Outbreak of multidrug-resistant Salmonella infections in people linked to pig ear pet treats, United States, 2015-2019: results of a multistate investigation.

Background: International distribution of contaminated foods can be a source of Salmonella infections in people and can contribute to the spread of antimicrobial-resistant bacteria across countries. We report an investigation led by the United States Centers for Disease Control and Prevention, the Food and Drug Administration (FDA), and state governmental officials into a multistate outbreak of salmonellosis linked to pig ear pet treats. Methods: Pig ear treats and companion dogs were tested for Salmonella by state officials and the FDA. Products were traced back to the country of origin when possible. Cases were defined as outbreak illnesses in people associated with one of seven Salmonella serotypes genetically related to samples from pig ear pet treats, with isolation dates from June 2015 to September 2019. Whole genome sequencing (WGS) of isolates was used to predict antimicrobial resistance. Findings: The outbreak included 154 human cases in 34 states. Of these, 107 of 122 (88%) patients reported dog contact, and 65 of 97 (67%) reported contact with pig ear pet treats. Salmonella was isolated from 137 pig ear treats, including some imported from Argentina, Brazil, and Colombia, and from four dogs. WGS predicted 77% (105/137) of human and 43% (58/135) of pig ear treat isolates were resistant to ≥3 antimicrobial classes. Interpretation: This was the first documented United States multistate outbreak of Salmonella infections linked to pig ear pet treats. This multidrug-resistant outbreak highlights the interconnectedness of human health and companion animal ownership and the need for zoonotic pathogen surveillance to prevent human illness resulting from internationally transported pet food products. Funding: Animal Feed Regulatory Program Standards award. Animal and product testing conducted by FDA Vet-LIRN was funded by Vet-LIRN infrastructure grants (PAR-22-063).

Campylobacter jejuni Outbreak Linked to Raw Oysters in Rhode Island, 2021.

Oysters and other shellfish are not a food that is commonly highlighted as high risk for Campylobacter contamination. The Rhode Island Department of Health (RIDOH) conducted a multiagency investigation of a Campylobacter jejuni outbreak that was linked to the consumption of raw oysters; the first such outbreak was detected in Rhode Island. The environmental investigation identified birds as the likely source of contamination of the aquacultured oysters. As a result of this outbreak response, several investigative processes and best practice recommendations are offered. 1) RIDOH will be including exposure to raw shellfish as a question on their case report forms to better identify future oyster-related Campylobacter clusters. 2) It is important that shellfish aquaculture farms be aware of the risks of using floating gear to hold oyster cages and of the importance of using bird abatement to keep birds off floating aquaculture gear to prevent contamination of oysters from bird feces. 3) It should be recognized that fecal coliform water samples collected near an oyster aquaculture farm may not act as an adequate indicator for the presence of Campylobacter. 4) For the first time, Rhode Island has developed guidelines for the closure and reopening of oyster harvest areas due to contamination with Campylobacter. It is hoped that increased awareness and mitigation of the described risk factors will help prevent future similar outbreaks of illness.

Multistate outbreak of Salmonella Mbandaka infections linked to sweetened puffed wheat cereal - United States, 2018.

In May of 2018, PulseNet, the national molecular subtyping network for enteric pathogens, detected a multistate cluster of illnesses caused by an uncommon molecular subtype of Salmonella serovar Mbandaka. A case was defined as an illness in a person infected with the outbreak strain of Salmonella Mbandaka with illness onset on or after 3 March 2018 and before 1 September 2018. One-hundred thirty-six cases from 36 states were identified; 35 hospitalisations and no deaths were reported. Ill people ranged in age from <1 year to 95 years (median: 57 years). When standardised questionnaires did not generate a strong hypothesis, opened-ended interviews were performed. Sixty-three of 84 (75%) ultimately reported consuming or possibly consuming a specific sweetened puffed wheat cereal in the week before illness onset. Environmental sampling performed at the cereal manufacturing facility yielded the outbreak strain. The outbreak strain was also isolated from open cereal samples from ill people's homes and from a sealed retail sample. Due to these findings, the brand owner of the product issued a voluntary recall of the cereal on 14 June 2018. Additional investigation of the manufacturing facility identified persistent environmental contamination with Salmonella Mbandaka that was closely genetically related to other isolates in the outbreak. This investigation highlights the ability of Salmonella to survive in low-moisture environments, and the potential for prolonged outbreaks linked to products with long shelf lives and large distribution areas.

Cake Decorating Luster Dust Associated with Toxic Metal Poisonings - Rhode Island and Missouri, 2018-2019.

During 2018-2019, the Rhode Island Department of Health (RIDOH) and the Missouri Department of Health and Senior Services (DHSS) investigated cases of metal poisonings associated with commercially and home-prepared cakes decorated with products referred to as luster dust. Several types of glitters and dusts, broadly known as luster dust,* for use on prepared foods can be purchased online and in craft and bakery supply stores (1). Decorating foods with luster dust and similar products is a current trend, popularized on television programs, instructional videos, blogs, and in magazine articles.† Some luster dusts are specifically produced with edible ingredients that can be safely consumed. Companies that make edible luster dust are required by law to include a list of ingredients on the label (2). Luster dusts that are safe for consumption are typically marked "edible" on the label. Some luster dusts used as cake decorations are not edible or food grade; labeled as "nontoxic" or "for decorative purposes only," these luster dusts are intended to be removed before consumption (3). RIDOH (2018) and Missouri DHSS (2019), investigated heavy metal poisonings associated with commercially and home-prepared cakes decorated with luster dust after receiving reports of children (aged 1-11 years) who became ill after consuming birthday cake. Cases in Rhode Island were associated with copper ingestion, and the case in Missouri was associated with a child's elevated blood lead level. In Rhode Island, luster dust products that had been used in cake frosting were found to contain high levels of multiple metals.§ These events indicate that increased vigilance by public health departments and further guidance to consumers and bakeries are needed to prevent unintentional poisonings. Labeling indicating that a product is nontoxic does not imply that the product is safe for consumption. Explicit labeling indicating that nonedible products are not safe for human consumption is needed to prevent illness from inappropriate use of inedible products on foods. Educating consumers, commercial bakers, and public health professionals about potential hazards of items used in food preparation is essential to preventing illness and unintentional poisoning from toxic metals and other nonedible ingredients.

