A Series of Papaya-Associated Salmonella Illness Outbreak Investigations in 2017 and 2019 – A Focus on Traceback, Laboratory, and Collaborative Efforts

In 2017 and 2019, five outbreaks of infections from multiple strains of Salmonella linked to the consumption of whole, fresh Maradol papayas were reported in the United States, resulting in 325 ill persons. Traceback, laboratory, and epidemiologic evidence indicated papayas as the likely vehicle for each of these outbreaks and identified the source of papayas. State and FDA laboratories recovered Salmonella from papaya samples from various points of distribution, including at import entry, and conducted serotyping, pulsed-field gel electrophoresis (PFGE), and phylogenetic analyses of whole genome sequencing (WGS) data. Federal and state partners led traceback investigations to determine the source of papayas. Four different suppliers of papayas were linked by traceback and laboratory results to five separate outbreaks of Salmonella infections associated with papayas. In 2017, multiple states tested papaya samples collected at retail, and Maryland and Virginia investigators recovered strains of Salmonella associated with one outbreak. FDA collected 183 papaya samples in 2017, and 11 samples yielded 62 isolates of Salmonella. Eleven serotypes of Salmonella were recovered from FDA papaya samples, and nine serotypes were closely related genetically by PFGE and WGS to clinical isolates of four outbreaks, including the outbreak associated with positive state sample results. Four farms in Mexico were identified and their names were released to the general public, retailers, and foreign authorities. In 2019, FDA collected 119 papaya samples, three of which yielded Salmonella; none yielded the 2019 outbreak strain. Investigators determined that papayas of interest had been sourced from a single farm in Campeche, Mexico through traceback. This information was used to protect public health through public guidance, recalls, and import alerts and helped FDA collaborate with Mexican regulatory partners to enhance the food safety requirements for papayas imported from Mexico.

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81. Azithromycin-Nonsusceptible Salmonella Newport Infections Associated with Mexican-style Soft Cheese and Beef—the United States, 2018–2019

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz359.005 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S3-S3

Author(s):

Ian D Plumb ◽

Selam Tecle ◽

Colin Schwensohn ◽

Zachary Schneider ◽

Laura Gieraltowski ◽

...

Keyword(s):

United States ◽

The United States ◽

Outbreak Strain ◽

Surveillance Network ◽

Illness Onset ◽

Salmonella Newport ◽

Salmonella Infections ◽

Soft Cheese ◽

Salmonella Serotype ◽

Healthy Persons

Abstract Background Azithromycin is a recommended oral agent for treating nontyphoidal Salmonella (NTS), when antibiotics are indicated. Azithromycin nonsusceptibility among NTS is <1% in the United States. CDC, FSIS, and state health departments investigated an outbreak of azithromycin-nonsusceptible Salmonella serotype Newport infections to determine sources. Methods We classified isolates as the outbreak strain if they were within 11 alleles by core genome multilocus sequence typing. We defined a case as infection with the outbreak strain during June 2018–February 2019. After stratifying by gender and ethnicity, we compared food exposures ≤7 days before illness onset with those reported by healthy persons in the Foodborne Diseases Active Surveillance Network population survey (2006–2007). We used broth microdilution to determine antimicrobial susceptibility. Results We identified 218 case patients from 31 states; 49 of 176 (28%) were hospitalized and 2 died. Overall, 65% (121/187) were Hispanic, and 41% (70/169) visited Mexico in the 7 days before illness onset. Among travelers to Mexico, 71% (23/32) reported eating Mexican-style soft cheese; 16/23 (70%) recalled obtaining the cheese in Mexico. Among nontravelers, the proportion who ate Mexican-style soft cheese (30%, 18/60) was similar to that reported by healthy persons, whereas the proportion who consumed beef (91%, 60/66) was higher than reported by healthy persons (P = 0.04). The outbreak strain was detected in a sample of soft cheese obtained in Mexico, and in a cecal sample from a steer and a beef sample that was collected at FSIS-regulated establishments in the United States. Isolates were resistant to ampicillin and trimethoprim–sulfamethoxazole, nonsusceptible to azithromycin, and showed decreased susceptibility to ciprofloxacin. Conclusion This is the first documented outbreak of azithromycin-nonsusceptible Salmonella infections in the United States. Two food vehicles—soft cheese obtained in Mexico, and beef obtained in the United States—were epidemiologically and genetically associated with this outbreak. Further investigation is warranted to determine the routes of entry, prevalence, and spread of azithromycin-nonsusceptible Salmonella in US and Mexican cattle. Disclosures All Authors: No reported Disclosures.

