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Food Poison Journal Food Poisoning Outbreaks and Litigation: Surveillance and Analysis

Monthly Archives: May 2011

Is There A Hepatitis A Outbreak Emerging in Knoxville, Tennessee?

Local NBC affiliate WBIR in Knoxville, Tennessee is reporting tonight that the Knox County Health Department is investigating an unusually large spike in confirmed Hepatitis A illnesses in the area.

“In the past week we’ve received reports of 7 cases, which is really a significant increase,” Dr. Martha Buchanan, of Knox County’s Health Department said.

The virus is relatively rare in Knox County. So, when they got that many calls from doctors in the area, the health department started investigating and called local hospitals to let them know of the outbreak.

So far no confirmed source has emerged, but the investigation is ongoing.  Some notable recent past Hepatitis A outbreaks have involved various food service establishments, including:

Hepatitis A is a particularly nasty virus, with symptoms taking between 15 and 50 days to appear after exposure.  The symptoms typically include include muscle aches, headache, anorexia (loss of appetite), abdominal discomfort, fever, and malaise.  After a few days of these initial symptoms, jaundice appears.  Jaundice is a yellowing of the skin, eyes and mucous membranes that occurs because bile flows poorly through the liver and backs up into the blood.  The urine will also turn dark with bile and the stool light or clay-colored from lack of bile. When jaundice sets in, the initial systemic manifestations (such as fever and headache) typically begin to subside.

FDA Warning Letter to Tiny Greens

sproutsafety.jpgPhyllis Entis at efoodalert.com gives a nice summary of recalls and FDA Warning Letters issued recently.  Looks like the FDA is cracking down a bit, especially on seafood processors found to have deficiencies in their HACCP plans.  Notably, in addition to these warning letters, the FDA recently issued its warning letter to Tiny Greens, the sprout company from Urbana, Illinois that was linked to an outbreak that sickened as many as 140 people with Salmonella in multiple states in the end of 2010.

Among the violations noted during the FDA’s inspection:

  • Run-off water from the compost pile was pooling into a drain along the walkway 11 feet from the entrance to the greenhouse. The subsample that yielded the Salmonella outbreak strain was taken from this site. An employee entered the compost area to dump production waste. After walking through the compost pile and water that had pooled along the walkway, the employee returned to the production area wearing the same clothing and boots that he had worn outside.
  • The sink employees use to wash their hands in the lunch room before entering the production area had a hose with a valve on its end that was leaking water onto the floor where there was a substantial amount of foot traffic. Organic matter, in conjunction with wet conditions, such as those observed in your facility, foster the growth of Salmonella and other pathogens.
  • An employee placed a screen from a shaker table on the floor and rinsed it with a hose. This operation was performed within 2 inches of open trays of germinated sprouts. Aerosol water droplets from the water stream onto the floor were splashing into the trays of germinated sprouts.
  • Germination drum plexi-glass doors were stored on the drum frames less than 12 inches from the floor. The drum closest to the greenhouse door had all four doors stored in this manner. Water and debris from the floor was observed splashed onto the doors. The doors were not cleaned prior to installation on the germination drum.
  • Sprouts were unloaded from the germination drums into white perforated pails on dollies. When the dollies were rolled to the table for placing the sprouts in trays, water from the rotating wheels on the floor was observed splashing up on the perforated pails with access to the sprouts.

Additionally, and as a very likely route by which contamination happened in this outbreak, the FDA noted:

We observed that micro-greens were being grown using the compost you generate at your facility. We acknowledge that in your letter dated February 6, 2011, (b)(4). Because the pathogen implicated in the outbreak that occurred between November 1, 2010 and February 9, 2011 was isolated from run-off from your compost, we strongly recommend that all compost you use to grow food is treated with a scientifically valid process to kill pathogens, and that you have an adequate monitoring program to verify your process.

Michigan Company recalling ground beef due to E. coli O157:H7 contamination

Irish Hills Meat Company of Michigan, a Tipton, Mich., establishment is recalling approximately 900 pounds of ground beef products that may be contaminated with E. coli O157:H7, the U.S. Department of Agriculture’s Food Safety and Inspection Service (FSIS) announced today.

