If we want more evidence-based practice, we need more practice-based evidence.*

If we want more evidence-based practice, we need more practice-based evidence.*


Chapter 15 - Archives of Headlines
Community Food and Vector Control


Study says smoking ban works. SAN FRANCISCO (AP, Dec. 8, 1998) - Since California banned smoking in bars early this year, bartender Oscar Delcastillo has noticed a few things - he's less tired, his eyes don't bother him as much and he can breathe a lot easier. Researchers say the Los Angeles bartender is not alone. Scientists interviewed 53 San Francisco bartenders before the smoking ban took effect in January. At that time, about three-fourths of them reported symptoms of respiratory distress, things like wheezing, coughing and phlegm. Two to three months after the ban was imposed, 59% of the bartenders said their symptoms were gone, according to a study in Wednesday's issue of The Journal of the American Medical Association. See full story in JAMA, December 9, 1998.

Food Protection through Genetic Engineering. WASHINGTON (Reuters, Nov. 12, 1998) - It's not easy being a grapefruit. After being bashed by wind and rain and plucked from trees, grapefruit are usually heaped onto conveyor belts to be washed, waxed and packed. Sometimes the grapefruit bump against the machinery at high speeds and become bruised. Bruised grapefruit are a danger to themselves and those around them. The bruises allow pathogens to enter the grapefruit, causing the fruit to develop mold that can spread to its neighbors. And the bruises, hard to identify, can take weeks to materialize. But now, thanks to agricultural researchers at Michigan State University have developed a sort of artificial "super grapefruit."

US President Forms Food Safety Council. President Bill Clinton issued an executive order at the end of
August 1998 creating a Council on Food Safety. The Council will coordinate several federal agencies that oversee the safety of the nation's food supply. The executive order followed on the heels of a new report from the National Academy of Sciences warning that the nation's food-protection system needs a major overhaul to ensure a safe food supply. Congress commissioned the report last year after a series of lethal E. coli outbreaks across the country. Food poisoning kills an estimated 9,000 Americans each year and sickens 81 million, according to the report. Public health experts are increasingly concerned about the "dangerous mix" of emerging diseases, foreign produce, and mass food production that pose new threats to food safety. The current food-protection system was designed decades ago to protect the public from a different set of threats.
Among the problems with the current system:

* Inspection agencies are too slow to respond to new dangers, are hampered by "arcane" laws, and are not making use of new technology that could prevent contamination;
* Twelve federal agencies regulate food, fragmenting efforts and wasting scarce resources;
* Inspection procedures are sometimes worthless, and occur so infrequently that they are meaningless;
* Protection rules are ill-focused=97for example, testing for pesticide residues even though bacterial infections pose a greater risk.

The food safety report called for the creation of a new federal agency for food protection, which would require an act of Congress. This would likely generate a political firestorm because it requires carving up existing agencies. Although two bills to create such an agency have been introduced, Congress is not expected to act on reform legislation this year.
For a summary of the report on the Internet, go to http://www.nap.edu/readingroom/books/safefood/

Mosquito invasion as Argentina warms. BUENOS AIRES (Reuters, Nov 5, 1998) - Mosquitoes carrying dengue fever have invaded more than a third of the homes in Argentina's most populous province, a doctor said Thursday. The aedes aegypti mosquito appeared in Argentina in 1986 and is now being found in 36% of homes in Buenos Aires province, according to Dr. Alfredo Seijo of the Hospital Munoz. The province is home to 14 million people. "Aedes aegypti now exists from the south of the United States as far as the south of Buenos Aires province and this is obviously due to climatic changes which have taken...over the past few years, he told a news conference organized by the World Wildlife Fund at United Nations climate talks.

