Transmission of Cryptosporidium by Fresh Vegetables

ABSTRACT

Consumption of fresh fruits and vegetables is increasing thanks to a greater awareness of the human health benefits. Vegetables may become contaminated by enteric pathogens (protozoan parasites, bacteria, and viruses) by irrigation with contaminated water, fertilization with fresh animal manure, or by infected food handlers. Cryptosporidium spp. are fecal-oral protozoan parasites, known to be highly persistent in the environment. Efficient methods were developed for releasing and concentrating Cryptosporidium oocysts from leafy vegetables, and sensitive and specific methods were applied for detection. The aims of this review are to discuss the development and optimization of methods applied to elute, concentrate, and detect oocysts from leafy vegetables, to review the prevalence of Cryptosporidium oocysts on fresh leafy vegetables from various parts of the world, and to discuss cryptosporidiosis outbreaks resulting from the consumption of leafy vegetables. Three solutions were used with comparable efficiency to release oocysts from leafy vegetables: 1 M glycine solution; 0.1% Alconox; and filter elution buffer, with an efficiency of 36.2, 72.6, and 44%, respectively. The prevalence of Cryptosporidium oocysts was reported in developed, as well as from developing countries, although simple detection methods were applied. Most of the cryptosporidiosis outbreaks were reported in developed countries, which can be related to the efficient surveillance system. Transmission of infectious pathogens, such as Cryptosporidium, may be facilitated by fresh vegetables, which are imported and transferred from less developed to highly developed countries and consumed uncooked. Monitoring of Cryptosporidium oocysts by sensitive detection methods may enhance measures to prevent transmission by freshly consumed vegetables.

HIGHLIGHTS

Retrospective whole-genome comparison of Salmonella enterica serovar Enteritidis from foodborne outbreaks in Southern Brazil

Salmonella enterica serovar Enteritidis is frequently isolated from animal-source foods associated with human salmonellosis outbreaks. This serovar was spread to animal (mainly poultry) farms worldwide in the 1980s, and it is still detected in foods produced in many countries, including Brazil. The present study reports a retrospective genome-wide comparison of S. Enteritidis from foodborne outbreaks in Southern Brazil in the last two decades. Fifty-two S. Enteritidis isolates were obtained from foodborne outbreaks occurring in different cities of the Brazilian southernmost State, Rio Grande do Sul (RS), from 2003 to 2015. Whole-genome sequences (WGS) from these isolates were obtained and comparatively analyzed with 65 additional genomes from NCBI. Phylogenetic and Bayesian analyses were performed to study temporal evolution. Genes related to antibiotic resistance and virulence were also evaluated. The results demonstrated that all S. Enteritidis isolates from Southern Brazil clustered in the global epidemic clade disseminated worldwide originally in the 1980s. Temporal analysis demonstrated that all Brazilian isolates had a tMRCA (time to most recent common ancestor) in 1986 with an effective population size (N_e) increase soon after until 1992, then becoming constant up to now. In Southern Brazil, there was a significant decrease in the spreading of S. Enteritidis in the last decade. In addition, three antibiotic resistance genes were detected in all isolates: aac(6')-Iaa, mdfA, and tet(34). These results demonstrate the high frequency of one only specific S. Enteritidis lineage (global epidemic clade) in foodborne outbreaks from Southern Brazil in the last two decades.

Attributing Human Foodborne Diseases to Food Sources and Water in Japan Using Analysis of Outbreak Surveillance Data

