Because of the volume of clientele that the restaurant receives, hundreds of people may have been exposed to Hepatitis A. The Quiznos sees between 100 and 500 patrons per day but averages between 150 and 200 clients daily. Since the Hepatitis A positive employee served patrons on August 6^th and 7^th, affected individuals should seek shots soon. The Hepatitis A shot will only provide protection for an individual for up to 14 days after initial exposure. Only this Quiznos store was affected.

Hepatitis A symptoms include jaundice, fever, nausea, headache, fatigue, and pain in the lower right abdominal region. Symptoms do not appear immediately after consuming  Hepatitis A tainted food. Instead, Hepatitis A symptoms will normally appear within two to seven weeks of exposure. Reoccurrence of Hepatitis A symptoms occurs in some individuals up to nine months following the initial exposure.

This is the second Hepatitis A incident related to an employee at a restaurant in recent weeks. Two Colorado restaurants had to issue a Hepatitis A warning to patrons once it was discovered that an employee was infected. Max and T’s (July 26 through July 30^th)and the Sagebrush (July 24th and August 3^rd) located in Colorado both recommended Hepatitis A vaccines for its patrons who were served during these time periods.

The reason that patrons are being encouraged to receive Hepatitis A vaccines even though they were already exposed to the virus is that the Hepatitis A vaccine can be used to prevent a possible Hepatitis A infection for up to 14 days after a victim is exposed to the virus.

An individual who has been exposed to Hepatitis A will normally experience symptoms similar to a stomach virus. If the victim is a young child, they may be asymptomatic. Symptoms normally manifest between two and seven weeks after initial exposure to the virus. The symptoms often include lethargy, headache, muscle pain, fever, nausea, lower abdominal pain on the right side, and possibly jaundice or dark urine.

Hepatitis A is a liver infection. Normally, symptoms disappear over time without treatment. The Hepatitis A virus can be spread through contact with contaminated food, unchlorinated drinking water, shellfish from sewage polluted water, close contact with an infected individual, and blood transfusions.

Hemolytic uremic syndrome (HUS) causes renal failure and can be fatal. This potentially lethal complication, most commonly appears in young children. Initially, hemolytic uremic syndrome (HUS) appears as blood in stools, moodiness, fever, weakness and lethargy. Vomiting and diarrhea are also possible side effects.

In later stages, hemolytic uremic syndrome (HUS) causes changes in urination frequency, seizures, bruising, jaundice, petechiae, and pale skin. According to the National Library of Medicine (NLM), further complications would include blood clot difficulties, hemolytic anemia, kidney failure, nervous systems problems, thrombocytopenia (too few platelets) and uremia.

The NLM uses the following tests to determine  when hemolytic uremic syndrome (HUS) is present: blood clotting tests (PT and PTT), comprehensive metabolic panel, creatinine, complete blood count which  may show increased white blood cell count and decreased red blood cell count, platelet count, urine protein test.

An October 19, 2009 report entitled “Recommendations for Diagnosis of Shiga Toxin–Producing Escherichia coli Infections by Clinical Laboratories” stated the following in relation to HUS:

Approximately 8% of persons who receive a diagnosis of O157 STEC infections develop hemolytic uremic syndrome (HUS), a life-threatening condition characterized by thrombocytopenia, hemolytic anemia, and renal failure. Whether an illness progresses to HUS depends on strain virulence and host factors. Although most persons with diarrhea-associated HUS have an O157 STEC infection, certain non-O157 STEC strains also can lead to HUS. The virulence of non-O157 STEC is partly determined by the toxins they produce; non-O157 STEC strains that produce only Stx2 are more often associated with HUS than strains that produce only Stx1 or that produce both Stx1 and Stx2. STEC infections and HUS occur in persons of all ages, but the incidence of STEC infection is highest in children aged <5 years, as is the risk for HUS. Although STEC infections are more common during summer months, they can occur throughout the year.