The following ground beef products are subject to recall: 10-lb. clear polybags with the establishment number “EST. 10014″ inside the USDA mark of inspection. The polybags are packaged in boxes that contain 3-5 bags. The production dates of May 23 and May 26 are stamped on the boxes.

The ground beef was shipped to restaurants in Southern Michigan.

The problem was discovered through routine FSIS monitoring which confirmed a positive result for E. coli O157:H7. FSIS and the company have received no reports of illnesses associated with consumption of these products. Individuals concerned about an illness should contact a healthcare provider.

Could Vector of European E. coli O104:H4 Outbreak be Slugs?

A well-done and comprehensive article on Der Spiegel online by Veronika Hackenbroch, Samiha Shafy and Frank Thadeusz confirmed a few things but also raised more questions.

By the numbers: This E. coli O104:H4 outbreak is the third largest that I have found (behind Japan’ E. coli O157:H7 outbreak in 1996 and Canada’s E. coli O157:H7 outbreak in 2000). To date, 1,200 are reported ill in Germany, Sweden, Denmark, Britain, Austria and the Netherlands. There have been others reported ill with E. coli infections in both Switzerland and Spain, but as yet not confirmed as part of this larger outbreak. Two U.S. residents who recently traveled in northern Germany appear to be among victims of the outbreak, federal health officials confirmed Tuesday.  373 have been confirmed with acute kidney failure (hemolytic uremic syndrome) and there are 16 deaths. Nearly 70% of those sickened have been women. The numbers in this tragedy seem clear, the cause, perhaps less so.

Earlier reports from Germany officials linked the outbreak to Spanish cucumbers after the lab at the Hamburg Institute for Hygiene and Environment found “four positive results … on three cucumbers from Spain and one from somewhere else, possibly the Netherlands … Two of the cucumbers were organic … [However, the lab] isn’t sure about the other ones yet.”

Then today Hamburg’s health minister announce that “Spanish cucumbers were probably not the source … [as] the bacteria on two of the four cucumbers did not match” the bacteria in stools of ill patients. However, warnings against eating cucumbers, tomatoes and lettuce have not been lifted.

Speculation has also arisen as to the original method of contamination (assuming it is cucumbers, tomatoes and/or lettuce). Liquid manure, water contamination have been discussed. However, apparently now the lowly slug is being fingered, albeit the Spanish slug, Arion vulgaris:

Whatever the source, this bug is nasty. Mr. E. coli in Germany, Dr. Helge Karch, reported that “the O104:H4 bacteria responsible for the current outbreak are a so-called “chimera” that contains genetic material from various E. coli bacteria. It also contains DNA sequences from plague bacteria which makes it particularly pathogenic.”

USDA Urged to Prohibit Antibiotic-Resistant Salmonella in Ground Meat and Poultry

Dangerous Strains Make Foodborne Illnesses Harder to Treat, Says CSPI

Ground meat and poultry found to contain antibiotic-resistant strains of Salmonella should be recalled from the marketplace or withheld from commerce, according to a regulatory petition filed today by the Center for Science in the Public Interest. The nonprofit food safety watchdog group wants the U.S. Department of Agriculture to declare four such Salmonella strains as “adulterants” under federal law, making products that contain them illegal to sell.

CSPI is also urging testing for antibiotic-resistant Salmonella in ground meat and poultry, citing a number of major outbreaks of foodborne illnesses linked to the four strains. Those illnesses are harder for physicians to treat, resulting in longer hospitalizations and increased mortality, according to the group.

“The only thing worse than getting sick from food is being told that no drugs exist to treat your illness,” said CSPI food safety staff attorney Sarah Klein. “And that’s what more consumers will hear if these drug-resistant pathogens keep getting into our meat.”

USDA already recalls products contaminated with antibiotic-resistant Salmonella—but only after those products have made people sick, according to CSPI. The group’s petition asks the agency to establish a testing regime for these pathogens in ground meat and poultry in the same way that it has for E. coli O157:H7. USDA declared that particularly dangerous strain of E. coli an adulterant in 1994.

“USDA should take action before people get sick, and require controls and testing for these pathogens before they reach consumers,” said CSPI food safety director Caroline Smith DeWaal. “The research shows that antibiotic-resistant Salmonella in ground meat and poultry is a hazard and its time to move to a more preventive system of controlling the risks at the plant and on the farm.”