ABSTRACT

In Japan, strategies for ensuring food safety have been developed without reliable scientific evidence on the relationship between foodborne diseases and food sources. This study aimed to provide information on the proportions of foodborne diseases caused by seven major causative pathogens (Campylobacter spp., Salmonella, enterohemorrhagic Escherichia coli [EHEC], Vibrio parahaemolyticus, Clostridium perfringens, Staphylococcus aureus, and norovirus) attributed to foods and to explore factors affecting changes in these source attribution proportions over time using analysis of outbreak surveillance data. For the calculation of the number of outbreaks attributed to each source, simple-food outbreaks were assigned to the single-food category in question, and complex-food outbreaks were classified under each category proportional to the estimated probability. During 2007 to 2018, 8,730 outbreaks of foodborne diseases caused by seven pathogens were reported, of which 6,690 (76.6%) were of unknown source. We estimated the following source attribution proportions of foodborne diseases: chicken products (80.3%, 95% uncertainty interval [UI] 80.1 to 80.4) for Campylobacter spp.; beef products (50.1%, UI 47.0 to 51.5) and vegetables (42.3%, UI 40.9 to 45.5) for EHEC; eggs (34.6%, UI 27.8 to 41.4) and vegetables (34.4%, UI 27.8 to 40.8) for Salmonella; finfish (50.3%, UI 33.3 to 66.7) and shellfish (49.7%, UI 33.3 to 66.7) for V. parahaemolyticus; grains and beans (57.8%, UI 49.7 to 64.9) for S. aureus; vegetables (63.6%, UI 48.5 to 74.6), chicken products (12.7%, UI 4.6 to 21.5), and beef products (11.1%, UI 8.5 to 13.1) for C. perfringens; and shellfish (75.5%, UI 74.7 to 76.2) for norovirus. In this study, we provide the best available evidence-based information to evaluate the link between foodborne diseases and foods. Our results on source attribution for Campylobacter spp. and EHEC suggest that the strict health regulations for raw beef were reflected in the proportions of these diseases attributed to this food.

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Shellfish contamination with marine biotoxins in Portugal and spring tides: a dangerous health coincidence

Bivalve molluscs can acquire marine biotoxins by filter-feeding upon certain toxin-producing microalgae. The two most common syndromes observed in temperate coastal waters have been diarrhetic shellfish poisoning (DSP) and paralytic shellfish poisoning (PSP). While DSP is a non-fatal gastrointestinal syndrome, PSP is a neurological syndrome which can lead to death by respiratory paralysis in high intoxication scenarios. In Portugal, the presence of both DSP and PSP toxins leads to recurrent seasonal bans of bivalve harvesting. On a few occasions, the bans were not placed in time, not properly disseminated to the public or were disregarded by recreational harvesters. Several cases of poisonings have been studied in collaboration between health authorities and the laboratory in charge of the biotoxin monitoring programme. Some of the outbreaks have even called the attention of the local media. In several of these recorded cases, a common trait has emerged throughout the years: bivalve harvest had often been done during very low tides attributed to either new or full moons. These tides expose intertidal bivalves more widely, increase harvesting time, and allow picking of larger-sized specimens. In some occasions, the consumers were extremely unfortunate because a noxious coincidence had occurred: larger-sized specimens were available but had attained the highest toxin content of the toxic season. This review alerts that despite costly monitoring programmes have been perfected through the years, human poisonings still take place due to the rapid increase in toxin levels and/or disrespect of harvest bans.

Outbreaks, Germination, and Inactivation of Bacillus cereus in Food Products: A Review

ABSTRACT

Bacillus cereus has been reported as a foodborne pathogen worldwide. Although food processing technologies to inactivate the pathogen have been developed for decades, foodborne outbreaks related to B. cereus have occurred. In the present review, foodborne outbreaks, germination, inactivation, and detection of B. cereus are discussed, along with inactivation mechanisms. B. cereus outbreaks from 2003 to 2016 are reported based on food commodity, number of cases, and consequent illnesses. Germination before sporicidal treatments is highlighted as an effective way to inactivate B. cereus, because the resistance of the pathogen increases significantly following sporulation. Several germinants used for B. cereus are listed, and their efficacies are compared. Finally, recently used interventions with sporicidal mechanisms are identified, and rapid detection methods that have been developed are discussed. Combining two or more interventions, known as the hurdle technology concept, is suggested to maximize the sporicidal effect. Further study is needed to ensure food safety and to understand germination mechanisms and sporicidal resistance of B. cereus.

