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

Over the last several years, there have been multiple outbreaks linked to, and recalls of, various kinds of spices. From white pepper, to red pepper, to black pepper and beyond, spices are a potentially ideal vehicle for the transmission of foodborne disease. More and more people are becoming ill from contaminated spices, and more and more recalls are occurring. So is this problem merely an emerging threat? Or is it a problem that food producers must confront here and now, finding ways to better ensure the safety of the consumers they profit from.

Spice outbreaks in recent history:

1. Veggie Booty

In May 2007, the Centers for Disease Control and Prevention (CDC) began a multi-state investigation in response to an increase in laboratory reports, first posted on PulseNet on April 2, 2007, of Salmonella Wandsworth. Salmonella Wandsworth is a very rare serotype that was never before implicated in a U.S. outbreak. As of September 6, 2007, there were 69 reported cases of Salmonella Wandsworth in 23 states and 14 cases of Salmonella Typhimurium in six states who became ill after consuming Veggie Booty, a puffed vegetable snack food with a raw, dried vegetable coating. A total of 61 bags of Veggie Booty were ultimately tested in twelve states. Salmonella was isolated from thirteen of them. Eleven of the thirteen bags were positive for the outbreak strain of Salmonella Wandsworth, and one bag was positive for Salmonella Typhimurium and Enterobacter sakazakii. One bag also tested positive for Salmonella Kentucky, and Salmonella Haifa and Saintpaul were isolated from other bags.

2. Union International

The Union International Food outbreak sickened more than 79 people in Western states between December 2008 and April 2009; the majority of the illnesses were in California. Public health officials traced the outbreak to white pepper manufactured by Union International and sold under the brand names Uncle Chen and Lian How. Ultimately the company recalled more than 50 products, including spices, oils, and sauces, due to potential contamination with Salmonella.

3. Wholesome Spice Company and Overseas Spice

This outbreak and recall is, of course, still going on.  According to the CDC just days ago, 238 individuals infected with the outbreak strain of Salmonella Montevideo, which displays either of two closely related pulsed-field gel electrophoresis (PFGE) patterns, have been reported from 44 states and District of Columbia since July 1, 2009.  Epidemiological investigation showed that these 238 sick people all ate Daniele Inc salami products contaminated by salmonella.  Daniele used salmonella-contaminated pepper in the production of the various kinds of recalled salami. 

4. Today’s recall of Johnny’s brand French dip au jus powder?

Will the Johnny’s recall, announced today out of Tacoma, Washington, be another recall or outbreak to add to this list? The ingredient list for the recalled prodcut states that it contains: 'MSG, Wheat, Soy & Milk; Hydrolyzed vegetable protein (corn, soy, wheat), yeast extract, salt, rice flour, monosodium glutamate, partially hydrogenated vegetable oil (soy & cottonseed), caramel color, whey solids, non-fat milk solids, mono & diglycerides."  Only time will tell, hopefully, what happened at Johnny's to prompt today's recall.  Spices?  Certainly possible.

The historical trend:

These kinds of events naturally prompt the question why are we suddenly seeing outbreaks and recalls linked to pepper and other spices. Is this truly a new phenomenon; a new species of failure by food importers and producers? 
 

The USDA's Food Safety and Inspection Service just published the list of retail locations that may have beef and veal products subject to Huntington Meat's 4.9 million pound E. coli recall.  There are far too many retail locations that may have the recalled meat to list here.  See Retail List to see whether stores in your neighborhood may have recalled meat.  My local grocery store is not, but I've been to many that are.  No illnesses have yet been reported due to the potentially contaminated meat.

 The Centers for Disease Control (CDC) has announced that  norovirus was the cause of over 400 illnesses that forced a Celebrity Cruise's ship back to Charleston, South Carolina during a voyage to the Caribbean.

According to CNN, the Celebrity Cruises' outbreak sickened 435 of 1,838 passengers, as recounted by Cynthia Martinez, Celebrity spokeswoman.

According to the CDC norovirus "can spread from contact with contaminated food or drink, by touching objects infected by people who are already sick, or through close contact with people who are infected."

Outbreaks of gastrointestinal illness, and norovirus in particular, are not new to the cruise industry.   In fact, the phenomenon prompted the CDC to create and oversee a "vessel sanitation program (VSP)."  The VSP "assists the cruise ship industry to prevent and control the introduction, transmission, and spread of gastrointestinal illnesses on cruise ships."