The four Salmonella strains covered by the petition, Salmonella Heidelberg, Salmonella Newport, Salmonella Hadar, and Salmonella Typhimurium, have all been linked to outbreaks.

In 2009, an outbreak of antibiotic-resistant Salmonella Newport linked to Cargill beef resulted in at least 40 illnesses in four states. And this year, the USDA oversaw a recall of frozen turkey burgers contaminated with antibiotic-resistant Salmonella Hadar. That outbreak sickened at least 12. But because foodborne illness is dramatically underreported the true number of illnesses is likely much higher.

“Physicians and patients are now facing pathogens that are virtually untreatable,” said Dr. Stephen A. Lerner, a professor of medicine specializing in infectious disease at Wayne State University School of Medicine. “This petition would reduce human exposure to some dangerous drug-resistant Salmonella, which is crucial because our critically-important antibiotics are losing effectiveness and they aren’t being replaced by new ones. We must do all that we can to reduce antibiotic-resistant infections from food.”

The danger of antibiotic-resistant pathogens in the food supply is well-documented and has been recognized by the Centers for Disease Control and Prevention, the Food and Drug Administration, and by USDA itself. Those agencies are working together to address the issue and recently produced a document stating that “drug resistant pathogens are a growing menace to all people,” and that “drug resistance threatens to reverse the medical advances of the last half century.”

Antibiotic resistance is an inevitable consequence of antibiotic overuse, according to CSPI. Most antibiotics used on animal farms are not used to treat disease, but to promote growth or to prevent diseases caused by overcrowding, poor hygiene, and other problems.

CSPI has long urged the FDA to stop the non-therapeutic use of antibiotics. In fact, CSPI is a co-plaintiff in a lawsuit filed today by the Natural Resources Defense Council aimed at compelling the FDA to withdraw its approval for most non-therapeutic uses of two important antibiotics, penicillin and tetracyclines, in animal feed.

Improving conditions on factory farms, thereby reducing both the need for antibiotic use and the resulting resistance, is a primary tenet of Food Day—a new grassroots mobilization CSPI is planning for October 24. Reducing overcrowding in hen houses and concentrated animal feeding operations, or CAFOs, could lead to more judicious use of antibiotics and would be beneficial for animal and human health, according to the group.

US-Experte William Lebensmittelsicherheit Marler bietet Hilfe in E. coli-Ausbruch in Deutschland und EU

Bill Marler B-W headshot.jpgDer amerikanische Anwalt und Lebensmittelsicherheitsfachmann William (Bill) Marler bietet den deutschen Anwälten, welche die Opfer des jüngsten EHEC-Ausbruchs vertreten, bei dem Hunderte von Menschen erkrankten, seine Hilfe an. Marlers Kanzlei in Seattle, Marler Clark, ist führend bei der Vertretung von Opfern von E.-coli-Bakterien und anderen Fällen von Lebensmittelvergiftungen in den USA.

Der Ausbruch von EHEC-Erregern des Typs O104:H4, bei dem mindestens 5 Menschen starben und 600 Menschen erkrankten, wurde unlängst mit aus Spanien importierten Gurken in Verbindung gebracht. Weitere 214 haben ein akutes Nierenversagen oder ein hämolytisch-urämisches Syndrom (HUS) entwickelt.

„Es ist unzumutbar, dass das Leben eines Menschen nie mehr so sein wird wie vorher, nur weil er etwas Falsches gegessen hat“, sagte Marler. „Firmen, die Lebensmittel produzieren und vertreiben, haben eine Verpflichtung gegenüber dem Verbraucher, Produkte zu liefern, die keine schädlichen Erreger enthalten.“

Zusätzlich zu den Fällen in Deutschland sind jetzt auch Opfer in Schweden, Dänemark, den Niederlanden und Großbritannien aufgetaucht. „Der Ausbruch scheint sich weiter zu verbreiten, und ein Fall dieser Größenordnung verdient umgehend unsere volle Aufmerksamkeit“, so Marler weiter. „Als Person, die ihr Leben dem Kampf für mehr Lebensmittelsicherheit gewidmet hat, möchte ich den Anwälten, die im Namen der von diesem Vorfall betroffenen Menschen tätig sind, sowie den Opfern und ihren Angehörigen, die sich von dieser verheerenden Erkrankung zu erholen versuchen, meine Fachkenntnis und Hilfe anbieten.“

