A crackdown on slaughterhouses has helped cut rates of certain types of food poisoning, the Centers for Disease Control and Prevention reported on Thursday. But other causes of stomach upset are on the rise – a trend that indicates better regulation of meat from hoof to plate is needed, as well as stricter regulation of produce and processed food, the CDC says.

One type of stomach bug called Campylobacter, carried in chicken and unpasteurized milk and cheese, is becoming more common, the CDC’s regular survey of foodborne illness finds.

Dr. Robert Tauxe, an expert in foodborne illness at CDC, says meat-related foodborne illnesses have plummeted since the agency started intensively studying trends in 1996. “When we look at what has changed between the 2006-2008 period and now, unfortunately nothing has gone down and a couple of infections have gone up,” Tauxe added in a telephone interview.

“Campylobacter has increased 14 percent since 2006-2008 and then there are the much less common Vibrio infections -- and those have increased 43 percent.” There were 193 reported cases of Vibrio infection in 2012, with six deaths.

Vibrio bacteria are in the same family as cholera, but in this case not nearly as dangerous. They thrive in warm sea water and mostly sicken people who eat raw oysters or who go into affected waters with an open cut, Tauxe says. “The warmer it is, the more Vibrios there are,” he said. “It grows a lot when the water is warm. It is a problem in the summer much more than in the winter.”

But by far the most common cause of food poisoning is Salmonella, the CDC found using its Foodborne Diseases Active Surveillance Network or FOODNet, which collects data in 10 states. “Salmonella is in the number one spot, causing 40 percent of the infections that the FOODNet system collected,” Tauxe said. “Campylobacter was number two, pretty close behind at 35 percent.”

The FOODNet system documented 7,800 Salmonella infections in 2012, with 33 deaths. Nearly 7,000 people were diagnosed with Campylobacter infections, and six died. That’s just a small percentage of the actual cases – CDC estimates that about 48 million Americans, or one in six, get sick from eating contaminated food each year and 3,000 die.

“We figure that for every infection that is diagnosed, there are 25 or 30 more illnesses out there,” Tauxe said. “Maybe some of those people don’t see a doctor or maybe they do see a doctor but there isn’t a culture.”

New USDA regulations that require more intense testing of food animals probably caused Campylobacter infections to fall in the late 1990s and early 2000s, the CDC says. But not enough, Tauxe said.

“What I take away from this is we need to think more and more about what happens to the animals before they come to slaughter, what happens back on the farm and what happens with other foods such as produce and processed foods,” he said.

New Food and Drug Administration regulations regarding produce may help prevent other sources of illness, he added. They require facilities that manufacture, process, pack or hold human food to develop formal plans for preventing their products from causing foodborne illness.

The 2011 Food Safety Modernization Act was designed to help the FDA better able to prevent foodborne outbreaks, rather than simply reacting after one happens. FDA commissioner Dr. Margaret Hamburg asked Congress for $295.8 million this year to help implement the new regulations.

“The fresh produce is important. We have had a lot of Salmonella problems related to fresh produce,” Tauxe said. “Further attention to poultry parts and ground poultry like ground turkey may help, and the processed food industry – the people who make peanut butter and many other processed foods – I think there is room for improvement there.”

Many of the bugs that sicken people live naturally in the digestive systems of animals, including people. Outbreaks of disease have been linked to unclean slaughtering processes and unhygienic meat handling.

And it was thought that fresh produce, such as lettuce and cantelopes, were contaminated by manure. But there may be more to it than that, Tauxe says.

“There is reason to think that some Salmonella may be more at home than we think in plants,” he said. “They are not just passively on the plant. They may be inside the plant, which is a great place to be because you don’t get washed off and the next animal or person to eat the plant gets it.”

In January CDC released a report showing that produce accounted for 46 percent of foodborne illnesses between 1998 and 2008, while contaminated meat accounted for fewer illnesses but more deaths -- 29 percent of deaths in total.

Related:

• Trader Joe's peanut butter recall expands
• Chicken linked to Salmonella outbreak
• Raw milk recalled after Campylobacter found

Salad greens make the most people sick, but contaminated poultry kills the most Americans, federal researchers report in the first comprehensive look at the foods that cause foodborne illnesses. And there are a few surprises -- the bug most likely to be lurking in a salad is norovirus, and it probably came from the hands of the person who made it.

