Listeria: Lest We Forget

It seems almost ludicrous to mention a 130-pound food recall in the midst of a nationwide Salmonella outbreak, but today's announcement by USDA is a useful reminder that Salmonella isn't the only food-borne pathogen, and tomatoes not the only problematic food.

USDA reported this morning that Gourmet Foods, Inc. of Rancho Dominguez, CA has recalled 130 pounds of ready-to-eat chicken products after the agency detected Listeria monocytogenes in a sample of the products. There have been no reported illnesses.

The recalled products were available for sale in the Los Angeles area only, and are labeled with the establishment number EST. P-7738. Packages carrying "Sell By" dates of 06/04/08 through 06/07/08 are included in the recall.

If you have any of the recalled products, please discard them. If you have already eaten one of the recalled items and think that you are experiencing any symptoms of Listeria monocytogenes infection, please consult your doctor.

For more information on this recall, consumers are invited to contact the Gourmet Foods Quality Assurance Manager, Abelardo Rodriguez, at (310) 632-3300.

Salmonella Outbreak: The Morning Line

CDC has updated the totals on the Salmonella Saintpaul outbreak that has been oozing its way amoeba-like across the United States since mid-April. As of last evening, the agency reports 167 confirmed cases in 17 states. Twenty-three people have been hospitalized. According to CDC, there have been no fatalities reported so far.

But Bill Marler reported in his blog yesterday evening that a Houston cancer patient, who was hospitalized with severe nausea, high fever and diarrhea after becoming infected with the outbreak strain of Salmonella Saintpaul, has since died. Texas Health officials, according to Marler, confirmed the death but declined to attribute it to the Salmonella illness.

Meanwhile, FDA has added several more US states to the "safe" list – tomato-growing areas that investigators have cleared from suspicion. Here is a complete list of US and international growing areas that are NOT implicated in the Salmonella Saintpaul outbreak as of June 9th:

Alabama, Arkansas, California, Georgia, Hawaii, Louisiana, Maine, Maryland, Minnesota, Mississippi, New York, Nebraska, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, Texas, West Virginia, Belgium, Canada, Dominican Republic, Guatemala, Israel, Netherlands, Puerto Rico

As I reported yesterday evening, major restaurant chains and food retailers have responded to the FDA's nationwide warning by suspending the use of suspect raw tomatoes in restaurant meals and by withdrawing those tomatoes from retail produce displays.

According to a story in this morning's Washington Post, Safeway, Giant Food, Harris Teeter and Wegmans have all suspended sale of the varieties of tomatoes that may be the source of the Salmonella outbreak. Harris Teeter plans to restock promptly with tomatoes from one or more of the "safe" growing areas identified by FDA. McDonald's, Subway and Burger King are among the restaurant chains that have temporarily removed the suspect varieties of tomatoes from their menus.

Thursday will mark the first anniversary of the introduction of FDA's Tomato Safety Initiative. The multi-year program was introduced after the United States experienced 12 tomato-related outbreaks of Salmonella illness in the space of ten years. Many of those outbreaks were traced to tomatoes that had been grown in Florida and the coastal areas of Virginia.

FDA began visiting Virginia growers in mid-2007, and announced on March 31st that it would begin its Florida visits this year. In both cases, FDA personnel are working in cooperation with the appropriate state agencies to encourage grower compliance with Good Agricultural Practices and sanitation programs. Interestingly, both Florida and Virginia are still in contention as possible sources of the contaminated tomatoes.

As long as contaminated tomatoes remain on the market, this outbreak will continue to expand – in numbers of victims and geographically. Until government investigators have identified with certainty the source of the tomatoes that are spreading Salmonella Saintpaul, consumers would be wise to limit themselves to those varieties of tomatoes that have been identified as safe: grape tomatoes, cherry tomatoes, tomatoes still attached to their vine, and home-grown tomatoes.

Salmonella Outbreak: 166 Cases and Counting

The Oregon Department of Human Services has just announced three lab-confirmed cases of Salmonella Saintpaul in the state, with two more cases under investigation. The cases are part of the multi-state outbreak that has been linked to Salmonella-contaminated raw tomatoes.

