The Newest SuperBug: CRE

Mar 21 2013 :: Published in Infectious Diseases

By Laura Iwig, Senior Specialist, Infectious Disease Program, APHL

What is this new antibiotic-resistant superbug that is flooding the news streams these days?  Nightmare bacteria?  Triple threat?  What is this monster?

On March 5, 2013, CDC’s Vital Signs featured a report describing the newest superbug circulating health care facilities around the world: Carbapenem Resistant Enterobacteriaceae (CRE). It has targeted patients in health care facilities receiving care that requires devices such as ventilators, urinary catheters, or intravenous catheters.  People receiving these treatments are immunocompromised and more susceptible to other infections.  Symptoms can include gastrointestinal illness, pneumonia, or, in serious cases, infections of the bloodstream or other organs.

Hospital bed

CRE is unlike other antimicrobial resistant bacteria.  As Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention, stated “They’re resistant to nearly all antibiotics. They have high mortality rates, killing half of people with serious infections. And they can spread their resistance to other bacteria.”

Most health departments are only beginning to look for CRE.  Many report health care-associated infections only when there is an outbreak.  As indicated in the MMWR article, only six states require facilities to report CRE infections!  This means that the true impact of CRE is not known.

What are public health laboratories doing in response?

Depending on the presence of CRE in their state, public health laboratories are either working to respond or preparing for an influx of testing orders.  The Colorado public health laboratory, for example, has collaborated with state epidemiologists to implement CDC screening procedures for CRE in response to an outbreak at a Colorado hospital.  To date, the lab has screened a total of 126 swab samples for the presence of CRE, and validated and implemented detection of two CRE genes to support identification of the nightmare bacteria.

At the same time, APHL is assisting public health labs to build CRE testing capability.  In August 2012, the association, in collaboration with CDC, selected the Indiana State Public Health Laboratory and Michigan Public Health Laboratory to develop non-automated antimicrobial susceptibility testing capability for CRE to provide confirmatory testing for clinical laboratories.  These critical projects are well underway; it is in the public’s interest to ensure that they are sustained.

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Anthrax in Minnesota? The Laboratory Response Network Springs Into Action

Mar 05 2013 :: Published in Public Health Preparedness & Response

By Kara MacKeil, Associate Specialist, Public Health Preparedness and Response, APHL

Picture a small rural hospital in northern Minnesota.  A man walks into the emergency room late in the afternoon complaining of flu-like symptoms. He’s admitted and at first seems stable, but rapidly deteriorates.  As he is transported by helicopter to a larger hospital for advanced treatment, his condition plummets en route and survival seems increasingly unlikely.  The backstory: The man was three weeks into a road trip and could have passed this fast-acting, apparently lethal bug on to any number of people.  Sounds like the script pitch for Contagion 2, right?  Mystery illness in Minnesota, I can see it now.*

But while it sounds like a script pitch, this actually happened in the fall of 2011, with Bacillus anthracis, as the causative agent of anthrax, as the starring villain.  There was one very important change to the storyline though.  Thanks to the efforts of the laboratorians at Lake Region Healthcare in Fergus Falls, Minnesota, and the Minnesota Department of Health Laboratory Response Network (LRN) staff, the mystery bug was identified in time to provide treatment, and the patient is alive and well today. Maureen Sullivan of the Minnesota Public Health Laboratory told us the story of the legwork that went in on the laboratory side, and it would definitely make for a pretty good movie!

First, a word on the LRN.  The LRN was developed in 1999 by the Centers for Disease Control, APHL, the Federal Bureau of Investigation (FBI) and the Department of Defense.  Today, there are two main arms of the LRN: chemical and biological threats preparedness and response (LRN-C and LRN-B), which provide a strong, unified system of laboratories that can respond to any threat.  There are standard protocols for everything, and regular trainings to keep everyone up-to-speed. In the LRN-B, Sentinel Level laboratories like the Lake Region Healthcare Laboratory can rely on reference laboratories such as the Minnesota Public Health Laboratory, and the Minnesota Public Health Laboratory, in turn, can call on resources within the CDC. Further, the Minnesota Public Health Laboratory can leverage partnerships with the local law enforcement, FBI and the National Guard Civil Support Team.  From the first culture to the final treatment, the Minnesota anthrax case was a perfect illustration of what dedicated laboratory and first responder professionals can do with the strength of the LRN behind them.

