SENIORS ON CRUISES WATCH OUT!

I received sad news this morning. An elderly friend of mine had died. She became ill while on a cruise. The official cause will probably be listed as “congestive heart failure” or something similar. But although that explanation will be much more acceptable to the cruise line, it is not the whole story.

First, a bit of background. My friend is (I typed “is” as I am still having trouble using the past tense..)..was in her 80’s. Like many people of that age, she had a few chronic conditions, one being arthritis, and another, a “weak” heart. But she had never had a heart attack and her doctor in the UK considered her well enough to go on the cruise with her caregiver.

I was told that she really enjoyed the trip up until day 22 of this 44 day cruise. At that point there was an outbreak of food poisoning on the ship. She became very ill, dehydrated, and had to be sent to a hospital in Jamaica, which was the closest port. Several of the passengers ended up there, especially those who were over 60. At least one died soon after she was hospitalized in Jamaica.

Along with a few of the others, my friend was confined to the intensive care unit. After a few days she seemed to be better, but because she was still weak and considered at risk, she was sent to a hospital in Florida, and then to one in England, where she now lived. She died there.

If you have been following this blog, you will know that food poisoning outbreaks on cruise ships are common, with the majority of them caused by norovirus – a highly contagious group of viruses which often infects both passengers and crew. Usually an outbreak starts through contaminated food (perhaps contaminated by a crew member), but you can also catch it directly from someone who is ill (by taking care of them, using the same eating utensils or even from sprayed vomit), and, from surfaces.

Most people recover after 1-3 thoroughly miserable days. However, passengers who are older frequently develop severe dehydration which can aggravate or lead to other serious conditions as seemed to have occurred in my friend’s case. It is not unusual for relapses to happen a couple of weeks or so after the food poisoning incident itself, even after the patient seems to have recovered and has been released from hospital.

The Safe Food Handbook (available on Amazon) discusses how you can protect yourself, as do other posts on this blog. Be careful if you are going on a cruise!

TSF

FOOD POISONING OUTBREAKS FROM EGYPT

Egypt’s huge food poisoning incident of a few days ago sickened 3,353 school children and sent 3,300 to the hospital. The school lunch is clearly suspect as all the children who became ill ate it. What a horrible experience for the poor teachers and the schools – all these children with vomiting and diarrhea. They are probably still having nightmares about it.

So far the causal agent or specific lunch item has not been identified. I would lay my money on norovirus. One reason I suspect norovirus is because the symptoms are typical. Another is that norovirus was also suspected in one of the food poisoning outbreaks at Al-Arbak University in Cairo in 2013 and is quite common in such mass meal programs all over the world (see next post).

In all, Egypt’s food has had a bad run of luck over the last few years and it is commonly known that national hygiene in food processing, packaging, preparation and food service is poor. The world is beginning to wonder whether it is safe to eat at all, particularly since it has caused havoc overseas as well as domestically.

The worst case of such exported food was that large outbreak of E. coli 0104 food poisoning which originated in Northern Germany in 2011. It made some 4,100 people ill, mainly in Europe, and killed at least 50. After many false turns by investigators, it was finally traced to fenugreek seeds imported from Egypt that had been sprouted in Germany (see the several posts on this blog).

You may also recall the Salmonella-contaminated organic celery seed that originated in Egypt. I had to pat myself on the back for predicting correctly on this blog that these seeds had been imported from Egypt.

Then over the last few months there has been that Hepatitis A problem with frozen strawberries imported from Egypt, which were used to make not-so-healthy smoothies in the U.S. They have given 143 unsuspecting people in 9 states a dangerous liver disease.

Of course, this isn't the end of the list.

TSF

FOOD WORKERS OFTEN PASS ON NOROVIRUS

I just checked this blog and found that I had 33 posts dealing with Norovirus. Many of them have well over a thousand hits. The most popular ones are those which deal with Norovirus on cruise ships. That is a very common place for large outbreaks caused by this nasty virus. But sizeable Norovirus outbreaks have also occurred in restaurants, nursing homes, catered receptions and, in schools, where they have been occurring a lot recently in the U.S.