According to the Oregon news release, there are now 166 confirmed cases in 17 states. And the tally of victims will continue to grow as additional suspect cases are confirmed by lab investigators.

The latest list of states that have reported one or more confirmed cases of Salmonella Saintpaul infection is as follows:

Arizona, California, Connecticut, Colorado, Idaho, Illinois, Indiana, Kansas, Michigan, New Mexico, Oklahoma, Oregon, Texas, Utah, Virginia, Washington, Wisconsin.

Ironically, this week marks the first anniversary of FDA's Tomato Safety Initiative. The multi-year program was intended to reduce the incidence of Salmonella contamination in raw tomatoes grown in the United States. We don't yet know the country of origin – or even the variety – of tomatoes implicated in this latest outbreak, but it's clear that the we are a long way from solving the problem of contaminated tomatoes.

Food Retailers React To Tomato Alert

Several restaurant and food chains have reacted to FDA's nationwide Salmonella alert by pulling suspect tomatoes from their menus and produce departments.

McDonald's has taken the extraordinary step of temporarily eliminating sliced tomatoes from its sandwiches. The fast food chain is continuing to serve grape tomatoes – one of the varieties designated as "safe" by FDA – in its premium salads. Chipotle Mexican Grill, likewise, has stopped serving raw tomatoes for now.

Several food retailers, including Wal-Mart, Target, Winn Dixie and Grocers Supervalu have also removed the suspect varieties of tomatoes from sale.

At last count, 145 people in 16 US states have been infected with Salmonella Saintpaul in this outbreak, and the FDA and CDC are still unable to pinpoint the source of the contaminated tomatoes believed to be responsible for the illnesses.

Until the variety of tomato and its geographic origin are known, consumers should limit themselves to grape tomatoes, cherry tomatoes, vine-attached tomatoes or home-grown tomatoes, and should avoid eating dishes made from raw tomatoes (such as salsa) unless they are sure of the origin of the tomatoes.

New Jersey Firm Recalls Ground Beef

Dutch’s Meat, Inc. of Trenton, NJ has recalled more than 13,000 pounds of ground meat products after USDA's Food Safety and Inspection Service found E. coli O157:H7 in a sample of the meat while carrying out a routine sampling program.

The ground meat products are labeled with EST 5424 inside the USDA inspection seal, and with a packaging date between May 27, 2008 through June 6, 2008. None of the recalled product was distributed to retail stores; all of it was supplied to restaurants and food service establishments in the Trenton, NJ area.

This recall is a timely reminder that E. coli O157:H7 is still with us. To avoid illness from E. coli O157:H7 – or from Salmonella – when preparing hamburgers, cook them to an internal temperature of 160ºF.

For more information on ground beef – including safe handling, storage and preparation – check out USDA's Focus on Ground Beef.

Tomato Outbreak Continues to Expand

FDA has issued an expanded warning to consumers nationwide to avoid eating certain varieties of raw tomatoes that may be implicated in a Salmonella Saintpaul outbreak that has sickened 145 people in 16 states so far. At least 23 people have been hospitalized.

The illnesses have been associated with consumption of red plum, red Roma, or red round tomatoes, and products containing these raw, red tomatoes. Cherry tomatoes, grape tomatoes, vine-attached tomatoes and home-grown tomatoes have not been implicated in this outbreak.

While the source of the contaminated tomatoes has not yet been determined, epidemiological investigations have excluded tomatoes grown and harvested in the following states, territories and countries:

Arkansas, California, Georgia, North Carolina, South Carolina, Tennessee, Texas, Belgium, Canada, Dominican Republic, Guatemala, Israel, Netherlands, and Puerto Rico.

Please check on the country, state or territory of origin when buying tomatoes, and restrict your purchases to tomatoes that have not been implicated in this outbreak.