Rat urine toll climbs to 22 in Thailand. BANGKOK (Reuters, Nov. 5, 1998) - An outbreak of a disease transmitted by rat urine has killed at least 22 people in rural Thailand and made hundreds ill, health officials said Thursday. The outbreak of leptospirosis, otherwise known as Weil's disease, has centered on the northern province of Prae and the northeastern province of Surin, the officials said. An official in Surin said 12 people had died of the disease in the province this year and about 90 people had been taken to hospital. Leptospirosis is a bacterial disease most commonly spread by rats and other rodents. Humans can contract it via scratches or other wounds.

Use of employee health and wellness programs by companies growing in Canada, says new study Organizational values support Employee Health Programs and Activities (EHPA) Implementation  VANCOUVER, Oct. 5 /CNW/ - A new study shows that Canadian companies are embracing employee health and wellness programs, as the costs of employee health and absenteeism mount. Kevin Nagel, a PhD candidate at the University of Victoria and a senior consultant with Bayer Inc.'s Bayer Care employee health promotion and disability prevention program, conducted the study among 187 major Canadian organizations to examine organizational values and EHPAs (employee health programs and activities). EHPAs refer to programs and services offered by companies to their employees, to encourage health and wellness and in so doing cut down on health-related lost time, insurance claims and ultimately save money. Nagel presented his findings last week at the Health, Work and Wellness Conference in Whistler, B.C.
``Canadian companies are increasingly embracing these employee health and wellness programs,'' said Nagel. ``Compared to a decade ago, target-specific health initiatives sponsored by companies for their employees are becoming more and more prevalent.''
A 1996 study by the Conference Board of Canada reported that between 1990 and 1994, employers' health spending grew by an average of 26 per cent.
A 1998 Statistics Canada report stated that each full time worker in Canada missed on average 7.4 days in 1997 due to illness, disability or family responsibility.  For an organization of 1,000 employees, with an average salary of $190 per day, this rate of absenteeism translates into a cost of approximately $1.4 million per year or $1,400 per full-time employee.  Nagel's research shows that employee health programs and activities are not yet as effective as they might be in reducing employee absenteeism, sickness and associated costs because companies lack comprehensive information and data about their employees' health, wellness and the effects these problems have on their bottom line. In fact, only 27 per cent of the companies in Nagel's study thought they had the information needed to identify and track health costs, which include costs related to absenteeism, long term disability costs, benefits costs, hospitalization and medical costs, worker's compensation, replacement training, salaries and benefits, prescription drug costs, death claims, administration costs, among others.  Nagel's research also suggests that one reason most organizations do not have comprehensive information about their real needs in terms of employee health and wellness is due to gaps between the types of departments managing this information in an organization. For example, benefits administrators often don't have the information they need to understand the health issues that affect employees. In another example, occupational health personnel are not in the business of developing cost/benefit analyses to support the implementation of employee health programs.

Health Minister releases benchmark report on the Pest Management Regulatory Agency (14 September 1998) Health Minister Allan Rock today released a study commissioned to examine how Canada's regulatory system for pesticides compares to other countries. The report indicates that the Pest Management Regulatory Agency is as efficient as the system existing in the United States. It does however, make recommendations for improving performance standards, addressing re-evaluation issues, making the cost recovery structure more fair and enhancing stakeholder participation. "I am acting immediately on the study's recommendation to create a Pest Management Advisory Council," Minister Rock said. In addition, Mr. Rock announced that the stakeholder membership of the PMRA's Economic Management Advisory Committee (EMAC) will also be broadened, and its role enhanced."This report contains useful and timely information," Mr. Rock said. He predicts that when the improvements now under way at the PMRA are completed, Canada's system will rank  among the best in the world. For more information, visit http://www.hc-sc.ca/english/media/releases/1998/98_58e.htm