Comparing Minor Hand Procedures Performed with or without the Use of a Tourniquet: A Randomized Controlled Trial.

BACKGROUND: Carpal tunnel syndrome and trigger finger are two of the most common conditions treated by the hand surgeon. During these procedures, a tourniquet is often used to minimize bleeding and improve visualization of the operative field. However, it may be associated with pain and discomfort. To date, there are few prospective studies investigating the safety and patient-centered outcomes of tourniquet-free minor hand procedures. METHODS: This is a randomized controlled trial comparing patients undergoing open carpal tunnel or trigger finger release with or without the use of a tourniquet. Perioperative subjective patient experience was investigated for both techniques. This was measured based on a numerical rating scale for pain, anxiety, and overall satisfaction. In addition, this was an equivalence trial in terms of operative time, bleeding scores, and perioperative complication rates. RESULTS: A total of 67 patients were recruited. Both groups were similar with respect to distribution of age, sex, handedness, anti-platelet use, and tobacco use. Median scores for operative time, anxiety, and overall satisfaction were comparable between the 2 groups. With regard to patient discomfort, median scores were significantly higher in the tourniquet group when compared with the no tourniquet group (3.58 versus 1.68, respectively, P = 0.02). Bleeding scores for the tourniquet group were significantly lower than for the no tourniquet group (1.14 versus 1.90, respectively, P = 0.001). CONCLUSIONS: The application of wide awake local anesthesia no tourniquet (WALANT) in minor hand surgery procedures has been shown to decrease tourniquet-associated discomfort, improving perioperative patient experience. Additionally, it demonstrated the noninferiority of the tourniquet-free technique with respect to operative time and the rate of perioperative complications.

Rhode Island Department of Health Foodborne Illness Complaint System: A Descriptive and Performance Analysis.

Foodborne illnesses create a large impact on both the health and economy of the United States. Early detection of an outbreak is essential to preventing additional illnesses. Foodborne illnesses are commonly identified through foodborne illness complaint systems, and it is vital that public health agencies ensure their systems are functioning effectively for successful detection of foodborne outbreaks. The purpose of this study was to provide a descriptive summary of foodborne illness complaint data in Rhode Island and to evaluate the Rhode Island Department of Health (RIDOH) foodborne illness complaint system's ability to detect foodborne outbreaks using the Council to Improve Foodborne Outbreak Response (CIFOR) target performance measures. Data were collected from all foodborne illness complaints reported to RIDOH by the public from 1 January 2010 to 31 December 2017. During this period, 1,218 foodborne illness complaints in total were reported to RIDOH; 85% of complainants reported their illness within 7 days of symptom onset. Most complainants (73%) did not seek medical attention. There were 54 outbreaks, 80% of which were identified by the complaint system. Most pathogens that were identified during an outbreak detected by the complaint system were nonreportable (69%). CIFOR metrics indicate that the complaint system is functioning (i) at an acceptable level of illness complaints expected based on population size and (ii) at preferable levels for metrics related to outbreak detection. This review of the RIDOH foodborne illness complaint system provides evidence for the vital role of complaint systems in detecting foodborne illness outbreaks. In addition, it demonstrates that complaint systems can detect illnesses in a timely manner, likely preventing further illnesses. This was the first multiyear evaluation of Rhode Island's illness complaint surveillance system and will serve as a baseline for future analyses to monitor trends in performance.

Adaptation to high altitude: effects of small changes in the regulatory behavior of the andean chicken hemoglobin

Se ha descubierto en los Andes Peruanos un grupo de gallinas de altura (Gallus gallus) con alta afinidad de la hemoglobina por el oxígeno. Hemos estudiado el posible mecanismo molecular subyacente de esta adaptación a la altura. Se ha postulado pequeños cambios en la concentración intracelular de inositol pentafosfato (IPP), el principal efecto alostérico de la hemoglobina en los eritrocitos de aves. Hemos estudiado la sangre de gallinas andinas y de nivel del mar. Las afinidades de suspensiones frescas de eritrocitos están significativamente incrementadas en gallinas andinas comparadas con las de nivel del mar. Los valores de los coeficientes de Hill a saturación 50 por ciento (n50) son mayores para suspensiones de gallinas que para las de mamíferos. Esto podría sugerir la existencia de un proceso de agregación molecular dentro de las células deoxigenadas, altamente concentradas de ambos tipos de aves. Para las soluciones "desnudas" de hemolizados de ambos tipos de gallinas, las afinidades son idénticas en el buffer libre de fosfato, indicando que las afinidades intrínsecas de las Hbs de gallinas andinas y de nivel del mar son las mismas. Con la adición de inositol hexafosfato (IHP), un fuerte efecto alostérico de hemoglobinas de aves, observamos un incremento pequeño pero significativo (aproximadamente 20 por ciento) en la afinidad de los hemolisados de altura en relación a los de nivel del mar. Nuestros resultados también sugieren que la diferencia en la afinidad entre sangres de altura y de nivel del mar puede deberse a un proceso adaptativo posiblemente relacionado con una ligera disminución en la concentración y/o actividad del principal efector celular IPP, más bien que un anormalidad estructural de la hemoglobina.