Salmonella Outbreaks in Restaurants in Minnesota, 1995 through 2003: Evaluation of the Role of Infected Foodworkers

ABSTRACT The 23 restaurant-associated salmonellosis outbreaks that occurred in Minnesota from 1995 through 2003 were reviewed to characterize the role of infected foodworkers. The median duration of the outbreaks was 21 days (range, 1 to 517 days). The median number of culture-confirmed patron cases per outbreak was seven (range, 1 to 36 cases). The median incubation for patron cases ranged from 9 h to 5.9 days. A specific food vehicle was implicated in four outbreaks and suspected in five

Epidemiologic investigation of immune-mediated polyradiculoneuropathy among abattoir workers exposed to porcine brain

Background In October 2007, a cluster of patients experiencing a novel polyradiculoneuropathy was identified at a pork abattoir (Plant A). Patients worked in the primary carcass processing area (warm room); the majority processed severed heads (head-table). An investigation was initiated to determine risk factors for illness. Methods and Results Symptoms of the reported patients were unlike previously described occupational associated illnesses. A case-control study was conducted at Plant A. A case was defined as evidence of symptoms of peripheral neuropathy and compatible electrodiagnostic testing in a pork abattoir worker. Two control groups were used - randomly selected non-ill warm-room workers (n = 49), and all non-ill head-table workers (n = 56). Consenting cases and controls were interviewed and blood and throat swabs were collected. The 26 largest U.S. pork abattoirs were surveyed to identify additional cases. Fifteen cases were identified at Plant A; illness onsets occurred during May 2004–November 2007. Median age was 32 years (range, 21–55 years). Cases were more likely than warm-room controls to have ever worked at the head-table (adjusted odds ratio [AOR], 6.6; 95% confidence interval [CI], 1.6–26.7), removed brains or removed muscle from the backs of heads (AOR, 10.3; 95% CI, 1.5–68.5), and worked within 0–10 feet of the brain removal operation (AOR, 9.9; 95% CI, 1.2–80.0). Associations remained when comparing head-table cases and head-table controls. Workers removed brains by using compressed air that liquefied brain and generated aerosolized droplets, exposing themselves and nearby workers. Eight additional cases were identified in the only two other abattoirs using this technique. The three abattoirs that used this technique have stopped brain removal, and no new cases have been reported after 24 months of follow up. Cases compared to controls had higher median interferon-gamma (IFNγ) levels (21.7 pg/ml; vs 14.8 pg/ml, P<0.001). Discussion This novel polyradiculoneuropathy was associated with removing porcine brains with compressed air. An autoimmune mechanism is supported by higher levels of IFNγ in cases than in controls consistent with other immune mediated illnesses occurring in association with neural tissue exposure. Abattoirs should not use compressed air to remove brains and should avoid procedures that aerosolize CNS tissue. This outbreak highlights the potential for respiratory or mucosal exposure to cause an immune-mediated illness in an occupational setting

Epidemiologic investigation of immune-mediated polyradiculoneuropathy among abattoir workers exposed to porcine brain

Background In October 2007, a cluster of patients experiencing a novel polyradiculoneuropathy was identified at a pork abattoir (Plant A). Patients worked in the primary carcass processing area (warm room); the majority processed severed heads (head-table). An investigation was initiated to determine risk factors for illness. Methods and Results Symptoms of the reported patients were unlike previously described occupational associated illnesses. A case-control study was conducted at Plant A. A case was defined as evidence of symptoms of peripheral neuropathy and compatible electrodiagnostic testing in a pork abattoir worker. Two control groups were used - randomly selected non-ill warm-room workers (n = 49), and all non-ill head-table workers (n = 56). Consenting cases and controls were interviewed and blood and throat swabs were collected. The 26 largest U.S. pork abattoirs were surveyed to identify additional cases. Fifteen cases were identified at Plant A; illness onsets occurred during May 2004–November 2007. Median age was 32 years (range, 21–55 years). Cases were more likely than warm-room controls to have ever worked at the head-table (adjusted odds ratio [AOR], 6.6; 95% confidence interval [CI], 1.6–26.7), removed brains or removed muscle from the backs of heads (AOR, 10.3; 95% CI, 1.5–68.5), and worked within 0–10 feet of the brain removal operation (AOR, 9.9; 95% CI, 1.2–80.0). Associations remained when comparing head-table cases and head-table controls. Workers removed brains by using compressed air that liquefied brain and generated aerosolized droplets, exposing themselves and nearby workers. Eight additional cases were identified in the only two other abattoirs using this technique. The three abattoirs that used this technique have stopped brain removal, and no new cases have been reported after 24 months of follow up. Cases compared to controls had higher median interferon-gamma (IFNγ) levels (21.7 pg/ml; vs 14.8 pg/ml, P<0.001). Discussion This novel polyradiculoneuropathy was associated with removing porcine brains with compressed air. An autoimmune mechanism is supported by higher levels of IFNγ in cases than in controls consistent with other immune mediated illnesses occurring in association with neural tissue exposure. Abattoirs should not use compressed air to remove brains and should avoid procedures that aerosolize CNS tissue. This outbreak highlights the potential for respiratory or mucosal exposure to cause an immune-mediated illness in an occupational setting

\u3ci\u3eSalmonella enterica\u3c/i\u3e Serotype Enteritidis: Increasing Incidence of Domestically Acquired Infections