Why these places? True the virus is highly contagious. But there is another reason - these are all places where food is prepared by food service workers. Low income food service workers, with no health insurance, often turn up for work when they are ill so that they don't lose the wages they need to live on. In fact, if they have been ill with this virus, they should actually stay home for at least two days after they feel fine, because they could still be contagious. But of course, they don't. Can you blame them?

It estimated that at least 21 million people in the U.S. get sick from Norovirus every year, and some 70,000 or so are sick enough to end up in hospital. Those who die are often already ill or are older people who become very badly dehydrated. That is why I have often warned seniors not to eat at salad bars, which are a common place for the virus to hide out.

TSF

IT'S NOROVIRUS SEASON: THERE'S BAD NEWS AND GOOD NEWS

In the U.S. we are currently in the middle of peak season for Norovirus outbreaks. Just google the term and you’ll find a number of reported outbreaks, including huge outbreaks in schools.

So here’s some bad news and good news about this virus.

The bad news about Norovirus is that it is a very contagious virus which you can catch not just from food (especially salad bars) but also all kinds of surfaces such as hand rails, countertops and even plastic bags. Don’t suck your thumb or bite your fingernails and wash your hands thoroughly before eating (Is my son reading this?). What is more, you can feel truly awful if you have it. Also bad news is the fact that it is often caught in places where you go to have fun – not get sick – such as cruises, restaurants, weddings, parties and celebrations of all kinds (I won’t put schools and nursing homes on that “fun” list). Another piece of bad news is that you can catch it more than once. Having been ill with Norovirus once will not protect you from getting it. As in the case of the flu, there are many types of noroviruses.

The good news is that while you may feel absolutely awful for what seems like a million years, you’re likely to get better quickly – usually between one to three days. Another piece of good news is that if you are fairly healthy to start off with and keep yourself well hydrated while vomiting all over the place, you will be OK once it’s over. This could be another plus - you may find that you have just undergone a crash weight loss program. And the final good news is that if you work outside your home, or are in charge of cooking for your household, you will have a couple of days of rest afterwards, as no one will want you anywhere near them or preparing any food while you could still be contagious.

TSF

WEDDINGS CAN BE DANGEROUS FOR YOUR HEALTH

Next time you go to a wedding - your own or someone else's - remember this blog. Weddings can be dangerous for your health. Why? Because the food served is much more likely to be contaminated than the food prepared in your home. In other words, the risks of getting a case of food poisoning are pretty high.

The guests who attended a wedding last month in Missouri in the United States, are unfortunately very aware of this fact. There were some 750 people present, and of those, around 300 came down with food poisoning. And it happened so quickly - within hours of dining at the reception.

In such cases of quickly occurring symptoms that are clearly linked to a place where all the victims ate together, the natural suspect is Norovirus (also known as "The Cruise Ship Virus" because it so often crops up on cruises). However, testing did not show it to be present. After additional samples were taken from the food and the victims, and tests were done, the culprit was found to be a bacterium - Clostridium perfringens.

And which food was the contaminated one? It turned out to be the gravy, which had reportedly been cooled down too slowly, allowing maybe a very few bacteria which were in it to multiply, to the point where only a little of the gravy carried large enough numbers to make guests ill. I guess the people who escaped were those who were on a diet and decided to pass on it. I am sure they were glad afterwards.

As pointed out by The Safe Food Handbook: How to Make Smart Choices about Risky Food, mass produced food that is served at places such as weddings, as well as at conventions, parties, on cruise ships and in institutional settings such as hospitals, nursing homes and schools, tends to be more likely to carry bacteria or viruses for a number of reasons. The large-scale food preparation has a lot to do with it. In such situations, foods are not always evenly cooked. The fact that food has to be prepared ahead is also a factor. Sometimes, with cold storage space limited, the prepared food is not always stored at the right temperature (as could also have been to blame at the Missouri wedding). These are just some of the factors.

So did the Missouri bride and groom get food poisoning as well? I have been trying to find out, but so far, no luck. But in checking around, I did find several instances when either the bride or groom or both became ill at their own wedding. Not much fun!

To your good health,
TSF

ANOTHER OUTBREAK ON A CRUISE SHIP

There's another bad outbreak of illness on a cruise ship. At least three to six hundred passengers and crew have had a few days of absolute misery with vomiting and diarrhea. They wish they had never set foot on board.

