Fw: [BITES-L] bites Oct. 13/10 -- II

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Date: Wed, 13 Oct 2010 21:47:21 -0500

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Subject: [BITES-L] bites Oct. 13/10 -- II

bites Oct. 13/10 -- II

NY restaurants argue their grade at Night Court

Roaches are dead, but problems remain at St. Paul restaurant

Nikki Marcotte: Some Manhattan restaurants sloppy with food safety

OHIO: At least 8 sickened by Salmonella B after attending school event in Lorain County

Web-based surveys can help track infection outbreaks

WISCONSIN: Illnesses prompt Hillcrest inspection

Comparison of Survey Methods in Norovirus Outbreak Investigation, Oregon, USA, 2009

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NY restaurants argue their grade at Night Court
13.oct.10
barfblog
Doug Powell
http://www.barfblog.com/blog/144539/10/10/13/ny-restaurants-argue-their-grade-night-court
The health department tribunal is, according to the New York Times, a little-publicized court system that metes out penalties for violations of the city sanitary code.
It has been there for years, in a nondescript government office in Lower Manhattan where more than a dozen administrative law judges escort their charges into cramped rooms and hear them wrangle over infractions, in a ritual reminiscent of visiting the principal's office.
But in the weeks since the city adopted a new system requiring restaurants to post large, brightly colored letter grades rating their cleanliness and safety, the tribunal has become a high-stakes food court of last resort where hundreds of restaurant owners and their representatives trudge each day to defend what they say are their very livelihoods.
Whether from Dunkin' Donuts or Le Bernardin, whose case was called last week, they stand in line behind two strips of grimy gray tape on the floor to check in at a reception desk. Then they wait, sometimes all day, to defend their kitchens, many in hopes of nudging a humiliating C up to a bearable B, or turning that middle-of-the-class B into a gold-star A.
At one recent hearing, the judge asked Jay Gavrilov, director of dining services at a residence for the elderly in Battery Park City, if he had anything to say. He responded with an impassioned speech: he was not seeking to reduce his fines or dismiss the violations that had earned him a B.
"My purpose here is to try to get an A to put up," he said plaintively, "for the well-being and mental well-being of my 80-to-105-year-old residents."
http://www.nytimes.com/2010/10/14/nyregion/14inspect.html?_r=2&partner=rss&emc=rss

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Roaches are dead, but problems remain at St. Paul restaurant
13.oct.10
barfblog
Doug Powell
http://www.barfblog.com/blog/144540/10/10/13/roaches-are-dead-problems-remain-st-paul-restaurant
A popular St. Paul restaurant (that's in Minnesota, in the U.S., dontchaknow?) is fighting to stay open no longer has live cockroaches in its kitchen, city inspectors have reported, but there are dead ones nearby, as well as other problems.
TwinCities.com reports that days after the owner of Kim Huoy Chor Asian Cuisine publicly pledged his University Avenue eatery was sparkling clean after two years of failing inspections, city inspectors found numerous problems remained, from food being left out for hours to "dozens of dead roaches in an unused hallway in the basement," according to an inspection report.
Last Wednesday, council member Dave Thune was the lone holdout on a city council that was short a couple members. He prevented his colleagues from closing the restaurant after city attorneys and inspectors reported that two years of violations at Kim Huoy Chor amounted to the worst chronic violation in the history of city food inspections. At least two patrons reported being sickened after eating at the restaurant at 1664 W. University Ave.
Since Taing assumed ownership two years ago, inspectors documented a "cockroach infestation" and persistent food safety violations that they said could lead to food poisoning.
http://www.twincities.com/news/ci_16322873?source=rss&nclick_check=1

