Rachel Marrs

Influenza Among Afebrile and Vaccinated Healthcare Workers

Among healthcare workers with influenza, half were afebrile. There was no significant difference in the rate of fever among individuals with influenza who had been previously vaccinated compared with those who had not been vaccinated (55% vs 39%; P = .33).

The Hospital Microbiome Project: Meeting Report for the 2nd Hospital Microbiome Project, Chicago, USA, January 15th, 2013

This report details the outcome of the 2nd Hospital Microbiome Project workshop held on January 15th at the University of Chicago, USA. This workshop was the final planning meeting prior to the start of the Hospital Microbiome Project, an investigation to measure and characterize the development of a microbial community within a newly built hospital at the University of Chicago. The main goals of this workshop were to bring together experts in various disciplines to discuss the potential hurdles facing the implementation of the project, and to allow brainstorming of potential synergistic project opportunities.

A pseudo-outbreak of foodborne illness in a hospital cafeteria caused by consumption of sorbitol

Foodborne illness causes significant morbidity and mortality in the United States. An estimated 128,000 people are hospitalized and 3,000 people die from foodborne illness in the United States each year.1 Food service establishments, including those within hospitals, must meet stringent food safety regulations to prevent foodborne illness. However, numerous outbreaks of foodborne illness linked to eating at hospital cafeterias have occurred.2-4 Because hospital cafeterias serve patients who may have compromised immune systems, hospital infection control programs must be vigilant about any potential foodborne illness outbreaks related to food service establishments at their facilities. However, the gastrointestinal (GI) symptoms of foodborne illness (eg, nausea, vomiting, diarrhea) are not specific. We describe multiple cases of GI symptoms caused by consumption of a sugar substitute that were initially mistaken for an outbreak of foodborne illness at our institution. In September 2014, a physician notified the infection control program at our hospital that multiple residents and medical students on his team had fallen ill with GI symptoms after eating at our hospital food court over the prior several months. In response to his concerns, we undertook an outbreak investigation. We defined a case as any individual who suffered from nausea, vomiting, or diarrhea (3 loose stills within a 24-hour period) after eating at the food court from July 1, 2014-September 30, 2014. Individuals identified by the reporting physician were interviewed. Confirmed cases are described in Table 1. All other residents who had called in sick during the defined time period were contacted and questioned regarding food consumption and GI symptoms. One additional student and 2 residents were identified as potential cases by medical student A, but we were unable to successfully contact them. We reviewed all complaints received by food services during the time period but did not identify any additional possible cases among visitors or other employees. A food safety inspection was undertaken of all vendors in the food court; no serious violations were noted. A careful evaluation of the confirmed cases revealed they had all consumed frozen yogurt containing sorbitol from the same vendor. Sorbitol is a sugar substitute that is not absorbed in the GI tract. It can cause GI symptoms including nausea, bloating, and diarrhea.5,6 We determined that sorbitol consumption, rather than an infectious foodborne pathogen, was the cause of the cases’ symptoms. Others have similarly reported individual cases of GI symptoms as a result of sorbitol consumption.7-10 Prior reports have documented diarrhea and weight loss as a result of heavy use of chewing gum or consumption of candy and other sorbitolcontaining foods.7-10 However, to our knowledge, this is the first report of a pseudo-outbreak of GI illness caused by sorbitol in a cluster of individuals. Although foodborne illness is a frequent cause of GI symptoms, it is important to recognize alternative etiologies that can be mistaken for an infectious foodborne outbreak.