So what else is new? It happens all the time. The latest to be hit by this kind of outbreak is a Royal Caribbean cruise ship named Explorer of the Seas. It was on a 10-day trip to the Caribbean. No more. The cruise is over. With about 10 to 20 percent of the passengers ill, the cruise line decided to call it quits.

It's probably thanks again to norovirus, sometimes called the "cruise ship virus." However, that still has to be confirmed. Inspectors from the U.S. Centers for Disease Control and Prevention (CDC) are presently on board and laboratory tests are being done. I would bet that food has played a role in the spread of this virus, as it usually does.

Incidentally, the Explorer of the Seas scored 98 - pretty close to perfect - on its recent sanitation inspection by the CDC's Vessel Sanitation Program.

I just checked back on this blog. It seems that I have posted 28 times on norovirus. About half of the posts dealing directly with outbreaks on cruise ships. So if you want to learn how to avoid it, there's plenty of information.

In the meantime ..To your good health!

UPDATE 1/28/14: I notice a lot of readers are clicking on a much older post "Hundreds Fall in on Cruise Ship." Even though this refers to a similar outbreak on a different ship, much of what it says also applies here.

TSF

THE MOST COMMON CAUSE OF FOOD POISONING

A friend recently told me that both she and her husband had become ill after attending a wedding. "A really bad case of the stomach flu," she said. "We are still on antibiotics."

That "stomach flu" was most likely food poisoning caused by a virus called "Norovirus" that was somewhere in the food served at the wedding reception. And no, those antibiotics are not going to help. Most basically healthy people will recover on their own in a few days.

Noroviruses are responsible for about half of all reported outbreaks of gastroenteritis (vomiting, diarrhea, and stomach cramping caused by inflammation of the stomach and intestines) in the U.S. Over 80% of these illnesses occur between November and April - right now.

The virus is often spread through food, but can also be caught from your drinking water, by touching things that have the virus on them, and directly from person to person. Almost half of all cases of food poisoning in the U.S. are believed to be caused by this virus (compared,for instance to about a quarter with bacterial causes).

In the U.S. and other industrialized countries, the most common settings for norovirus outbreaks are long-term care facilities, such as nursing homes, where outbreaks can last months and even be fatal as people are more vulnerable. The virus is also common in restaurant food and at parties and catered events of all kinds - such as weddings, on cruise ships and tours, and in schools and child-care facilies (see earlier blogs).

Be careful!

To your good health,

TSF

CRUISING MAY BE NO CARNIVAL IF YOU GET FOOD POISONING

I noticed that there have been a lot of views lately of my post of 25 February of last year, titled "Is Cruise Ship Food Safe to Eat?" People must be planning cruises this time of year. That is, if they still want to take the risk after the Carnival Cruises disaster in Italy a few days ago. But if you do - remember, running aground is not the only risk on the trip. There's also food poisoning.

In case you need convincing about the health risks on cruise ships, read the second comment on this post - much abbreviated here: "Just returned from my third cruise in about 3 years. Both my daughter and I got sick........ I feel like death warmed over. I wouldn't wish this on my worst enemy!..." It sounds like a bad case of Norovirus - the most common cause of food poisoning, which frequently crops up on cruise ships. It can really ruin your vacation.

There are actually three post on the topic of cruise ship food on this blog, and you should particularly read the second on the list if cruising is on your agenda:

"Why are Cruise Ships Risky Places to Eat" - 26 February 2011

"How to Avoid Getting Sick on a Cruise Ship" - 25 February 2011

"Is Cruise Ship Food Safe to Eat?" 25 February 2011

And choose your cruise ship carefully to make sure it has not had recent outbreaks by checking the CDC "green sheet" (information on the posts).

To your good health,

TSF
Updated on Jan. 16

FROZEN OYSTERS WITH NOROVIRUS FROM KOREA

Norovirus is believed to be the most common cause of food poisoning, although we can also get it from other sources. It's rarely in the news - except when there is a large outbreak on a cruise ship or plane (see posts for Feb. 25 and 26).

Symptoms of Norovirus illness (diarrhea, vomiting, stomach cramps, and occasionally other flu symptoms) are usually over quickly (1-2 days). We often refer to it as "stomach flu" and don't even consider that it might have come from something we ate. Unfortunately, though, this virus is very contagious.