Hemolytic uremic syndrome (HUS) is a life-threatening disease which can seriously impact its victims, especially children. Knowing the symptoms and being aware is key in ensuring proper treatment quickly.

Campylobacter is not the only bacteria which can survive in water. Campylobacter results in Campylobacteriosis which causes sticky, watery, or bloody diarrhea as well as fever, nausea, headaches, and body pain.  Here is a list of some other bacteria, a virus, and parasites which can be found in water and can result in “foodborne” illnesses:

1. Giardia  – Giardia is a parasite which forms a cyst and causes diarrhea when ingested. Diarrhea associated with Giardia can last for up to 14 days; however cases of much longer duration have occurred.  Food and water can be a source of Giardia infection.
2. Cryptosporidium parvum – Cryptosporidium is a protozoan which if ingested can cause coughing, fever, and watery diarrhea. Some individuals with Cryptosporidium food poisoning have no symptoms while other suffer terrible diarrhea.
3. Escherichia Coli – E. coli is a bacteria which exists in differing strains. Some such as E. coli O157:H7 are Shiga toxin producing and can lead to Hemolytic Uremic Syndrome (HUS). Shiga toxin producing E. coli such as O157:H7 can lead to bloody diarrhea. Others strains of E. coli are milder and symptoms are not as severe.
4. Vibrio vulnificus – Vibrio is a bacteria normally acquired through consumption of contaminated shellfish. Additionally, individuals with open sores who have swum or played in Vibrio contaminated seawater can contract a Vibrio infection in their wound.
5. Shigella – Shigella is normally associated with contaminated feces entering a water or food supply. Shigella can be fatal in some cases and can lead to dehydration and ulcerations. Some individuals who have contracted Shigella can develop conditions known as Hemolytic Uremic Syndrome (HUS)or reactive arthritis.
6. Hepatitis A – Hepatitis A symptoms include lethargy and jaundice as well as nausea, stomach pain, and severe loss of appetite. Food and water containing Hepatitis A virus particles can be a cause of infection. Additionally, an Hepatitis A can be transferred from person to person in certain circumstances related to feces transfer.

The patients who contracted Listeria monocytogenes were between 66 and 93. The source of the Listeria outbreak has not been pinpointed and this Listeria outbreak appears to be a complex one. With only seven cases and a geographic dispersion of 300 miles, it will be difficult to determine where the Listeria originated.

On the heels of this outbreak is an announcement by the Food Safety Inspection Service regarding Canadian ready-to-eat deli meats which have been recalled due to possible Listeria monocytogenes contamination. According to the recall:

The U.S. Department of Agriculture’s Food Safety and Inspection Service (FSIS) is issuing a public health alert for various ready-to-eat deli meat products because they may be contaminated with Listeria monocytogenes.

FSIS was notified by the Canadian Food Inspection Agency (CFIA) that various ready-to-eat deli meat products subject to recall in Canada may have been exported to the United States. Recently, a problem was discovered through FSIS microbiological testing of imported product from Canadian Establishment 665, which resulted in a positive sample for Listeria monocytogenes and two FSIS recalls dated May 4 and 5, 2010. FSIS and Canada have received no reports of illnesses as result of consumption of products subject to this alert. Anyone with signs or symptoms of foodborne illness should contact a physician. FSIS will continue to provide information as it becomes available, including information about any related recall activity.

Products exported to the United States include, but are not limited to, the following:

“Casa Italia Gastronomia Prosciutto”

“Casa Italia Gastronomia Prosciutto Boneless”

“Casa Italia Gastronomia Prosciutto Mattonella”

“Casa Italia Prosciutto Boneless”

“Casa Italia Prosciutto Boneless Sliced”

“Casa Italia Prosciutto Ham Sliced”

“Emma Dry Prosciutto”

Implicated products were produced by Zadi Foods Ltd., CFIA Establishment 665, located in Brampton, Ontario, and may have been distributed to retail locations nationwide. All lots and production dates for the above-listed products are subject to this public health alert.

