The Food and Drug Administration (FDA) and California's Department of Health Services (CDHS) have issued a final report on their spinach-related E. coli outbreak investigation. The study attributes the contamination risk to several existing environmental factors, however the investigative team reports it could not determine the origins of the contamination that led to the outbreak. Traced to E. coli infected bags of Dole brand baby spinach, the food safety crisis resulted in 205 confirmed illnesses and three deaths nationally.

Members from the California Food Emergency Response Team (CalFERT) joined experts from FDA and CDHS in the investigation and were assisted by specialists from the Centers for Disease Control and Prevention (CDC) and members of the Animal and Plant Health Inspection Service of the U.S. Department of Agriculture.

According to the report, risk factors including the presence of wild pigs in the spinach fields, the proximity of irrigation wells and the presence of surface waterways exposed to cattle and wildlife feces were each considered likely contributors to the E. coli O157:H7 contamination. While the exact way the bacteria spread to the spinach remain unknown, the investigation yielded valuable information that experts say will reduce the likelihood of future breakouts, including the recently introduced FDA guidance, "Guide to Minimize Microbial Food Safety Hazards of Fresh-cut Fruits and Vegetables."

FDA recommends washing all fresh-cut produce prior to eating to reduce the risk of contamination, although the agency specifies that this practice would not have prevented the recent E. coli outbreak.

The view the final report on the outbreak, please go to: "Investigation of an Escherichia coli O157:H7 Outbreak Associated with Dole Pre-Packaged Spinach"

A new report released by the World Health Organization (WHO) highlights proper household water management practices and the implementation of affordable technologies as a potential key contributor to meeting the U.N.'s Millennium Development Goal of halving the number of people who are without access to safe drinking water by 2015. The report, "Combating Waterborne Disease at the Household Level" emphasizes the key role that in-home point-of-use water quality interventions can play in reducing diarrheal disease in a cost-effective manner.

WHO estimates that 94% of diarrheal cases are preventable through interventions, including programs to increase the availability of clean water, and to improve sanitation and hygiene.

International research has shown that household drinking water can be contaminated not only during storage in the home, but also at a number of points before it reaches the consumer, including at the water's source, within the delivery pipes and during transport. According to WHO, point-of-use household water treatment methods such as chlorination, boiling and solar disinfection can benefit billions of people. Based on research presented in the WHO report, household water treatment and safe storage practices have a number of positive effects, including:

• dramatically improves microbial water quality
• significantly reduces diarrhea cases
• highly cost-effective
• rapidly deployable for immediate use by vulnerable populations.

To view the WHO report, please go to: http://www.who.int/household_water/advocacy/combating_disease.pdf

According to the U.S. Centers for Disease Control and Prevention (CDC), norovirus infection and illness reports have increased significantly, with the appearance of a new strain accounting for at least 60 percent of the outbreaks this past winter. Outbreaks have occurred across the U.S. in a variety of settings, including colleges, prisons, elementary schools, cruise ships and long-term care facilities.

Noroviruses are a group of gastrointestinal illness-causing pathogens found in the stool or vomit of those infected with the virus. Infection can occur in several ways, including eating food or drinking liquids that are contaminated with norovirus; touching surfaces or objects contaminated with the virus, and then placing their hand in their mouth; and having direct contact with a person who is infected and exhibiting symptoms.

The increased reports of norovirus illness prompted federal health officials to gather for an assessment of the new strain dubbed GII.4 Minerva. The pathogen is named for the Minerva II cruise ship, where health officials first became aware of the particularly virulent norovirus strain during a shipboard outbreak in January 2006.

The symptoms of norovirus illness normally include nausea, vomiting, diarrhea, stomach cramping and, in some cases, fever, that lasts up to two days. According to the CDC, GII.4 Minerva has increased both the length and severity of the illnesses reported. In response, the CDC has recommended switching to bleach-based cleansing products to limit the transmission of the virus.

According to the CDC, a detailed report on the Minerva strain of norovirus will be issued this spring.

Health experts gathered at the 17th European Congress of Clinical Microbiology and Infectious Diseases in Munich, Germany have called for an immediate improvement in the diagnosis and treatment of Clostridium difficile-associated disease (CDAD). Noted as a growing concern among public health officials, doctors and scientists, the spread of the hospital-acquired diarrhea is occurring more frequently and increasing in severity in the U.S., Canada and various European countries.

According to data presented at the conference, CDAD affects more than 500,000 people in the U.S. per year and one out of every 1,000 patients hospitalized in Europe since 2005.

In the symposium, "Clostridium Difficile-Associated Disease: Underdiagnosed, Underreported, Undertreated; How to Overcome the Challenge" evidence of a growing CDAD epidemic was presented, including:

• the emergence of a highly virulent and resistant strain of CDAD known as North American Phenotype 1/027 (NAP1/027);
• an increase in the incidence and severity of infection;
• an increase in failed responses to existing therapies; and
• a growing number of recurrences following treatment.

Data presented from a study in the Netherlands showed that early and rapid diagnosis, strict hand hygiene with soap and water, environmental cleaning with chlorine-based disinfectants, the use of gloves and aprons, and grouping patients with CDAD were effective in slowing the spread of the disease.

For information from CDC on Clostridium Difficile, please go to:
http://www.cdc.gov/ncidod/dhqp/id_Cdiff.html

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