Produce-associated foodborne disease outbreaks, USA, 1998-2013.

The US Food Safety Modernization Act (FSMA) gives food safety regulators increased authority to require implementation of safety measures to reduce the contamination of produce. To evaluate the future impact of FSMA on food safety, a better understanding is needed regarding outbreaks attributed to the consumption of raw produce. Data reported to the US Centers for Disease Control and Prevention's Foodborne Disease Outbreak Surveillance System during 1998-2013 were analysed. During 1998-2013, there were 972 raw produce outbreaks reported resulting in 34 674 outbreak-associated illnesses, 2315 hospitalisations, and 72 deaths. Overall, the total number of foodborne outbreaks reported decreased by 38% during the study period and the number of raw produce outbreaks decreased 19% during the same period; however, the percentage of outbreaks attributed to raw produce among outbreaks with a food reported increased from 8% during 1998-2001 to 16% during 2010-2013. Raw produce outbreaks were most commonly attributed to vegetable row crops (38% of outbreaks), fruits (35%) and seeded vegetables (11%). The most common aetiologic agents identified were norovirus (54% of outbreaks), Salmonella enterica (21%) and Shiga toxin-producing Escherichia coli (10%). Food-handling errors were reported in 39% of outbreaks. The proportion of all foodborne outbreaks attributable to raw produce has been increasing. Evaluation of safety measures to address the contamination on farms, during processing and food preparation, should take into account the trends occurring before FSMA implementation.

Multistate outbreak of Salmonella serotype Typhimurium infections associated with consumption of restaurant tomatoes, USA, 2006: hypothesis generation through case exposures in multiple restaurant clusters.

Multiple salmonellosis outbreaks have been linked to contaminated tomatoes. We investigated a multistate outbreak of Salmonella Typhimurium infections among 190 cases. For hypothesis generation, review of patients' food histories from four restaurant-associated clusters in four states revealed that large tomatoes were the only common food consumed by patients. Two case-control studies were conducted to identify food exposures associated with infections. In a study conducted in nine states illness was significantly associated with eating raw, large, round tomatoes in a restaurant [matched odds ratio (mOR) 3·1, 95% confidence interval (CI) 1·3-7·3]. In a Minnesota study, illness was associated with tomatoes eaten at a restaurant (OR 6·3, mid-P 95% CI 1·05-50·4, P=0·046). State, local and federal regulatory officials traced the source of tomatoes to Ohio tomato fields, a growing area not previously identified in past tomato-associated outbreaks. Because tomatoes are commonly eaten raw, prevention of tomato contamination should include interventions on the farm, during packing, and at restaurants.

The growing burden of foodborne outbreaks due to contaminated fresh produce: risks and opportunities.

Foodborne outbreaks from contaminated fresh produce have been increasingly recognized in many parts of the world. This reflects a convergence of increasing consumption of fresh produce, changes in production and distribution, and a growing awareness of the problem on the part of public health officials. The complex biology of pathogen contamination and survival on plant materials is beginning to be explained. Adhesion of pathogens to surfaces and internalization of pathogens limits the usefulness of conventional processing and chemical sanitizing methods in preventing transmission from contaminated produce. Better methods of preventing contamination on the farm, or during packing or processing, or use of a terminal control such as irradiation could reduce the burden of disease transmission from fresh produce. Outbreak investigations represent important opportunities to evaluate contamination at the farm level and along the farm-to-fork continuum. More complete and timely environmental assessments of these events and more research into the biology and ecology of pathogen-produce interactions are needed to identify better prevention strategies.

Recurrent multistate outbreak of Salmonella Newport associated with tomatoes from contaminated fields, 2005.

Salmonella Newport causes more than an estimated 100,000 infections annually in the United States. In 2002, tomatoes grown and packed on the eastern shore of Virginia contaminated with a pan-susceptible S. Newport strain caused illness in 510 patients in 26 states. In July-November 2005, the same strain caused illness in at least 72 patients in 16 states. We conducted a case-control study during the 2005 outbreak, enrolling 29 cases and 140 matched neighbourhood controls. Infection was associated with eating tomatoes (matched odds ratio 9.7, 95% confidence interval 3.3-34.9). Tomatoes were traced back to the eastern shore of Virginia, where the outbreak strain was isolated from pond water used to irrigate tomato fields. Two multistate outbreaks caused by one rare strain, and identification of that strain in irrigation ponds 2 years apart, suggest persistent contamination of tomato fields. Further efforts are needed to prevent produce contamination on farms and throughout the food supply chain.

[Aortic debris in cerebrovascular ischemic disease]. / Debris aórtico en la enfermedad cerebrovascular isquémica.