Usual symptoms of norovirus infection include nausea, vomiting, diarrhea, and abdominal pain.  Headache and low-grade fever may also accompany this illness.

The illness caused by norovirus is usually brief.  It develops 24 to 48 hours after contaminated food or water is ingested and lasts for 24 to 60 hours.  People infected with norovirus usually recover in two to three days without serious or long-term health effects.  In some cases, though, severe dehydration, malnutrition, and even death can result from norovirus infection, especially among children and among older and immunocompromised adults in hospitals and nursing homes.

This evening, Wholesome Spice and Seasoning Company, a Brooklyn, NY, spice wholesaler, recalled "all lots of 25 lb boxes of Crushed Red Pepper sold between 4/6/09 and 1/20/10."  See FDA Recall Notice.  The reason for the recall is, of course, that the recalled red pepper is contaminated with Salmonella, thus explaining (partially, fully?) a national Salmonella outbreak that has sickened, to date, at least 238 people from 44 states and the District of Columbia.

Of course, the recall notice hedges a little bit, stating in bold that "It cannot be determined at this time if this product has been related to any illnesses to date."  Whether this is an acceptable qualification of Wholesome's recall remains to be seen.  After all, health authorities and the companies involved have long suspected that pepper was the source of contamination in the outbreak, and we know that at least 238 people are sick nationally with salmonella and an exposure to Wholesome's now recalled product.  Logic would suggest that there really isn't much reason to hedge. 

But, as has been the case throughout the evolution of this outbreak, there are still important questions to be answered.  Are other products implicated?  Not just other Daniele products, but food products from other companies to whom Wholesome may have sold the contaminated pepper.  Wholesome needs to reveal exactly where the contaminated pepper is now, and who bought it, so that public health authorities, not just the companies involved, can determine whether there is any ongoing threat to public health.   

Another question borne of legitimate concerns about the sheer size of this outbreak.  Did the manufacturing environment at Daniele become contaminated too, so that other products than only those containing red pepper may also be contaminated?  

Finally, how many people are really ill as a result of consuming the contaminated products?  There are many reasons why an infected person may not test positive for the outbreak bacteria.  The person may not have received medical attention; he may have seen his doctor and not had a stool test done; a stool test may have been done but returned falsely negative; or the doctor may have prescribed antibiotics before testing the stool sample, thereby basically eliminating the efficacy of the procedure.  In any case, it is a virtual certainty that, in any outbreak situation, more people than just the ones counted in the CDC's official list have actually been sickened. 

There has been no further word on the massive Salmonella outbreak that sparked a major recall by Daniele Inc. of salami products distributed nationally.  The latest CDC update on the outbreak was on February 18, at which point the CDC had identified 233 illnesses in 44 states linked to the outbreak.  But as of the date of the CDC's last update, there remained many unanswered questions in the outbreak investigation.

To recap, Daniele Inc has recalled a total of almost 1.4 million pounds of salami products, some produced as recently as mid February.  See list of recalled products.  It is widely thought that both red and black pepper used during production of the recalled salami products was the original source of contamination.  Daniele Inc's pepper suppliers are two companies called Overseas Mincing Spice Company and Wholesome Spice Company.  Daniele has terminated its relationship with Wholesome Spice Company and now reports that it is using irradiated pepper exclusively in its products. 

But it has been nearly a week since we have received any word on the status of the outbreak, despite epidemiological evidence that contaminated products may in fact still be in consumer households.  So, are people still getting sick?  Are we dealing with an ongoing threat to public health?  Has all potentially contaminated product been recalled?  And what is the latest on the status of the investigation into the pepper, both red and black, that has been identified as the original source of contamination?  Notably, neither pepper company, Overseas Spices or Wholesome Spice Company, has recalled any of its products.  What is the significance of this?  There are only three possibilities:  (1) the true source of contaminaton was at Daniele alone, (2) the pepper companies did not sell the contaminated pepper to any other companies, and they are confident that the Daniele recall is broad enough to include all potentially contaminated pepper, or (3) the companies simply have not acted to protect public health.  We would like to think, in this day and age and in this country, that the third possibility is, in fact, not possible, but events over the past several years are cause for concern.  Recall that we are only one year removed from the now infamous PCA salmonella outbreak, in which Stewart Parnell knowingly sent salmonella-contaminated product on to other companies for inclusion in peanut-based products.