Testing for anthrax

Back to our story.  The patient in question was a 61-year-old Florida man who had been driving through the northern plains states for the past few weeks with his wife, taking in your standard tourist attractions and enjoying the scenery. (Can’t you picture the opening montage of our movie?)  He had a previous history of pneumonitis and had been exposed to Agent Orange in the Vietnam War, but was otherwise healthy.  When he arrived at Lake Region Healthcare on a Thursday afternoon, there wasn’t anything to suggest that he might be infected with a deadly biological agent, so the hospital began its standard protocol for flu-like symptoms and sent blood cultures to the laboratory.  These cultures were examined that Friday morning and, after finding all four to be positive, the laboratory technician followed LRN sentinel protocols and plated all four to watch for growth.  Normally samples like these would have been checked again at about noon on Saturday, but the laboratory technician was suspicious and made a point to look at them again later Friday afternoon.  Cue the ominous music and enter the Minnesota Public Health Laboratory, an LRN Reference Lab, at camera left, because those plates had growth!

Realizing what she might have on her hands, the sentinel laboratory technician made a call to the MN public health lab to let them know what was happening, and then personally packaged the samples and drove them to the delivery drop box to ensure they would arrive at the state laboratory the next day. Thanks to her diligence, the plated samples arrived at the state laboratory about 24 hours early, at 11 AM Saturday morning, and Sullivan says when the on-call molecular biologist opened the box, “she looked at the colonies, closed it right up, went and called her husband and said ‘I think I might be here for a while.’”

Sullivan got the call with positive results for B. anthracis spores at 2:30 PM that afternoon (while on a family vacation, I might add) and started making phone calls.  The submitting hospital had to be notified so treatment could begin as soon as possible, but positive anthrax findings don’t stop with identification.  Because anthrax is so dangerous, the Minnesota LRN-B’s next task was to determine whether this patient was deliberately infected.  This is the point in our script where the military enters, in the form of the National Guard’s 55th Civil Support Team (CST).  The Minnesota laboratory conducts regular trainings in conjunction with the 55th CST, and they have a great working relationship. In conjunction with the National Institute for Occupational Safety and Health (NIOSH), the 55th CST and two representatives from the Minnesota laboratory (Sullivan included) spent a day combing over the patients rental car, removing anything that might give them a clue as to where the spores had come from.  Altogether they collected over 50 samples, including the patient’s boots and a set of deer antlers.  While none of the samples collected from the car tested positive, Sullivan notes, “It was a very good collaboration with the CST team and with our partners at CDC to put the environmental sample plan together.”

Testing for anthrax

Meanwhile, the patient’s condition had deteriorated.  On Sunday, he was loaded into a medevac helicopter and sent south to a larger hospital for treatment. Despite a nail-biting collapse en route, doctors were able to stabilize him, and the following day a team from the CDC administered emergency treatment.  It’s important to note that this treatment would not have happened without the positive B. anthracis identification from the Minnesota State Public Health Laboratory. That treatment, coupled with the early changes to the patient’s antibiotic regimen after the positive identification, is likely the reason the patient recovered completely.

Like any good movie, this story leaves a few questions behind.  First, where did the anthrax come from? While the movie version of this story would probably end with some hint at nefarious origins in order to create a sequel, the truth is it was probably a complete coincidence.  Anthrax is found naturally in all seven continents and lies dormant in soil for hundreds of years.  The spores can reactivate when they are kicked up and inhaled, commonly by grazing animals.  Our patient had spent some time on his road trip collecting rocks from riverbeds, and at one point drove past a large herd of grazing buffalo.  It’s probable that he inhaled some spores (and it would only take one) in one of these locations, but we will truly never know. You may also be wondering why the patient’s wife didn’t get sick, despite being in all the same places and presumably getting the same exposures.  It’s possible that the patient’s history of lung problems might have made him more susceptible, but again, there is no way to know.  She may have just been very lucky.

Despite these questions, the reality remains that without the smooth functioning of the LRN-B, this could have been a very different story.  But thanks to the dedication of a wide variety of people, the patient was on the road to recovery a mere four days after the initial blood cultures were drawn.  “I think what this really showed us was that all of the efforts we’ve put forth for our training really have made a difference,” says Sullivan. “All of those things really came together and we had a very successful response.”

In conclusion, Contagion 2: LRN in Action.  Get the popcorn!

*Speaking of Contagion, my friends in Minnesota would probably like me to point out that this case study does an awesome job of refuting the movie Contagion’s very unflattering portrayal of Minnesota public health and emergency response systems.  Despite what Steven Soderbergh may have you believe, when trouble arrives in real life, Minnesota is on its game!