Update on Salmonella-contaminated Tomatoes

The CDC and FDA are continuing to work with state agencies to determine the scope and the source of the Salmonella Saintpaul outbreak. In its June 5th update, CDC reported that 71 cases of lab-confirmed Salmonella Saintpaul illnesses have been linked to consumption of raw tomatoes in New Mexico (36 people) and Texas (35 people). Nineteen of the 71 victims have needed hospital care.

The number of cases in New Mexico is certain to grow, as the state is still awaiting lab results on several additional victims. The latest news (June 4th) from the New Mexico Department of Health indicates a total of 40 confirmed and suspected outbreak victims.

Meanwhile, 10 other states have reported a total of 34 cases of Salmonella illnesses, caused by the same strain as the one responsible for the New Mexico/Texas outbreak. Investigators are still working to determine whether any of these illnesses can be traced to raw tomatoes.

One California resident has been confirmed to be infected with the outbreak strain of Salmonella Saintpaul. The California Department of Public Health is working to determine whether this person ate raw tomatoes within California or while traveling out of state. Additionally, an Oregon resident who visited southern California has also been infected with the outbreak strain.

FDA has posted a special web page dedicated to the tomato outbreak. This page includes a list of countries whose tomatoes have been cleared of any involvement in the current outbreak. Consumers, restaurant managers and food service operators who purchase raw tomatoes should consult this list and only buy tomatoes originating from one of these countries until the source of the outbreak has been determined.

Preliminary epidemiological information is pointing an accusatory finger at raw red plum, red Roma, or round red tomatoes. Cherry tomatoes, grape tomatoes, vine-attached tomatoes, and home-grown tomatoes do not appear to be involved in the outbreak. Until more information is available, stick to one of the "safe" varieties – especially if the store has no information on where its tomatoes were grown.

And In Other News . . .

Here is a summary of other food alerts and other health-related news items that popped up during the last couple of weeks.

May 27th
Supreme Cuts LLC of Mahwah, NJ recalled 87 cases of "Off the Cob Fresh Kernel Corn" after the company found Listeria monocytogenes in a sample of the product. Supreme Cuts suspended production until it could track down the source of the contamination. The corn was distributed to a small number of stores in New Jersey and Massachusetts. Customers were told to discard any unused "Off the Cob" corn that was labeled with a "best before" date of May 26.

May 28th
Orval Kent Foods recalled 23,000 pounds of Amish Macaroni Salad after the Ohio Department of Agriculture found E. coli O157:H7 in a sample. The salad was shipped to retail and food service establishments in Delaware, Illinois, Indiana, Maryland, Michigan, New Jersey, New York, Ohio, and Pennsylvania. Customers were urged to return unopened containers for a full refund. No illnesses have been reported.

May 30th
The UK Food Standards Agency has updated its advisory to British consumers against consuming Bantry Bay frozen mussels, which may contain Azaspiracid Shellfish Poisoning toxins. The advisory has been expanded to include the following product:

• Bantry Bay Mussels in Garlic
• Size: 900g
• Best before: 6 June 2009
• Product code: GBDBL12
• Batch: 24A2

The product was sold only in Makro stores. Consumers are advised to return the recalled mussels to the store for a refund.

May 30th
Fresca Italia, Inc., a California company, recalled one production batch of Burrata, an Italian-style fresh cheese, after the California Dept. of Food & Agriculture detected Listeria monocytogenes in a sample of the cheese. The Burrata, which carries an expiration date of 24/5/2008, was distributed to retail stores and restaurants in the San Francisco Bay area and in southern California.

And that should bring us up to date – at least for now.

Salmonella in Smoked Sausage

Consumers in the United Kingdom should be aware that two batches of chorizo have been recalled by Creative Ingredients Ltd, according to an alert issued by the Food Standards Agency. The recall is due to the presence of Salmonella in the sausages.

The following two batches of chorizo have been recalled:

D’elitte Chorizo Picanté Extra
Pack Size: 200g
Batch Number: 189/07
Best Before: Feb 2009

D’elitte Chorizo Suavé Extra
Pack Size: 200g
Batch Number: 26/08
Best Before: March 2009

Chorizo is a fermented, cured and smoked pork sausage, which is often eaten without further cooking. Consumers who have purchased this sausage should return it to the store for a full refund.