HIGHLIGHTS

Restaurant Policies and Practices Related to Norovirus Outbreak Size and Duration

ABSTRACT

Norovirus is the leading cause of foodborne illness outbreaks in the United States, and restaurants are the most common setting of foodborne norovirus outbreaks. Therefore, prevention and control of restaurant-related foodborne norovirus outbreaks is critical to lowering the burden of foodborne illness in the United States. Data for 124 norovirus outbreaks and outbreak restaurants were obtained from Centers for Disease Control and Prevention surveillance systems and analyzed to identify relationships between restaurant characteristics and outbreak size and duration. Findings showed that restaurant characteristics, policies, and practices were linked with both outbreak size and outbreak duration. Compared with their counterparts, restaurants that had smaller outbreaks had the following characteristics: managers received food safety certification, managers and workers received food safety training, food workers wore gloves, and restaurants had cleaning policies. In addition, restaurants that provided food safety training to managers, served food items requiring less complex food preparation, and had fewer managers had shorter outbreaks compared with their counterparts. These findings suggest that restaurant characteristics play a role in norovirus outbreak prevention and intervention; therefore, implementing food safety training, policies, and practices likely reduces norovirus transmission, leading to smaller or shorter outbreaks.

HIGHLIGHTS

Virological analyses in collective catering outbreaks in France between 2012 and 2017

Enteric viruses cause the majority of foodborne illnesses and common symptoms of many foodborne illnesses include vomiting, diarrhea, abdominal pain, and fever. Among the enteric viruses, human Norovirus (NoV) and hepatitis virus (HAV and HEV) are the main viruses suspected to cause foodborne outbreaks and represent a serious public health. The study presents survey tools of viruses in a wide variety of foodstuffs and results obtained during 56 foodborne outbreaks investigation in France between 2012 and 2017. 246 suspected foods were examined for the presence of four human enteric viruses (NoV GI and NoV GII, HAV or HEV) either using methods described in the EN ISO 15216-1 or in house methods. All viral analysis of food samples were performed with the implementation of process control and an external amplification controls. Eighteen of 56 foodborne outbreaks investigated included at least one positive food sample (16/18 NoV, 1/18 HAV and 1/18 HEV). The genomic levels of four viruses detected ranged from < 10² to 10⁷ genome copies per g or per L. This study showed the interest to develop methods for the extraction of viruses in different foodstuffs to increase the possibility to identify the association between viral illness and food consumption.

Outbreaks of Shiga Toxin-Producing Escherichia coli Linked to Sprouted Seeds, Salad, and Leafy Greens: A Systematic Review

Shiga toxin-producing Escherichia coli (STEC) outbreaks involving ready-to-eat salad products have been described in the scientific literature since 1995. These products typically do not undergo a definitive control step such as cooking to eliminate pathogens. To reduce the number of STEC infections from salad products, efforts will need to focus on preventing and reducing contamination throughout the food chain. We performed a systematic review of STEC outbreaks involving sprouted seeds, salad, or leafy green products to determine whether there were recurrent features, such as availability of microbiological evidence or identification of the contamination event, which may inform future investigations and prevention and control strategies. Thirty-five STEC outbreaks linked to contaminated leafy greens were identified for inclusion. The outbreaks occurred from 1995 to 2018 and ranged from 8 to more than 8,500 cases. Detection of STEC in the food product was rare (4 of 35 outbreaks). For the remaining outbreaks, the determination of leafy greens as the source of the outbreak mainly relied on analytical epidemiology (20 of 35) or descriptive evidence (11 of 35). The traceback investigation in 21 of 32 outbreaks was not able to identify possible routes leading to where the STEC bacteria came from or how the leaves were contaminated. Investigations in eight outbreaks found poor practice during processing that may have contributed to the outbreak, such as insufficient postharvest disinfection of the product. Six outbreak investigations were able to identify the outbreak strain in animal feces near the growing fields; two of these were also able to find it in irrigation water on the farms, providing a likely route of contamination. These results highlight the limitations of relying on microbiological confirmation as a basis to initiate investigations of upstream production to understand the source of contamination. This review also demonstrates the importance of, and difficulties associated with, food-chain traceback studies to inform control measures and future prevention.