FSIS is working with the CFIA to verify that the recalling firm notifies its customers of the recall and is conducting effectiveness checks to verify that the product is no longer available to consumers. The products would have been sold to consumers at deli counters, and the original brand may not have been transferred at the deli counters to consumer packages. Consumers who may have purchased any of these products and do not know original brand are advised to check with their retailer or supplier to determine if they have the affected products. If consumers have any of the implicated products, they should discard them or return them to the point of purchase.

Listeria is particularly dangerous for pregnant women as it can cause stillbirths. The elderly and young children are also strongly susceptible to Listeria food poisoning. Diarrhea, nausea, fever, and muscle aches are common Listeria symptoms. According to MedlinePlus.com, Listeria foodborne illness symptoms in infants can include decreased appetite, jaundice, vomiting and skin rash. Infants and adults battling Listeria can develop meningitis. In adults, Listeria can also cause the development of septicemia, lesions, and abscesses, and conjunctivitis.

According to a USAToday article by Peter Eisler entitled “’Growing Concern’ Over Marketing Tainted Beef,” the regulation of food contaminants is, to say the least, inadequate. The EPA is responsible for setting contaminant “tolerance levels” in regards to pollutants and pesticides while the FDA regulates levels of antibiotics and other medicines. The lack of existing “tolerance levels” means that even if some of these unsavory substances are found in our foods, the FSIS, who tests cattle for contaminants, is unable to do anything about it.

Some of the contaminants specifically mentioned in the report include:

1. Penicillin which can cause allergic reactions in certain individuals as well as diarrhea, facial swelling, nerve damage, and bleeding.
2. Copper which can cause kidney problems, death, and jaundice.
3. Arsenic which can lead to malignancies, lesions, and hypertension.

Whatever these contaminants are, I don’t want them in my food. The fact that governmental agencies have not set limits regarding the inclusion of these substances in food hitting market shelves is shocking. Legislation and adaptation of current FDA as well as EPA standards is needed and it is needed quickly. Producers are expected to provide food products which are free from bacteria such as E. coli and Salmonella. There is no reason that we as consumers cannot expect our food to also be free from heavy metals and medicinal byproducts.  We will continue to follow the progress made by the FDA, the EPA and legislators in improving the safety of our nation’s food supply. Stay tuned to this blog.

Recent investigations looking into food sanitation and handling at some of the most popular stadiums in the country have revealed some rather unsavory practices. Documented incidents of food being stored in vermin infested facilities, improper hygiene practices and insufficient safety protocols have called to the media’s attention the potential for outbreaks of epic proportions. Today, we will look into one of the many unfortunate situations that can occur from food service failures in the stadium/arena setting.

The most likely food poisoning situation to occur in a stadium situation would be related to a human to human transmission. Foodborne pathogens like norovirus, Shigella or hepatitis A can pass from an infected individual’s feces to an unsuspecting victim. It is rather disturbing when you think about it, but minuscule amounts of feces on one unwashed hand can serve as a hub that exposes every food item that passes through that hand to foodborne illness. This poses an unusual risk since the prepared food could be free of pathogens but since it passes through the infected handler, ALL food now becomes a transmission source, not just foods known as high risk. In a stadium or arena that could mean tens of thousands of individuals exposed in a manner of hours.

And it doesn’t even have to be a food item. Viruses like hepatitis A and norovirus could find their way onto counters, money, utensils, essentially anything handled by an infected individual. Shigella (a bacterium) is believed to cause infection with exposure to as little as ten individual bacteria. An unwashed hand could contain millions of Shigella and any surface touched could easily leave behind enough bacteria to cause illness.

 Fortunately these illnesses are rarely life threatening, but as with almost any illness, there will be some individuals who get sick and suffer severe complications. Norovirus typically lasts only a day or two and usually resolves quickly without complication, but it is one of the most intense illnesses one could endure for that day or two. The illness can be so intense that people often seek medical intervention because of the severity. Norovirus can cause dehydration from the constant vomiting and for a child, dehydration could pose a serious risk.