Lettuce Under Suspicion Again

The Washington State Department of Health is investigating a possible link between contaminated lettuce and nine confirmed cases of E. coli O157:H7 infection in the state. A tenth case, which might also be part of the same outbreak was not lab-tested.

Bill Marler, who is based in the Seattle, WA area, reports that the outbreak has been traced to bagged, commercial romaine lettuce, according to a news item on King 5 TV. The lettuce was apparently supplied to restaurants and/or food service establishments, and was not available through retail stores.

Canada Cautions Consumers On California Cantaloupe

On June 2nd, the Canadian Food Inspection Agency alerted consumers in the province of Ontario that some US-grown cantaloupes distributed in the province might be contaminated with Salmonella.

The KingFisher brand cantaloupes are the product of Fisher Ranch Corp., Blythe, CA. They were sold in retail stores in the province of Ontario between May 16th and June 2nd, inclusive.

While no illnesses have been associated with the cantaloupe, the importer, Gambles Ontario Produce Inc., Toronto, Ontario, has recalled all outstanding stock. Consumers who have purchased whole or cut cantaloupe – including products containing pieces of cantaloupe – should check with the store to determine the origin of the cantaloupe.

If you have experienced symptoms of gastroenteritis within a few days of having eaten cantaloupe that you believe to be implicated in this recall, please contact your health care provider.

Stewing Over Salmonella-Contaminated Tomatoes

The FDA, the CDC and several state departments of health are investigating an outbreak of Salmonella Saintpaul illnesses that have been linked to certain varieties of raw tomatoes.

According to information provided on the CDC website, 57 people in Texas and New Mexico have been infected with the identical strain of Salmonella Saintpaul. At least 17 of the victims have been hospitalized. Epidemiological evidence is pointing investigators to large tomato varieties, including Roma and red round tomatoes, as the source of the outbreak.

Eight other states have also reported having recovered the outbreak strain of Salmonella Saintpaul from a total of 29 people. CDC does not yet know whether or not these illnesses are also linked to consumption of raw tomatoes.

Until the source of the outbreak can be determined, FDA has warned consumers in New Mexico and Texas to limit themselves to tomato varieties that have not been implicated in the investigation – cherry tomatoes, grape tomatoes and tomatoes still attached to the vine – or to home-grown tomatoes.

Including this latest incident, contaminated tomatoes have accounted for a baker's dozen (13) Salmonella outbreaks in the past ten years. While researchers haven't yet established how a tomato crop becomes contaminated, a recent study revealed that Salmonella can survive in soil for at least six weeks – enough time for debris from a contaminated crop to infect a subsequent crop.

Even hydroponic tomatoes are not immune to Salmonella contamination. The pathogen can be tracked in on workers' soiled boots, or by small field animals that find their way into the greenhouses.

Investigators into the cause of the current outbreak are still facing a long list of unanswered questions. Until the source of the Salmonella Saintpaul has been found – and has been taken off the market – consumers throughout the United States should follow the advice given to the citizens of Texas and New Mexico. Stick to cherry tomatoes, grape tomatoes, and "tomatoes on the vine". Or grow your own.

Plus Ça Change . . . .

I've been catching up on the news after being away for a couple of weeks. I'll be posting at a "double time" pace over the next few days to bring everyone up to date on the following stories:

1. Salmonella Saintpaul food poisoning outbreak linked to tomatoes in several US states.
2. Source of Princeton University Salmonella outbreak found.
3. Cost of gastrointestinal illness in Canada estimated at $115 CAD per person per year.
4. Canada warns consumers about Salmonella-contaminated cantaloupe imported from USA.
5. UK Food Standards Agency updates warning on toxic Bantry Bay frozen mussels.
6. Burrata recalled after California finds Listeria monocytogenes in a sample of the Italian-style fresh cheese.