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Nikki Marcotte: Some Manhattan restaurants sloppy with food safety
13.oct.10
KMAN
Nikki Marcotte
http://www.barfblog.com/blog/144538/10/10/13/nikki-marcotte-some-manhattan-restaurants-sloppy-food-safety
In the month of September, there were three Manhattan (Kansas) restaurants that received five critical violations or more during routine food safety inspections by the state.
On September 20, 2010. HuHot Mongolian Barbecue in the Manhattan Town Center received nine critical violations for issues such as employees not properly washing their hands, bare hand contact with ready-to-eat food during preparation, improperly sanitizing food contact and preparation areas, and improper cold holding temperatures.
On September 22, Chili's Bar & Grill received eight critical violations for things like employees improperly washing their hands, improperly sanitizing food contact and preparation areas, improper cold holding temperatures, and failing to post their license within the establishment.
On September 28, Pat's Blue Ribbon Barbecue in Aggieville received nine critical violations for employees not properly washing their hands, improperly sanitizing food contact and preparation areas, and not marking correct dates on food storage containers.
Follow-up inspections have been or will be conducted sometime this month.

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OHIO: At least 8 sickened by Salmonella B after attending school event in Lorain County
13.oct.10
newsnet5.com
Mike Waterhouse
http://www.newsnet5.com/dpp/news/local_news/at-least-8-sickened-by-salmonella-b-after-attending-school-event-in-lorain-county
LORAIN, Ohio -- At least eight people were sickened by Salmonella B after attending a school event in Lorain County.
The Lorain County General Health District said tests confirmed eight cases from people who attended a function at Clearview High School.
The health department sent eight samples to the Ohio Department of Health, and all eight came back positive.

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Web-based surveys can help track infection outbreaks
13.oct.10
MedPage Today
Nancy Walsh
http://www.medpagetoday.com/InfectiousDisease/PublicHealth/22715
Internet-based surveys -- increasingly being used by public health officials to investigate infectious disease outbreaks -- are convenient but need careful design and follow-up if they are to be as reliable as telephone surveys, CDC researchers suggested.
Five days after an outbreak of norovirus gastroenteritis among participants in a 475-mile bicycle ride in September 2009, public health officials recruited 204 of the riders for a web-based survey and 93 for a telephone survey, according to John Y. Oh, MD, of the CDC and the Oregon Public Health Division.
The surveys, which were identical, contained 95 questions about food consumption and accommodations during the race, and were expected to take 10 to 15 minutes to complete.
Similar numbers of riders initiated responses to the surveys -- 76% of the Internet group and 84% of the telephone group.
However, fewer of the Internet survey group completed the survey (64% versus 79%, P=0.01), Oh and colleagues reported in the November Emerging Infectious Diseases.
And while 94% of the telephone survey group answered at least 90% of the questions about foods consumed during the race, only 57% of the Internet group did so (P<0.0001).
Significantly more men in the telephone group than in the Internet group completed the survey (79% versus 62%, P=0.03).
More riders 50 years and older in the Internet cohort completed the questionnaire (70% versus 56%, P<0.05).
A total of 18% of both Internet and telephone cohorts were determined to be cases of gastroenteritis.
Camping in the organizer's tents during the race, as opposed to having other accommodations, was significantly associated with illness in the Internet group (35% versus 12%, RR 3, 95% CI 1.4 to 6).
Using the tents, however, was not associated with illness in the telephone group (22% versus 17%, RR 1.3, 95% CI 0.5 to 3.8).
The reasons for this difference were unclear, because similar proportions in the two groups used the organizer's tents. Also, the tents were reassigned at the end of each day, so participants didn't use the same tent each night.
Insufficient power in the telephone survey group could help explain this, according to the researchers.
"Nonetheless, an environmental source of exposure from contaminated tents is biologically plausible, given the low infectious dose of norovirus and its ability to persist on surfaces," they wrote.
Certain lessons can be learned from these findings, the researchers explained.
Reminders sent five days after the original message increased the response rate, and more reminders sent earlier might further increase the response.
The surveys and reminders should specifically request responses from all those invited to participate, not just from those who were ill.
And because the Internet surveys lack the assistance of a telephone prompter who could answer questions and encourage completion of the questionnaire, designing on-line surveys to have mandatory data checks during progression through the questions could help encourage participants to finish.
"Internet survey methods might be more practically suited for relatively shorter, straightforward questionnaires that do not risk respondent fatigue and early termination and do not attempt to assess complex arrays of potential exposures that might require interviewer clarification and assistance," they observed.
They also noted that, although the up-front time and cost of designing high-quality Internet surveys could be higher, once the instrument is in use there would be less public health expense incurred.
There also is a need for ongoing evaluation and validation of the surveys, they noted.
Limitations of the study included possible lack of generalizability of the data to populations with different Internet access and use.
Also, the five-day initial delay in administering the survey may have influenced recall and responses.

