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Quick Update: What Bugs Are Making The Rounds (September - November 2018)

Shiga toxin-producing E. coli (STEC) O26 in ground beef, September 2018

  • September 19, 2018, Cargill Meat Solutions (Fort Morgan, CO) recalled ground beef products

  • Produced and packaged on June 21, 2018 and were shipped to retailers nationwide.

  • See list of recalled products and retail locations

  • 18 cases in 4 states, 6 hospitalization and 1 death

  • PFGE and whole-genome sequencing (WGS) suggested a common source

  • WGS did not find genes conferring antibiotic resistance

  • Leftover ground beef from home of ill persons: positive for the same bug

  • Appears to be over

  • Review on STEC bugs

  • O157 and non-O157 “Big Six” (O26, O45, O103, O111, O121, and O145)

  • May cause hemolytic-uremic syndrome (HUS)

Salmonella Newport in ground beef, October 2018

  • 6.9 million lbs of ground beef recalled by Tolleson, Inc., of Tolleson, Arizona

  • Produced and packaged from July 26, 2018, to September 7, 2018 and were shipped to retailers nationwide

  • As of November 15: 246 cases in 25 states, 59 hospitalizations, no death

  • California has the most number of cases: 66

  • PFGE and whole-genome sequencing (WGS) suggested a common source

  • WGS did not find genes conferring antibiotic resistance

  • Unopened package of ground beef from an ill person: positive for the same bug

  • Ongoing

  • Note

  • In 2016: top 3 serotypes per FoodNet – Enteridis, Newport, Typhimurium

Multidrug-Resistant Salmonella Infantis Infections in Raw Chicken Products, October 2018

  • Seems to be associate with consumption of food prepared from raw chicken product, including ground chicken, chicken pieces, and whole chicken

  • Also identified in individuals that reported having pets consuming ground chicken pet food

  • 92 people in 29 states, 21 hospitalizations, no death

  • PFGE and whole-genome sequencing (WGS) suggested a common source

  • WGS predicted resistance to some or all of the following: AMP, CRO, CHL, CIP, FOS, GEN, hygromycin, KAN, NAL, STR, SXT, TET (BOLDED = confirmed with AST)

  • This may be because these isolates were from chicken – probably received loads of antibiotics!

  • Food and environment samples: positive for the same bug

  • Found in both live and raw chicken

Shiga toxin-producing E. coli (STEC) O157:H7 infections linked to romaine lettuce

  • Another reason not to eat salad so don't make me!

  • CDC advices against consuming all types or uses of romaine lettuce, such as whole heads of romaine, hearts of romaine, and bags and boxes of precut lettuce and salad mixes that contain romaine, including baby romaine, spring mix, and Caesar salad

  • If not sure, throw it away

  • 32 cases in 11 states, 13 hospitalizations, no death.....yet

  • PFGE and whole-genome sequencing (WGS): isolates among patients were closely related

  • Also closely related E. coli strain isolated from ill people in a 2017 outbreak linked to leafy greens in the United States and to romaine lettuce in Canada

  • NOT related to those from multistate outbreak of STEC O157:H7 infections linked to romaine lettuce (also STEC O157:H7 but different lineages)

  • MDs: Antibiotics NOT recommended until STEC O157 is ruled out

Yay more measles!

  • Since Jan: 220 individual cases confirmed in 26 states and DC

  • LA folks: LA HAN is coming out in a few days!

  • Active outbreak of measles in Israel among areas with low vaccination rates with over 1500 cases as of now

  • Per Professor Yehiel Schlesinger, director of the Wilfe Children’s Hospital at Sha’arei Tzedek: “The problem in Jerusalem is with certain population regions, such as some of the Haredi areas where there are pockets of unimmunized people, and not everyone makes sure to be vaccinated.”

  • Haredi are parts of Jerusalem heavily populated with ultra-orthodox jews.

  • Guess what. It’s here now! Cases have been reported in the Orthodox Jewish community of New York City and several surrounding communities in New York and New Jersey

  • Some have traveled to Israel

  • No cases in LA County…..yet

  • If suspected in LA County: call ACDC or Vaccine Preventable Disease Program IMMEDIATELY

  • Which specimens to collect? Details here for California

  • Blood for serology – should not be collected prior to 72 hours after symptom onset or may get false negative IgM

  • Throat swab (NP swab or wash is NOT ideal) and urine for PCR

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