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Relationship between home food-handling practices and sporadic salmonellosis in adults in Louisiana, United States

Epidemiology and Infection ◽

10.1017/s0950268802007471 ◽

2002 ◽

Vol 129 (2) ◽

pp. 267-276 ◽

Cited By ~ 26

Author(s):

K. S. KOHL ◽

K. RIETBERG ◽

S. WILSON ◽

T. A. FARLEY

Keyword(s):

United States ◽

The United States ◽

Food Items ◽

Salmonella Infections ◽

Home Food ◽

Outbreak Investigations ◽

Handling Practices ◽

Safe Food ◽

Food Handling Practices ◽

Specific Food

Salmonellosis is the leading cause of death caused by foodborne bacterial pathogens in the United States. Approximately 90% of salmonella infections are sporadic, but most of what is known about salmonellosis has come from outbreak investigations. We studied the risk for sporadic salmonellosis among 115 persons aged [ges ]15 years reported to the Louisiana Office of Public Health during May 1998–April 1999, compared with 115 age-matched controls. Significantly more case-patients than controls had chronic underlying medical conditions [adjusted odds ratio (aOR) = 4.3; 95% confidence interval (CI) = 2.2–8.7]. Although reported consumption of specific food items likely to contain salmonella was not associated with illness, inconsistent handwashing between preparation of meat and non-meat items was associated with illness (aOR = 8.3; CI = 1.1–61.8). Enhanced measures to provide a consistently safe food supply and promote safer food preparation in households will depend on prevention of sporadic salmonellosis.

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Lower Recovery of Nontuberculous Mycobacteria from Outdoor Hawai’i Environmental Water Biofilms Compared to Indoor Samples

Microorganisms ◽

10.3390/microorganisms9020224 ◽

2021 ◽

Vol 9 (2) ◽

pp. 224

Author(s):

Ravleen Virdi ◽

Melissa E. Lowe ◽

Grant J. Norton ◽

Stephanie N. Dawrs ◽

Nabeeh A. Hasan ◽

...

Keyword(s):

Pulmonary Disease ◽

Environmental Samples ◽

Nontuberculous Mycobacteria ◽

Phylogenetic Analyses ◽

Environmental Water ◽

Rpob Gene ◽

The United States ◽

Indoor Environments ◽

Respiratory Specimens ◽

Rpob Sequence

Nontuberculous mycobacteria (NTM) are environmental organisms that can cause opportunistic pulmonary disease with species diversity showing significant regional variation. In the United States, Hawai’i shows the highest rate of NTM pulmonary disease. The need for improved understanding of NTM reservoirs led us to identify NTM from patient respiratory specimens and compare NTM diversity between outdoor and indoor locations in Hawai’i. A total of 545 water biofilm samples were collected from 357 unique locations across Kaua’i (n = 51), O’ahu (n = 202), Maui (n = 159), and Hawai’i Island (n = 133) and divided into outdoor (n = 179) or indoor (n = 366) categories. rpoB sequence analysis was used to determine NTM species and predictive modeling applied to develop NTM risk maps based on geographic characteristics between environments. M. chimaera was frequently identified from respiratory and environmental samples followed by M. chelonae and M. abscessus; yet significantly less NTM were consistently recovered from outdoor compared to indoor biofilms, as exemplified by showerhead biofilm samples. While the frequency of M. chimaera recovery was comparable between outdoor and indoor showerhead biofilms, phylogenetic analyses demonstrate similar rpoB gene sequences between all showerhead and respiratory M. chimaera isolates, supporting outdoor and indoor environments as possible sources for pulmonary M. chimaera infections.