I'll also have some news about the incidence of bacterial contamination in Australian meat and poultry sold in retail markets, a report of a hepatitis outbreak in France, and a norovirus outbreak in Canada, and the latest updates on cholera outbreaks in Asia and Africa.

Or perhaps I should just post a few pictures from our walk through a small farmer's market in Cannes, France.

Food Poisoning a la Mode

Home-made ice cream claimed another batch of victims this month. More than 70 people who attended the Relay for Life in Center, Texas on May 2nd were infected with Salmonella after eating home-made ice cream at the fund-raiser.

This was the most recent in a series of sporadic Salmonella outbreaks traced to home-made ice cream over the years. Three such outbreaks – in Fort Monmouth, New Jersey (1988), in Florida (1993), and in Edmonton, Alberta (1999) – were all linked to the use of raw shell eggs in the ice cream.

But commercial ice cream isn't immune to contamination. In 1994, Schwan's ice cream was the source of a major, multi-state outbreak of Salmonella infections. The company purchased pasteurized ice cream premix in bulk, mixed it with flavoring and other ingredients in its own processing facility, and then packaged the finished ice cream.

At the time of the outbreak, Schwan's did not have an in-house pasteurizer. The company relied on its sanitary handling practices to prevent the bulk ice cream premix from becoming contaminated. The sanitary tankers that were used to transport the ice cream premix to Schwan's location were – according to Schwan's contract with the trucker and supplier – supposed to be dedicated to that purpose.

Some of those tankers, however, had been used previously to transport bulk quantities of unpasteurized raw egg. Investigators concluded that one or more batches of the pasteurized ice cream premix had become contaminated by traces of Salmonella left behind in the bulk tank of one or more trucks. Schwan's changed its practices as a result of this outbreak, and no longer relies on outside pasteurization to ensure the safety of its ice creams.

Three years ago, another multi-state Salmonella outbreak was traced to contaminated ice cream. This time, the culprit was Cold Stone Creamery's cake batter-flavored ice cream. A batch of cake mix that Cold Stone used to flavor its ice cream was found to be contaminated with Salmonella.

Batter-flavored ice creams have gained in popularity in the last few years, in spite of the Cold Stone Salmonella outbreak. A Google search quickly turns up recipes for home-made cake batter ice creams, including this fairly typical recipe, found on www.recipezaar.com. These recipes use cake mix to flavor the ice cream – the same practice that was the source of the Cold Stone outbreak.

The Google search also uncovered at least three commercial ice cream brands that offer batter-flavored ice creams: Blue Bell, Ben & Jerry's, and Cold Stone Creamery. Both Cold Stone and Ben & Jerry's give consumers some insight into how their ice creams are made, though neither company talks about how it prevents contamination of their products after the pasteurization step.

I sent an email to Ben & Jerry's one week ago to ask for more information. I received the following automated reply:

"Your question has been received. We will do our best to respond to you as quickly as possible. Thanks for your patience!"

I sent a similar message to Cold Stone Creamery, and was pleased to receive a more detailed – and more personal – message from Anne Christenson, Sr. Public Relations Manager of Kahala Corp (Cold Stone's parent company). Ms. Christenson has given me permission to quote her reply to my query in full. It reads,

"Following the voluntary recall in 2005, the original cake batter flavor was reformulated and introduced using a new supplier. More specifically, the ingredients added to this new Cake Batter formulation are manufactured by Continental Mills using a proprietary recipe prepared exclusively for Cold Stone Creamery. Continental Mills develops specialty foods for raw consumption.

Two of the new batter flavors, Blueberry and Chocolate Cake Batter, use the new cake batter formula along with conventional extracts, fruit purees and pasteurized chocolate ice cream base, depending on the flavor. In addition, Cinnamon Bun and Cookie Dough flavors use “ready-to-eat” batter mixes made with ingredients that are rendered “food safe”. When introducing these new batter flavors along with all our products, it is our intention to offer the most indulgent, highest quality products that comply with all food safety standards."