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Nanotechnology and Public Health: Part 2/2

Dec 11 2012 :: Published in Environmental Health, Food Safety, Public Health Preparedness & Response

By: Michael Heintz, Senior Specialist, Environmental Laboratories, APHL

This is the second in a two-part series on the implications of nanotechnologies on public health. See Part 1 for an introduction to nanotechnology and nanomaterials. Part 2 delves into how this emerging field may impact various parts of public and environmental health.

Nanotechnology and Public Health

Nanomaterials provide new opportunities for detection, remediation and protection. Laboratories, in particular, need to understand the uses of nanomaterials because the small particles with very different properties and reactivity will affect laboratory operations.

- Environmental Health: Nanomaterials may provide significant new remediation tools, while also presenting contamination concerns. As consumer goods use nanomaterials more often, the potential for accidental exposure or release increases. Disposal from nanomaterial-containing goods, such as cosmetics and paint, could cause increased soil and water contamination as the nanomaterials leach. In some instances, nanomaterials are small enough to permeate the liners of landfills and other barriers, providing exposure pathways into groundwater and other environmental resources. Similarly, accidents or other releases can cause direct environmental harm. Additionally, nanomaterials appearing in sunscreens may be small enough to pass through the skin and into the biological system of people.

Of particular concern for laboratories is that nanomaterials may begin appearing in both clinical and environmental samples. Without proper controls, nanomaterials may cause unknown impacts on results. And, given the higher reactivity at lower concentrations, test methods may not accurately reflect the presence of nanomaterials leading to confusing or illogical test results.

- Food Safety: Food safety issues may be the largest area of concern when it comes to nanomaterials. Nanotechnology is employed in a large portion of the food chain including agriculture (pesticides and sensors), processing (nanocapsules and flavor enhancers), packaging (sensors and spoilage barriers), and supplements (vitamin sprays). On the other hand, the potential for longer food preservation, more efficiency in nutrient uptake, and disease resistant crops provides significant benefits to society. In addition, nanomaterials may allow for rapid pathogen testing in food sources. Such tests could potentially avoid outbreaks and recalls before food is moved to the market.

- Preparedness: For emergency response preparedness, the products using nanomaterials are largely the same as in other industries. Nanosensors and testing platforms used in the environmental sector are available to emergency responders for contamination warning and rapid analysis using handheld equipment (lab-on-a-chip). However, because the reactivity of nanomaterials is not widely understood in an emergency context, preparedness may be impeded by adding variables to emergency response situations. For example, nanomaterials age during environmental oxidation, but there is no information on how this aging process will change the properties of the materials.

In addition to these potential benefits and risks, the overarching issue remains uncertainty. Without clear direction as to the limits of nanotechnology, industry will continue to operate in a vacuum, products will continue to be developed and sold, and research will be left to catch up.

For more information on nanotechnology issues and areas of concern, see the following:

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Beware of the Nose Pickers

Oct 16 2012 :: Published in Food Safety, Infectious Diseases

By Kara MacKeil, BA, Senior Technician, Public Health Preparedness and Response, APHL

Let’s all stop and think for a moment about why you, personally, should wash your hands.  We all agree that washing your hands is a good thing; according to the US Agency for International Aid, good hand washing can reduce death from diarrheal disease by almost half.  But you may notice that “I know I should wash my hands” often does not equal “I DO wash my hands.” (Feel free to read this if you don’t believe me.)  So in the interests of public health, I’m going to do my best to scare you all into picking up the soap.

Nose Picker

Picture the handle on the front door of your workplace (if yours doesn’t have one, skip ahead to the elevator buttons).  Who might have used this handle before you arrived this morning?  What have they all been touching before they came to work? Many have small children at home; conceivably they changed a diaper or dealt with an accident before they left the house.  Almost certainly they used the bathroom themselves.  There are numerous pet-owners, perhaps they did the morning walk or scooped a litter box. It’s cold season, so quite a few have been coughing and sneezing, and just as many have spent the last hour sitting in traffic with their index fingers shoved firmly up their nostrils.  They might have hit the sink, they might have used hand sanitizer, but they all touched that handle before you did.

Go inside and walk to your desk.  Notice that the cleaning crew has thoughtfully dusted underneath your various pencil holders, convention toys, and other objects.  How nice!  I’m sure they washed their hands before they picked up the mouse you’re about to spend all day holding. The rest of the day passes as usual.  You touch buttons on the copy machine and objects on your desk.  You pick up a pen, and wonder idly how you came to own it, since you didn’t attend the convention it advertises.  Someone must have left it on your desk.  Wonder what they touched?