This doesn’t mean salad is more dangerous, the team at the Centers for Disease Control and Prevention stresses: It just shows what foods are most involved and may reflect how often people eat them.

“When the average American looks at this data, they need to know that we are not trying to make estimates of the risk of illness per serving of any of the food categories,” says the CDC’s  Dr. Patricia Griffin, who heads the agency’s branch that investigates stomach bugs.

“We are just providing information on what are the food categories that are the major sources of illness ... so regulators can take action to make food safer.”

Food poisoning is extremely common.  The CDC estimates that 48 million Americans get some sort of foodborne illness every year, 128,000 of them are sick enough to go to the hospital and 3,000 die. Most of the time, the bacteria, virus or parasite responsible is never identified, and usually the particular food isn’t, either.

Griffin’s team analyzed all the data they could get on every outbreak of foodborne illness reported between 1998 and 2008 in which both the food source and the microbe responsible were known. They broke the food down into 17 categories.

“We attributed 46 percent of illnesses to produce and found that more deaths were attributed to poultry than to any other commodity,” they wrote in their report, published in the journal Emerging Infectious Diseases on Tuesday.

“(The data ) indicate that efforts are particularly needed to prevent contamination of produce and poultry.”

This doesn't mean people should swap out salads for, say, fries.

“We certainly would not want people to avoid any category of food,” Griffin said. “We know that the vast majority of meals are safe. As far as fruits and vegetables in particular, CDC is well aware and promotes the fact that they are an important part of a healthy diet. They are linked to reduced risk of heart attacks, strokes and cancer. “

Cooking food is one of the best ways to prevent illness, as proper cooking will kill most disease-causing agents. As raw meat and eggs are often contaminated, proper food handling techniques are also important.

It’s harder to protect against germs on raw food, however. “Our data found that produce items were a common cause of illness, accounting for almost half of illnesses,” Griffin said in a telephone interview. “Most of those produce items that caused those illnesses were consumed raw.”

And norovirus – also known as Norwalk virus, which causes gastrointestinal upset commonly known as stomach flu or winter vomiting disease – was a major cause of illness contracted from raw vegetables, the CDC finds.

Contaminated meat and poultry accounted for 22 percent of illness but 29 percent of deaths, while dairy and eggs accounted for 20 percent of illnesses and 15 percent of deaths.

Last week, CDC reported 1,527 foodborne disease outbreaks in 2009 and 2010. They said 29,444 people got sick and 23 died in these outbreaks. Norovirus or Salmonella -- especially in eggs, sprouts, tomatoes and peppers -- caused most, while Campylobacter in unpasteurized dairy products, Salmonella in eggs, and E. coli 0157 in beef were also very common causes of food poisoning outbreaks. And nearly half -- 48 percent -- of all outbreaks from a single place were traced to restaurants or delis.

News reports have focused a great deal on outbreaks of diseases such as salmonella, listeria and E. coli, and the Food and Drug Administration, US Department of Agriculture and other regulators have focused on protecting food from animal contamination such as bird droppings and manure from pigs and cows, which carry these agents.

But norovirus is carried and spread only by humans.

“The way that you get it from food is when a food handler doesn’t wash his hands after an episode of diarrhea or vomiting and then prepares food,” Griffin said. This is an area that may require extra focus, she says.

“Washing hands is very, very important,” she added.  Norovirus can be spread before a person feels sick and for days after he or she recovers, also.

Adding to the risk is the issue of sick leave. Many food preparers, restaurant workers and food handlers do not get paid sick leave, and thus are encouraged to work while they are ill.  One study published in 2011 in the American Journal of Public Health projected that workers who did not get paid time off for illness helped spread 5 million cases of respiratory disease during the 2009 H1N1 swine flu pandemic.

The Bureau of Labor Statistics says 39 percent of private sector workers have no paid sick leave, and this number rises to 70 percent for food and hotel workers.

There’s a bill in Congress that would mandate sick leave for many employers,  supported by President Barack Obama and groups including  the National Women’s Health Network, the AFL-CIO,  Families USA and others. It was last considered in 2009.

So besides cooking meat and making sure greens are washed well, how can people protect themselves? “I would advise people to avoid eating raw foods of animal origin, and that includes raw milk,” Griffin said.  Shellfish? “You have to make a decision about raw shellfish and how much you love them, how much risk you want to take and what your risk might be,” she said.

