Food Poison Journal - Food poisoning outbreaks and litigation: surveillance and analysis

News Radio 1420 out of Lubbock, Texas, reported last week that Marissa Cisneros, a young victim of the botulism outbreak traced to Castleberry's chili products, may be returning to school soon. 

Last July, Castleberry's recalled canned meat products that were distributed nationwide, with the exception of Great Value chili products which were exported only to Canada, after two children in Texas and Indiana residents were confirmed ill with botulism after eating the company's canned chili products.  A public health investigation led to a recall of three types of meatless hotdog chili sauce, which was expanded to include all meatless products produced at the Castleberry Georgia plant that might still be in commerce.  The recall was further expanded to include products containing meat.  The USDA press release with pertinent information is found here.

As reported by Newsradio 1420's James Clark:

Cisneros and her older brother were the first cases of poisoning that led to a nationwide recall of Castleberry Chili and subsequently other Castleberry products. They ate contaminated Chili on June 28th. Her brother was hospitalized for about a month. But the young Ms. Cisneros was hospitalized clear up until mid September, which included time in Covenant and then later rehab in Dallas.

The botulism poisoned her diaphragm so she could not breathe. She was on a ventilator machine for well more than a month. She had to learn how to walk all over again. Needless to say the botulism could have killed her.

Classic symptoms of botulism include double vision, blurred vision, drooping eyelids, slurred speech, difficulty swallowing, dry mouth, and muscle weakness. Infants with botulism appear lethargic, feed poorly, are constipated, and have a weak cry and poor muscle tone. These are all symptoms of the muscle paralysis caused by the bacterial toxin. If untreated, these symptoms may progress to cause paralysis of the arms, legs, trunk, and respiratory muscles. In foodborne botulism, symptoms generally begin 18 to 36 hours after consuming contaminated food, but they can occur as early as 6 hours or as late as 10 days after consumption.

Botulinum toxin causes flaccid paralysis by blocking motor nerve terminals at the myoneural junction. The flaccid paralysis progresses symmetrically downward, usually starting with the eyes and face, then moving to the throat, chest, and extremities. When the diaphragm and chest muscles become fully involved, respiration is inhibited and unless the patient receives treatment in time, death from asphyxia results.

If diagnosed early, foodborne botulism can be treated with an antitoxin that blocks the action of toxin circulating in the blood. This can prevent patients from worsening, but recovery still takes many weeks. Physicians may try to remove contaminated food still in the gut by inducing vomiting or using enemas.

While botulism has been known to cause death due to respiratory failure, in the past 50 years the proportion of patients with botulism who die has fallen from about 50% to 8%. The respiratory failure and paralysis that occur with severe botulism may require a patient to be on a ventilator for weeks, plus intensive medical and nursing care. After several weeks, the paralysis slowly improves.

The Times-Argus of Barre and Montpelier, Vermont, featured an article about Listeria monocytogenes, a foodborne pathogen.  The article focuses on the need for specific populations (i.e. pregnant women, elderly people) to be aware of the risks Listeria poses to them, and on the importance of public knowledge about Listeria since it is present in many environments and can be a contaminant in processed foods.

Listeria emerged as a serious contamination problem in meat and poultry products in the 1980s. By 1999, an especially virulent strain of L. monocytogenes had evolved, alarming health officials and prompting them to urge food producers to clean up their act. When another disastrous outbreak occurred in 2002, the inspection service concluded that voluntary measures were not enough and more stringent regulations were needed.

Although the "interim final rule" for ready-to-eat meat and poultry products issued in 2003 has helped control exposure to the bacteria, it has clearly not eliminated it. According to the Centers for Disease Control and Prevention, an estimated 2,500 people become seriously ill with listeriosis each year, and 500 people die of it.

Last year, in a further effort to protect the public, the Food and Drug Administration approved using an antiseptic spray to help control contamination of ready-to-eat meat and poultry products. The spray contains a mix of six bacteriophages, otherwise harmless viruses that destroy L. monocytogenes. Consumers cannot tell, however, whether this spray has been used, which means those at risk of serious listeria infections should continue to follow the guidelines below.

More about Listeria can be learned at about-listeria.com.

This week's food safety infosheet from the International Food Safety Network focuses on proper cooking temperatures for food. 