Lunchtime hits, and you eat with your co-workers.  Hopefully everyone washed their hands, especially the one passing out cookies.  After lunch it’s more buttons, more objects, more mystery pens.  Someone coughs in the background, jolting you from your post-lunch stupor, and you hit the candy jar for a boost.  Just be sure to get to it before the cougher does.

You use the bathroom.  Uh-oh, there’s another door handle.  Are you sure you heard the sink when the last person finished?

Work is done, so it’s time for errands, or maybe the gym. Whatever you do, you’ll be touching things. More door handles, more objects, more nose pickers. On the way home, you realize your EZ pass isn’t in the car, and you’ll have to use cash.  Amazing how long a coin lasts, I bet THOUSANDS of people have touched that!

Here’s your front door, safe at last!  It’s late, so crawl into bed, maybe read a few pages of that great book you snagged from the secondhand bookstore.  As you drift off, try not to think about how many things you have touched today, and all the hands that touched them first. Pay no mind to all those times you touched your face.

Wash your hands!

 

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System Built for Responding to Bioterrorism Confirms Plague in Colorado Girl

Sep 13 2012 :: Published in Member News, Public Health Preparedness & Response

By Larry Sater, MS BT/CT Coordinator, Colorado Department of Public Health & Environment Laboratory Services Division

When the Laboratory Response Network (LRN) was established in 1999, the goal was to establish accurate, rapid testing methods to confirm or rule out dangerous bacteria, viruses and toxins that bioterrorists might unleash on the American public.  However, those same laboratory tools and trained staff do not sit idle waiting for a bioterrorist threat. A great success of the LRN is the day-to-day use of these resources in detecting the presence of select agents in people, pets, livestock and food during everyday life.  If you do not believe me, speak with a seven-year-old Colorado girl and her parents.

Colorado Bioterrorism Lab

Each year, and especially during the summer, the Colorado Department of Public Health & Environment Laboratory Services Division (CDPHE) laboratory is busy testing for West Nile Virus, rabies, plague and other diseases in both clinical and environmental samples.  On August 27, 2012, the lab received another one of these calls, but this one was very different.  A seven-year-old girl was critically ill and determination of the cause of her illness was critical to quickly proceed with appropriate treatment.  A courier from Presbyterian/St. Luke’s Rocky Mountain Hospital for Children delivered the specimens to the state laboratory just before noon on that day.

This was the story: While at a Colorado campground, the little girl found a dead squirrel and insisted on giving it a proper burial.  In the process, it is suspected that fleas containing the plague bacteria left the squirrel carcass and contacted the girl, inflicting several bites. The child soon became ill with a fever of 107 and required airlifting to St. Luke’s.  There, an alert physician checked both symptoms and the literature, concluding bubonic plague was a possible culprit.

The hospital collected specimens for culture and could not rule out the presence of Yersinia pestis, the bacteria causing plague.  At this point, the Laboratory Services Division was contacted and specimens collected from the girl were sent to us for confirmation testing.

Before the LRN, bacteria had to be grown in a culture for at least 1-2 days before the organism could be detected and colonies sampled for testing. However, thanks to rapid technologies adopted by LRN laboratories, the DNA for the plague bacteria was detected and identified within 2 hours of receipt of the specimens using a method called polymerase chain reaction (PCR).  A second rapid test, direct fluoroimmunoassay (DFA) which uses the antibody to the suspected bacteria, confirmed the presence of Yersinia pestis.

Thus within hours, the cause of the girl’s life-threatening illness had been identified as a presumptive positive and a confirmation test conducted that supported the physician’s suspicions.  Samples of the specimens were cultured overnight with microscopic observation of the organisms. Other tests confirmed the presence of the agent and the fact that it was still alive.

Earlier that month, two human cases of brucellosis were confirmed by the CDPHE laboratory, as well as several cases of plague in rabbits discovered in communities across Colorado.

Such specimens come in routinely to the CDPHE laboratory—all part of a day’s work for the staff.  While the LRN Network was established to rapidly confirm the presence of biological and chemical agents that could be employed in a terrorist attack, it has offered a bonus to the American public, protecting them from naturally-occurring health threats every day of the year.