Marlers Laufbahn als Fürsprecher für Lebensmittelsicherheit begann, als er 1993 während eines Ausbruchs von E.-coli-Bakterien, von dem über 500 Menschen betroffen waren und der die US-Lebensmittelindustrie nachhaltig veränderte, für schwer erkrankte Kinder Abfindungssummen in Rekordhöhe herausholen konnte. Seine Arbeit im E.-coli-Fall um die Fastfood-Kette Jack in the Box wurde kürzlich im Buch „Poisoned“ des Bestseller-Autors Jeff Benedict porträtiert.

Marler prozessierte im Namen von Tausenden weiteren Opfern von Lebensmittelvergiftungen und war in den vergangenen zwanzig Jahren bei jedem größeren Vorfall mit E.-coli-Bakterien in den USA als Opferanwalt beteiligt. Außerdem setzt er sich unermüdlich für bessere Lebensmittelsicherheit rund um die Welt ein. Er wurde als Redner zu Konferenzen in China, England, Kanada, Australien, Südafrika, Neuseeland und in den Vereinigten Arabischen Emiraten eingeladen. Als Berater bei E.-coli-Ausbrüchen arbeitete er mit Anwälten aus China, England und Wales zusammen. 2011 regte seine Arbeit die Verabschiedung des ersten großen Lebensmittelgesetzes in Amerika seit über 60 Jahren an.

Weitere Informationen erhalten Sie unter www.marlerclark.com, oder wenden Sie sich telefonisch an Bill Marler unter 1-800-884-9840 oder per E-Mail an bmarler@marlerclark.com.

CDC Issues Chick and Duckling Salmonella Altona Warning

ChicksDucks.JPGCDC is collaborating with public health and agriculture officials in many states and the U.S. Department of Agriculture’s (USDA) National Poultry Improvement Plan (NPIP) to investigate a multistate outbreak of human Salmonella serotype Altona infections. As of May 25, 2011, a total of 25 individuals infected with the outbreak strain of Salmonella Altona have been reported from 11 states. The number of ill persons identified in each state is as follows: Indiana (1), Kentucky (3), Maryland (2), Minnesota (1), North Carolina (4), New York (1), Ohio (7), Pennsylvania (2), Tennessee (2), Virginia (1), and Vermont (1).

Screen shot 2011-05-29 at 8.31.48 AM.pngIn May 2011, laboratory testing yielded Salmonella Altona bacteria from three samples from a chick and its environment collected from an ill person’s household in Ohio, and three environmental samples collected from chick and duckling displays at two locations of Feed Store Chain A in North Carolina. Findings of multiple traceback investigations of live chicks and ducklings from homes of ill persons have identified a single mail-order hatchery as the source of these chicks and ducklings.

Most persons infected with Salmonella bacteria develop diarrhea, fever, and abdominal cramps 12-72 hours after infection. Infection is usually diagnosed by culture of a stool sample. The illness usually lasts from 4 to 7 days. Although most people recover without treatment, severe infections may occur. Infants, elderly persons, and those with weakened immune systems are more likely than others to develop severe illness. When severe infection occurs, Salmonella bacteria may spread from the intestines to the bloodstream and then to other body sites and can cause death unless the person is treated promptly with antibiotics.

German E. coli Outbreak Joins Cruel List

E. coli stock.jpgWith 1,000 sickened, 300 with Hemolytic Uremic Syndrome and nine deaths, the ongoing E. coli outbreak in Germany (and several other European Countries) will be quickly joining the list of the most severe outbreaks in history. Here is the list since I began litigating E. coli cases in 1993 as of today