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WISCONSIN: Illnesses prompt Hillcrest inspection
13.oct.10
The Sauk Prairie Eagle
Jeremiah Tucker
http://www.wiscnews.com/saukprairieeagle/news/local/article_d05e9bce-d6d6-11df-9c3b-001cc4c03286.html
The state and county health departments are investigating a possible food-borne illness outbreak at the Hillcrest on Lake Wisconsin Restaurant in Merrimac.
Cynthia Bodendein, a Sauk County health officer, said the state had inspected the restaurant, and she recommended anyone who is sick to wash their hands regularly and stay home from work. Beyond that, Bodendein said she couldn't discuss the investigation because it's ongoing.
Beth Kaplan, a spokesperson for Wisconsin Department of Health Services, said her department was contacted by the Sauk County Health Department Oct. 4 about the potential outbreak at the Hillcrest restaurant. Kaplan said a customer had called the county with a complaint.
Kaplan said her department won't know if the illnesses were a result of contaminated food at the restaurant or how many people were sick until the investigation is complete.
She said the health department did not close the restaurant, and it remains open for business.
"(The investigators) interview people involved, they interview people who work there, they take samples to see if anyone was or is sick," Kaplan said.
"Then they look at lab results, try to make a determination of what it is or if it's a particular food item that made people sick."
Kaplan said the state's health staff is considering norovirus as the potential cause of the illness.

