Dr. Edo McGowan
Subject: RE: U.S. vulnerable to food-borne illnesses-- but what else is out there?
Date: 11/24/2006
It would be interesting to cross correlate these data from Scripps Howard on illness (see below) with the application of
sewage sludge or irrigation with reclaimed sewage water effluent. I'm assuming (perhaps wrongly) that some
governmental agency (EPA, USDA, or USF&W or USGS) has these areas receiving sludge and their cumulative
amounts mapped out on some GIS system. Thus one could inspect areas of high food and other disease rates with a
more profound basis and hopefully begin to make some sense of this.
I'm writing a guest editorial for the campus newspaper on the school's use of reclaimed sewage effluent for irrigation and
the info from Scripps Howard thus is on point. See background below.
The issue is that several sources of infection are not watched and land application of sewage sludge as well as irrigation
with reclaimed wastewater are, in reality, not well regulated despite what those in the business may contend. If one were
to read Dr. Snyder's paper,-------- http://www.ijoeh.com/pfds/IJOEH_1104_Snyder.pdf ----------- one sees that there is
considerable subterfuge within these agencies and programs that are set up to protect public health and the politicizing
of their missions has rendering their efforts moribund.
Cheers------------Edo
++++++++++++++++++++++++++++++++
To: Editorial staff
Fm: Dr Edo McGowan
Re: Use of reclaimed sewage water to irrigate campus greenscape.
In reflecting on this subject, it occurred to me that a full-length analysis rather than a more limited guest column might be
more appropriate and thus better inform the students. I would consider helping one of your reporters with the
background material if they wish to write this. It is complicated and there easily available pit-falls that the unwary might
stumble into. But with a bit of work, I think we could do a credible job.
One needs to consider finger-to-mouth transfer of pathogens found in sewage contaminated surfaces, including school
lawns. What is the increased risk for students sitting on the grass previously irrigated with reclaimed sewer water and
having lunch? With areosol movement of spray irrigation, what of the adjacent commons and its food falilities? From the
report below provided through Scripps Howard, one sees the problems with food-borne illness. But is it always the food
or the co-contamination from other sources? We depend upon those within civil service to protect our communitie's
health------------------but can they and do they?
In checking with the State of California and its agency licensing sewer plant operators, there was no requsite for training
in infectious diseases. Nonetheless, sewer plants generate vast numbers of pathogens that are released to the
environment. Although reclaimed sewer water may meet the minimum standards, these standards and their designated
lab tests are far from adequate and there are numerous papers in the literature demonstrating failure to protect the
public health of this nation. This is not some new suddenly breaking finding but something that has been known for
decades. Nonetheless, there is little incentive within legislative halls to change this.
Thus for the students exposed to the residue of irrigation with reclaimed wastewater, there are some compelling
questions that beg answers. Who might pick up a pathogen on the playing fields through a dropped mouthpiece? What
are the chances for a scuffed knee to meet an antibiotic resistant pathogen and then what happens? The first round of
antibiotics may fail, but by then the infection has raged on---now you have a serious thing at hand and they try a second
course of a different antibiotic. How much damage is there by the time this is stopped---assuming it can be stopped.
Some pathogens are virtually resistant to all know antibiotics? For a young person with a serious infection, this may be
disfiguring for life. What if it is one of the numerous pathogens that cause necrotizing fasciitis. To stop this rapidly
advancing and life-threatening disease the flesh down to the muscle is completely removed---skin and underlying fat---
and there is then a horribly grotesque limb that remains, but at least the life is often saved (see inserted photo below).
How soon can antibiotic resistance begin and then get away from control by clinicians? Walsh (2003) notes that
resistance to antibiotics is not a matter of IF but one of WHEN.
Schentag, et al. (2003), followed surgical patients with the subsequent results. Pre-op nasal cultures found
Staphylococcus aureus 100% antibiotic susceptible. Pre-op prophylactic antibiotics were administered. Following
surgery, cephalosporin was administered. Ninety percent of the patients went home at post-op day 2 without infectious
complications. Nasal bacteria counts on these patients had dropped from 105 to 103, but were now a mix of sensitive,
borderline, and resistant Staphylococcus sp. By comparison, prior to surgery, all of the patients’ Staphylococcus
samples had been susceptible to antibiotics. For the patients remaining in the hospital and who were switched on post-
op day 5 to a second generation cephalosporin (ceftazidine), showed bacterial counts up 1000-fold when assayed on
post-op day 7 and most of these were methicillin resistant Staphylococcus aureus (MRSA). These patients were
switched to a 2-week course of vancomycin. Cultures from those remaining in the hospital on day 21, revealed
vancomycin resistant enterococcus (VRE) and candida. Vancomycin resistant enterococci infections can produce
mortality rates of between 42 and 81%.