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Moving Away from Category Exclusivity Deals to Sponsorship Activation Platforms: The Case of the Ryder Cup

Sustainability ◽

10.3390/su13031151 ◽

2021 ◽

Vol 13 (3) ◽

pp. 1151

Author(s):

Yunchao Bai ◽

Brian H. Yim ◽

John Breedlove ◽

James J. Zhang

Keyword(s):

United States ◽

Social Media ◽

Financial Services ◽

Case Analysis ◽

The United States ◽

Brand Awareness ◽

Inquiry Process ◽

Standard Life ◽

The Uk ◽

Collaborative Efforts

As a biennial event, the Ryder Cup is a men’s golf competition between teams from Europe and the United States. Ernst & Young (EY) and Standard Life Investments (SLI), who are in same business category (i.e., financial services), have served as official partners of the event in recent years. While the two firms are willing to move away from the traditional sponsorship practices of category exclusivity deals, both have been able to achieve significant success through their collaborative efforts in activating their sponsorships. This is a new, fascinating phenomenon in both sponsorship concept and practice. Through an exploratory inductive inquiry process, in this study we conduct a case analysis by examining the sponsorship activations of EY and SLI at the 2014 Ryder Cup event held in the UK. The findings demonstrate that social media plays an impactful role in the companies’ ability to engage target audiences. EY used the Ryder Cup captain as a brand ambassador, who embodied its sponsorship theme of leadership and teamwork. SLI focused on running advertising campaigns to build company image and increase brand awareness.

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Two new species of Undifilum, fungal endophytes of Astragalus (locoweeds) in the United States

Botany ◽

10.1139/b2012-056 ◽

2012 ◽

Vol 90 (9) ◽

pp. 866-875 ◽

Cited By ~ 33

Author(s):

Deana L. Baucom ◽

Marie Romero ◽

Robert Belfon ◽

Rebecca Creamer

Keyword(s):

New Species ◽

New Mexico ◽

Random Amplified Polymorphic Dna ◽

Phylogenetic Analyses ◽

Fungal Endophytes ◽

Morphological Characteristics ◽

Its Region ◽

The United States ◽

Neighbor Joining

New species of Undifilum , from locoweeds Astragalus lentiginosus Vitman and Astragalus mollissimus Torr., are described using morphological characteristics and molecular phylogenetic analyses as Undifilum fulvum Baucom & Creamer sp. nov. and Undifilum cinereum Baucom & Creamer sp. nov. Fungi were isolated from dried plants of A. lentiginosus var. araneosus , diphysus , lentiginosus , and wahweapensis collected from Arizona, Oregon, and Utah, USA, and A. mollissimus var. biglovii , earleii , and mollissimus collected from New Mexico, Oklahoma, and Texas, USA. Endophytic fungi from Astragalus locoweeds were compared to Undifilum oxytropis isolates obtained from dried plant material of Oxytropis lamberteii from New Mexico and Oxytropis sericea from Arizona, Colorado, New Mexico, Utah, and Wyoming. Extremely slow growth in vitro was observed for all, and conidia, if present, were ellipsoid with transverse septa. However, in vitro color, growth on four different media, and conidium size differed between fungi from Astragalus spp. and U. oxytropis. Neighbor-joining analyses of internal transcribed spacer (ITS) region and glyceraldehyde-3-phosphate dehydrogenase (GPD) gene sequences revealed that U. fulvum and U. cinereum formed a clade distinct from U. oxytropis. This was supported by neighbor-joining analyses of results generated from random amplified polymorphic DNA (RAPD) fragments using two different primers.

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Cheese-Associated Outbreaks of Human Illness in the United States, 1973 to 1992: Sanitary Manufacturing Practices Protect Consumers

Journal of Food Protection ◽

10.4315/0362-028x-61.10.1405 ◽

1998 ◽

Vol 61 (10) ◽

pp. 1405-1407 ◽

Cited By ~ 78

Author(s):

SEAN F. ALTEKRUSE ◽

BABAGALEH B. TIMBO ◽

JOHN C. MOWBRAY ◽

NANCY H. BEAN ◽

MORRIS E. POTTER

Keyword(s):

