Picnic risks extend beyond food poisoning

Over the 4th of July holiday, many Americans will get together for picnics, barbeques, and other gatherings.  For many, food will take center stage, and hopefully proper food safety practices will ensure that in the days following these gatherings people will not be doubled-over in pain, running to and from the bathroom because of something they ate.  The FDA has published recommendations for keeping food safe when eating outdoors that could be useful in helping prevent foodborne illness among your friends and family. 

Recreational WaterFor some, water - not drinking water - will take center stage.  And water sources can contain some of the same pathogens as food sources.  Pools, recreational water, and even municipal water sources have been pinpointed as the source of E. coli, cryptosporidium, Salmonella, and other outbreaks in recent years.   (See Cryptosporidiosis: A Recreational Water Threat That Hasn’t Gone Away)

Water sources can become contaminated with E. coli and other pathogens in a variety of ways. Water that is downstream from cattle pastures, feed lots, or barns can easily become contaminated with pathogens from runoff. When lakes become contaminated, several weeks or months can pass before water quality conditions improve or return to normal.  

Pools can become contaminated with E. coli by animal feces or through fecal contamination from an infected person. Children who are not yet toilet trained and soil diapers while playing in water have been identified as the source of several outbreaks. Proper chlorine levels must be maintained to prevent the spread of E. coli in pools and at water parks. 

In 1998, an E. coli O157:H7 outbreak was traced to an infected toddler who played in a pool at the White Water Water Park outside Atlanta, Georgia. Although the pool was chlorinated, the chlorine concentration and contact time was presumably insufficient to kill the E. coli resulting from fecal contamination by the toddler, and other children who were in the pool ingested E. coli bacteria while playing in the pool. Twenty-six culture-confirmed E. coli cases were identified during the outbreak, and 40 percent of children under five years of age with recognized E. coli infections were diagnosed with hemolytic uremic syndrome (HUS).

In 2005, thousands of people fell ill with cryptosporidiosis, a gastrointestinal illness that causes diarrhea and vomiting, after visiting the spraypark at the Seneca Lake State Park in New York State.  By the time the public health investigation had concluded, at least 3,900 people in New York had reported becoming ill with cryptosporidiosis after taking part in recreational activities at the spraypark, which is located near Geneva. Cryptosporidium was found in two water storage tanks that supplied the 11,000-square-foot spraypark.  Since that time, the spraypark has undergone a renovation for its water storage devices. 

When municipal water sources become contaminated, systems must be flushed to ensure all bacteria has been eliminated from the system, and chlorine levels high enough to kill any bacteria, parasites, or viruses must be introduced.

In 2008, the Colorado Department of Public Health and Environment (CDPHE) reported that 417 people became ill with Salmonella after drinking water from the Alamosa municipal water system, and one resident died. The Centers for Disease Control and Prevention (CDC) and CDPHE confirmed the presence of Salmonella in five out of six water samples taken from various areas around Alamosa, and laboratory results confirmed the presence of Salmonella in the water system, which was flushed in a three-stage water treatment process beginning March 25.

CDC Releases Report on Cryptosporidium Outbreak at Splash Park

This week's MMWR includes a report by the CDC on an outbreak of cryptosporidiosis at a "splash park" in Idaho in 2007.  Cryptosporidiosis is the illness caused by the protozoan cryptosporidium.   According to the CDC:

Symptoms of cryptosporidiosis generally begin 2 to 10 days (average 7 days) after becoming infected with the parasite. The most common symptom of cryptosporidiosis is watery diarrhea. Other symptoms include: 

  • Stomach cramps or pain
  • Dehydration
  • Nausea
  • Vomiting
  • Fever
  • Weight Loss

 Symptoms usually last about 1 to 2 weeks (with a range of a few days to 4 or more weeks) in persons with healthy immune systems. Occasionally, people may experience a recurrence of symptoms after a brief period of recovery before the illness ends. Symptoms can come and go for up to 30 days.

The 2007 outbreak in Idaho occurred in August, and involved 5 laboratory confirmed and 45 probable cases of illness associated with exposure to a "splash park"  The report states that water samples from the splash park tested positive for cyrptosporidium.  Cryptosporidium is a chlorine resistant bacteria, and therefore, the CDC says, "splash park design, operation, access to hygiene facilities, and public education" are essential to outbreak prevention. 

Splash parks have a long history of association with cryptosporidium outbreaks.   Marler Clark currently represents plaintiffs in a class action lawsuit related to an outbreak in upstate New York in 2005.

3 Sickened With Crytposporidium Near Philadelphia

Officals in Montgomery County, Pennsylvania have anounced that 3 individuals have been confirmed with cryptosporidium.    While public swimming pools are common source of cryptosporidium outbreaks, there is reportedly no evidence of such a connection here.   None of the ill individuals had public pool exposures.  Officials are still investigating to possible source of the cluster of illnesses.

Symptoms of cryptosporidium generally occur 2 to 10 days after exposure.  Symptoms include abdominal cramps, nausea, vomiting, fever, and dehydration.   The symptoms usually last 1 to 2 weeks, although they may last up to 4 weeks.  Persons with compromised immune system are at risk for more severe complications.

Baby water recalled for Cryptosporidium contamination

Mom Enterprises, Inc., announced today that the company is recalling Apple Flavored Baby's Bliss Gripewater for potential Cryptosporidium contamination.  The product, which was distributed nationwide, is coded 26952V 10/08, with an expiration date of October, 2008.  In a press release, Mom Enterprises, also known as Bliss by Mom, stated:
One instance of illness has been reported in Minneapolis, MN (August 2007). The most common symptom is watery diarrhea, however, other symptoms may include dehydration, weight loss, stomach cramps or pain, fever, nausea, and vomiting. Symptoms typically begin two - ten days after infection and generally last one - two weeks. While most people with healthy immune systems will recover without treatment, the infection could be serious or life-threatening for certain individuals. Infants, children and pregnant women are susceptible to dehydration, which can be life-threatening, resulting from diarrhea. Individuals with weakened immune systems are also at risk for a more serious and life-threatening form of illness.
Cryptosporidiosis, the infection caused by ingestion of the Cryptosporidium parasite, causes painful abdominal cramping and profuse, watery diarrhea. In addition to diarrhea, symptoms of infection are fatigue, fever, nausea, vomiting, and loss of appetite.

Symptoms of Cryptosporidiosis appear an average of seven days after oocysts are swallowed, and normally last for two weeks or less in healthy adults. People with compromised immune systems (those with diabetes, receiving cancer treatments, who have received organ transplants, or are infected with HIV/AIDS), the elderly, pregnant women, and small children are more likely to become infected, and will suffer more severe illnesses than healthy adults. In some cases, Cryptosporidiosis can be life-threatening, especially when those infected become dehydrated.

Infection's starting point remains a mystery

Betsy Taylor of the Associated Press reports that the Madison County Health Department said Monday that no one source was discovered for illnesses caused by microscopic parasites that sickened dozens of people earlier this year.

Between the first reports on Aug. 8 and the last on Sept. 14, the department in Missouri received word of 57 cases of the illness, said registered nurse Carolyn Amelunke. Despite work to determine where the illness began, no starting point was identified, she said.

The Fredericktown municipal swimming pool voluntarily shut down after the first cases were identified. One of the first children with a confirmed case was at the pool, but several of those infected with the parasite had not been there. It is expected to open again next season, Amelunke said.

The majority of cases were an illness called cryptosporidiosis, though there were two reports of giardiasis, both caused by tiny parasites. Symptoms included diarrhea, nausea, headache, low-grade fever and loss of appetite.