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Preparedness and Politics in Florida: All in a Day’s Work

Aug 28 2012 :: Published in Public Health Preparedness & Response

By Chris N Mangal, MPH, Director of Public Health Preparedness and Response, APHL; Rick France, PhD, MPH, Chemical Threat Coordinator, Bureau of Public Health Laboratories – Tampa, Florida Department of Health

Many of us are keenly aware of the upcoming presidential elections. The 24 hour cable news is inundating the public with the minutia of each campaign tactic, misfire or other rhetoric — it’s hard to miss that this is a critical time for the American people. So first pitch, whatever party you support – ensure you vote.

Second pitch – prior to voting, learn some more about the candidates and their platforms. That is, learn more about the services they support and how those services in turn support your community.

Republican National Convention

Speaking of supporting your community… a big part of our jobs is to educate people about public health, specifically public health laboratories and their role in protecting the nation’s health. Given that the country is ablaze with hot button political issues and the Republican National Convention kicked-off yesterday, we thought this is a great time to highlight Florida’s Bureau of Public Health Laboratories (BPHL), a critical component of the Florida Department of Health, charged with protecting the public health, safety and welfare of the citizens of the state. The BPHL supports Florida’s county health departments, physicians, hospitals and other Florida Department of Health program components by providing public health diagnostic and reference laboratory services.

The four BPHL laboratories (located in Jacksonville, Tampa, Miami and Pensacola), in addition to the Bureau of Food Laboratories of the Florida Department of Agriculture and Consumer services, comprise the Laboratory Response Network (LRN) in Florida. In addition to their daily functions, these laboratories have been planning for over a year to be ready for the activities surrounding the Republican National Convention (RNC) in Tampa, convening from August 27 to August 30. The four laboratories continue frontline efforts to prepare for and respond to all hazard threats such as natural disasters (What if Hurricane Isaac wreaks havoc on the Gulf states?); acts of terrorism (Remember anthrax 2001?) or emerging infectious diseases (West Nile Virus).

The Florida BPHL is not new to unusual biological events. In October 2001, they received a specimen from a patient at a south Florida hospital. The specimen was identified as positive for B. anthracis – anthrax. This turned out to be the index case for the American Media Inc. intentional release, and the subsequent Amerithrax (as it came to be known) Outbreak.

What do Florida’s public health laboratories do on a routine basis?

The LRN laboratories provide rapid detection of threat agents and expand the ability of the Centers for Disease Control and Prevention (CDC) to analyze a large number of patient samples by using unique high-throughput analysis capabilities when responding to large-scale exposure incidents.  Additionally, the LRN for Biological Terrorism Preparedness (LRN-B) has continued to provide training to the sentinel clinical laboratories for the packaging and shipping of infectious agents.

What is being done specifically for the Republican National Convention?

  • The LRN-B component of the public health laboratory has stepped up their outreach and training with first responders on sample collection for white powder and other incidents.
  • The LRN for Chemical Threat Preparedness (LRN-C) has been doing more outreach and training with the local health and medical community on awareness of and preparedness for chemical threats and exposure. In fact, the BPHL-Jacksonville is one of ten chemical surge capacity laboratories for the CDC and is able to detect metabolites of toxic chemical agents including blister agents, blood agents, nerve agents, hazardous industrial chemicals, toxic elements and biological toxins.
  • More importantly, these four laboratories worked together with the LRN-B and LRN-C to conduct a joint biological and chemical statewide exercise in preparation for the RNC. The exercise, conducted in February 2012, involved over twenty local, state and federal agencies as well as numerous hospitals and county health departments.
  • The BioWatch Program, a Department of Homeland Security (DHS) nationwide effort to detect the release of biological pathogens in the air, will also be on heightened awareness with an increase in surveillance. Additional staff have been brought in to assist with these increased surveillance efforts.
  • The BPHL will continue working closely with the Hillsborough County Health Department’s epidemiology program, which will be “extra vigilant” with their surveillance activities during the RNC. Epidemiologists will be paying close attention in particular to any reports of patients with an unusual rash, a food-related illness, cases of bloody diarrhea, any unexplained severe infectious illness or death in an otherwise healthy person.

The Florida BPHL has planned and prepared extensively for the upcoming RNC. Although there is always the possibility of the unexpected occurring, with increased outreach, training and exercises the laboratories are prepared to be on the frontlines no matter what.  It’s all in day’s work!