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It's about to get faster and easier to diagnose food poisoning, but that progress for individual patients comes with a downside: It could hurt the nation's ability to spot and solve dangerous outbreaks.

Next-generation tests that promise to shave a few days off the time needed to tell whether E. coli, salmonella or other foodborne bacteria caused a patient's illness could reach medical laboratories as early as next year. That could allow doctors to treat sometimes deadly diseases much more quickly — an exciting development.

The problem: These new tests can't detect crucial differences among different subtypes of bacteria, as current tests can. And that fingerprint is what states and the federal government use to match sick people to a contaminated food. The older tests might be replaced by the new, more efficient ones.

"It's like a forensics lab. If somebody says a shot was fired, without the bullet you don't know where it came from," explained E. coli expert Dr. Phillip Tarr of Washington University School of Medicine in St. Louis.

The federal Centers for Disease Control and Prevention warns that losing the ability to take a germ's fingerprint could hamper efforts to keep food safe, and the agency is searching for solutions. According to CDC estimates, 1 in 6 Americans gets sick from foodborne illnesses each year, and 3,000 die.

"These improved tests for diagnosing patients could have the unintended consequence of reducing our ability to detect and investigate outbreaks, ultimately causing more people to become sick," said Dr. John Besser of the CDC.

That means outbreaks like the salmonella illnesses linked this fall to a variety of Trader Joe's peanut butter might not be identified that quickly — or at all.

It all comes down to what's called a bacterial culture — whether labs grow a sample of a patient's bacteria in an old-fashioned petri dish, or skip that step because the new tests don't require it.

Here's the way it works now: Someone with serious diarrhea visits the doctor, who gets a stool sample and sends it to a private testing laboratory. The lab cultures the sample, growing larger batches of any lurking bacteria to identify what's there. If disease-causing germs such as E. coli O157 or salmonella are found, they may be sent on to a public health laboratory for more sophisticated analysis to uncover their unique DNA patterns — their fingerprints.

Those fingerprints are posted to a national database, called PulseNet, that the CDC and state health officials use to look for food poisoning trends.

There are lots of garden-variety cases of salmonella every year, from runny eggs to a picnic lunch that sat out too long. But if a few people in, say, Baltimore have salmonella with the same molecular signature as some sick people in Cleveland, it's time to investigate, because scientists might be able narrow the outbreak to a particular food or company.

But culture-based testing takes time — as long as two to four days after the sample reaches the lab, which makes for a long wait if you're a sick patient.

What's in the pipeline? Tests that could detect many kinds of germs simultaneously instead of hunting one at a time — and within hours of reaching the lab — without first having to grow a culture. Those tests are expected to be approved as early as next year.

This isn't just a science debate, said Shari Shea, food safety director at the Association of Public Health Laboratories. If you were the patient, "you'd want to know how you got sick," she said.

PulseNet has greatly improved the ability of regulators and the food industry to solve those mysteries since it was launched in the mid-1990s, helping to spot major outbreaks in ground beef, spinach, eggs and cantaloupe in recent years. Just this fall, PulseNet matched 42 different salmonella illnesses in 20 different states that were eventually traced to a variety of Trader Joe's peanut butter.

Food and Drug Administration officials who visited the plant where the peanut butter was made found salmonella contamination all over the facility, with several of the plant samples matching the fingerprint of the salmonella that made people sick. A New Mexico-based company, Sunland Inc., recalled hundreds of products that were shipped to large retailers all over the country, including Target, Safeway and other large grocery chains.

The source of those illnesses probably would have remained a mystery without the national database, since there weren't very many illnesses in any individual state.

To ensure that kind of crucial detective work isn't lost, the CDC is asking the medical community to send samples to labs to be cultured even when they perform a new, non-culture test.

But it's not clear who would pay for that extra step. Private labs only can perform the tests that a doctor orders, noted Dr. Jay M. Lieberman of Quest Diagnostics, one of the country's largest testing labs.

A few first-generation non-culture tests are already available. When private labs in Wisconsin use them, they frequently ship leftover samples to the state lab, which grows the bacteria itself. But as more private labs switch over after the next-generation rapid tests arrive, the Wisconsin State Laboratory of Hygiene will be hard-pressed to keep up with that extra work before it can do its main job — fingerprinting the bugs, said deputy director Dr. Dave Warshauer.