A Bacteriophage Cocktail Eliminates Salmonella Typhimurium from the Human Colonic Microbiome while Preserving Cytokine Signaling and Preventing Attachment to and Invasion of Human Cells by Salmonella In Vitro

Nontyphoidal Salmonella strains continue to be a major cause of foodborne illness globally. One intriguing approach to reducing the risk of salmonellosis is the direct ingestion of phages targeting Salmonella to enhance natural gut resilience and provide protection during foodborne disease outbreaks. We evaluated the ability of a prophylactically administered bacteriophage cocktail, the foodborne outbreak pill (FOP) targeting Escherichia coli O157:H7, Listeria monocytogenes, and Salmonella, to resolve a Salmonella infection in the Simulator of the Human Intestinal Microbial Ecosystem (SHIME), a simulated gut platform populated by the human intestinal microbiome of healthy donors. The FOP preparation eliminated Salmonella enterica serovar Typhimurium from the colon compartment of the SHIME platform but health-associated metabolites, such as short-chain fatty acids and lactate, remained stable or increased in a donor-dependent manner. In studies of human intestinal cells, pretreatment of Salmonella Typhimurium with the FOP cocktail preserved lipopolysaccharide-stimulated signaling in a Caco-2-THP-1 Transwell system and prevented destruction of the Caco-2 monolayer by Salmonella. Adhesion and invasion of intestinal epithelial cells by Salmonella-a critical factor in Salmonella pathogenesis-was blunted when the bacteria were incubated with the FOP preparation before addition to the monolayer. The FOP phage cocktail was effective for (i) eliminating Salmonella from a simulated human gut without disturbing the indigenous microbiota and (ii) reducing the risk of invasion by Salmonella into the intestinal epithelia. These results suggest that the FOP preparation may be of value for reducing the risk of salmonellosis in humans, e.g., during foodborne disease outbreaks.

Sex and age distributions of persons in foodborne disease outbreaks and associations with food categories

Sex and age differences in food preferences may be reflected in the demographics of outbreaks. Outbreaks from 1998-2015 with a single confirmed implicated food source in the Centers for Disease Control and Prevention Foodborne Disease Outbreak Surveillance System were analysed using logistic regression to assess associations between a food category, sex and age. Males were more likely to be involved in outbreaks attributed to beef, pork, game, dairy and shellfish; females were more likely to be involved in grains-beans, nuts-seeds, fruits, sprouts and vegetable row crops outbreaks. Children &lt;5-years-old were more likely than other age groups to be involved in dairy outbreaks, children 5-19-years-old were most likely to be involved in beef and game outbreaks, adults 20-49-years-old were most likely to be involved in fish, shellfish and sprout outbreaks and adults ⩾50-years-old were most likely to be involved in turkey outbreaks. Age and sex are associated with specific food categories in outbreaks. This information may be useful in helping to identify sources of foodborne disease outbreaks.

Effective inhibition of Salmonella Typhimurium in fresh produce by a phage cocktail targeting multiple host receptors

Salmonella contamination of fresh produce is the primary bacterial cause of a significant number of foodborne outbreaks and infections. Bacteriophages can be used as natural antibacterial agents to control foodborne pathogens. However, the rapid development of bacterial resistance to phage infection is a significant barrier to practical phage application. To overcome this problem, we developed a novel phage cocktail consisting of the three phages (BSPM4, BSP101 and BSP22A) that target different host receptors, including flagella, O-antigen and BtuB, respectively. Whole genome sequence analysis of the phages revealed that three phages do not harbor genes involved in lysogen formation or toxin production, suggesting they are safe for use as biocontrol agents in foods. In vitro treatment of the phage cocktail resulted in a significant reduction in the development of bacterial resistance. Phage cocktail treatments achieved 4.7-5.5 log CFU/cm2 reduction of viable cell number in iceberg lettuce and 4.8-5.8 log CFU/cm2 reduction in cucumber after 12 h at room temperature (25 °C). The phage cocktail exhibited good antimicrobial efficiency, suggesting that it could reduce S. Typhimurium contamination of fresh produce. The strategy of developing cocktails of phages that target multiple host receptors can be used to develop novel biocontrol agents of S. Typhimurium.