Public Health Problem ◽

The United States ◽

Contributing Factors ◽

E Coli ◽

Salmonella Infections ◽

Consumer Safety ◽

Control And Prevention ◽

Control Step ◽

Pathogen Control ◽

Human Illness

To identify contributing factors for cheese-associated outbreaks, we reviewed all cheese-associated outbreaks of human illness reported to the Centers for Disease Control and Prevention (CDC) with onsets during 1973 to 1992. The infrequency of large, cheese-associated outbreaks was notable because such outbreaks had been a frequent public health problem before the mid-20th century. Of 32 reported cheese-associated outbreaks, 11 attributed to manufacturing errors caused most of the illnesses and hospitalizations and all 58 deaths. Important factors in these 11 outbreaks were manufacturing cheese with raw or improperly pasteurized milk and postpasteurization contamination. If current Food and Drug Administration sanitary requirements for cheesemaking had been met, these outbreaks would have been preventable. In two outbreaks of Salmonella infections, fewer than 10 Salmonella per 100 g of cheese were detected. In two outbreaks of Brucella infections, efforts to recover the pathogen from the implicated cheese were unsuccessful, emphasizing the inadequacy of end product testing for assuring consumer safety. Curing cheeses kills most bacteria present in cheeses; however, evidence from sources other than the CDC Foodborne Disease Outbreak Surveillance System suggests that curing alone may not be a sufficient pathogen control step to eliminate Salmonella, Listeria, and E. coli O157:H7 from cheese.

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Rien ne Va Plus? Distinguishing domestic regulation from market access in GATT and GATS

World Trade Review ◽

10.1017/s1474745605002351 ◽

2005 ◽

Vol 4 (2) ◽

pp. 131-170 ◽

Cited By ~ 17

Author(s):

JOOST PAUWELYN

Keyword(s):

Market Access ◽

The United States ◽

Online Gambling ◽

Important Distinction ◽

Basic Point ◽

Safety Requirements ◽

Market Intervention ◽

Domestic Regulation ◽

Legal Consequences ◽

Import Quotas

Depending on how one classifies market intervention, trade liberalization disciplines can be lenient or strict. Perhaps the most important distinction in this respect is that between government intervention labeled as a ‘market access restriction’ and that defined as ‘domestic regulation’. Both the GATT and the GATS declare market access restrictions (such as import quotas or limitations on the number of service suppliers) to be, in principle, prohibited. In contrast, domestic regulations (such as internal taxes, health standards, and safety requirements) are treated with much more deference. They are, in essence, only prohibited when discriminatory or more trade restrictive than necessary. Notwithstanding these major legal consequences, the distinction between market access and domestic regulation remains unclear. Based on a recent WTO dispute condemning the United States for banning online gambling, this article is an attempt to clarify the distinction. Starting from broad similarities, it finds crucial differences in this respect between GATT and GATS. For both, however, the paper's basic point is that a domestic regulation should not be regarded as a market access restriction simply because it has the effect of banning certain imports. To do otherwise risks seriously undermining the regulatory autonomy of WTO Members beyond anything imagined by the drafters of the WTO treaty.

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An outbreak of Salmonella Typhimurium infections in Denmark, Norway and Sweden, 2008

Eurosurveillance ◽

10.2807/ese.14.10.19147-en ◽

2009 ◽

Vol 14 (10) ◽

Author(s):

T Bruun ◽

G Sørensen ◽

L P Forshell ◽

T Jensen ◽

K Nygård ◽

...

Keyword(s):

Food Safety ◽

Salmonella Typhimurium ◽

Tandem Repeats ◽

International Communication ◽

Variable Number ◽

Outbreak Strain ◽

Cross Border ◽

Trace Back ◽

Outbreak Investigations ◽

Minced Meat

In November-December 2008, Norway and Denmark independently identified outbreaks of Salmonella Typhimurium infections characterised in the multiple-locus variable number of tandem repeats analysis (MLVA) by a distinct profile. Outbreak investigations were initiated independently in the two countries. In Denmark, a total of 37 cases were identified, and multiple findings of the outbreak strain in pork and pigs within the same supply chain led to the identification of pork in various forms as the source. In Norway, ten cases were identified, and the outbreak investigation quickly indicated meat bought in Sweden as the probable source and the Swedish authorities were alerted. Investigations in Sweden identified four human cases and two isolates from minced meat with the distinct profile. Subsequent trace-back of the meat showed that it most likely originated from Denmark. Through international alert from Norway on 19 December, it became clear that the Danish and Norwegian outbreak strains were identical and, later on, that the source of the outbreaks in all three countries could be traced back to Danish pork. MLVA was instrumental in linking the outbreaks in the different countries and tracing the source. This outbreak illustrates that good international communication channels, early alerting mechanisms, inter-sectoral collaboration between public health and food safety authorities and harmonised molecular typing tools are important for effective identification and management of cross-border outbreaks. Differences in legal requirements for food safety in neighbouring countries may be a challenge in terms of communication with consumers in areas where cross-border shopping is common.