Warning not to use any products containing mustard seed oil/mustard oil (11 September 1998)
Health Canada is warning consumers not to use any mustard seed oils/mustard oils because they may be contaminated with argemone oil, a toxic oil which can cause severe illness and sometimes death when consumed or absorbed through the skin. These oils are not used in prepared mustards made in Canada and these products are therefore not of concern. No reports of illness or death associated with these products have been reported in Canada. However, there are reports in India of serious illness, blindness and death associated with the consumption of contaminated oil. Health Canada is currently testing samples of mustard seed oil/mustard oil to determine if any contaminated items were imported to Canada. Until the quality of mustard seed oils/mustard oils can be confirmed, consumers should not purchase or use any products containing these oils. For more information, visit http://www.hc-sc.gc.ca/english/protection/warnings/1998/98_57e.htm

Update on the review of policies concerning the addition of vitamins and minerals to foods (11 September 1998) A joint meeting of the External Advisory Panel (made up of representatives of food industry, consumer, dietetic and health associations, provincial governments and the scientific community) and the government Working Group was held in June 1998. This resulted in the development of criteria by which policy options could be assessed. This work will continue at the next follow-up meeting scheduled for September 14-15,1998. A draft policy options and criteria will then be circulated to the wider stakeholder community for their evaluation and comment this fall. The policy review was initiated in January 1998 to develop an appropriate policy for the future regulation of the addition of vitamins and minerals to foods, taking into account the public health role of nutrient addition to foods, consumer needs and expectations, and industry concerns.  For more information, visit http://www.hc-sc.ca/food-aliment/english/subjects/dietary_reference_intakes/review_of_hc_policies/e_review_of_health_canada.html.

Britain to test appendix, tonsil specimens for CJD. LONDON (Reuters, Aug 27, 1998) - Britain is planning to test appendix and tonsil specimens that are routinely kept at hospitals after removal for evidence of the human form of mad cow disease, the Health Department said. The government decided  on the tests after a marker for the illness, known as new variant Creutzfeldt-Jakob Disease (nvCJD), was found in the appendix of a man who later died of the condition, a spokeswoman said. British media speculated if similar evidence was found in appendix and tonsil specimens taken from others, it could provide a possible way to screen people entering hospital for organ removal.

For information on Mad Cow Disease, go to http://ic.net/~hfm.   Look for link to: Creutzfeldt-Jakob Disease Foundation, & CJD Support Network, Inc. (Australian).

Also:  Hemophilia Foundation of Michigan
117 N. First St. Suite 40, Ann Arbor, MI 48104
734-761-2535 (phone)   800-482-3041 (toll-free)  734-761-3267 (fax)
Look for link to: Creutzfeldt-Jakob Disease Foundation, & CJD Support Network, Inc. (Australian)

Outbreak of Cyclosporiasis -- Ontario, Canada, May 1998. Morbidity and Mortality Weekly Report, October 1, 1998/Vol. 47/No. 38.