Also one must consider transfer of genetic information from these organisms to more robust organisms as highlighted by
Sjolund et al. (2005) indicating that resistance in the normal flora, which may last up to four-years, might contribute to
increased resistance in higher-grade pathogens through interspecies transfer.
These authors go on to note that since populations of the normal biota are large, this affords the chance for multiple
and different resistant variants to develop. This thus enhances the risk for spread to populations of pathogens.
Furthermore, there is crossed resistance. For example, vancomycin resistance may be maintained by using macrolides.
How much state income does the school give up with ADA decreases as students become ill and does irrigation with
sewage enter that equation? Is the school, already pushed for funds, well prepared for a major court case in the event
of a serious disease or accident that causes major loss of life or disfigurement? Will the school’s insurance carrier stand
behind the school and will the city that is putting out this reclaimed water share in the expense? Who pays for a
replacement piping system with clean water? In one classic case a biofilm formed within the distilled water system of a
hospital, the entire system thus required replacement. Once contaminated with biofilms, is is almost impossible to
decontaminate pipes. But the hospital had pure distilled water, not heavily contaminated reclaimed sewage water.
What will it cost to answer some of these questions or are the politics involved too politically expensive to see the subject
even discussed. These are just a few of the unanswered questions.
Looking at several studies, anywhere from 10 to 100% of the bacteria present on contaminated material was transferred
to the hands of study volunteers when handling a fabric contaminated with a known amount of bacteria (Marples and
Towers 1979; Scott and Bloomfield 1990). The actual level of contamination of hands is not known. For the purposes of
this analysis, it was assumed that 0·1 g of faecal material may be picked up by the hand.
Comparative surface-to-hand and fingertip-to-mouth transfer efficiency of gram-positive bacteria, gram-negative
bacteria, and phage
P. Rusin1*, S. Maxwell1 and C. Gerba1
p. rusin, s. maxwell and c. gerba. 2002.
Aims: To determine the transfer efficiency of micro-organisms from fomites to hands and the subsequent transfer from
the fingertip to the lip.
Methods and Results: Volunteers hands were sampled after the normal usage of fomites seeded with a pooled culture of
a Gram-positive bacterium (Micrococcus luteus), a Gram-negative bacterium (Serratia rubidea) and phage PRD-1
(Period A). Activities included wringing out a dishcloth/sponge, turning on/off a kitchen faucet, cutting up a carrot,
making hamburger patties, holding a phone receiver, and removing laundry from the washing machine. Transfer
efficiencies were 38·47% to 65·80% and 27·59% to 40·03% for the phone receiver and faucet, respectively. Transfer
efficiencies from porous fomites were <0·01%. In most cases, M.luteus was transferred most efficiently, followed by
phage PRD-1 and S. rubidea. When the volunteers' fingertips were inoculated with the pooled organisms and held to
the lip area (Period B), transfer rates of 40·99%, 33·97%, and 33·90% occurred with M. luteus, S. rubidea, and PRD-1,
respectively.
Conclusions: The highest bacteral transfer rates from fomites to the hands were seen with the hard, non-porous
surfaces. Even with low transfer rates, the numbers of bacteria transferred to the hands were still high (up to 106 cells).
Transfer of bacteria from the fingertip to the lip is similar to that observed from hard surfaces to hands.
Significance and Impact of the Study: Infectious doses of pathogens may be transferred to the mouth after handling an
everyday contaminated household object.
Indoor Air
Volume 16 Page 335 - October 2006
doi:10.1111/j.1600-0668.2006.00432.x
Volume 16 Issue 5
Droplet fate in indoor environments, or can we prevent the spread of infection?
L. Morawska
Abstract When considering how people are infected and what can be done to prevent the infections, answers from many
disciplines are sought: microbiology, epidemiology, medicine, engineering, and physics. There are many pathways to
infection spread, and among the most significant from the epidemiological point of view is airborne transport.
Microorganisms can become airborne when droplets are generated during speech, coughing, sneezing, vomiting, or
atomization of feces during sewage removal. The fate of the droplets is governed by the physical principles of transport,
with droplet size being the most important factor affecting their dispersion, deposition on surfaces and determining the
survival of microorganisms within the droplets. In addition, physical characteristics of the indoor environment as well as
the design and operation of building ventilation systems are of critical importance. Do we understand the mechanisms of
infection spread and can we quantify the droplet dynamics under various indoor conditions? Unfortunately no, as this
aspect of infection spread has attracted surprisingly little scientific interest. However, investigations of numerous cases
in which a large number of people were infected show how critical the physics of microorganism spread can be. This
paper reviews the state of knowledge regarding mechanisms of droplet spread and solutions available to minimize the
spread and prevent infections.
Practical Implications
Every day tens of millions of people worldwide suffer from viral infections of different severity at immense economic cost.