BACKGROUND: The aortic atherosclerotic debris is considered a high risk embolic source, being an independent predictor for cerebrovascular ischemia. The incidence is higher in the elderly and in patients with coronary artery disease. Transesophageal echocardiogram (TEE) is an important diagnostic tool that allows its detection. OBJECTIVE: To describe characteristics of patients with ischemic stroke and echocardiographic diagnosis of aortic debris. PATIENTS AND METHODS: We analyzed the group of patients with debris diagnosis in 209 TEE performed between 01/01/99 and 31/05/02, in 835 consecutive ischemic events. The information was collected from the Stroke Database of the Neurology Department of Policlinica Bancaria. RESULTS: TEE was accomplished in 25% of all assisted events. The mean age was 66.56 years (SD 11.22). In 30 studies (14%) aortic debris was detected. In this group of patients, 26 men and 4 women, was also found: plaques grade IV 60%, left atrial dilatation 40% and spontaneous echo contrast 20%. The most frequent risk factors were hypertension, dislipemia and smoking, with no significative difference compared to the group without debris. 40% had a prior cerebrovascular event. They presented with clinical subtype LACI 53%, PACI 27%, POCI 17%. 63% of patients had lacunar infarct (53% anterior and 10% posterior). CONCLUSION: The contribution of TTE for detection of embolic sources is relevant. A high percentage of the population with echocardiographic diagnosis of aortic debris, had a lacunar infarct, defined radiologically and by clinical features.

[Ischemic stroke: transesophageal echocardiographic findings]. / Accidente cerebrovascular isquémico: hallazgos en ecocardiograma transesofágico.

INTRODUCTION: Since its initial application in 1976, the transesophageal echocardiogram (TEE) has improved the detection of cardiovascular emboligenic sources. Even though its indication in patients with stroke is still controversial, its use has contributed to the identification of potential embolic stroke sources. OBJECTIVE: To describe the transesophageal echocardiographic findings in ischemic stroke patients. PATIENTS AND METHODS: We analyzed case series of 162 TEE performed on a total of 576 ischemic events dated between 01/01/99 to 01/05/01. The required information was collected prospectively in the Stroke Data Bank of the Neurology Department at Policl nico Bancario in Buenos Aires. RESULTS: TEE was carried out in 162 (28.1%) cases. Of theses cases 13% belonged to the clinical subtype TACI, 37% to PACI, 17% to POCI, and 37% to LACI subtype. Pathologic findings corresponded to cardiac level: spontaneous contrast in 29% of the cases, and to aortic level: plaques grade IV in 34% and debris in 13% of the cases. According to the etiology of ischemic stroke, 67 patients had been registered under the diagnosis of lacunar infarct (60 in the anterior region and 7 in the posterior region), 93 had been diagnosed medium and grand artery infarct (73 in the anterior region and 29 in the posterior region), and 2 had remained unclassified. Emboligenic sources were found in 69.5% of TACI, 65% of PACI, 52% of POCI, and 53% of LACI. CONCLUSIONS: A high percentage of aortic artheroembolic pathology was detected in the population under study. However, spontaneous contrast was the echocardiographic phenomenon more frequently reported. It is to be pointed out the presence of potential cardiac and/or aortic emboligenic sources in 48% of the population with lacunar infarct

Ethnic trends in survival curves and mortality.

The nature of secular trends in survival curves has been widely debated. Fries (1984) has argued for increasing rectangularization, while Myers and Manton (1984a; 1984b) have observed increases in mean age at death with little or no change in standard deviation--arguing against rectangularization. We hypothesize that ethnic differences in mortality trends may shed light on this argument. Using California population data for 1970, 1980, and 1990, we examined ethnic differences in rectangularization using both visual and means and standard deviations analyses. The resulting patterns varied by ethnicity, gender, and type of analyses. Nearly all female groups demonstrated modest rectangularization, regardless of mean age of death, while most of the male groups did not.

Permanent cardiac pacemakers implanted in the pleural space.

Intrapleural implantation is recommended for children, active adolescents and adults, psychiatric patients, and infection-prone patients because of the protection afforded by the pleural space. The implantation technique is briefly described. Complications include diaphragmatic muscle stimulation (with a unipolar unit) and continuous migration of the pulse generator. The advantages of this implantation site include the following (1) reduced risk of lead fracture, (2) protection from physical trauma, (3) reduced risk of infection and erosion. (4) improved cosmetic appearance, and (5) minimized child/generator size disproportion. In one groups of patients undergoing both standard and intrapleural implantation, the number of pacing months per surgical procedure was increased from 5.1 months (standard implant) to 26.2 months (intrapleural implant). Intrapleural implantation may be considered the generator position of choice for the small percentage of patients who require special pacing system protection.