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Comparison of Survey Methods in Norovirus Outbreak Investigation, Oregon, USA, 2009
01.nov.10
Emerging Infectious Diseases
John Y. Oh, June E. Bancroft, Margaret C. Cunningham, William E. Keene, Sheryl B. Lyss, Paul R. Cieslak, and Katrina Hedberg
http://www.cdc.gov/eid/content/16/11/pdfs/10-0561.pdf
We compared data from an Internet-based survey and a telephone-based survey during a 2009 norovirus outbreak in Oregon. Survey initiation, timeliness of response, and attack rates were comparable, but participants were less likely to complete Internet questions. Internet-based surveys permit efficient data collection but should be designed to maximize complete responses.
Internet-based questionnaires are increasingly used during investigations of outbreaks; however, compared with telephone interviews, a differential response rate on the basis of exposures or outcomes might bias results (1–6). On September 24, 2009, the Oregon Public Health Division was notified of an outbreak of gastroenteritis that occurred among participants of a 475-mile bicycle ride during September 13–19, 2009. Five of 6 riders who independently reported illness to the event organizer and provided stool specimens were positive for norovirus (GII) infection. In responding to the outbreak, we administered a questionnaire using Internet- and telephone-based methods to directly compare data with regard to response rates, attack rates, and risk factors for illness.
The Study
The event organizer provided telephone numbers, email addresses, and age and sex information for all 2,273 registered riders, of whom 1,288 were Oregon residents. Separate samples of Oregon cyclists were randomized to participate in identically worded surveys, either over the Internet (n = 204) or by telephone (n = 93). The survey contained 95 questions, including 46 about food items eaten. Survey completion was defined as provision of an answer to the last question in the survey (did the participant become ill?), unless the respondent answered "yes." An affirmative answer led to additional questions about symptoms of illness. Each survey took ≈10–15 minutes to complete.
The Internet survey was formatted with Inquisite Survey (Inquisite, Inc., Austin, TX, USA). We sent an email message that included a link to the survey to the riders. Among 204 riders selected for the Internet survey, 201 had valid email addresses. A reminder was emailed to nonresponders after 5 days. Of the 93 riders selected for the telephone survey, 91 had valid telephone numbers. Oregon Public Health Division interviewers attempted at least 5 times to telephone each participant, including during the evening.
We defined a case as vomiting or >3 loose stools within 24 hours in an event rider with onset during September 11–22, 2009 (i.e., a period that included the 2 days before and the 3 days after the ride). Analyses were conducted in SAS 9.1 (SAS Institute, Inc., Cary, NC, USA). Statistical tests were performed by using χ2 tests with significance determined as p<0.05.
Although similar proportions of participants initiated each survey type (153/201 [76%] Internet vs. 76/91 [84%] telephone) (Table 1), participants in the Internet survey were less likely to complete the survey (129/201 [64%] vs. 72/91 [79%]; p = 0.01 for difference in overall completion rate). Within each subgroup, participants were less likely to complete the Internet survey than the telephone survey (Table 2), although the differences were not significant in each subgroup. Within the Internet survey cohort, riders >50 years of age were more likely to complete the survey (80/114 [70%]) than were riders <50 years (48/86 [56%]; p<0.05).
Both cohorts completed the survey within 2 days (92/129 [71%] Internet vs. 47/72 [65%] telephone; p = 0.44) (Table 1, Figure 1). Only 74 (57%) of 129 riders who completed the Internet survey answered >90% of the food item questions, compared with 68 (94%) of 72 riders in the telephone survey (p<0.0001).
Three Internet survey respondents reported illness that did not meet the case definition; they were excluded from analysis. Among the remaining 126 Internet respondents, illness of 23 (18%) met the case definition, as did illness of 13 (18%) of 72 telephone interviewees. The attack rate for the Internet survey cohort who responded within 2 days after survey release (21/91 [23%]) was higher than for those who responded later (2/35 [6%]; p = 0.02); among telephone interviewees, percentage of cases among early interviewees (8/47 [17%] did not differ significantly from those among later interviewees (5/25 [20%]).
The epidemic curve appeared consistent with propagated transmission that peaked near the end of the event (Figure 2). Illness was not significantly associated with age, sex, hand- hygiene practices, reported availability of soap and water, or any of the food items in either survey cohort.
Camping in the organizer's tents during the event was not significantly associated with illness in the telephone survey (4/18 [22%] in the organizer's tents vs. 9/54 [17%] in other accommodations; risk ratio [RR] 1.3, 95% confidence interval [CI] 0.5–3.8). However, it was significantly associated with illness in the Internet survey (12/34 [35%] vs. 11/92 [12%]; RR 3.0, 95% CI 1.4–6.0) and in the combined dataset (Mantel-Haenszel summary RR 2.3, 95% CI 1.3– 4.0).
Conclusions
The Internet and telephone survey methods yielded similar findings with noteworthy differences. Our Internet survey response rate was comparable with that in some reports (1) and higher than in others (2,7). Overall, we found a lower response rate for the Internet survey cohort, with significantly fewer complete surveys. Riders ≥50 years of age were somewhat more likely to complete the Internet survey than were their younger peers in this relatively affluent cohort.