Background. Salmonella enterica causes an estimated 1 million cases of domestically acquired foodborne illness in humans annually in the United States; Enteritidis (SE) is the most common serotype. Public health authorities, regulatory agencies, food producers, and food processors need accurate information about rates and changes in SE infection to implement and evaluate evidence-based control policies and practices. Methods. We analyzed the incidence of human SE infection during 1996–2009 in the Foodborne Diseases Active Surveillance Network (FoodNet), an active, population-based surveillance system for laboratory-confirmed infections. We compared FoodNet incidence with passively collected data from complementary surveillance systems and with rates of SE isolation from processed chickens and egg products; shell eggs are not routinely tested. We also compared molecular subtyping patterns of SE isolated from humans and chickens. Results. Since the period 1996–1999, the incidence of human SE infection in FoodNet has increased by 44%. This change is mirrored in passive national surveillance data. The greatest relative increases were in young children, older adults, and FoodNet sites in the southern United States. The proportion of patients with SE infection who reported recent international travel has decreased in recent years, whereas the proportion of chickens from which SE was isolated has increased. Similar molecular subtypes of SE are commonly isolated from humans and chickens. Conclusions. Most SE infections in the United States are acquired from domestic sources, and the problem is growing. Chicken and eggs are likely major sources of SE. Continued close attention to surveillance data is needed to monitor the impact of recent regulatory control measures

Methodological approach for the assessment of acute inhalation toxicity of smoke ammunitions by in silico, in vitro and in vivo modelling

Assessing the toxicity of military pyrotechnic products is a growing challenge in the current context of Human and Environment protection. The Allied Ordnance Publication (AOP) 45 and the Standard NATO Agreement (STANAG) 4588 “Guidelines for toxicity testing of smokes, obscurants and pyrotechnics mixtures” proposed a practical framework to assess the toxicity of obscurant smoke compositions in relation with human health hazard and environmental impact. However, the latter document was not ratified and therefore withdrawn as it was impractical to implement. The PROTOCOL study, carried out by LACROIX and TNO and sponsored by the Direction Générale de l’Armement (DGA), allowed to pave the way for a new methodological approach for assessing the acute inhalation toxicity of obscurant and decoy smoke compositions. The aim was to establish to which extent in silico predictions and/or in vitro toxicity experiments can replace animal testing. On the basis of experimental results, it appeared that at the present time the in silico and in vitro approaches cannot replace totally in vivo toxicity tests on animals. Nevertheless, a methodological procedure was proposed allowing the reduction of animal use

Development of an in vitro method to assess the cytotoxic effect of pyrotechnic smoke compositions

International audienc

Factores asociados a placa blanda en pacientes con score de calcio igual a cero

Background: The coronary artery calcium score is used for risk stratification in asymptomatic patients. Although coronary arterydisease can occur in the absence of coronary artery calcifications, no conditions associated with the presence of soft non-calcifiedplaques have been described in this scenario, beyond the presence of symptoms.Objectives: The aim of this study was to determine the associations between non-calcified plaques and independent variables inpatients with coronary artery calcium score of zero.Methods: Consecutive patients with coronary artery score of zero Agatston units who also underwent computed tomography coronaryangiography were included in the study. Univariate logistic regression analysis was used to find associations. (15) Sensitivity,specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LH+) and negative likelihoodratio (LH-) were calculated.Results: Among a total of 93 patients, 10% (n = 9) presented non-calcified plaque. A positive exercise stress test was associated withplaques of any degree of severity (OR 6.5; 95% CI, 1.3-33, p = 0.02). This association persisted for non-severe plaques when the positiveexercise stress test was combined with a negative myocardial perfusion SPECT or stress echocardiography for ischemia (OR,12.4; 95% CI 1.5-101, p = 0.02). Sensitivity and specificity of ST-segment depression for non-calcified plaque of any degree of severitywas 44.4% and 86%, respectively, with NPV of 94%, PPV of 25%, LR+ of 3.11 and LR– of 0.65.Conclusions: ST-segment depression could be associated with non-calcified plaques in patients without coronary artery calcifications,even with normal exercise stress myocardial perfusion or wall motion (non-obstructive disease).Introducción: El score de calcio (SC) es una prueba utilizada en la estratificación de riesgo de pacientes asintomáticos. Aunque la enfermedad coronaria puede ocurrir en ausencia de calcificaciones, no se han descripto  afecciones asociadas a la presencia de placa blanda (PB) en este contexto, más allá de la presencia de  síntomas. Objetivos: determinar predictores clínicos de PB y su eventual precisión diagnóstica en pacientes con un SC de cero. Materiales y métodos: Se incluyeron pacientes consecutivos con un SC de 0 Unidades Agatston que se hubieran realizado además una angiotomografía coronaria. Se determinaron predictores a partir de tres modelos de análisis multivariado. Se calculó la sensibilidad, especificidad, VPN, VPP, + LR y - LR. Resultados: Se incluyeron 93 pacientes. El 10% (n = 9) presentaron PB. La ergometría  positiva fue predictor independiente de placas de cualquier severidad (OR 6.5; IC del 95%: 1.3-33, p = 0.02). El poder predictivo persistió para placas no severas cuando se combinó la ergometría con  perfusión miocárdica SPECT o ecocardiograma estrés negativos para isquemia (OR 12.4 IC 95% 1.5 - 101, p = 0.02). La sensibilidad y la especificidad del infradesnivel del ST para placa blanda de cualquier grado de severidad fue 44.4% y 86%, respectivamente. El VPN fue del 94% y el VPP del 25%, + LR fue de 3.11 y -LR fue de 0.65.  Conclusiones: El infradesnivel del ST podría ser predictor de PB en pacientes sin calcificaciones coronarias,  incluso en contexto de  perfusión miocárdica o ecocardiograma estrés normales (enfermedad no obstructiva)