Hepatitis A is not a very severe illness but it can last for weeks and can come back months after it is believed to be resolved. Constant tiredness and jaundice are not something a person wants to deal with, especially from an illness that could have been prevented from a simple handwashing with soap and water. A mere 20 seconds of washing could prevent weeks of illness for thousands of individuals.

Shigella can produce a toxin similar to the one produced by E. coli O157:H7, the same E. coli that always makes the news for causing outbreaks, severe illness in children and is often responsible for deaths. That poison can cause a complication called hemolytic uremic syndrome (HUS), a really nasty disease that is the leading cause of acute kidney failure for children in the U.S.  A “simple” Shigella poisoning can lead to a lifetime of treatments, possible need for kidney transplant and even death. It is a situation where a parent will have to watch their child battle hemolytic uremic syndrome (HUS) for weeks and medical bills pile up into the millions because someone didn’t want to take the half a minute to wash their hands.

Norovirus, hepatitis A and Shigella are examples of pathogens that are commonly spread from human to human contact. Dangerous foodborne pathogens such as Salmonella, E. coli and Campylobacter are also known to spread to unsuspecting victims from an unwashed hand or surface. The more massive the centralized food distribution, the stricter sanitation protocols need to be. Hand sanitization and cleanliness are not options; they are absolute necessities in the world of foodborne illness. With thousands of people getting their food and drink from a centralized location, an act of simple sanitization negligence on the part of one individual could lead to an outbreak on an epic scale.

Tomorrow we will look into the dangers of stadiums serving food contaminated at the manufacture and processing level.

In isolation, Hemolytic Uremic Syndrome (HUS) frequently affects young children following E. coli food poisoning due to the presence of Shiga-toxins. E. coli foodborne illness results when Shiga-toxin producing E. coli bacteria enter a person’s body, sometimes through food, but possibly when swimming in contaminated water. Hemolytic Uremic Syndrome (HUS) symptoms include lethargy, urinating infrequently, jaundice, bruising, vomiting, and bloody stools. 

Thrombotic Thrombocytopenic Purpura (TTP) can develop independently of HUS. Like Hemolytic Uremic Syndrome (HUS), bruising, the presence of petechiae, and hemolytic anemia are also symptoms. The main concern with TTP is the formation of blood clots. Blood clots can also be a HUS complication. Blood clots can be dangerous because they can prevent proper blood flow throughout the body.

Hepatitis A symptoms include jaundice, fever, nausea, and vomiting. Individuals who have contracted Hepatitis A may also experience joint pain as well as a decrease in appetite. Hepatitis A can incubate between 15 and 50 days. Symptoms of Hepatitis A normally last approximately sixty days; however, Hepatitis A relapses are not uncommon. High rates of asymptomatic Hepatitis A cases are common in young children. However, in other age groups, 70 percent of individuals experience jaundice in relation to the onset of Hepatitis A. Hepatitis A is not chronic. If someone is exposed to Hepatitis A, they can receive an immunoglobulin shot. If the Hepatitis A immunoglobulin shot is received within two weeks of contact with the virus, that is when the vaccine is most effective.

The CDC states that food contaminated with rodent urine or feces can carry Salmonella, Leptospirosis, rat-bite fever, or Tularemia. Salmonella food poisoning can cause diarrhea and other stomach  ailments. Leptospirosis is a bacteria which, according to the CDC can cause “high fever, severe headache, chills, muscle aches, and vomiting, and may include jaundice (yellow skin and eyes), red eyes, abdominal pain, diarrhea, or a rash.” Rat-bite fever is rare in the United States and is caused by Streptobacillus moniliformis. Symptoms of Rat-bite fever usually include fever and pain. In regards to Tularemia, which can be deadly, the CDC states that it can involve high fever, “sore throat, mouth ulcers, tonsillitis, and swelling of lymph glands in the neck.”