Illness was associated with use of the event organizer's tents in the Internet survey only. Similar proportions of respondents reported illness and reported sleeping in the tents in both survey cohorts, making response bias an unlikely explanation for the different findings. Tents
were reallocated at each stop; thus, riders did not use the same tent every night. Smaller sample size, leading to insufficient power in the telephone survey, could have contributed to the differing results, which might have led to different conclusions on the association of the event organizer's tents with illness. Nonetheless, an environmental source of exposure from contaminated tents is biologically plausible, given the low infectious dose of norovirus and its ability to persist on surfaces (8).
Our experience is relevant to other public health agencies considering Internet surveys for outbreak investigations. First, early respondents to the Internet survey were more likely to report illness than were later respondents, suggesting that a response bias was present soon after survey release that disappeared with time and the reminder email. Survey invitations and reminders must explicitly encourage all invitees, not just those in whom illness developed, to complete the survey. Second, 1 reminder after 5 days boosted response to the Internet survey; more frequent reminders initiated earlier would have required minimal time and might have boosted overall response further. Third, a disadvantage of Internet questionnaires is the absence of a prompter to encourage survey completion and address questions. Implementing mandatory data-entry checks to advance through the survey might lead to more complete survey data. Internet survey methods might be more practically suited for relatively shorter, straightforward questionnaires that do not risk respondent fatigue and early termination and do not attempt to assess complex arrays of potential exposures that might require interviewer clarification and assistance.
This study has certain limitations. Our findings may not be generalizable to groups with different patterns of Internet access or use (9). Also, delays in administering our survey (the first notification came 5 days after the event) might have influenced response rates and exposure recall. Finally, we did not formally quantify and compare the costs of designing and conducting these 2 surveys.
Internet surveys will likely be increasingly used to investigate outbreaks. Our experience suggests that developing quality Internet surveys requires more initial time and effort (greater fixed cost), but once the survey instrument is deployed, it requires less time and expense per respondent for public health agencies (less variable cost). Accordingly, Internet surveys probably become more economical as the group to be surveyed becomes larger. Continued evaluations of
Internet surveys are warranted to validate their findings, particularly among populations with lower Internet access and use.
Acknowledgments
We thank Ryan M. Asherin, Steven C. Fiala, Joyce Grant-Worley, Matthew Jaqua, and Jamie H. Thompson and the bicycle event organizers for their support of this investigation.
This work was supported by the Centers for Disease Control and Prevention's Emerging Infections Program Cooperative Agreement 5U01CI000306-05.
Dr Oh is a CDC Epidemic Intelligence Service Officer assigned to the Oregon Public Health Division. He is a preventive medicine physician with the United States Air Force. His research interests include applied epidemiology and preventive medicine.
References
1. Ghosh TS, Patnaik JL, Alden NB, Vogt RB. Internet- versus telephone-based local outbreak investigations. Emerg Infect Dis. 2008;14:975–7. PubMed DOI: 10.3201/eid1406.071513
2. Srikantiah P, Bodager D, Toth B, Kass-Hout T, Hammond R, Stenzel S, et al. Internet-based investigation of multistate salmonellosis outbreak. Emerg Infect Dis. 2005;11:610–2. PubMed
3. Kuusi M, Nuorti JP, Maunula L, Miettinen I, Pesonen H, von Bonsdorff CH. Internet use and epidemiologic investigation of gastroenteritis outbreak. Emerg Infect Dis. 2004;10:447–50. PubMed
4. Pryor JH, Martin MT, Whitney CG, Turco JH, Baumgartner YY, Zegans ME. Rapid response to a conjunctivitis outbreak: the use of technology to leverage information. J Am Coll Health. 2002;50:267–71. PubMed DOI: 10.1080/07448480209603444
5. Mesquita JR, Nascimento MS. A foodborne outbreak of norovirus gastroenteritis associated with a Christmas dinner in Porto, Portugal, December 2008. Euro Surveill. 2009;14:19355. PubMed
6. Lessler J, Reich NG, Cumming DAT, New York City Department of Health and Mental Hygiene Swine Influenza Investigation Team. Outbreak of 2009 pandemic influenza A (H1N1) at a New York City school. N Engl J Med. 2009;361:2628–36. PubMed DOI: 10.1056/NEJMoa0906089
7. Iuliano AD, Reed C, Guh A, Desai M, Dee DL, Kutty P, et al. Notes from the field: outbreak of 2009 pandemic influenza A (H1N1) virus at a large public university in Delaware, April–May 2009. Clin Infect Dis. 2009;49:1811–20. PubMed DOI: 10.1086/649555
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8. Glass RI, Parashar UD, Estes MK. Norovirus gastroenteritis. N Engl J Med. 2009;361:1776–85.
PubMed DOI: 10.1056/NEJMra0804575
9. Samal L, Hutton HE, Erbelding EJ, Brandon ES, Finkelstein J, Chander G. Digital divide: variation in internet and cellular phone use among women attending an urban sexually transmitted infections clinic. J Urban Health. 2010;87:122–8. PubMed DOI: 10.1007/s11524-009-9415-y

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