Stay tuned: Research is beginning to look for solutions that one day might allow rapid and in-depth looks at food poisoning causes in the same test.

"As molecular techniques evolve, you may be able to get the information you want from non-culture techniques," Lieberman said.

Related stories:

• Peanut plant closed after feds find more salmonella
• Trader Joe's peanut butter recalled
• Nine types of salmonella at one peanut plant

A North Carolina company that has recalled tens of thousands of cantaloupes because of potential food poisoning extended the recall to honeydew melons on Tuesday, the U.S. Food and Drug Administration said.

Burch Equipment LLC (Burch Farms) of Faison, N.C., is expanding its recall to include all of this growing season's cantaloupes and honeydew melons that may still be on the market.  “The honeydew melons involved in this recall expansion do not bear any identifying stickers but were packed in shipping cases labeled melons,” the FDA said in a statement.

“The cantaloupes and honeydew melons involved in this expanded recall were sold to distributors in the states of Florida, Georgia, Illinois, Kentucky, Massachusetts, Maryland, Maine, Michigan, North Carolina, New Hampshire, New Jersey, New York, Ohio, Pennsylvania, South Carolina, Virginia, Vermont and West Virginia, who may have further distributed them to other states,” the FDA said.

People who bought melons should ask the stores whether they got the fruit from Burch Farms.
 
The FDA said it found the bacteria Listeria monocytogenes (L. mono) on a honeydew melon grown and packed by Burch Farms.

Listeria can cause sometimes serious food poisoning, although no one has been confirmed sick from this particular recall, FDA said.  Symptoms of listeriosis include fever and muscle aches, diarrhea and other gastrointestinal problems. “The disease primarily affects older adults, pregnant women, newborns, and adults with weakened immune systems. However, rarely, persons without these risk factors can also be affected,” FDA says.

It can take anywhere from three days to more than two months to get sick after eating food contaminated with Listeria.

Earlier this month, Burch recalled 188,902 melons from stores. Food safety officials are especially wary of cantaloupes after one of the deadliest foodborne illness outbreaks in U.S. history last year, in which contaminated Colorado cantaloupes sickened at least 147 people, including at least 30 who died and one woman who had a miscarriage.

Related links:

NC company recalls cantaloupes

Salmonella in beef sickens 33 

thenewreview.net

Chris Fronzak, lead singer for the heavy metal band Attila, had to perform several nights last month despite a serious salmonella infection from eating tainted tuna.

When heavy metal singer Chris Fronzak dubbed his latest gig “The Sick Tour,” he didn’t mean it literally.

But by the time the 22-year-old frontman for the band Attila was done with his multi-state concert series, he knew only too well what it meant to be stricken with gut-wrenching salmonella poisoning -- and to still have to strut and scream onstage.

“It was the worst,” recalled the performer known as “Fronz” to his fans and friends. “I was very miserable.”

Fronzak is among at least 258 people sickened by an outbreak of two rare strains of salmonella linked to sushi and other foods made from contaminated tuna.

Seattle law firm Marler Clark, which specializes in foodborne illnesses, filed a lawsuit on Fronzak's behalf Thursday in U.S. district court in Portland, Ore., where the singer lives.

He’s among the first people to sue Moon Marine USA Corp. of Cupertino, Calif., the firm that last month recalled 58,828 pounds of frozen Nakaochi Scrape, tuna bits gleaned from the backbones of the fish.

Government health officials have linked the Moon Marine tuna to the outbreak of salmonella Bareilly and salmonella Nchanga infections that have put at least 32 people in the hospital.

Fronzak says the culprit is a spicy tuna roll he ate on April 10 in Metairie, La. Thirty hours later, he was in a different state and nearly flattened by vomiting, diarrhea, fever, cramps and more. He spent six days trying to treat the illness himself, traveling in a tour bus and performing nearly nightly shows.

“[Cancelling] would have cost the band several thousand dollars,” said Fronzak. “It left me with no choice.”

Attila, which formed in Atlanta in 2005, has put out several albums, including "Outlawed." Fronzak said the group should be described as "a party metal band." "It's not dark music or anything," he said.

