CDC comes out stronger on threat of C. diff in meat
CDC comes out stronger on threat of C. diff in meat
A fourth of cases in CT lack traditional risk factors
The Centers for Disease Control and Prevention is actively investigating the issue of Clostridium difficile in retail meat, and for apparently the first time has published concerns about the issue as a possible cause for unexplained C. diff cases in the community.
Though previously acknowledging the threat to the food supply in meeting discussions and in interviews with Hospital Infection Control, the CDC formally expressed such concerns in print recently in its Morbidity and Mortality Weekly Report.1 In a surveillance report in Connecticut that found about one-fourth of C. diff cases could not be explained by traditional risk factors, the CDC stated:
"Postulated risk factors for acquiring C. difficile in the community include contact with a contaminated health care environment, contact with persons who are infected with and shedding C. difficile (person-to-person transmission), and ingestion of contaminated food. Studies have shown C. difficile to be a pathogen or colonizer of calves, pigs, and humans.2,3
The recent detection of the NAP1 strain of C. difficile in retail ground beef is cause for concern. This hypertoxin-producing strain has been reported as a cause of serious outbreaks of health care-associated disease in humans in North America and Europe and was found among a small subset of specimens from CA-CDAD cases in Connecticut. Further studies are needed to determine whether C. difficile is transmitted via the food chain and the relative importance of such transmission in human CDAD."
"We have a paper coming out that might speak to this [food supply issue] a little more," says L. Clifford McDonald, a medical epidemiologist in the division of health care quality promotion at the Centers for Disease Control and Prevention. One aspect of the CDC research is to determine if cooking will kill spore-forming C. diff, which some researchers think can survive in cooked meat and presumably be transmitted to consumers.
In 2006, the Connecticut Department of Public Health implemented a statewide surveillance system to assess the burden of C. diff- associated disease in the community (CA-CDAD) and to determine the descriptive epidemiology, trends, and risk factors for this disease. A total of 456 possible cases, determined on the basis of tests conducted on outpatients or within two days of hospitalization, were reported during 2006; 241 (53%) were subsequently confirmed as meeting the case definition. The overall annual 2006 incidence of CA-CDAD was 6.9 cases per 100,000 population, with similar rates found in most counties, the report found.
"[O]ne fourth of all CA-CDAD cases were in persons who lacked established predisposing risk factors for CDAD, including advanced age, an underlying health condition, and a health care exposure during the 12 months preceding illness," investigators found. The hypervirulent NAP1 epidemic strain is being found in about 20% to 25% of the community cases, says McDonald. Though citing previously published research on C. diff in meat, the state researchers in Connecticut made no formal attempt to trace unexplained cases back to food consumption. Food was cited as a possible risk factor because additional research is ongoing and the epidemiological evidence begs the question, notes James Hadler, MD, state epidemiologist in Connecticut. "People are a little bit surprised at how fast this more toxigenic strain has appeared all over the country within a relatively short period of time," he says. "The question is, 'How did it get all over the place so quickly?' One hypothesis is that food could certainly do it. It's conceivable that it could be in food, most likely in animals that might have it in their intestines and are slaughtered for meat."
References
- Centers for Disease Control and Prevention. Surveillance for community-associated Clostridium difficile — Connecticut, 2006. MMWR 2008; 57:340-343.
- Rodriguez-Palacios A, Staempfli H, Duffield T, et al. Clostridium difficile PCR ribotypes in calves, Canada. Emerg Infect Dis 2006; 12:1,730-1,736.
- Rodriguez-Palacios A, Staempfli HR, Duffield T, et al. Clostridium difficile in retail ground meat, Canada. Emerg Infect Dis 2007; 13:485-487.
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