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

Salmonella Outbreak Linked to Sprouts:

The CDC has issued its final update in the Salmonella outbreak linked to raw alfalfa sprouts, which caused 44 confirmed cases of salmonellosis in 11 states.  No deaths were reported, but 7 of 34 patients with available information were hospitalized, the CDC said. Illness onset dates ranged from Mar 1 to Jun 1.

The sprouts outbreak led J. H. Caldwell and Sons Inc. of Maywood, Calif., to recall several brands of alfalfa sprouts on May 21. The previous CDC update, on Jun 3, listed 35 cases in 11 states. California has had the most cases with 19; no other state has had more than 6.

Not including this outbreak, since 1990, raw or slightly cooked sprouts have caused an estimated 2,273 illnesses, through 37 outbreaks. The U.S. Food and Drug Administration (FDA) estimates that sprout-link outbreaks account for 40 per cent of all food-borne illness associated with produce.

Hydrolyzed Vegetable Protein Recall

The US Food and Drug Administration (FDA) has asked a Las Vegas, Nev., company called Basic Flavors Foods to report on corrective actions it has taken since Salmonella Tennessee was found earlier this year in hydrolyzed vegetable protein (HVP) made by the firm. After the contamination was found in February, Basic Food Flavors Inc. recalled all the HVP it had produced since September 2009.

The FDA inspected the firm's processing facility in February and March, after a customer found Salmonella Tennessee in HVP from the company. The FDA's Jun 23 warning letter to the firm says inspectors found Salmonella in nine environmental samples, six of which contained Salmonella Tennessee that matched the strain in the HVP. In a March12 letter to the FDA, the company pledged to take a number of corrective steps. The FDA is asking the firm to report within 15 days the actions it has taken since then. The HVP contamination prompted the recall of 177 products containing the ingredient, according to a Food Safety News report, but no illnesses were traced to the contamination.

After a Salmonella outbreak that claimed 97 confirmed foodpoisoning victims, and probably caused thousands of unconfirmed Salmonella illnesses, many employees at Subway restaurants involved in the outbreak have been cleared to return to work.  The Illinois Department of Public Health (IDPH) has been conducting stool tests on the Subway employees to determine whether they were infected in the outbreak as well, and thus represent an ongoing threat to consumers.  So far, according to recent news accounts, tests have cleared 86% of Subway workers statewide. 

The Subway Salmonella outbreak in Illinois was likely caused, at least with regard to initial illnesses occuring in May 2010, by a produce item.  After learning about the outbreak, Illinois Subway stores took the admirable step of discarding all possibly contaminated produce.  The investigation into the outbreak is still ongoing, and it is not yet publicly known whether the IDPH, or any local health departments, have been able to determine which specific produce item was originally contaminated. 

But contaminated produce may not have been the only culprit in this outbreak.  Very clearly, the IDPH had concerns that Subway employees had become infected as a result of consuming, or having contact with, the contaminated produce items in their stores, and thus represented a continuing source of infection to consumers past the point at which Subway discarded all of its produce.  This is precisely why IDPH has required 2 consecutive negative stool tests before allowing Subway employees at implicated restaurants to return to work. 

More than any other state in the country, Illinois has endured many very large outbreaks in recent years that were caused by restaurant employees who worked while ill and caused lots of customers to become ill. 

Currently, of course, the Salmonella outbreak at Skokie Country Club has sickened 29 with confirmed Salmonella illnesses, and has caused an estimated 50 (and growing?) other illnesses.  Although the investigation is ongoing into the Skokie Salmonella outbreak, it certainly appears to have been caused, at least in part, by cross-contamination, sick foodworkers, and other foodhandling errors.

Skokie Country Club pales in comparison to the Subway Shigella outbreak, however, that occurred in Lombard, Illinois in late February and early March, in which approximately 125 people suffered confirmed Shigella infections at one Subway restaurant.  The final report has not yet been released on the Lombard Subway outbreak either, but it's a safe bet that the report will be highly critical of foodhandling practices at the restaurant; and surely there were ill employees working during the outbreak exposure period. 

Far and away the king of all recent Illinois foodpoisoning outbreaks caused by ill employees and bad foodhandling practices, however, is the Vernon Hills Chili's Salmonella outbreak in 2003.  Here is the summary of this unforgettable outbreak: 

The Lake County Health Department concluded its investigation into the outbreak on July 18 2003, by which time over 300 individuals had been sickened as a result of consuming contaminated food. Of those, 141 customers and 28 employees had tested positive for the Salmonella bacteria, while 105 other infected individuals met the LCHD’s definition of a probable case. LCHD issued a preliminary report that concluded the outbreak was caused by infected employees who contaminated food with Salmonella as a result of poor sanitary practices and improper food-handling. It was by this time also determined that the Salmonella associated with the outbreak was Salmonella serotype javiana, a relatively rare and virulent strain often associated with foodborne transmission.