Fronzak's illness got so bad he finally went to an emergency room on a tour stop in Kansas City, Mo., where doctors treated him for pain and performed tests that finally revealed the problem: salmonella poisoning. But it was still several days and several more states before Fronzak got an antibiotic that started to help.

“Before I knew I had salmonella, I honestly thought I had stomach ulcers or liver failure from alcohol,” he Tweeted from his account @Fronz1lla on April 29.

Fronzak said he decided to sue because he has a family -- including a 7-month-old son, Blaise – and no health insurance. He doesn’t think he should be stuck with all the bills, like the $9,872 tab from the hospital in Missouri. He posted that on Twitter, too, with an unprintable hashtag.

“I’m not at fault for any of that,” Fronzak said. “I feel like I’ve been done wrong and I deserve compensation.”

Fronzak is not alone. Government food safety officials estimate that for every salmonella infection they hear about, 29.3 go unreported. Using that multiplier, the tainted tuna may have sickened as many as 7,558 other people.

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258 now sick with sushi salmonella

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E. coli-tainted venison kabobs sicken Minn. students

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Dozens of Kansas high school students and chaperones were being treated for symptoms of food poisoning Wednesday at a hospital in Mount Pleasant, Pa., after a band trip to New York, the hospital said.

About 160 students and chaperones made the trip on three buses to New York from De Soto High School, just across the Kansas border from Kansas City, Mo. They were returning home Wednesday morning when about 40 students, ages 13 to 18, and 10 adults fell ill.

The students and chaperones were being treated at Excela Frick Hospital in Mount Pleasant, about 50 miles southeast of Pittsburgh, NBC station WPXI of Pittsburgh reported. The Pennsylvania and New York state health departments were both investigating because the members of the caravan became ill after having eaten at an Italian restaurant in New York City on Tuesday evening.

"The common factor seems to be the chicken Parmesan," Alvie Cater, a spokesman for the De Soto School District, told the Kansas City Star.

"Roughly 25 were treated at the hospital, but more than that actually displayed symptoms," Cater said. "We're looking at up to 50 that displayed symptoms, but some of them were not severe at all."

The hospital said most of the victims were treated for severe dehydration and were expected to be back on the road later Wednesday.

NBC station WPXI of Pittsburgh contributed to this report by M. Alex Johnson of msnbc.com. Follow M. Alex Johnson on Twitter and Facebook.

Related: 

• Months later, deaths from cantaloupe outbreak continue to climb
• E. coli-tainted venison kabobs sicken Minn. students
• 19 sickened by ground beef from Maine grocery chain

At least 12 people in five states have been sickened by a rare strain of E. coli linked to raw clover sprouts served at Jimmy Johns Gourmet Sandwiches restaurants, federal health officials reported Wednesday.

The victims fell ill in late December and mid-January, apparently after they ate clover sprouts grown from seeds contaminated with E. coli O26. That strain is similar to, but not as common as the E. coli O157:H7 often associated with illness outbreaks caused by ground beef.

More victims may be pending, officials with the Centers for Disease Control and Prevention indicated.

Traceback information has identified a common lot of clover seeds used to grow the sprouts, CDC officials said. The strain of E. coli O126 has rarely been identified before in PulseNet, the CDC’s surveillance tool.

The bacteria responsible for the Jimmy Johns outbreak are part of a group known as Shiga toxin-producing E. coli, or STEC, which make poisons that can cause severe disease, including bloody diarrhea and hemolytic uremic syndrome, or HUS, which can be fatal.

A widespread outbreak of another non-O157 STEC was responsible for devastating illnesses in Europe last summer, a crisis eventually traced to contaminated sprout seeds.

In the current outbreak, victims were sickened in five states, including five in Iowa, three in Missouri, two in Kansas and one each in Arkansas and Wisconsin, the CDC said.

Ill people ranged between 9 and 49 years old; all were female. Among the 12 sickened, 2 were hospitalized. Illnesses were reported between Dec. 25, 2011 and Jan. 15, 2012.

Illnesses that occurred after Jan. 27 might not have been logged yet because of the time it takes between when a person becomes ill and when the case is reported.

This is the fourth outbreak tied to sprouts served at Jimmy Johns restaurants. Previous outbreaks were logged in 2008, 2009 and 2010, according to CDC reports.

Health officials confirmed Friday that a fast-acting gut bug known as norovirus is responsible for an outbreak of illness that sickened more than 200 people gathered for a cheerleading championship in Washington state last weekend.

