as the etiologic agent, all five patients were evaluated in the medical toxicology clinic at UTSW and were confirmed to have fully recovered, without clinical sequelae. The police investigation is now closed.
Reported by
Evan S. Schwarz, MD, Paul M. Wax, MD, Kurt C. Kleinschmidt, MD, Kapil Sharma, MD, Univ of Texas Southwestern School of Medicine and North Texas Poison Center; Elizabeth Todd, PhD, Erin Spargo, PhD, Dallas County Southwestern Institute of Forensic Sciences; Wendy M. Chung, MD, Gabriela Cantu, MPH, Mariama Janneh, MPH, Juan Rodriguez, MPH, Taye Derse, MD, Dallas County Dept of Health and Human Svcs. Joshua G. Schier, MD, Div of Environmental Hazards and Health Effects, National Center for Environmental Health, CDC. Corresponding contributor: Evan S. Schwarz, schwarze@wusm.wustl.edu, 314-747-3690.
Editorial Note
Sodium azide is an odorless, tasteless, water-soluble crystalline powder that has been used in the manufacture of automobile airbags and explosives, and as a laboratory preservative (1,2). In the 1950s, sodium azide was used to treat hypertension because of its profound vasodilatory effects, possibly resulting from the production of nitric oxide (2,3). Systemic absorption of sodium azide can result in hypotension, loss of consciousness, headache, dyspnea, nausea, vomiting, metabolic acidosis, dysrhythmias, and death. The mechanism of poisoning with sodium azide is similar to cyanide, which suggests that use of traditional cyanide antidotes such as nitrite therapy and sodium thiosulfate might be beneficial. However, experience with antidotes in humans is limited mainly to case reports, and none have shown a conclusive, convincing, or consistent benefit. Therefore, good supportive care remains the cornerstone of treatment.
Previous reports of sodium azide poisoning primarily are limited to case reports involving ingestion of sodium azide either by accident or during attempted suicide. Patients at a dialysis center became symptomatic when treatment filters preserved with sodium azide were not rinsed properly (4). Two foodborne sodium azide mass poisonings have been described briefly, but neither report included clinical or epidemiologic details regarding the victims or the investigations (3,5). In 2009, six workers at Harvard Medical School became ill after drinking from a communal coffee pot that was contaminated with sodium azide; whether or not the poisoning was intentional is unknown (3). Within minutes of ingestion, the laboratory workers had palpitations and diaphoresis; two fainted. All of their symptoms rapidly resolved. In 1998, sodium azide was deliberately added to a teapot in Niigata, Japan, poisoning nine persons (5). No clinical data or other details about these two poisoning incidents have been reported (3,5).
The potential for future incidents and the challenges in identification of unusual chemicals reinforce the need to continue educating health-care providers regarding the possibility of such poisonings. Public health agencies should consider such incidents and the complexity of such investigations in their emergency response planning (6,7).
Acknowledgments
John T. Carlo, MD, Joey Stringer, Tony Jenkins, Dallas County Dept of Health and Human Svcs; Richard T. Briley, Garland Health Dept; David Klein PhD, Linda Gaul PhD, Texas Dept of State Health Svcs. William H. Keene, PhD, Oregon Health Svcs. Larry Enmon, Food and Drug Administration. Marc A. LeBeau, PhD, Eileen M. Waninger, Federal Bureau of Investigation Laboratory.
References
1.Chang S, Lamm SH. Human health effects of sodium azide exposure: a literature review and analysis. Int J Toxicol 2003;22:175–86.
2.Klein-Schwartz W, Gorman RL, Oderda GM, Massaro BP, Kurt TL, Garriott JC. Three fatal sodium azide poisonings. Med Toxicol Adverse Drug Exp 1989;4:219–27.
3.Gussow L. Toxicology rounds: the case of the contaminated coffee pot. Emergency Medicine News 2010;32:8. Available at http://journals.lww.com/em-news/fulltext/2010/01000/the_case_of_the_contaminated_coffee_pot.10.aspx. Accessed June 22, 2012.
4.Gordon SM, Drachman J, Bland LA, Reid MH, Favero M, Jarvis WR. Epidemic hypotension in a dialysis center caused by sodium azide. Kidney Int 1990;37:110–5.
5.Okumura T, Ninomiya N, Ohta M. The chemical disaster response system in Japan. Prehosp Disaster Med 2003;18:189–92.
6.Schier JG, Rogers HS, Patel MM, Rubin CA, Belson MG. Strategies for recognizing acute chemical-associated foodborne illness. Mil Med 2006;171:1174–80.
7.Patel MM, Schier JG, Belson MG. Recognition of illness associated with covert chemical releases. Pediatr Emerg Care 2006;22:592–601.

Shigella Outbreak in Onondaga County, New York
Source : http://foodpoisoningbulletin.com/2012/shigella-outbreak-in-onondaga-county-new-york/
By Kathy Will (June 26, 2012)
Dr. Cynthia Morrow, Commissioner of Health for Onondaga County in New York state, announced on June 22, 2012 that there are 15 lab confirmed and 10 probable cases of shigellosis in that county. More cases are expected as the investigation continues.
“Shigellosis is an infectious disease called by a group of bacteria called Shigella,” she explained. “It is associated with consuming water or products contaminated with fecal matter. The incubation period is 1 – 3 days. Many people who are infected with Shigella develop fever, painful bloody or mucous diarrhea, and stomach cramps. Shigellosis usually resolves in 5 – 7 days. The disease is often worse in children and medical treatment is sometimes necessary in severe cases.”
To avoid spreading Shigella bacteria, follow these tips:
¡áWash all fruits and vegetables
¡áCook food to the appropriate final internal temperature and check with a thermometer
¡áMinimize cross-contamination of foods
¡áDon’t prepare foods for others while ill, especially when you have diarrhea
¡áWash hands well with soap after using the bathroom, changing diapers, and before preparing foods and beverages
¡áSupervise hand washing of small children after they use the bathroom
¡áDispose of soiled diapers properly
¡áDisinfect diaper-changing areas after using them
¡áKeep children with diarrhea out of child care settings
¡áAvoid swallowing water from ponds, lakes, or untreated pools
Some people can be carriers of the Shigella bacteria with no symptoms. Those with mild infections usually recover with no treatment, but some patients need medical care or hospitalization. A severe infection may be associated with seizures in patients under the age of two. About 2% of people who are infected with Shigella flexneri develop post-infectious arthritis which can lead to chronic arthritis.