Now the U.S. Food and Drug Administration (FDA) has warned consumers not to eat certain ASSI Brand frozen oysters (shucked, not in shells). There's been an outbreak of norovirus-caused illness in Washington state and they've traced it to these oysters. The oysters were imported from Korea, and processed there - yes, another problem with processed imported food.

By the way, the oysters come in 3-lb bags . Each bag identifies Central Fisheries Co. Ltd., as the packer and Korean Farms of Santa Fe Springs, Calif., as the distributor. Korean Farms distributes a variety of Asian food products. "Assi" is their flagship brand. Incidentally, the word Assi comes from the traditional Korean title for an upper class, young, married woman. Ooops..We used to have a dog called that.

The “Better if Used By” date on the bags of oysters is “2013.02.232.” Although the recall notice does not specifically state it, most likely the oysters went to restaurants, since few of us buy 3lbs of shucked oysters at a time. Certainly, the illnesses that triggered this recall were the result of three people eating the oysters at a Washington State restaurant.

This product was shipped to the states of Washington, California, Texas, Colorado, Arizona, Idaho, and Utah. If you live in one of those seven states, you may want to pass on the oyster dish on the restaurant menu, or, any dish containing oysters, in case they have been undercooked. Thorough cooking does kill this virus.

To your good health,
TSF

NOROVIRUS FROM CONTAMINATED ICE

The problem is that Norovirus is very infectious. You only need to be exposed to about 100 particles to catch it, whereas in the case of seasonal flu it's around 10,000 - quite a difference. It's also a survivor. Norovirus can live outside the body much better and longer than many other viruses.

Virus-contaminated food is only one of the vehicles for catching it, but an important one. You can also inhale the virus from the air where someone has vomited, or

get sick from touching an infected surface, or a sick person. You can even catch Norovirus from contaminated ice, as occurred a few decades ago at a football game between University of Pennsylvania (where I went to graduate school) and Cornell, or, at a museum fundraiser for that matter.

Here's what happened (my source is the Centers for Disease Control - CDC report on the incidents). Within 48 hours of the University of Pennsylvania-Cornell football game in Philadelphia in 1987, a large number of band members from both universities, Cornell football players, and spectators, including visiting students and university staff and faculty, all started having symptoms of gastrointestinal illness, especially projectile vomiting and nausea. A smaller percentage had diarrhea, headaches, chills and additional symptoms. These were typical of Norovirus. Almost all had bought soda with ice from the stadium vendor.

Oddly, many of the Pennsylvania football team members became ill several days later. Apparently this team had used ice from a different source at the September 19 game, but had used the contaminated ice at practice a few days later.

Just a couple of days later there was an outbreak of gastroenteritis among 750 people who attended a museum fund-raiser in Wilmington, Delaware, not far away. The ice was traced to the same Pennsylvania ice supplier. It turned out that its wells had been flooded by a creek (obviously contaminated) following a torrential downpour of rain. Probably, in all, about 5,000 people became ill from this Norovirus contaminated ice.

There is no reason why this kind of outbreak can't happen again anytime, anywhere. And there's no way to know that ice is contaminated. Opt for a warm soda?

TSF

WAS IT SALMONELLA IN THE EGGS? A FOOD POISONING CASE STUDY

Last night a good friend told me had recently had a miserable case of food poisoning. Since he reads this blog, as do several other mutual friends, let's just call him Joe. Joe is over 65 years old, owns and runs his own company, physically active, and relatively healthy. Here's the sad tale he told me.

Joe had gone to his usual pastry shop for coffee and a custom-made pizza after a bike ride in San Francisco. He asked for the following on the pizza: egg whites, smoked salmon and fried onions. Three hours later, just as he was starting a very critical meeting with an important new client, he started to have stomach cramps. All he wanted now was for the meeting to finish. As soon as the client walked out the door he began vomiting and continued to vomit violently all night. He recovered in about a day. Joe was convinced that there had been salmonella in the eggs on his pizza. But was it the eggs, and was it Salmonella bacteria?

Let's look at four possible causes in Joe's case - all of which are commonly associated with restaurant food, starting with Salmonella. Since he did not go to a doctor, we'll never know what it was, but have a guess. By the way, his case will not be reported as a food poisoning statistic either - as most aren't.