Results of state laboratory tests showed that that the nasty group of viruses caused the short-but-severe vomiting and diarrhea that affected some people who participated in and attended the state championship and Salute to Spirit cheerleading, dance and drill team event held in Everett, Wash. Norovirus is typically spread through person-to-person contact.

The outbreak was likely precipitated by people who were ill in public, said Suzanne Pate, spokeswoman for the Snohomish Health District.

"Somebody arrived at the event sick," said Pate, noting that janitorial crews were called to clean up vomit in a restroom and on an adjacent walkway. Those areas were likely exposure sites for the cheer and dance teams, she said.

Some 229 people were sickened and least 33 people sought medical attention for their illnesses, state health officials said late Friday. That number is expected to grow as the investigation continues.

More than 3,000 people attended the event Feb. 4, which included more than 1,000 competitors at the Comcast Arena, a popular venue for large gatherings.

A Comcast Arena spokeswoman said officials had sanitized the premises in accordance with federal health guidelines before a new event scheduled for Friday night. Tests of the arena's water supply showed no problems, Pate said.

"It's probably the best-scrubbed place in the county," she added.

State health officials are conducting an online survey of 2000 event participants and their families to identify a common source of illness. Participants have until Feb. 13 to submit the surveys, and results should be available soon after that.

About 20 million cases of gastrointestinal illness are caused by noroviruses each year, according to the Centers for Disease Control and Prevention. Thorough hand-washing with hot water and soap and immediate sanitizing of contaminated surfaces and clothing is recommended to prevent the spread of the bug. If symptoms last longer than 48 hours, people should seek medical care.

Cheerleading camps or competitions have been the source of previous outbreaks, including a 2002 E. coli O157:H7 outbreak in Eastern Washington.

Related:

Nearly 200 sick at cheerleading competition

By Msnbc.com staff and wire

Nearly 200 people reported getting sick after attending the Salute to Spirit and State Cheerleading Championships at the Comcast Arena in Everett, Wash., last weekend, according to KING 5 News.

Washington state health officials said they were investigating and that people who'd attended the weekend high school cheerleading competition began reporting vomiting or diarrhea on Sunday and Monday.

"At least 19 squads are reporting high numbers of illnesses," Kate Lynch, a spokeswoman for the Washington State Department of Health, told Reuters. She said 1,200 cheerleaders from 45 high schools participated in the event about 30 miles northeast of Seattle.

Health officials said they learned of the outbreak, which has flu-like symptoms similar to those found in the illnesses norovirus, rotavirus or a food-borne illness, on Tuesday.

More than 3,000 people attended the event, the Washington Interscholastic Activities Association said in a statement. "Our immediate concerns are for those who have been affected by this illness and our thoughts are with them," Mike Colbrese, the association's executive director, said in a statement.

Cheerleaders at Seattle's Ballard High School said nearly half their squad became sick.

Ballard cheerleader Summer Gnoinski told KING 5, "I threw up every hour on the hour." Her sister, Karly, who did not get sick, calls herself "one of the lucky ones."

Assistant cheerleading coach Michelle Whelan says until they know what's going on, she's taking extra precautions. "I'm not letting the girls use pom-poms, signs, flags or anything else that was at the competition until we can disinfect them."

Twenty-eight people are now dead after contracting listeria infections tied to contaminated cantaloupe, federal health officials reported Tuesday.

A total of 133 people have been sickened by the outbreak, which continues to claim victims more than a month after fresh, whole melons grown and packed at Jensen Farms in Holly, Colo., were recalled, the Centers for Disease Control and Prevention said.

Dirty equipment, poor sanitation and bad storage techniques were blamed for the outbreak, which has led to illnesses in 26 states, federal Food and Drug Administration officials announced last week. Members of Congress have asked Jensen Farm owners to appear at a staff briefing likely scheduled for next week and to bring all relevant documents from the outbreak.

Deaths tied to the listeria-tainted cantaloupe have been reported in a dozen states, including seven in Colorado, five in New Mexico, three in Kansas, two each in Louisiana, Missouri, New York and Texas and one each in Indiana, Maryland, Nebraska, Oklahoma and Wyoming. Four illnesses were related to pregnancy, with one illness diagnosed in a newborn and one miscarriage reported.