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Spices for donair cones served at locations A and B were obtained from different suppliers, but vegetables and processed cheese for beef donairs were obtained from the same supplier. Ground beef for donair cones served by locations A and B and two additional locations C and D originated from the same small specialty meat supplier, located in the Edmonton area. Locations A and D received cones prepared at location C; location B prepared cones on site. The remaining locations E and F also prepared cones on site but received ground beef for donair cones from suppliers different from each other and from locations A, B, C and D.

There was no beef available for analysis from the same lot as was served to outbreak cases; however, five beef samples were collected as part of the investigation. Four were donair beef samples from location A two cooked donair cone surface cuts, one deep cut that appeared undercooked or location B one sample of raw donair beef.

One raw ground beef sample was collected from the meat facility from which ground beef originated for donair meat served by locations A, B, C and D. All beef samples were negative for E.

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The last case identified in the outbreak reported consumption of a beef donair from location A on 14 June, i. Food handling employees of location A were investigated as a possible outbreak source. The two food handling employees of location A were screened for E. Locations A and B reportedly had no employees in common. On 9 June, to facilitate case finding, an alert was posted on CIOSC Canadian Integrated Outbreak Surveillance Centre , a secure Web-based system through which outbreak alerts are distributed to local, provincial and national enteric disease surveillance professionals nationwide.

Case finding methods resulted in the identification of one case outside of the Capital Health Region. Donairs and similar products called doner kebabs, gyros, shawirmas and chawarmas are specialty foods of Middle Eastern origin that have been served by Canadian retail food facilities for over 30 years, typically prepared by placing meat usually spiced ground beef that has been formed into a conical shape onto a rotisserie on which it is cooked, sliced and placed into a pita wrap with vegetables and condiments 1.

A Calgary, Alberta, outbreak of E. Similar foods have been associated with outbreaks of Salmonella infection 3,4. Improper handling of such products has long been known to be a potential foodborne illness risk 6,7. This investigation confirms that an outbreak of E. This allowed the investigators to detect background cases and focus the investigation on exposures among outbreak cases. A predominant PFGE pattern is also consistent with one specific food association among outbreak cases - isolates of an indistinguishable PFGE pattern collected from different individuals suggests a common source 8.

There is strong epidemiologic evidence linking consumption of beef donairs from one of two locations of a restaurant chain and infection in outbreak cases: seven of nine cases reported this exposure, and there was no other significant epidemiologic link identified among the cases. The two implicated restaurant locations received ground beef for donair cones from the same small specialty supplier, consistent with the hypothesis that ground beef frequently implicated in E. Food ground beef samples collected as part of the investigation were all negative for E. Neither could it be determined whether other donair ingredients such as lettuce and tomatoes were contaminated with the pathogen, nor whether food handlers may have been the source, as it is not known whether they were shedding the pathogen at the time the implicated food was prepared.

The lack of employees common to both implicated locations means that multiple employees would have to have been infected during the outbreak period for this to be the source. There was evidence of mishandling of ground beef at the implicated restaurants, which may have been a contributing factor in this outbreak. Processes that may have resulted in pathogenic survival or growth in donair meat included the use of unreliable methods to confirm the thoroughness of ground beef cooking, and the re-heating and serving of donair meat that had been kept on a rotisserie the previous day and then refrigerated or frozen whole.

The likelihood of donair beef undercooking may have been further increased by high customer volume reportedly observed during post-hockey game celebrations in the vicinity of one implicated location and the possible resultant reduction in the length of time that donair beef was cooked on the rotisserie in response to this increased demand.

The risks associated with the potential mishandling of donairs have been identified previously in Canada, and at the time of this outbreak, local, provincial and federal health and food safety agencies were working collaboratively to devise strategies to reduce the risk 1. This outbreak has demonstrated the importance of the continuation of this work, to help ensure that this food product is safe in Canada. The authors thank the following for their assistance: D.

Mah, C. Galbraith, D.

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Langier-Blythe, P. Wagner, K. Shaw and G. Health Canada.

Issue identification paper: Donairs and similar products , June draft. Ottawa: Health Canada, Currie A. Outbreak of E. Calgary: Calgary Health Region, An outbreak of Salmonella typhimurium DT associated with kebab meat and yogurt relish. Epidemiol Infect ; An outbreak of Salmonella mikawasima associated with doner kebabs.

Ulukanli Z, Cavli P. Detection of Escherichia coli OH7 from beef doner kebabs sold in Kars. G U J Sci ; Donairs gyros — potential hazards and control. J Food Prot ; Time-temperature conditions of gyros.

J Food Prot ;43; Molecular epidemiology and infectious diseases. Infectious disease epidemiology: Theory and practice. Todd ECD. Escherichia coli OH7 infections associated with ground beef and their control in Canada. CCDR 13 Exercise equipment should be wiped off between usages and should be thoroughly cleaned daily.

Additional precautions need to be taken in athletic treatment areas involving examination tables, whirlpools, and even commonly used items such as treatment and medical devices.

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Individuals with any infection but particularly those caused by MRSA need to be isolated and all contaminated bandages and other treatment instruments need to be disposed of properly. An excellent review of these preventive measures is available through the National Athletic Trainers Association Physician Statement from March which is available at the NATA website link at the conclusion of this article.

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In closing, MRSA infections are of considerable concern within the healthcare community. Their increasing frequency and, in particular, their increasing emergence outside of the hospital environment is very worrisome. Being highly contagious and capable of causing considerable morbidity and mortality, early diagnosis and treatment of MRSA infections is of paramount importance. The prevention of MRSA infections and its spread is essential.

The athlete has specifically been identified as a member of the high-risk group for acquiring MRSA infections. The nature of many sports exposes the individual athlete to the possibility of infection through this agent, and others like it, and puts them at high risk. Extra attention in personal hygiene practices and special precautions in the use and maintenance of equipment in training and treatment facilities needs to be established and carried out routinely. Alexandra M.

Burgar, M. Roger D.


Dainer, D. Gregory Horner, M. David J. Jupina, M. Ian A. Stine, M.

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Steven S. Liu, M. It can be passed via open wounds, something that easily occurs in football.

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