Salmonella bacteria can get into almost any food and at any point between the field and plate, although they are most likely to be in foods of animal origin. Food workers may also carry Salmonella and pass them on. Most persons infected with Salmonella develop diarrhea, abdominal cramps and fever. Onset of symptoms usually occurs 12-72 hours after eating. Luckier victims recover in as little as 48 hrs, but usually it's 4-7 miserable days. It can be even longer if complications set in (that is, if it gets into bloodstream, requiring hospitalization).

Listeria monocytogenes is also becoming a major public health problem. Unlike Salmonella, the onset of symptoms can be very slow - 3 to 20 days, and occasionally even longer. Victims tend to have fever and muscle aches (like flu) and sometimes a stiff neck. Gastrointestinal symptoms aren't always present. Like Salmonella, L.monocytogenes is found in soil and water, but can get into food at any point. It is often present in ready-to-eat foods, most likely because a high percentage of food workers carry it - some estimates are as high as 30 percent.

Staphylococcus aureus is another bacterium that commonly causes food poisoning, especially in restaurants. It could get into food from the nose or skin of a food workers (it is believed that up to 25% may carry it without symptoms). Onset of symptoms is caused by the Staph toxins and occurs very quickly - in perhaps as little as 30 minutes, but usually, 1-6 hrs and normally includes several of the following: nausea, retching, vomiting, stomach cramps, and diarrhea, lasting about one day, but sometimes up to 3 days.

Norovirus is the most common cause of food poisoning and is a very contagious virus. It usually gets into food directly from food handlers, and sometimes from contaminated surfaces or kitchen tools. Onset of symptoms is usually 24-48 hours after eating contaminated food, but occasionally it is earlier, and includes very bad vomiting, watery non-bloody diarrhea with abdominal cramps, and nausea. Luckily, recovery is almost always within 1-3 days (and, miserable nights).

A final thought - we tend to think that we got food poisoning from the last meal we ate. This could be true, but it may not be. As you see from the preceding, the onset of symptoms could range from 30 minutes to 20 days - just with these four possible causes. And there are others. Could Joe have got the food poisoning from something else he ate?

TSF

NOROVIRUS OUTBREAK ON A PLANE

Flight 167 from Boston to Los Angeles must certainly have been the trip from hell. The stench was unbearable, people were throwing up all over the place and the first class cabin aisle was fouled with diarrhea. In the end, the situation on board was so bad that the flight had to be aborted: the plane was diverted to Chicago O'Hare International Airport, where it was met with paramedics and ambulances. Several passengers were rushed off to hospital.

This is not a recent incident. It happened in 2008. But there is no reason why it can't happen again any time, any flight, anywhere. In fact, it has happened since then, although with less media coverage. The original reported cause of this incident, was food poisoning on a large tour. Several members of this tour group did not even make the flight home because they were too ill, but about another 41 did get on - some already exposed to Norovirus. This common cause of foodborne illness tends to crop up and spread in places where people are in close contact, such as cruises, tours - and, even planes. You can catch it from food, other people and surfaces. On this particular flight, the virus spread from the sick tour group members to other passengers on the plane just in the matter of a few hours.

Here are a few lessons that just might come in useful. Remember, this virus is very contagious.

• If you are on a flight where someone is throwing up, try to move as far away from them as possible preferably not to an aisle seat. In the case of flight 167, people sitting next to a sick person and those in an aisle seat tended to be the ones who became ill (probably because passengers were running up and down the corridors to the rest rooms, and because of the contaminated aisle).
• Try not to use the rest rooms if you believe someone has thrown up in them, even if it has been cleaned up. This type of quick clean during a flight would not be likely to get rid of the virus. In fact, even a thorough sanitation of the plane after this flight did not get rid of it completely.
• Do not eat or drink anything during the flight.
• Be careful not to touch your mouth during the flight (don't even apply lipstick), and as soon as you land, wash your hands very well with soap and water.
• When you get home or to a hotel, throw everything you are wearing into the wash.Even soap down and wash your handbag or other luggage your had with you in the cabin.

And - just hope and pray you'll never be on a flight like this one!

TSF

WHY ARE CRUISE SHIPS RISKY PLACES TO EAT?