  • 12,680 sickened in 1996 in Sakai, Japan from radish sprouts. Fukushima H, Hashizume T, Morita Y, Tanaka J, Azuma K, Mizumoto Y, Kaneno M, Matsuura MO, Konma K, and Kitani T. 1999. Clinical experiences in Sakai City Hospital during the massive outbreak of enterohemorrhagic Escherichia coli O157 infections in Sakai City, 1996. Pediatr Int 41:213–217.
  • 2,300 sickened in 2000 in Walkerton, Canada from drinking water. Hrudey SE, Payment P, Huck PM, Gillham RW, and Hrudey EJ. 2003. A fatal waterborne disease epidemic in Walkerton, Ontario: comparison with other waterborne outbreaks in the developed world. Water Sci Technol 47:7–14.
  • 1,000 sickened in 1999 in New York, USA from well water. Charatan F. 1999. New York outbreak of E. coli poisoning affects 1000 and kills two. Brit Med J 319:873.
  • 788 sickened in 2000 in Wisconsin, USA from raw beef, cross contamination of other foods (Sizzler). Archer, John (personal communication). Epidemiologist, Wisconsin Division of Public Health, Bureau of Communicable Diseases and Preparedness, Communicable Disease Epidemiology Section. http://dhfs.wisconsin.gov/communicable/Communicable/Contacts.htm
  • 700 sickened in 1992–93 in Western USA from hamburger at fast food restaurant (Jack in the Box). Bell BP, Goldoft M, Griffin PM, Davis MA, Gordon DC, Tarr PI, Bartleson CA, Lewis JH, Barrett TJ, Wells JG, and et al. 1994. A multistate outbreak of Escherichia coli O157:H7 associated bloody diarrhea and hemolytic uremic syndrome from hamburgers. The Washington experience. J Am Med Assoc 272:1349–1353.
  • 633 sickened in 1995 in Fife, Scotland from sewage contamination of drinking water. IG and Roworth M. 1996. An outbreak of Escherichia coli O157 and campylobacteriosis associated with contamination of a drinking water supply. Public Health 110:277–282.
  • 512 sickened in 1996–97 in Scotland from meat from one shop. Cowden JM, Ahmed S, Donaghy M, and Riley A. 2001. Epidemiological investigation of the Central Scotland outbreak of Escherichia coli O157 infection, November to December 1996. Epidemiol Infect 126:335–341.
  • 503 sickened in 1996 in Scotland from lunch foods. Pennington H. 1998. Factors involved in recent outbreaks of Escherichia coli O157:H7 in Scotland and recommendations for its control. J Food Safety 18:383–391.
  • 332 sickened in 1997 in UK from restaurant food. Anonymous. 1997. Escherichia coli O157 outbreak in Lincolnshire. CDR Weekly 7:101.

Thanks to Human Illness Caused by E. coli O157:H7 from Food and Non-food Sources.  M. Ellin Doyle, John Archer, Charles W. Kaspar, and Ronald Weiss.

Nine Dead, 300 with HUS and 1,000 Sick Due to E. coli O104:H4-tainted Cucumbers

micro.pngNews reports on the number of sickened and dead, in what is quickly becoming one of the largest E. coli outbreaks that I have seen in nearly two decades of litigating E. coli outbreaks, have varied. As of this morning, the press is reporting that the latest victim was an 84-year-old woman, who died on Saturday in the northern state of Schleswig-Holstein. This follows the death of an 87-year-old woman in the early hours of Saturday morning in Hamburg. On Thursday night a 38-year-old woman died from Hemolytic Uremic Syndrome (HUS). As many as six other women (a total of nine) have died in the last week.

Other reports have nearly 300 suffering from HUS. In addition, as many as 1,000 have been hospitalized with E. coli according to other press reports. Cases have also been reported in Britain, Netherlands, Switzerland, Sweden and Denmark.

German officials have said they found 3 cucumbers from Spain with the bacterium, and they are currently probing whether the cucumbers were contaminated with E. coli when they were shipped from southern Spain, or whether they went bad during shipment or while being handled in Germany.

What’s up with Cucumbers? E. coli and Salmonella?

ww.jpgIn the last month a total of 276 Hemolytic Uremic syndrome (HUS) cases had been confirmed in Germany. Over 600 people (mostly women) have been sickened with five deaths. E. coli O104:H4 illnesses have also been reported in Britain, Sweden, Denmark, Switzerland and the Netherlands. German authorities have identified organic cucumbers from Spain as a source of the outbreak.

In the United States, Giant Eagle announced today that its cucumber supplier has recalled cucumbers due to possible Salmonella contamination. C.W. Hendrix Farms Inc. of Boca Raton, Fla. voluntarily recalled cucumbers distributed from its facility between May 6 and May 13. It wasn’t clear when those cucumbers would have been available in stores.