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Dispatches from the Newbie: The 2012 Public Health Preparedness and Response Summit

Feb 28 2012 :: Published in Public Health Preparedness & Response

By Kara MacKeil, Senior Technician, Public Health Preparedness and Response

Greetings from sunny southern California! By the time you read this I’ll be back in chilly DC, but as I write it’s over 70 degrees outside and the Tower of Terror is beckoning.  The 2012 Public Health Preparedness and Response Summit has just wrapped up, and I think it’s safe to say this has been a very important, but very fun week for everyone involved.  Even though we can see Disneyland from our hotel rooms, the APHL staff and members who attended this meeting have been making the most of a great opportunity to form new connections in the world of public health preparedness and share ideas for improvement.  As a relative newcomer, I’ve been really interested to see all of the different types of agencies that work in public health along with the laboratories.  The exhibit hall was full of different vendors, federal agencies, and other groups, all with interesting positions and experiences to contribute (and great decorations for my desk).  But thanks to the Fantastic Wheel of Fun, the APHL booth was definitely one of the most popular stops in the exhibit hall!  Super-secret plans are in the works to top ourselves next year…

APHL's Kara MacKeil at the 2012 Public Health Preparedness and Response Summit

When I wasn’t handing out giant microbes, I did manage to make it to a few sessions.  I particularly liked the town hall discussion, “A Family Vacation That Won’t Soon Be Forgotten: A Naturally Acquired Inhalational Anthrax Case.”  Collaboration between different agencies and labs is something we talk about a lot and this was a great example of these partnerships — a local hospital lab (in this case the Lake Region Healthcare Laboratory in Fergus Falls, Minnesota) working with the Minnesota Department of Health Laboratory and the Minnesota National Guard Civil Support Team to identify and then respond to a very sudden, very scary case of inhalational anthrax.   This story had been covered in the national news from a public safety perspective, but the presenters chose to follow from the point of view of the patient, from zero hour to present day.  Seeing the process laid out step by step made the role of each participating agency very clear, and I thought it gave the audience a great way to connect with the story and understand the importance of these networks on a really personal level. The best part was that the patient recovered thanks to this seamless response structure!

My favorite session this week was the closing session, a talk by D.A. Henderson, MD, MPH on the history of public health preparedness and where it needs to go in the future.  Even though most of the attendees have been in this game a lot longer than I have, I think everyone there was just as captivated as I was.  As you might guess, the trajectory Dr. Henderson presented was very much a before and after 9/11 trend, but he pointed out that since 2001 we haven’t had the steady increase in funding and training you might hope for.  The theme of this year’s Summit was “Regroup, Refocus, Refresh: Sustaining Preparedness in an Economic Crisis,” and Dr. Henderson tackled this problem head on with his Complacency Curve to show the general decline in public health preparedness funding since 2001.  My hope is that this curve will shift soon. This session also touched on a personal interest of mine with Dr. Henderson’s answer to an audience member’s question about declining vaccination rates and how we might convince parents to get their children immunized.  When you’re talking preparedness it is easy to stay focused on biological and chemical warfare, but as a former healthcare worker, declining vaccine rates scare me just as much.  While it might be a little gruesome, I had to agree that parents might be more willing to vaccinate if they knew just how bad some of the vaccine-preventable diseases can be.  On the other hand, I know there are some parents who are never going to choose vaccination no matter what they’re advised to do.  I’ll be interested to see where this issue goes as herd immunity gets weaker.

Aside from the early morning start-times (and the jet lag), we all had a great time and learned a lot.  I hope the new ideas from this meeting stay with us when we get home, but the sooner the ticking of that prize wheel leaves my dreams, the better…

 

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Barf-humbug! Holiday cookies, latkes and everyday safe egg handling

Dec 20 2011 :: Published in Food Safety

By Michelle Forman, Senior Media Specialist, APHL

Ah, the holidays… whatever holiday it is that you celebrate (or just the holiday called “Quiet Time in the Office”), I think it is safe to assume that your holiday is overflowing with deliciousness.  Friends hosting parties; family gathering for dinners; coworkers bringing treats to share.  Whether sweet or savory, this time of year screams FOOD.  (And that means my pants scream LOOSEN ME.) However you choose to celebrate – or not celebrate – this time of year, let’s talk about some ways to make sure your holiday season doesn’t scream BARF-HUMBUG!

Egg

Around Thanksgiving we talked about safely handling raw meat.  Quick! Do we rinse our turkeys or not?  I hope you said NOT.  This time of year I think we need to talk about eggs and Salmonella.  That unexciting ingredient that goes into cookies, cakes and other sweet treats, and let’s not forget about latkes, a Chanukah staple, and of course eggnog.  I don’t know about you, but I often quickly add them and move on to the more exciting ingredients like chocolate chips!  Let’s take a step back and think about those eggs.