Most Salmonella infections are mild. Nevertheless, some can have serious consequences. One of the victims of the recent Texas outbreak – a teenager named Ashlyn Johnson – was hospitalized with kidney failure as a result of her infection.

Home-made ice cream can be made safely. To enjoy the richness and flavor of an ice cream that contains eggs, either use pasteurized shell eggs or else choose a recipe that calls for cooking the eggs into a custard.

For safety's sake, avoid home-made cake mix-flavored ice creams. The cake mixes that you purchase at the store are meant to be baked before being eaten. They are not meant to be eaten raw. If you have a yen for batter-flavored ice cream, play it safe and buy a commercial product.

Pork Cracklings Seasoned With Salmonella

USDA's Food Safety and Inspection Service (FSIS) has taken the unusual step of issuing a public health alert, advising consumers that fully cooked pork crackling products produced at Sofia Chicharones, Inc. of Miami, FL may be contaminated with Salmonella.

The cooked pork cracklings are packaged in 3-pound and 5-pound bags, identified with Est. 21055 inside the USDA seal and a "Packed Date" of 051208-1. The 1,100-pound batch of cooked cracklings was sold at the Sofia Chicharones retail outlet on May 12th.

FSIS uncovered the Salmonella contamination as a result of routine testing. No illnesses have been reported, and no unsold product remains.

The company apparently has not issued a recall, and FSIS is advising consumers to discard any uneaten product that matches this description.

Myanmar After The Storm: Honoring The Victims

The government of Myanmar has borrowed a page from China's playbook and has declared three days of mourning for the victims of Cyclone Nargis. In honor of those victims – the dead and the still-living – here are some pictures of Myanmar people in slightly happier times.

FACES OF MYANMAR - JANUARY 2008

A monk at home in his monastery in Yangon, near the Reclining Buddha statue

The senior monk at the same monastery

Sidewalk fruit seller in Yangon's city center

Volunteers cleaning the stone pavement of the Shwedagon Pagoda in Yangon

Visitors relaxing at the Shwedagon Pagoda

Public bus service on the road outside of Yangon

A group of children on their way to school

Daily procession of monks near Bago

Solitary man - Bago

Young women at the Golden Rock Pagoda "base camp"

Myanmar's future rests here

In Defense of the Military - Against E. coli O157:H7

Meatingplace.com reported this morning that up to 10,000 pounds of 85% lean ground beef was recalled last week due to the possible presence of E. coli O157:H7.

The ground meat was sold between May 1st and May 14th at ten Army, Navy and Air Force commissaries around the country. The contamination was detected as a result of testing carried out by the Department of Defense Veterinary Food Analysis and Diagnostic Laboratory.

The ten commissaries involved in this recall include:

1. Great Lakes, IL
2. Fort McCoy, WI
3. Bolling Air Force Base, DC
4. Carlisle Barracks, PA
5. Fort Monmouth, NJ
6. Naval Air Engineering Station Lakehurst, NJ
7. Naval Submarine Base, New London, CT
8. Tobyhanna Army Depot, PA
9. Fort Carson, CO
10. Fort Leavenworth, KS

Customers who purchased 85% lean ground beef from any of the affected commissaries between May 1st and May 14th should either discard the meat or return it to the commissary for a refund.

Hepatitis A Virus Back In The News

The hepatitis A outbreak in San Diego seems to be winding down. At last count, 22 people who had eaten at the Chipotle Mexican Grill in La Mesa were confirmed to be infected with hepatitis A virus. None of the restaurant's 26 employees tested positive for the virus.

The small IHOP-linked outbreak in Albuquerque, NM also seems to have petered out. Two restaurant employees and two customers were infected with hepatitis A. No additional cases have surfaced since the initial report in late April.

A sports-themed restaurant in Riga, Latvia is the focal point of yet another hepatitis A outbreak. At least 44 people, including 7 employees of the restaurant, have been infected with hepatitis A virus since March. The source of the outbreak is believed to be a restaurant employee who began to display symptoms of hepatitis on March 22, and developed jaundice on April 2nd. The employee was hospitalized April 4th.