Alright, I still haven't really explained in recent blogs why cruise ships are among the riskiest places to eat. Mea culpa. So here goes.

Not every food borne illness originates on board a cruise ship. Some of the foods purchased for the cruise already carry contaminants (as was believed to be the case with contaminated shrimp served at the embarkation buffet on board one recent cruise). But the studies I have looked at suggest that most get into the food on board the vessel. Often people - crew or passengers - are involved in the spread of illness.

Here are some reasons:

• The mass preparation of food which is usually more prone to contamination ( whether done for catered events, nursing homes, schools, restaurants, conferences or cruise ships).

• The confined area and non-stop socializing among passengers, leading to close contact between people. This means that a crew member handling food can contaminate it, with several passengers (and maybe crew) becoming ill, and then these sick people will pass it on to others (as often happens in the case of Norovirus-caused illness), or, even contaminate more food (if crew members are involved, as they usually seem to be).

• The popularity of buffet service (often with passengers serving themselves): buffets are known to be especially risky type of food for a number of reasons (see future blog).

Investigation of on-board outbreaks has sometimes traced them back to just one ill crew member, which, by the end of the cruise, resulted in over a hundred, or several hundred, illnesses. The original carrier of an illness may also have been a passenger who came on board while ill (not wanting to miss a pre-paid cruise). He or she may then have passed it on to a crew member (cleaning up the mess) and from there to other crew members, including kitchen staff, and on to food and more passengers and crew.

Norovirus - the most common cause of gastrointestinal illness on board - is so very easy to pass on. Just a few viruses on a table surface, a fork or a lettuce leaf will do it. It is also extremely difficult to deep sanitize an infected ship if Norovirus is involved. I have looked at numerous cases in CDC records where the same ship was involved in repeated outbreaks in spite of all the efforts made.

TSF

IS CRUISE SHIP FOOD SAFE TO EAT?

No, eating too much and putting on weight is not what you should worry most about on that cruise you are about to take. Worry instead about gastrointestinal illness, often originating in those mountains of food served.

But look on the bright side: if you do come down with a really bad bout of vomiting and diarrhea, you may even lose weight. Mind you, there is that unfortunate downside: I guess you wouldn't enjoy the cruise all that much if you spent half of it doubled over the "lu" throwing up, instead of sunning on deck, going to all those shows and playing bingo.

The statistics show that cruises are one of the most dangerous places to eat. And things are not improving in spite of special programs such as the US one operated by the Centers for Disease Control (CDC) which inspect ships entering US ports for cleanliness (including of the food), employee hygiene, and collects statistics on the number of illnesses that have occurred on that trip.

I dug up CDC statistics on cruise-ship-based outbreaks of gastrointestinal illness. Let me tell you now, the news is not good. In the year 1999, only one outbreak was recorded on a cruise ship. 2000 and 2001 were pretty good too, with 5 and 4 outbreaks respectively. But during the last 9 years (2002 through 2010) there has been an average of 21.3 outbreaks in the cruise ships entering US ports, with all the major cruise lines involved, from the most expensive to the cheapest. In 2006 there were 33, and in 2004, 32. Some of these were repeats, in the sense that the same ship would have repeated problems, one cruise after another (more on this in another blog). This year - 2011 - is not off to a great start either, with a Celebrity Cruises ship (Celebrity Solstice) and a Royal Caribbean cruise ship (Radiance of the Seas) having outbreaks in January or early February.

And don't think it is just a case of a couple of people becoming ill and you won't be one of them. I haven't finished analyzing all the data yet, but the outbreaks I have looked at so far, show between 3% and 25% of passengers affected (plus a good number of the crew), and of course, as usual, these statistics are likely to be an underestimation, as not everyone who becomes will go to see the ship's doctor.

With a few exceptions, the cause of the illnesses has been Norovirus, which is sometimes called "the cruise ship virus." It is very, very contagious, and the most common way to catch it is from food, although it can be passed from one passenger to another and one crew member to another either directly or indirectly (e.g. through vomit spattered around). Usual symptoms are vomiting and diarrhea, and sometimes also a low-grade fever and headache - not exactly what you want on that long-anticipated cruise that you paid so much for and usually only lasts a few days anyway.

TSF