Shell eggs (ie, eggs in their shells as opposed to the egg product in a carton – more on this below) are not pasteurized.  That means they can contain Salmonella.  There are regulations in place that mandate certain procedures to clean the outside of eggs sold commercially so you’re good there.  The issue is that Salmonella can live inside the shell.  That means we have to be careful.

Here are a few suggestions to make sure you aren’t contaminating your kitchen:

1. When handling raw egg, you should think of it like raw meat.  Would you rub your raw chicken all over your countertops?  Would you get raw chicken on your hand, wipe it on your dishtowel and just move on without washing with soap and water?  I hope not.  And if you do, please don’t invite me over for dinner.  After you crack your eggs into the bowl, wash your hands and anything else you touched.  Wash with water AND soap.  Come on.  Will these soaps that look like bacterial cultures help make hand washing more fun?

2. Now don’t forget that whatever you just mixed your egg into has raw egg in it.  Did that sound like the most obvious statement ever?  Then why would you roll cookie dough out on your counter, cut out your adorable Rudolph cookies, line them up like a reindeer army marching across your baking sheet, and then NOT wash your hands again and anything else you touched including the counter?  I mean, really people!  If your eggs are contaminated, you just shmeared Salmonella all over the place and *bing bong* your guests are here and not interested in eating your Salmonella cookies while gathered around your Salmonella countertops.  Do everything you possibly can to NOT cross contaminate.

Thumbprint cookies

3. Ok.  Now we need to have a difficult talk.  This won’t be easy for either of us to discuss but it is necessary.  Eating raw cookie dough.  I know, I know… it is delicious.  I’m right there with you!  So I’m not going to tell you not to eat raw cookie dough.  I know you’ll stop reading right now and brush me off as the mean lady who ruined your favorite indulgence.  What I am going to tell you is that you have to lick those delicious spoons at your own risk.  Just like with raw meat or fish, it could make you sick.  Any egg could contain Salmonella.  Just because you got it at Fancy Pants Grocery doesn’t mean it is exempt from contamination.  Officially we don’t recommend eating raw cookie dough.  Unofficially? You decide if you feel it is worth the risk.  I would strongly discourage you from letting your kids, an elderly friend or relative or anyone with a compromised immune system have it.  In that case, it probably is not worth the risk.  Salmonella is potentially very dangerous.  And to those of you tough guys who are like, “Oh, I eat raw cookie dough all the time and I’m still alive!”  You may get sick – you may not get sick.  But ask any person who has ever contracted Salmonella and they will likely tell you about the time when they wish they weren’t alive as they slept on the bathroom floor cuddled up to the toilet.

4. As I already mentioned, most shell eggs are not pasteurized but egg product is. Egg product is the stuff that comes in cartons.  Many restaurants use egg product for that reason – Pasteurized! No lawsuit!  Hooray!  If you’re making sauces that call for raw egg (Caesar dressing, Hollandaise, béarnaise, etc), using egg product is safer.  Some egg product won’t work well for baking so check the side of the carton first.  It will tell you.

5. Make sure things are cooked all the way through.  You’re not going to stick a meat thermometer in every cookie and latke, but you can still check to make sure they aren’t raw in the center.  You want the chocolate chips to be gooey, not the cookie part.  And when frying latkes, be sure your pan isn’t too hot so they cook through before the outside burns.  In both cases, break one in half to check the center.  Oh, and you know those delicious runny sunny side up eggs you love to dip your toast in?  Yeah, those aren’t cooked all the way through.  Just like with the cookie dough, eat at your own risk.

6. Don’t drink unpasteurized eggnog.  You can get pasteurized eggnog, so why risk it?  Friends don’t let friends drink unpasteurized eggnog and hold their own hair back… if you know what I mean.

As GI Joe said, “Now you know, and knowing is half the battle.”  He was obviously referring to safe food handling when he said that.

Why do we go to so much trouble to entertain and be entertained this time of year?  Because it is nice.  Because seeing people enjoy cookies and latkes that you made makes you feel good. You know what won’t make you feel good?  Seeing people snacking on thumbprint cookies with a dollop of Salmonella in the center where a Hershey kiss should be.   That won’t end well for anyone.

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The State of America’s Health

Dec 15 2011 :: Published in General

By Asha Farrah, Associate Specialist, Newborn Screening & Genetics, APHL

After attending a lunch briefing on America’s 2011 Health Rankings at the National Press Club in D.C., I realized that our nation has a lot of work to do in terms of making its people healthier. The briefing discussed state-by- state findings from the United Health Foundation’s annual assessment of the nation’s health. In the assessment, health was measured using several determinants including (but not limited to) childhood poverty, crime rate, infectious disease, high school graduation rate, prevalence of binge drinking, rate of uninsured, early prenatal care, immunization coverage, smoking rate, diabetes, and prevalence of obesity.