The 36 men and 8 women who were infected with hepatitis in this outbreak became ill during April – all but one of them between April 10th and April 27th. All of them reported having visited or having worked in the Riga restaurant within the normal incubation period for hepatitis A. Forty of the 44 victims have been hospitalized. The restaurant has been closed since April 22nd for thorough cleaning and disinfection.

The Latvian public health authorities have received unofficial reports that three foreign visitors – one each from Estonia, Lithuania and Germany – to the implicated restaurant have developed hepatitis. Two cases of secondary infections in family members have also been reported.

On the other side of the pond, New Zealand is also in the throes of a hepatitis scare. A waitress at the Copthorne Hotel in Queenstown has been diagnosed with hepatitis A after being admitted to hospital. The waitress worked in the hotel's restaurant between April 11 and May 4. The hotel serves breakfast to an average of 300 guests per day, which means that as many as 6,900 people may have been exposed to infection.

Queenstown, on New Zealand's South Island, is a magnet for adventure-seeking tourists from around the world. The town offers activities that include bungee jumping, sky diving, and white-water rafting.

Anyone who ate at the Copthorne Hotel between April 11th and May 4th should be watchful for early symptoms of hepatitis A infection – nausea, vomiting, stomach aches, lack of appetite, fever – and should seek medical treatment immediately if any of these symptoms appear.

Myanmar After The Storm: Part 6

The official toll of dead and missing in the aftermath of Cyclone Nargis has increased to more than 133,000. Nearly 78,000 people have died, according to the Myanmar government, and more than 55,000 are still unaccounted for.

Estimates of the total number of people affected by the cyclone are as high as 3.2 million, based on a computer model of the population distribution in the area. And the International Red Cross has warned repeatedly and urgently that clean water is needed to avert a public health disaster.

But we need not worry, because the Myanmar government has announced that there is no outbreak of infectious diseases in the region hit by Cyclone Nargis. And that makes it so.

The World Health Organization, however, has confirmed some cases of cholera, but it reports that the number of cases seen so far don't exceed the usual pattern for this time of year. That could change at any moment.

Fortunately, more supplies – and more aid workers – are being permitted to enter Myanmar than before. And the government has shown a bit less reluctance in recent days to allow some foreign aid workers access to the Ayeyarwaddy Delta. A deal has evolved that would have foreign aid efforts coordinated by Myanmar's neighbors and members of the ASEAN group of countries, all of whom are on better terms with the Myanmar government than are the United States, Britain and the European Union.

General Than Shwe, the head of the Myanmar government has finally stirred from his isolated capital of Naypyitaw to visit two relief camps in suburban Yangon.

The cyclone has ended, but the misery lingers on.

Salmonella Invades Sydney Beaches

Playgrounds at the northern beaches of Sydney, Australia are closed to the public after Salmonella paratyphi biovar Java was detected in the sand in two playgrounds.

Twenty-three children have been infected by this strain of Salmonella. The children were stricken with severe vomiting, diarrhoea and stomach pain. In the past, Salmonella Java infections have been associated with tropical fish aquariums and pet turtles, although food-related outbreaks have occurred.

Officials don't yet know – and may never determine – how the playground sand became contaminated. The source might have been an infected child, or possibly an animal.

Recently, the US Environmental Protection Agency reported that fecal bacteria can be found in both wet and dry sand at swimming beaches in Florida. The sand appears to act as a filter, with the result that E. coli is present at a higher concentration in the sand than in the seawater near the shore. The microbes were able to survive – and multiply – in the sand.

The presence of E. coli in the sand, though, had no apparent effect on the health of beach goers. A questionnaire that was distributed to beach users as part of the EPA study did not uncover any conclusive evidence linking illnesses to beach use.

While Sydney health authorities await tests results to determine whether any other playgrounds are contaminated, park officials are devising plans to eliminate the Salmonella. One solution being considered is to remove and replace all of the sand in the playgrounds. Until the problem has been solved, all of the playgrounds along Sydney's northern beaches will remain closed.