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Outbreaks — Local, National, and Not
September 2007                                                                                                       Vol. 12, No. 9    

During the summer of 2007 local and state public health agencies were involved with several significant outbreaks.  Although cases of West Nile virus infections and vibriosis had been expected to present a public health challenge, efforts instead were directed towards outbreaks of foodborne illnesses and vaccine preventable diseases.

epiTRENDS     P.O. Box 47812     Olympia, WA 98504-7812   Mary C. Selecky     Secretary   Maxine Hayes, MD, MPH     State Health Officer   Marcia J. Goldoft, MD, MPH     Scientific Editor   Deborah Todd, RN, MPH     Managing Editor

Commercial Canned Chili 

During the second week in July, two states reported cases of botulism associated with consumption of a canned product.  A joint Centers for Disease Control and Prevention (CDC) and Food and Drug Administration (FDA) investigation resulted in a manufacturer voluntary recall on July 18th.

As of August 24, 2007 CDC reported eight cases of botulism associated with the product.  Onset dates ranged from June 29 to August 7, 2007.  Cases were identified from Indiana (2 cases), Texas (3 cases), and Ohio (3 cases).   Botulinum toxin was identified in leftover product for cases in Indiana and Ohio.  One person had consumed the chili sauce after a product recalled had been announced.  Although citizens called with concerns because of consuming the product, no cases were identified in Washington State.

Foodborne botulism in this country is primarily associated with home-canned foods or less commonly commercial products mishandled after purchase.  The last outbreak involving deficiencies in a commercial canning process was in 1974.  Such exposures are of concern because botulism can be life-threatening and commercial products are widely distributed.

Suspected botulism is a public health emergency.  Health care providers suspecting botulism should contact their local health jurisdiction (LHJ) immediately.  LHJs in turn should contact CDES for assistance with treatment and diagnostic testing.

Commercial Veggie Snack 

Washington cooperated in a multi-state case-control of an outbreak of Salmonella Wandsworth, a rare serotype.  The investigation showed an association with Veggie Booty, a puffed snack with a vegetable powder coating, and there was a voluntary recall on June 28 which was later expanded to include other products.

CDC reported 69 cases of S. Wandsworth from 23 states including Washington.  Over 90% of cases were children aged 10 months to 3 years.  There were six hospitalizations.  Known onset dates ranged from February 26, to July 4, 2007.  The outbreak strain of S. Wandsworth was isolated from sealed bags of product.

A second serotype, S. Typhimurium, was also isolated from the product and an additional 14 cases with that outbreak strain were identified.

This outbreak highlights the potential for Salmonella contamination of commercially processed foods containing raw ingredients applied after cooking. In this case the product was a snack food provided widely to young children with no realization that the product posed a risk for infection.

Ground Beef

On August 30, 2007 the United States Department of Agriculture announced a federal consumer alert for ground beef due to E. coli O157:H7 infections.  Six cases in Washington had onsets in late July and early August.  Cases have also been reported in Oregon, Alaska, and Idaho.  The products involved were ground and distributed by Interstate Meat Dist., Inc. out of Clackamas, Oregon. The beef was produced on various dates between July 19 and July 30, distributed in Alaska, Idaho, Oregon and Washington, and sold through multiple chains.  Consumers were advised to check for product in their freezers.   The ongoing investigation involves local, state, and federal agencies. 

Pertussis at a Camp 

A multi-county pertussis outbreak was detected at a summer camp in August.  It came to the attention of public health on August 13 with a positive pertussis PCR result from a ten year old who attended the camp in late July and had an onset on August 3.  The ensuing investigation identified an out of state child without laboratory testing but who met the clinical case definition as having the first known onset.  Three counselors, three more campers, and one relative of a camper were eventually identified as confirmed cases with onsets from July 30 to September 3, 2007.  Two campers (siblings) are currently suspect cases, including one with a positive PCR and an onset in September.  They are being followed to determine if the case definition is met.

The camp had 30 summer staff and 915 campers during the season, coming from nine counties and several other states and countries.  One session included a group of ten international campers and an adult.  The involved country was contacted and all 11 people received medical examinations.

There have been several previous outbreaks of pertussis associated with summer camps as well as concerns about transmission of other vaccine preventable diseases in these settings.  Increased use of the acellular pertussis vaccine (Tdap) for adolescents and adults licensed in 2005 may help reduce disease and subsequent exposures for under- and unimmunized children.  LHJs should alert DOH if a suspected case attended camp during the exposure period or while infectious.  In addition, LHJs should attempt to obtain a list of the counties, states, and countries of residence for campers in the affected sessions. 

Outbreaks Not Occurring:  West Nile Virus and Vibriosis 

West Nile virus is a mosquito-borne infection that affects birds, horses, and humans.  A 1999 outbreak in New York City was the first report of West Nile virus infections in the United States.  Since then human infections have been acquired in all continental states except Maine.  In 2006 there were 996 human infections reported in Idaho and 69 in Oregon.  Washington had three reported West Nile virus infections acquired within the state.  Although DOH was preparing for a large number of human infections based on neighboring state’s records, as of September 7, 2007, the only West Nile virus infections among state residents have been associated with travel to high risk areas, particularly the Dakotas.

In 2006 a total of 267 confirmed and probable reports of vibriosis cases were reported from Washington and six other states or provinces associated with shellfish harvested in the Pacific Northwest.  The bacteria occur naturally in Pacific coastal waters and can contaminate bivalve shellfish, with a particular risk for raw oysters consumed during warmer months.  In response, DOH developed a control plan for vibriosis addressing temperature control during harvesting and shipping shellfish and monitoring of harvest areas.  During 2007, vibriosis cases in Washington were reported in the typical annual range of 20-30 cases.
 

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