Vermont proved for the fifth time in a row that it is the healthiest state in the country (see graphic).

Vermont ranks #1 in State Health Rankings

Interestingly, states such as New York and New Jersey saw substantial improvements in the health rankings, which were attributed to lower smoking rates. Despite these gains, the report indicated that America still needs to make progress in many areas. Findings from the health rankings report are as follows:

  • Despite three years of gains, the nation made no progress in improving health in 2011.
  • There were modest decreases in smoking and preventable hospitalizations.
  • There were dramatic increases in obesity and diabetes.
  • No state had an obesity rate under 20%.
  • Dramatic increases in obesity, diabetes, and childhood poverty offset improvements in smoking cessation, preventable hospitalizations and cardiovascular deaths.
  • Healthcare costs are continuing to skyrocket and expenditures are at 15% of our GDP.
  • There was a 21.5 % increase in child poverty in 2011.

Although the outlook was bleak, I am confident that if anyone can make a difference in their communities and can reverse some of these health outcomes, it will be public health workers.  It will be important that there is an emphasis on prevention and promoting community health in order to address many of these challenges.  We have a responsibility to work together to improve health outcomes for future generations in this country.

 

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A Culture of Preparedness

Nov 01 2011 :: Published in Public Health Preparedness & Response

By Karthik R. Sivaraman, MPH Candidate, Intern at the Institute for Disaster and Emergency Preparedness, College of Osteopathic Medicine, Nova Southeastern University

Ten years ago anthrax filled letters were mailed around the US, resulting in death, sickness and mass hysteria. One letter was sent to Boca Raton, Florida, not too far from where I attend graduate school. My own university has had two separate white powder incidents. Public health laboratories and biohazard response teams determined that neither incident was positive for anthrax. The events at my university were resolved via conscious vigilance by the staff, students and local response efforts. The attacks in 2001 lead to the notion that it is not a matter of whether a disaster will happen, but more a question of when a disaster will happen. In turn, we as a society must pursue a culture of preparedness.

In the decade since September 2001, millions of hours and dollars have been spent to better secure our safety and stop threats before they have a chance to act. The dilemma now is finding ways to decrease loss caused by man-made and natural disasters. The Deepwater Horizon oil spill, the Japanese earthquake and ensuing tsunami, the Joplin, Missouri tornado and pandemic disease (such as avian and swine influenza) have influenced the national psyche and have instilled fear. These events devastated the local populations, the resources they depend on and/or diminished their livelihood.

As our society becomes more complex, how can we address the issue of disaster and emergency preparedness and reduce fear? As I see it, the answer comes in two parts: promote preparedness and encourage resilience. Promoting preparedness goes beyond stocking up on water, food and amenities for the occasional hurricane. A culture of preparedness indicates that all people should prepare for the eventuality of a disaster. Preparedness includes creating a plan, practicing that plan and having a “go kit” for when you may need to evacuate your home or office. Preparedness can be applied to public health laboratories as well. The ability to continue functioning during a pandemic or violent weather can be the difference between lives saved and lives lost. Building resilience is equally important; recovering from a disaster requires the ability to reclaim your life, reestablish lab functionality and, more importantly, reclaiming your identity and accepting a new normal.

During National Preparedness Month (September 2011), surveys of people on campus and in the local community revealed that they had the bulk of required items to mitigate a disaster (food, water, medical materials, clothing, etc.), but the majority of it was dispersed around the house. Even more disturbing were those that had no preparedness plan or kits at all, because of the expectation that “the government will help me.” Although the government can and does help during major disasters, the current economic turmoil we are experiencing makes it even more imperative to prepare, plan and remain resilient. Moreover, engaging people to take the initiative to foster preparedness and resilience within their own communities is both sustainable and empowering.

A culture of preparedness is not about being an alarmist or causing panic. It is an idea that revolves around fostering community awareness, empowerment and prevention. It is about people helping people. In addition, disaster and emergency preparedness requires the tools and talents of all public health entities: first responders, public health laboratories and healthcare providers. If we can foster resilience, promote a culture of preparedness and remove complacency from our national lexicon, we can truly, as Sir Winston Churchill said, “Let our advance worrying become advance thinking and planning.”

Meet Karthik at about.me/karthikrs or on Twitter (@KarthVader)

 

 

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