There is, however, only minimal understanding of the dynamics of virus-laden aerosols, and so the ability to control and
prevent virus spread is severely reduced, as was clearly demonstrated during the recent severe acute respiratory
syndrome epidemic. This paper proposes the direction to significantly advance fundamental and applied knowledge of
the pathways of viral infection spread in indoor atmospheric systems, through a comprehensive multidisciplinary
approach and application of state-of-the-art scientific methods. Knowledge gained will have the potential to bring
unprecedented economical gains worldwide by minimizing/reducing the spread of disease.
Bacteriology of necrotizing fasciitis.
Giuliano A,
Lewis F Jr,
Hadley K,
Blaisdell FW.
Sixteen patients with necrotizing fasciitis were observed under clinical and laboratory conditions for collection,
preservation, and culture that permitted optimal retrieval of anaerobes. The clinical observations of necrosis of fascia,
subcutaneous fat and skin with thrombosis of the microvasculature, and absence of myonecrosis were clearly apparent
in these patients. Two clear-cut groups of culture and gram stain results were found, suggesting that the clinical entity of
necrotizing fasciitis can occur after infection by different infecting organisms. The cultivation of Streptococcus pyogenes
(group A), either alone or in combination with staphylococcus, in three patients conforms to the culture results found by
Meleney [1] in his original description.
--------------------------------------------------------------------------------
From: fpecar4525@aol.com
To: Ppecar@aol.com, pallafarms@aol.com, Kfhgeo@aol.com, IdealFellow99@aol.com, cgsnyder@post.harvard.edu,
ldennison@bak.rr.com, hshields@worldpath.net, pgiboney@mcaratan.com, edo_mcgowan@hotmail.com, BynJam@aol.
com, adrienne.dominguez@sen.ca.gov, RebeccaL@bolthouse.com, rudy.salas@sen.ca.gov, csmithdewaal@cspinet.
org, bob.alvarez@sen.ca.gov
Date: Fri, 24 Nov 2006 08:14:49 -0500
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November 24, 2006
Study: U.S. vulnerable to food-borne illnesses
Two-thirds of outbreaks undiagnosed
Thomas Hargrove / Scripps Howard News Service
More than 50,000 people got sick or died from something they ate in a hidden epidemic that went undiagnosed by the
nation's public health departments over a five-year period.
Americans play a sort of food-poisoning Russian roulette depending on where they live, an investigation by Scripps
Howard News Service found. Slovenly restaurants, disease-infested food-processing plants and other sources of
infectious illness go undetected all over the country, but much more frequently in some states than others.
Scripps studied 6,374 food-related disease outbreaks reported by every state to the federal Centers for Disease
Control and Prevention from Jan. 1, 2000, through Dec. 31, 2004. The causes of nearly two-thirds of the outbreaks in
that period were officially listed as "unknown."
The findings translate into an alarming potential for tragedy. If health officials are unable to connect illness to food,
victims who might eat from the same poisoned source cannot be warned. If food is known as the culprit, but the specific
disease lurking within is not diagnosed, the victims may get even sicker or die without proper treatment.
The poor track record of so many state labs also raises chilling questions about their ability to spot or deal with a food-
borne terrorist attack.
Families of children who got sick during the five-year period in the study tell heart-rending stories of heroic efforts they
made to cohundreds of people became violently ill or died from something they ate, according to the Scripps study.
The CDC defines an "outbreak" as two or more people who got sick or died after eating the same food. State and local
epidemiologists are diagnosing an average of 36 percent of the nation's reported outbreaks even though some
outbreaks have hundreds of victims.
After learning of the study's findings, Kentucky officials ordered changes to their disease-reporting system. "We really
hadn't been categorizing food- and waterborne outbreaks," said Kentucky Epidemiologist Kraig Humbaugh.
"My daughter's death would have been listed just as a 'stroke' and swept under the rug," said Todd Nelson, a
Continental Airlines pilot and father of a 19-month-old girl who died of E. coli. "But I wanted to know what my daughter
really died of. And I wanted somebody to blame."
The Nelson family believes Ana Leigh Nelson ate infected hamburger meat from a popular Minnesota restaurant in
2002. The family demanded further private tests that confirmed a rare strain of E. coli and then demanded that the
medical examiner change her death certificate to correctly report death from complications of food poisoning.
The study found that Kentucky, Oklahoma and Nebraska are virtually blind to outbreaks of food sickness, rarely
detecting that scattered illnesses have common food causes.
In Alabama, Florida and New Jersey, the cause of food poisoning is almost never found, even when it is known that
dozens or hundreds of people became violently ill or died from something they ate, according to the Scripps study.
http://www.detnews.com/apps/pbcs.dll/article?AID=/20061124/LIFESTYLE03/611240346/1040
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