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First Report of Leaf Rust of Blueberry Caused by Thekopsora minima on Vaccinium corymbosum in the Western Cape, South Africa

Plant Disease ◽

10.1094/pdis-94-4-0478c ◽

2010 ◽

Vol 94 (4) ◽

pp. 478-478 ◽

Cited By ~ 7

Author(s):

L. Mostert ◽

W. Bester ◽

T. Jensen ◽

S. Coertze ◽

A. van Hoorn ◽

...

Keyword(s):

South Africa ◽

South African ◽

Water Solution ◽

Phylogenetic Analyses ◽

The United States ◽

Vaccinium Corymbosum ◽

Tween 20 ◽

Western Cape ◽

The South ◽

First Report

Southern highbush blueberry plants (Vaccinium corymbosum interspecific hybrids) showing rust-like symptoms were observed in July 2006 in Porterville in the Western Cape (WC), South Africa. Diseased plants were also found in Villiersdorp and George in the WC in 2007. In 2008, symptoms were observed in George, and in 2009, in all the previous reported areas. Cvs. Bluecrisp, Emerald, Jewel, Sharpblue, and Star were infected. Reddish-to-brown spots appeared on the adaxial surface of leaves and developed into yellow-to-orange erumpent uredinia with pulverulent urediniospores. Uredinia were hypophyllous, dome shaped, 113 to 750 μm wide, and occasionally coalescing. Urediniospores were broadly obovate, sometimes ellipsoidal or pyriform, with yellowish orange content, and measured 19 to 27 × 12 to 20 μm (average 24 × 15 μm, n = 30). Spore walls were echinulate, hyaline, 1 to 1.5 μm thick, and with obscure germ pores. No telia or teliospores were observed. Voucher specimens were lodged in the South African National Fungus Collection in Pretoria (PREM 60245). The isolate was initially identified as Thekopsora minima P. Syd. & Syd., based primarily on the absence of conspicuous ostiolar cells characteristic of Naohidemyces spp. (3). Genomic DNA was extracted from urediniospores. Approximately 1,400 bp were amplified spanning the 5.8S, ITS2, and 28S large subunit of the ribosomal DNA (1). The sequence (GU355675) shared 96% (907 of 942 bp; GenBank AF522180) and 94% (1,014 of 1,047 bp; GenBank DQ354563) similarities in the 28S portion, respectively, to those of Naohidemyces vaccinii (Wint.) Sato, Katsuya et Y. Hiratsuka and Pucciniastrum geoppertianum (Kuehn) Kleb, two of the three known rust species of blueberry (2). Although no sequences of T. minima were available for direct comparison, phylogenetic analyses of the 28S region strongly supported the South African blueberry rust as congeneric with T. guttata (J. Schröt.) P. Syd. & Syd. (GenBank AF426231) and T. symphyti (Bubák) Berndt (GenBank AF26230) (data not shown). Four 6-month-old cv. Sharpblue plants were inoculated with a suspension (approximate final concentration of 1 × 105 spores per ml) of fresh urediniospores in a water solution with 0.05% Tween 20. After incubation at 20°C for 48 h under continuous fluorescent lighting, the plants were grown in a glasshouse (18/25°C night/day temperatures). Identical uredinia and symptoms developed approximately 3 weeks after inoculation on the inoculated plants, but not on two control plants of cv. Sharpblue sprayed with distilled water and kept at the same conditions. The alternate host hemlock (Tsuga spp.) is not endemic to South Africa and not sold as an ornamental plant according to a large conifer nursery. Hosts of T. minima include Gaylussacia baccata, G. frondosa, Lyonia neziki, Menziesia pilosa, Rhododendron canadense, R. canescens, R. lutescens R. ponticum, R. prunifolium, R. viscosum, V. angustifolium var. laevifolium, V. corumbosum, and V. erythrocarpon (3). Visual inspection of possible hosts in the gardens in close proximity of Vaccinium production areas did not show any rust symptoms. To our knowledge, this is the first report of T. minima on blueberries outside of Asia and the United States (2). References: (1) M. C. Aime. Mycoscience 47:112, 2006. (2) D. F. Farr and A. Y. Rossman. Fungal Databases. Systematic Botany and Mycology Laboratory. Online publication. USDA-ARS, 2009. (3) S. Sato et al. Trans. Mycol. Soc. Jpn. 34:47, 1993.

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