Once the LCHD believed the outbreak was controlled, the department sent a letter by certified mail informing the restaurant’s management of a hearing scheduled for July 31 to discuss their failure to cease operations during periods where no hot water, or no water at all, was available, failure to adequately monitor their employees’ health, and the steps management had implemented to prevent future outbreaks.

Following the hearing, Executive Director Dale Galassie stated that Chili’s had violated local ordinances by remaining open and serving customers while without available water. Although LCHD decided not to pursue punitive measures against Chili’s and its management, the department sent a letter to Chili’s corporate parent requesting reimbursement of outbreak-related investigation costs, including testing and training of staff, in the total amount of $32,500. A health department official stated, “[t]hese were extraordinary circumstances. There were excessive costs in dealing with [the outbreak] and therefore we are requesting reimbursement. The good news is that it prevented a secondary outbreak as a result of cooperation of the Chili’s corporation, local media, and ourselves, but it doesn’t excuse poor local management decisions made that caused it.” After a relatively lengthy, silent delay, it was announced on December 2, 2003, that Chili’s agreed to reimburse the LCHD for the costs associated with the outbreak.

The U.S. Food and Drug Administration today issued draft guidance intended to help reduce the development of resistance to medically important antimicrobial drugs used in food-producing animals.

Today’s draft guidance outlines the FDA’s current thinking on strategies to assure that antimicrobial drugs that are important for therapeutic use in humans are used judiciously in animal agriculture. The FDA acknowledges the efforts to date by various veterinary and animal producer organizations to institute guidelines for the judicious use of antimicrobial drugs, but the agency believes additional steps are needed.

The draft guidance summarizes a number of published reports on antimicrobial resistance and states that the overall weight of evidence available to date supports the conclusion that using medically important antimicrobial drugs for production or growth enhancing purposes (i.e., non-therapeutic or subtherapeutic uses) in food-producing animals is not in the interest of protecting and promoting the public health.

The document recommends phasing in measures that would limit medically important antimicrobial drugs to uses in food-producing animals that are considered necessary for assuring animal health and that include veterinary oversight or consultation. These steps would help reduce overall use of medically important antimicrobial drugs, thereby reducing the pressure that generates antimicrobial resistance.

The FDA recognizes the importance of antimicrobial drugs for addressing the health needs of animals. Antimicrobial drugs have been widely used in human and veterinary medicine for more than 50 years with benefits to both human and animal health. The development of resistance to these drugs, and the resulting loss of their effectiveness, poses a serious public health threat.

“Using medically important antimicrobial drugs as judiciously as possible is key to minimizing resistance development and preserving the effectiveness of these drugs as therapies for humans and animals,” said Bernadette Dunham, D.V.M., Ph.D., director of the FDA’s Center for Veterinary Medicine. “FDA is committed to working with animal drug sponsors, the veterinary and public health communities, the animal agriculture community, and all other interested stakeholders in developing a practical strategy to address antimicrobial resistance concerns that is protective of both human and animal health.”

The agency invites comments on the draft guidance, available online and titled The Judicious Use of Medically Important Antimicrobial Drugs in Food-Producing Animals.

Comedians have been getting "mileage" out of airline food jokes for years, but news today raises much more serious concerns about the safety of the food.   A report by Gary Stoller at USA Today states that:

Many meals served to passengers on major airlines are prepared in unsanitary and unsafe conditions that could lead to illness...FDA inspectors have cited numerous catering facilities that prepare airline food for suspected health and sanitation violations following inspections of their kitchens this year and last, according to inspection reports obtained through the Freedom of Information Act.

The cited caterers included  LSG Sky Chefs, Gate Gourmet, and Flying Food Group.

The food generated by these three caterers alone reaches a large number of people - serving 100 million meals annually, including both U.S. and foreign airports.  The reports were not pretty:

The FDA reports say many facilities store food at improper temperatures, use unclean equipment and employ workers who practice poor hygiene. At some, there were cockroaches, flies, mice and other signs of inadequate pest control.

The caterers responded, saying that they work hard to ensure safety, and include monitoring systems: 

LSG Sky Chefs has "comprehensive and multilayered quality-control standards in place to ensure our customers receive safe, healthy and high-quality food," says spokeswoman Beth Van Duyne.

Norbert van den Berg of Gate Gourmet says findings are taken "very seriously" and the company uses an independent auditor for quality assurance. Glenn Caulkins of Flying Food Group also says his company's facilities are independently audited for quality assurance.

The sheer volume of meals served by the airline caterers make this an important food safety issue.

Health officials in Cook County, Illinois are currently investigating 7 culture-confirmed Salmonella infections in folks who visited the Skokie Country Club in Glencoe.  The source of the bacteria is not currently known, and the country club has closed its kitchen since Thursday while the investigation continues.

The severity of those 7 victims is not presently known, although the symptoms of a Salmonella infection can vary.  Mild infections frequently include symptoms such as diarrhea, abdominal cramps, fever, nausea, and vomiting, while severe infections can lead to bloody diarrhea, typhoid fever, bacteremia, and Reiter's syndrome.