During May-June 1998, the Ontario Ministry of Health and local health departments in Ontario received reports of clusters of cases of cyclosporiasis associated with events held during May. This
report describes the preliminary findings of the investigation of a cluster in Toronto, Ontario, and summarizes the findings from investigations of 12 other clusters. These investigations indicated
that fresh raspberries imported from Guatemala were linked to the multicluster outbreak.
Toronto, Ontario On June 2, Toronto Public Health was notified of a laboratory-confirmed case of cyclosporiasis in a person who attended a dinner at a hotel in Toronto on May 8. Six other persons
who attended the dinner were reported to have diarrheal illness. A case of cyclosporiasis was defined as onset of any gastrointestinal (e.g., nausea or vomiting) or constitutional (e.g., fever or
fatigue) symptom 1-14 days after the dinner and either 1) laboratory confirmation of Cyclospora oocysts in a stool specimen; 2) diarrhea (i.e., three or more loose or watery stools during a
24-hour period); or 3) at least four gastrointestinal symptoms. Of the 174 persons who attended the dinner, 128 (74%) were interviewed. Of these 128 persons, 29 (23%) had illness that met the case definition; three of the 29 persons had laboratory-confirmed cyclosporiasis. The median incubation period was 8 days (range: 1-12 days). All 29 case-patients had diarrhea; the median duration of diarrheal illness was 7 days (range: 1-34 days).
Eating the berry garnish (which included raspberries, blackberries, strawberries, and possibly blueberries) for the dessert was significantly associated with risk for illness. Of the 108 persons who ate or probably ate the berry garnish, 28 (26%) became ill, compared with one (5%) of the 20 persons who did not or probably did not eat the berry garnish (relative risk [RR]=5.2; p=0.04, Fisher's exact test). Among the berries in the garnish, raspberries were the only berries significantly associated with risk for illness. Of the 94 persons who ate or probably ate the raspberries, 27 (29%) became ill, compared with two (6%) of the 32 persons who did not or probably did not eat the raspberries (RR=4.6; 95% confidence interval=1.2-18.3). Other Investigations
Twelve other clusters of cases of cyclosporiasis in addition to the Toronto cluster described above have been investigated; each of the 13 clusters had two or more cases, at least one of which was
laboratory confirmed. Based on preliminary data, the 13 clusters comprise 192 cases; 46 (24%) of the 192 were laboratory confirmed.
The dates of the events associated with the clusters ranged from May 2 through May 23, 1998.
Fresh raspberries were the only food in common to all 13 events. Raspberries were included in mixtures of various types of berries at 12 events and were the only type of berry served at one
event. The median of the event-specific attack rates for the 13 events, irrespective of exposures, was 89% (range: 23%-100%). The median of the event-specific attack rates for persons who ate or
probably ate the food items that included raspberries was 100% (range: 26%-100%); the median attack rate for persons who did not or probably did not eat these food items was 0% (range: 0%-67%). Eating the food items that included raspberries was significantly associated with risk for illness for five events; for the other eight events, eating the raspberry-containing food items could
account for 60 (92%) of 65 cases. Traceback investigations to identify the source(s) of the raspberries have been completed for eight events, including the event described above; Guatemala was the only source of the raspberries served at the events. Mesclun lettuce and fresh basil, which were implicated in outbreaks of cyclosporiasis in the United States in 1997 (1,2), each were served
at two events but were not significantly associated with risk for illness.
Reported by: Toronto Public Health, Toronto; Haliburton-Kawartha-Pine Ridge District Health Unit, Port Hope; Simcoe County District Health Unit, Barrie; York Regional Health Unit, Newmarket; Disease Control Svc, Public Health Br, Ontario Ministry of Health, Toronto; Central Public Health Laboratory, Laboratory Services Br, Ontario Ministry of Health, Toronto. Canadian Food Inspection Agency, Fresh and Processed Plant Products Div, Ottawa, and Food Inspection, Ontario Region, Toronto and Guelph; Bur of Infectious Diseases and Field Epidemiology Training Program, Laboratory Center for Disease Control, and Food Directorate, Health Canada, Ottawa. Parasitic Disease Surveillance Unit, New York City Dept of Health, New York. Div of Parasitic Diseases, National Center for Infectious Diseases; and an EIS Officer, CDC.