We've learned more about proper cooking temperatures in recent weeks since ConAgra recalled chicken and turkey pot pies for Salmonella contamination.  Microwave temperatures vary, and using a food thermometer to measure a food's internal temperature and determine food safety is important since consumers are the last line of defense when cooking at home.

The iFSN "barf blog" post titled, "Cooking a Frozen Pot Pie in a Microwave" is a good demonstration of why food thermometers are useful tools in the kitchen.

Amy Bowen of the St. Cloud Times has written about Stephanie Smith, 20, (Just for Kix instructor) who is struggling for her life after contracting what appears to be a critical case of E. coli poisoning. She was on life support Friday in the intensive care unit at St. Marys Hospital, Rochester. Doctors are treating her for a severe case of E. coli poisoning that they believe came from ground beef she ate, said Smith's mother, Sharon Smith of Cold Spring. Doctors have yet to confirm the strain of infection through lab tests. Doctors diagnosed Stephanie Smith with hemolytic uremic syndrome. The condition is caused when E. coli toxins enter the bloodstream. It causes kidney failure and low blood-cell counts, Dr. Kirk Smith said.

The ConAgra plant that produces the company's Banquet pot pies was closed yesterday among concerns of Salmonella contamination in Banquet chicken pot pies that had been manufactured in the plant.  The Associated Press reported on the closure today:

ConAgra Foods Inc. voluntarily stopped production Tuesday at the Missouri plant that makes its Banquet pot pies after health officials said the pies may be linked to 139 cases of salmonella in 30 states.

ConAgra officials believe the company's pies are safe if they're cooked properly, but the Omaha-based company told consumers Tuesday not to eat its pot pies until the government and company investigations are complete.

The U.S. Department of Agriculture also issued a health alert Tuesday afternoon to warn consumers about the link between the company's product and the salmonella cases.

The federal Centers for Disease Control and Prevention has been tracking reports of the salmonella cases since Wednesday. A CDC spokeswoman said the largest numbers of salmonella cases had been reported in Wisconsin, Pennsylvania and Missouri. 

The Centers for Disease Control and Prevention (CDC) issued a statement about the pot pie Salmonella outbreak, encouraging consumers to avoid any ConAgra-brand pot pies with a code of P-9, since they were produced in the same facility as the Banquet pot pies.

At this time, CDC recommends that people do not eat any Banquet pot pies or pot pies made by ConAgra Foods that have a printed code ending in “P9.” Other brands of pot pies made in the ConAgra Foods factory that makes Banquet brand pot pies and sold under other brand names may also be contaminated with Salmonella. These other pot pie boxes also have a printed code ending in “P9”. If you have any of these products at home, the safest thing to do is to discard them.

This information conflicts with what ConAgra has been telling the public, maintaining that if the pot pies are cooked properly they will be safe for human consumption.  The AP article stated included a few sentences on ConAgra's take on the outbreak:

[ConAgra spokeswoman Stephanie] Childs said ConAgra is confident in the safety of its chicken and turkey pot pies when all the cooking instructions on the package are followed. It is especially important to follow the directions when the pies are cooked in a microwave."

And on the International Food Safety Network's Barf Blog, Dr. Doug Powell wrote his family's experience with purchasing ConAgra-brand Banquet chicken pot pies and their attempt to get proper cooking information from ConAgra:

So Amy and I went to the local supermarket after dinner. We found the products in question, with the P-9 on the side, and on sale, 2-for-$1.

I called the number suggested by ConAgra (see above). After listening to a recorded message, I spoke with a human, who wanted to know my name, zip code, state, and when she got to address, I said, I just want to know how to properly cook these in the microwave, cause the press release says they're safe if cooked properly.

The human hung up.

Amy and I then examined the ingredient list, which included cooked chicken, and mechanically deboned chicken -- but did not specify whether the meat was coked or not. So maybe there is raw poultry in the pot pies, which could be a source of salmonella, or maybe it's all cooked but there was a failure in reaching 165F. Don't know at this point.

With the CDC reporting at least 139 cases of Salmonella epidemiologically linked to the ConAgra outbreak in 30 states - and that number growing - more information certainly will be available for Dr. Powell and others concerned about food safety very soon.