Comparison of advanced whole genome sequence-based methods to distinguish strains of Salmonella enterica serovar Heidelberg involved in foodborne outbreaks in Québec

Salmonella enterica serovar Heidelberg (S. Heidelberg) is one of the top serovars causing human salmonellosis. This serovar ranks second and third among serovars that cause human infections in Québec and Canada, respectively, and has been associated with severe infections. Traditional typing methods such as PFGE do not display adequate discrimination required to resolve outbreak investigations due to the low level of genetic diversity of isolates belonging to this serovar. This study evaluates the ability of four whole genome sequence (WGS)-based typing methods to differentiate among 145 S. Heidelberg strains involved in four distinct outbreak events and sporadic cases of salmonellosis that occurred in Québec between 2007 and 2016. Isolates from all outbreaks were indistinguishable by PFGE. The core genome single nucleotide variant (SNV), core genome multilocus sequence typing (MLST) and whole genome MLST approaches were highly discriminatory and separated outbreak strains into four distinct phylogenetic clusters that were concordant with the epidemiological data. The clustered regularly interspaced short palindromic repeats (CRISPR) typing method was less discriminatory. However, CRISPR typing may be used as a secondary method to differentiate isolates of S. Heidelberg that are genetically similar but epidemiologically unrelated to outbreak events. WGS-based typing methods provide a highly discriminatory alternative to PFGE for the laboratory investigation of foodborne outbreaks.

Consumer Response to Gastrointestinal Illness Perceived To Originate from Food Service Facilities

Consumer responses to food product recalls have been documented, but there is little information on how consumers respond to illnesses or outbreaks associated with food service facilities. This study uses an on-line survey of 885 adults conducted in 2012 to determine how respondents changed their dining behavior following personal experiences with and secondhand reports of gastrointestinal illness believed to be associated with food service facilities. In response to personally experiencing gastrointestinal illness that they attributed to a food service facility, 90% of survey participants reported that they avoided the implicated facility for a time following the incident; almost one-half decided to never return to the facility they believed had made them ill. In response to a secondhand report of gastrointestinal illness, 86% of respondents reported they would avoid the implicated facility for a time, and 22% said they would never return to the facility. After both personal experiences of illness and secondhand reports of illness, consumer responses were significantly more severe toward the implicated facility than toward all other food service facilities. Frequent diners avoided facilities for shorter periods of time and were less likely to never go back to a facility than were infrequent diners. The survey results indicate that 24 to 97 fewer meals were purchased per respondent, or a 11 to 20% reduction in meals purchased outside the home, in the year following respondents' illness. Future estimates of the economic burden of foodborne illnesses, including those caused by noroviruses, should consider the impacts on the food service industry attributable to changes in consumer behavior, in addition to health care costs and loss of productivity.

Whole genome sequencing of Salmonella Typhimurium illuminates distinct outbreaks caused by an endemic multi-locus variable number tandem repeat analysis type in Australia, 2014

Background

Salmonella Typhimurium (STM) is an important cause of foodborne outbreaks worldwide. Subtyping of STM remains critical to outbreak investigation, yet current techniques (e.g. multilocus variable number tandem repeat analysis, MLVA) may provide insufficient discrimination. Whole genome sequencing (WGS) offers potentially greater discriminatory power to support infectious disease surveillance.

Methods

We performed WGS on 62 STM isolates of a single, endemic MLVA type associated with two epidemiologically independent, food-borne outbreaks along with sporadic cases in New South Wales, Australia, during 2014. Genomes of case and environmental isolates were sequenced using HiSeq (Illumina) and the genetic distance between them was assessed by single nucleotide polymorphism (SNP) analysis. SNP analysis was compared to the epidemiological context.

Results

The WGS analysis supported epidemiological evidence and genomes of within-outbreak isolates were nearly identical. Sporadic cases differed from outbreak cases by a small number of SNPs, although their close relationship to outbreak cases may represent an unidentified common food source that may warrant further public health follow up. Previously unrecognised mini-clusters were detected.

Conclusions

WGS of STM can discriminate foodborne community outbreaks within a single endemic MLVA clone. Our findings support the translation of WGS into public health laboratory surveillance of salmonellosis.

Electronic supplementary material

The online version of this article (doi:10.1186/s12866-016-0831-3) contains supplementary material, which is available to authorized users.