Editorial Note: The findings in this report indicate that fresh raspberries imported from Guatemala were linked to the outbreak of cyclosporiasis in Ontario in May 1998. Outbreaks of cyclosporiasis
in North America in the spring of 1996 and 1997 also were linked to Guatemalan raspberries; the mode of contamination of the raspberries was not identified for any of these outbreaks (1,3). No
outbreaks were recognized in  association with Guatemalan raspberries during Guatemala's fall and winter export seasons in 1996 and 1997.
After the outbreak in 1996, berry growers and exporters in Guatemala, in consultation with the Food and Drug Administration (FDA) and CDC, voluntarily introduced control measures that focused
on improving water quality and sanitary conditions on individual farms (1). In the spring of 1997, another outbreak of cyclosporiasis occurred despite the implementation of control measures and the restriction (beginning April 22, 1997) that, during that spring, only farms classified by the Guatemalans as low risk could export to North America (1). In the spring of 1998, FDA did not allow importation of fresh raspberries from Guatemala into the United States. The Canadian Food Inspection Agency reported that fresh raspberries from farms that the Guatemalans had classified as low risk continued to be imported into Canada until June 9, 1998. The occurrence of outbreaks in 1997 and 1998 despite the implementation of control measures on Guatemalan farms suggests
either that the control measures may not have been fully implemented by some farms, were not effective, or were not directed against the true source of contamination of the raspberries (1).
The Guatemalan Berry Commission and the government of Guatemala are developing a more comprehensive plan for growing and handling raspberries that includes additional control measures and inspection criteria; the plan is being reviewed by U.S. and Canadian officials.
This is at least the third, and possibly the fourth (4), consecutive year in which outbreaks of cyclosporiasis linked to consumption of raw produce have occurred in North America. In addition to Guatemalan raspberries, fresh mesclun lettuce and fresh basil that were not from Guatemala have been implicated in outbreaks in the United States (1,2). The mode of contamination of the produce was not determined for any of the outbreaks, in part because the methods for detecting Cyclospora on produce and in other environmental samples are insensitive for detecting low levels of the parasite. Produce should be washed thoroughly before it is eaten; however, this practice does not eliminate the risk for transmission of Cyclospora (3,5,6).
Health-care providers should consider the diagnosis of Cyclospora infection in persons with prolonged diarrheal illness and specifically request testing of stool specimens for this parasite. The average incubation period for cyclosporiasis is 1 week; in patients who are not treated with trimethoprim-sulfamethoxazole (7), illness can be protracted, with remitting and relapsing symptoms. Cases of Cyclospora infection unrelated to travel outside of Canada or the United States may be associated with a new outbreak. Newly identified clusters should be investigated to identify the vehicles of infection and to identify the sources and modes of contamination of the implicated vehicles. Although cyclosporiasis is not a reportable disease in any Canadian province or territory, as of June 1998, five states and one municipality in the United States had mandated reporting. In June 1998, the Council of State and Territorial Epidemiologists passed a resolution recommending that cyclosporiasis be made a nationally notifiable disease in the United States. In jurisdictions where formal reporting mechanisms are not yet established, clinicians and laboratorians who identify cases of cyclosporiasis unrelated to travel outside North America
are encouraged to inform the appropriate local, provincial, territorial, or state health departments, which in turn are encouraged to contact, in Canada, the Division of Disease Surveillance, Bureau of Infectious Diseases, Laboratory Center for Disease Control, telephone (613) 941-1288; and, in the United States, CDC's Division of Parasitic Diseases, National Center for Infectious Diseases, telephone (770) 488-7760.
1. CDC. Update: outbreaks of cyclosporiasis--United States and Canada, 1997. MMWR 1997;46:521-3.
2. CDC. Outbreak of cyclosporiasis--Northern Virginia-Washington, D.C.-Baltimore, Maryland, Metropolitan Area, 1997. MMWR 1997;46:689-91.
3. Herwaldt BL, Ackers M-L, Cyclospora Working Group. An outbreak in 1996 of cyclosporiasis associated with imported raspberries. N Engl J Med 1997;336:1548-56.
4. Koumans EH, Katz DJ, Malecki JM, et al. An outbreak of cyclosporiasis in Florida in 1995: a harbinger of multistate outbreaks in 1996 and 1997. Am J Trop Hyg 1998;59:235-42.
5. Robbins JA, Sjulin TM. Scanning electron microscope analysis of drupelet morphology of red raspberry and related Rubus genotypes.  Journal of the American Society of Horticultural Science
6. Ortega YR, Roxas CR, Gilman RH, et al. Isolation of Cryptosporidium parvum and Cyclospora cayetanensis from vegetables collected in markets of an endemic region in Peru. Am J Trop Med
Hyg 1997;57:683-6.
7. Hoge CW, Shlim DR, Ghimire M, et al. Placebo-controlled trial of co-trimoxazole for Cyclospora infections among travellers and foreign residents in Nepal. Lancet 1995;345:691-3.

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